变性人 Transgender

我有一群好朋友。
是辅导路上的一群好友。
我们这一群人有十个。男男女女。
我们认识了已经一年之久。
因为对辅导有相同的共识、（都是怪卡、不服从权威、不喜欢一板一眼的缘故）；
所以被Yang Yang 抓了我们出来。
每一个月大家轮流present case。
Julianna是我们的督导。
是非常closed-group的一个团体。
我很珍惜这样用心的朋友。
一路上，我们走的非常迅速。

和他们在一起present case，很紧张。
可是也很挑战。很有意思。
我很喜欢。

这一次的督导。
因为我们共同的激荡，让我有好多反思。
我这一趟说的比较多东西了。
没有次序地写出来。
希望以后可以记起这些learning point。

坦白说，除了要一个好的督导之外，
也要有一群你能够信任的伙伴们，
你才能够有很棒的学习session。


记录开始了。


***


简单背景：部分经过修改。毕竟，要尊重当事人。

56岁。男士。
上有父母。老大。
下有妻女。五个女儿。
两次婚姻。
第一次婚姻只维持三个月。原因：妻子嫌弃他不够男性化。导致他企图自杀。
第二次婚姻维持25年。和妻子分床已长达三年。


六年前。工作压力。工作危机。同事排挤。上司奚落。没有花红。再次企图自杀。他想要变性。
寻求ABC辅导。很恶劣的后果：

1。psychologist disclose his problem to his wife and children，without getting his permission。这个真的是他妈的。我听了就火滚。太太威胁他，要求离婚。没有一个女儿支持他。还取笑他是“阿瓜”。

2。ABC counselling centre called police to lock him up and warded him into IMH for 3 weeks due to suicidal attempts. 这个也真的是他妈的。just because he called ABC for many time.

他不再相信人。不过依然继续寻求协助。寻求意见。
所以他找到Patrick，做他的辅导员。


***

讨论课题：


（1）个案不断问：Shall I go for Trans? （我应该去变性吗？）

- Julianna 说：这种问题不可以立即告诉对方：“决定在于你自己。”
这样的说法到最后一定没办法hold住对方前来。
首先ask SOP question:
-为什么你会来接受辅导？
-你是如何知道我们辅导中心的？
-你希望我们可以用怎样的辅导服务帮助你？
-你希望我们可以如何用不一样的方式/角度去帮助你？

然后check Past Help experience，如果对方看过无数的psychiatrist or psychologists。
- What has been helpful for you about the past help?
- and What has not been helpful for you about the past help?
- and what do you want from us so that we can help you further?
- 请对方说出Psychiatrists 还有psychologists的名字。

然后 Mei Ling 说的很好。

她说：“从男性变成女性这个过程，一定有许多information他不懂得。
在新加坡我们需要和他一同看这个过程里头的资讯、挣扎、代价。
过去的，看一看。
未来的，也看一看。
然后，再来决定他要不要make a trans。
很可能他了解了之后，他就不要再去冒险了。
也或许他了解了之后，更要继续前行。
好过我们说一句：这一切决定在于你自己。”

Julinna 继续说：“therefore, explore the context, not the content。
一句：决定在于你自己，会让个案立刻走出房门。”


***

2。 What to say, if client said, "You don't understand me."?
- admit that i don't understand you.
- don't tell client that i'm well-trained counsellor. bullshit.
- I don't understand you and i saw you..... (list down all the dilemmas he/she is having now.)
- would you mind for me to journey with you together so that i have a chance to understand you further?
- you have been raising this statement for several time, i wonder who is the most important person that you are seeking for being understood?


***


3。What client want, if he needs people to understand him?
- to be accepted.
- to be validated.
- to be connected.
- we need to have hypothesis (assumption), and check with the client, so that our direction can be aligned more closely with the client.


***

4。Bianca说了一句我很喜欢的话语。

What is the differences between "the need to change" and "the need to be straight"? If "the need to change" is larger than "the need to be straight", the intention or drive to have trans will be larger. so... are the differences larger, smaller, or almost the same, or totally don't know, get stucked in both?

改变需要ambivalence的矛盾。
一方面你不想要改变。另一方面你想要改变。
那一方比较大。那一方比较多。


***

5。 Julianna再次提醒我们。Transgender不等同于同性恋。
他要我们抛开同性恋角度去着手。
探索要带着无知。无知带来好奇。好奇他心中那一个trapped住的内心女孩。
询问他cross dressing的时候：感觉怎样？
性幻想是如何？近来的思维上有转变吗？
个案本身一直用了很多年压抑自己像变性的冲动。

他还说了一句：“I have been suppressing it successfully.”
可以询问他：你告诉我这一句话之后，你感觉如何？你如何看你自己？

Transgender的issue，我懂得真的不多。
算是大开眼界。要多花一些时间去了解。


***

6。 Julianna觉得我们问问题问得太general.Be more specific。

譬如：多少个儿女不喜欢他？排斥？如何排斥？说了什么话，让你感觉排斥？谁说的？不断追问下去。不要跳来跳去。这个地方我觉得在新加坡，Julianna做得最好。我很羡慕她，尤其是她追问别人问题过程所呈现的沉稳、包容、有礼。并不是咄咄逼人那种。


***

7。说到Kill myself。Julianna说：“你有没有想过，你可以问他：when you're talking about killing yourself, what does it mean to you? are you going to kill the male part of you, or the female part of you?”

嗯。这样问题是非常尖锐的。我们几个人不断从suicidal assessment着手。Julianna一句说出来，我仿佛又学习多了一些如何看个案内在的能力。每一个client说Kill myself的诠释都不一样。我们需要非常敏感。


***


8。

when the session is going to be ended soon, we asked client,"how have you found about the session?", "Have you benifited for last hour that we'd gone through?" "what do you bring out after this session?"

If client said"nothing." or "same." or "nothing much different.".... what are you going to do next?

- do apologize that you may overlook some parts that haven't been explored yet.
- ask, "in what different way that we can work in future?"
- listen, then, check, "we can talk about it in next session."

another version, we can mention that, "most of the time, changes occur outside of the room. and changes always need time. and i would like to hold you for few session, so that the changes become a better pattern in your lifestyle."


***

9。Patrick说：“when i affirm him that he is the responsible father. he cried...”

Sophie说了一句：“i found that this client still mentioned "the same" when the session has ended。 do we affirm him in wrong way, or not so appropriate?”

Juliann说她今天最大的学习是：“by giving affirmation about the client's behaviour, sometime, we may put client into tight spot. by giving affirmation, we indirectly express the position of our value. what is good. what is bad. it might not be so helpful for our client too.”

嗯。我很同意。我以为什么都说很好，就可以了。给很多affirmation就可以了。
不过给错affirmation，可能会带来反效果。
让个案动弹不得。也让个案比较无法和自己产生共鸣。


***

10。WHY NOW?

Julianna问了一句：“Why Now he seeks for counselling?”
Desmund说了一些systemic support的东西。
Sophie说了一些predisposing factor的东西。
然后这个课题又飞走了。
这个团体，因为同质性不强，所以团体里有很多方向、也有很多条线不断再延伸。
我还是很不甘愿。硬硬把团体拉回“Why now?”这个课题里头。

我说：“I am still stucked for the last topic that we discussed. you asked Why Now."
我指着julianna。
”为什么个案现在要变性？为什么不是20岁？30岁？40岁？为什么要在56岁？

Julianna笑着对我说：“so, yee leong, what is your hypothesis?”

我说：“by reading the presented paper, in year 2002, that was the first time he sought for counselling/psychotherapy, at that time actually he is 50 year-old. My hypothesis, overhere, is, when he is going to be 50 year-old, 50 might be another stage of his life. he may be triggered by this 50 figure in order to start searching the meaning of his real life. his true life. who am i? why am i here? you know.. those existential questions.... i personally felt that he is searching the meaning of his life now. that's why, he keep searching and searching until he got the answer that settle him down.”

我说完之后。
Julianna笑着说：“good.”
人怎样还是虚荣的。我很爽。
听到Julianna称赞我。哈哈。重点说回来。

我的分享刺激到Lawrence也说了一些：“and also because of empty-nest syndrome. the role being the father has been significantly reduced. he may be miserable or lost。。”

这个我也很同意。所以，我看到很多男人到最后都是50、60岁才去争取属于自己的一片天空。
这个很可悲。


***


11。Breast。胸部。


有一个环节。我非常有感觉。
怎么说？
不是有感觉。是个案给我太强的感觉。
而我不吐不快。

Patrick分享。
两人一同离开辅导室。
个案走下楼梯的时候，他转回头问Patrick：“have you noticed that i got breasts?”
Patrick冷淡地说：“ya... i notice.”
个案和Patrick不再对话。两人各自开车离开Oogachaga。

哇。我心里面想：“Patrick will lost this client。”

因此我不吐不快。
我很激动地说：“I don't know... this sentence gave me very strong impact.”
大家都笑了出来。
Julianna问我：“why?”

我说：“Ok. let us put it this way. if i were the client, i talked to Patrick for 1 hour and 45 minutes. after the session was ended, i asked Patrick, "have you noticed that i got breasts?" so....what would you feel for the client, if you sit in the counselling room for 1 hour and 45 minutes, and the counsellor didn't really notice that i have made surgery of my breats!”

Julianna问我：“so... your hypothesis?”

我想了一想：“my hypothesis will be ... this is a lonely man, very lonely, he has been being isolated for so many years and now started to seek not only affirmation but also connection and interaction with people who can accept him as trans. do you all agree with me?”


Mei Ling跳出来说："ya ya... a good one. this is very interesting sentence for us to analysize.”

我打岔Mei Ling说：“If i were Patrick, i may invite him back to counselling room and restart the session again.” 我自己忍不住笑。because the statement give lots of meaning for the client.

Mei Ling说：“we can check with the client, whether it is natural, surgery or what in next session?”

结果Julianna问：“is he skinny, tall, less body hair?”

patrick说：“yes。”

然后，我和Desmund很无聊地问起那个Breast的硬度。还有宽度。
他们看着我和Desmund笑成一堆。真的没有礼貌。

Julianna说：“it might be klienfelter syndrome.”

然后我们所有人开始听Julianna解释what is that。
简单来说，就是荷尔蒙失调。可以治疗。
不过，唯一不一样的是这个syndrome无法生育。他可以有五个儿女。
所以，Julianna要Patrick再继续跟进。


***


12。after case presentation, 我们每一个人轮流present自己的counselling position paper.


***

13。最后，Julianna问：“What would you bring out from this room?”

Desmund说：“Breast.”
我笑说:"me either."
Desmund说了一些不错的反应。

每人说一些。我说的则是：“killing the male part or female part striked me a lot。”

有关Trans这个话题，我有我自己很个人的看法。
这个主流，
男性喜欢自己多一些男性化。比较man.
女性喜欢自己多一些女性化。比较lady.

男性女性化。我们叫他死gay佬。
女性男性化。我们叫她男人头。
这样的人变成了社会次流。
受人讥笑、甚至歧视。

所以男性要杀掉自己女性化的一面。
而女性要杀掉自己男性化的一面。
是主流的压力。是主流的排挤。
迷失了自己。失去了自己。也没有了自己。
这些人选择了压抑。逃避。不面对。

同时，在另一个极端的角落里，
有些人选择了爆发。改革：变性人。
这个群族里，
男性要杀掉自己男性化的一面。
女性要杀掉自己女性化的一面。
然后，销声匿迹。
在另一个世界角落里用另一种身份生存着。

散会之后，当我们这一群counsellors问来问去，
都没有办法从社区找到一个从男变女的人给他认识。
Julianna说：“我有一个朋友从女变男。不知道他愿意不愿意？”

我不禁叹了一口气。

Mei Ling 对我说：“有时候，trans的人。比同性恋者更可怜。如果他们家人不接受，他们离开新加坡。如果他们家人接受，他们又不愿意走出来帮助其他人。”

我点点头。非常同意。
是的。

我们结束这一次的督导session。

-

好喜欢这一群counsellors。算我在内，总共十个。
大部分都是在不同社区机构里头担任辅导员、或者社工。
而Julianna已婚，有了家室。三个孩子。
乐意在礼拜六协助我们成长。好让我们更有效地帮助别人。



有福了。以量。




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