Good practice is based on listening to the child’s needs and enabling them to express their wishes

The recent TV mini-series, Butterfly, presents an engaging portrayal of the issues facing a trans child who is in the process of transitioning. Maxine, who is eleven, is able to dress as she wishes in the privacy of the family home, but in school and in public, she wears a boy’s school uniform and acts as a boy.

In the final episode, Maxine’s mum takes her the US to receive hormone blockers to delay puberty. Mother and daughter are arrested at the airport on their return, because the father had said his child was abducted, and an interim care order is placed on the family. Following an assessment, the initial recommendation is that Maxine should be taken into care. But then the parents resolve their conflict, the father accepts Maxine as his daughter and the care order is lifted.

A recent government report highlighted the lack of research evidence to inform social work decision-making with trans children and young people (Hudson-Sharp, 2018). We draw from autobiographical accounts to illustrate some of the issues posed in the drama. We think Butterfly is a potentially useful resource for social work educators, students and practitioners.Listen to Julie Fish and Matty Donaldson discuss social work with trans people and what good practice looks like in our Learn on the go podcast.

What is sex/gender?

There can be confusion about the meanings of sex/gender. ‘Sex’ is widely assumed to describe the physical or biological characteristics taken to define people as male or female (in particular the genitalia), while ‘gender’ refers to the social and cultural expectations typically associated with femininity and masculinity, including appearance, such as hair, clothing and behaviour. In light of these assumptions, many believe that gender can be fluid, but that sex (i.e. biology) is fixed and binary. The perception of a fixed concept of sex/gender is challenged by trans people who feel their biological and gender attributes do not correspond. Increasing numbers of children articulate this dissonance as being in the wrong body (gender variance).  As Natalie says:

‘Why was I born trans? … All I know is that I have felt this way for as long as I can remember.’

(Natalie, trans woman, in Henry, 2017:36).

Gender non-conforming behaviour in children

While most children are likely to experience their ‘gender identity’ as consistent with their male or female appearance, some children and young people will disrupt binary expectations by dressing and behaving in ways usually associated with the opposite gender. Our experiences as researchers suggest that this kind of play is ‘normal’ among children who will grow up to be lesbian, gay, bisexual or heterosexual. Stephanie articulates these expectations of typical gender behaviour:

‘I remember being in a ballet at an infant school and wanting to wear a tutu… Although I grew up knowing that I was not like everyone else, I learned to act like people expected me to act.’

(Stephanie, trans woman, in Henry, 2017:74).

However, a child growing up believing themselves to be gender variant is likely to experience considerable distress, disturbed behaviour, withdrawal and potentially mental ill-health, if their feelings about their body are not recognised or acknowledged by the adults around them. For example, in Butterfly, we see Maxine in the bath attempting to cut herself. This is, crucially, different from explorations of sexual orientation, which refer to the person’s sexual attraction to someone of the same gender. While this may (also) lead children to dress and behave in ways normally associated with the opposite gender, this is significantly different from the trans child experiencing bodily dissonance. The responses from other children, parents and carers towards their gender expression can also have a significant impact on their sense of self and wellbeing. Bullying in schools may occur: a child may socially withdraw, experience difficulties with peer relationships or truant from school.

Understanding how these perspectives underpin social work interventions may lead to improved outcomes. For example, in social work theories of the lifespan, the achievement of a sense of one’s personal identity forms a key stage of psychosocial development. In Erikson’s (1994) fifth stage, young people who receive positive affirmations will emerge with feelings of independence and a strong sense of self. By contrast, young people who do not receive validation may feel insecure about themselves both in the present and in their future relationships with others.

The process of transitioning

Some recent debates in the media imply a child can be encouraged by others to embark, as if on a whim, in the process of transitioning. Such depictions wilfully distort the care pathway. It is likely that a child and their parents will spend at least a year, involving considerable time and expense, travelling to one of the small number of gender identity clinics in the UK. The care pathway, which includes talking therapies, is a process which seeks to understand whether a child is gender variant. Hormone treatment is not prescribed until a child reaches the age of 16 and only while receiving ongoing psychological support.  Surgery and other treatments may become available once a young person reaches 18.

Social work practice with trans children and young people

Good practice in children’s social care is based on listening to the child’s needs, enabling them to express their wishes and builds on existing family support networks. Reflecting on the events unfolding in Butterfly, we feel that the application for an ICO was disproportionate to the family circumstances and probably unrealistic. In light of thresholds for intervention, much of the direct work with trans children and their families is likely to be conducted in early help services. Social workers may become involved with a family where being a trans child may be one of a number of life experiences being faced by a family, eg where a child who identifies as trans is in foster care, but they were placed in care for different reasons. Families would benefit if social workers could signpost them to specialist support services such as Mermaids or Gendered Intelligence, where social workers themselves may access reliable advice.

References

Erikson, E (1994)
Identity and the Life Cycle
New York: WW Norton and Company

Henry, D (2017)
Trans Voices. Becoming Who You Are
London: Jessica Kingsley

Hudson-Sharp, N (2018)
Transgender awareness in child and family social work education
London: National Institute of Economic and Social Research

Julie Fish is professor in social work and health inequalities and director of the Centre for LGBTQ Research and Dr Charlotte Knight is research associate, both at De Montfort University