The role played by the professional providing psychological care should be the same as when treating any other person in the health care system. Access to this form of support should be offered on a voluntary basis and in no way a requirement to access gender affirming care such as hormones or surgeries. In Malta, the law explicitly forbids pathologisation or psychological diagnosis on the basis of trans identities.
The goal of the professional should always be to support the trans person in their specific needs ensure that the trans person is able to explore the full range of gender identities, if needed, and is fully informed of the potential benefits and risks of transition-related medical care, and never to assess their gender identity. Only the trans person can know their gender and that should always be respected.
Some people seeking support are looking for tools to be able to deal with the consequences of transphobia in their daily life. This may include discrimination, violence, social rejection, lack of understanding, constant questioning or discredit, exclusion, etc. Being knowledgeable of the social implications of being trans in today’s society is fundamental to be able to provide quality support.
Some trans persons may find coming to terms with their gender identity more difficult, and may benefit from counselling. These accompanying conversations may have different objectives.
Conversations may be aimed at helping to explore questions and discomfort about gender. A psycho-social professional can help a trans person think about which gender roles and expressions feel comfortable. Trans people should also be encouraged to talk about ways to inform family and friends, discussing a gender role change in the workplace, school, etc (if applicable). Counselling provides a good opportunity to think through how other people will react and to plan for possible outcomes of coming out.
Conversations may serve to explore which medical treatment options might be available or desired. In this way, guidance offers help in making an informed decision about available medical steps. Both advantages and disadvantages of medical treatments can be discussed thoroughly, with the aim of ensuring clear and realistic expectations about existing treatments.
A partner or family members (together with the trans person or separately) can also benefit from participation in one or more conversations.
It is important that the care pathway of each trans person is highly individualised and based on their choices and at the pace that is suitable to them. The number of conversations and the duration of transition will therefore vary from person to person, as well as the steps that a person finds necessary to affirm their gender identity. Decisions regarding care are always made by the trans person in consultation with the practitioner(s) involved.
Trans persons can choose to be referred to the Gender Wellbeing Clinic which provides a range of services including psychosocial care under the National Health Service or access care through the private sector at their own cost. If accessing the services of the Gender Wellbeing Clinic an initial appointment will be set to obtain the necessary background information and to explore with the client the care being sought.
Social and physical changes can have an effect on mood, identity, and on relationships with others. In this transition, relatives, caregivers or significant others can be prepared and better equipped on how to handle new situations, how to deal with emotions, etc. For some trans people, access to the care they need will put an end to distress, insecurities and other mental and physical health consequences of not being comfortable with how they were perceived or they saw themselves. For others, even after all desired medical interventions have been completed, a period of getting used to the new situation can still arise, both for trans persons themselves, and for partners, and the different spheres they interact in. In the case of complications or unfulfilled expectations, reflections can sometimes arise. Trans people are also welcome for psycho-social support after their medical transition.
In the case of a partner having issues, the partner themselves should be encouraged to seek psychosocial support; the trans person cannot be responsible for addressing others’ issues with their transition, nor is that possible.