Abstract
There are two goals for presenting this article. The first goal is to discuss transvestism or cross-dressing, the history of diagnosis and traditional treatment, cross-dresser’s fears, and counseling with nonconventional people. The second goal is to prepare counselor educators, counselors, and counseling supervisors by encouraging consideration for the cross-dressing client and encouraging discussions around a cross-dressing client’s fear pertaining to gender identity and gender expression and to improve the therapeutic practices with nontraditional gender identities and nontraditional gender expressions.
Keywords
Despite the 2005 American Counseling Association Code of Ethics expansion of multiculturalism and diversity, little attention has been focused on treating persons with alternative lifestyles. Treating alternative lifestyle clients is a skill developed through education, research, practice, and supervision. In general, counselors’ views about alternative lifestyle expressions have not relatively been informed by objective empirical research (Fox, 1996). It is the aim of this article to inform counselor educators, counselors, and supervisors about the salient clinical issues which arise when working with alternative lifestyle clients, specifically people who identify as transvestites, also known as cross-dressers (Laird, 1999). This article will specifically address the following areas: (a) the emerging and evolving definition of transvestism and cross-dressing, (b) the history of conventional diagnosing and treatment of transvestism and cross-dressing, (c) potential fears in cross-dressers, and (d) counseling with nonconventional people.
Emerging and Evolving Definition of Transvestism and Cross-Dressing
Social justice for a marginalized and often misunderstood population presenting for clinical treatment is crucial. It can be argued, counselors are ethically responsible for assisting clients in discovering achievable and practical behaviors to thrive in life situations in which culturally unconventional expressions are internally integrated and do not adversely affect others. When working with clients who express their life differently from the conventional standards, competent counselors practice with appropriate, relevant, and sensitive skills (Sue et al., 1982; Sue & Sue, 1999).
Transvestism Defined
Hirschfeld (1991) introduced and restricted the modern term of transvestism as a way to concentrate on people who cross-dress as a result of an inner need or compulsion. The purpose of cross-dressing for a disguise or entertainment was intentionally excluded from Hirschfeld’s definition (Buhrich & McConaghy, 1977a). The term transvestite typically denotes a heterosexual man who gains erotic or sensual arousal from wearing women’s clothing, also known as cross-dressing (Reisbig, 2007). Carroll, Gilroy, and Ryan (2002) define cross-dressing as: an individual who dresses in clothing that is culturally associated with members of the “other” sex … heterosexual and conduct their cross-dressing on a part-time basis … for a variety of reasons, including pleasure, a relief from stress, and a desire to express “opposite” sex feeling to the larger society. (p. 138)
According to Peabody et al. (1953), the definition of fetishism is the worship of an object, material in nature, which serves as a surrogate for the original object which is loved. This may have led some researchers to believe transvestism is consistently associated with fetishistic pleasure (Alderson, 2012; Bancroft, 1972) and is characterized by eroticized cross-dressing in heterosexual males (Fagan, Wise, Derogatis, & Schmidt, 1988). In fact, Alderson (2012) stated transvestites or “fetishistic crossdressing individuals are men who crossdress, at least during adolescence, because of the sexual arousal and often climatic release it provides” (p. 141). Williams, Sawyer, and Wahlstrom (2011) found cross-dressers take pleasure in or have a compulsion for occasionally adopting aspects of the roles of the opposite gender such as dressing up in clothing, wigs, and other apparel to appear as a member of the opposite gender. Peabody et al. (1953) implied normal behavior may include fetishistic behavior and even cross-dressing but to a lesser degree. Examples may look like, the transvestite habitually overvaluing certain characteristics or possessions of their partner, as well as women wearing slacks and mannishly tailored clothing. Peabody et al. (1953) considered either behavior pathological when used as a primary means for sexual gratification. Yet, all cross-dressing is not fetishistic or used for means of sexual gratification.
History of Conventional Diagnosing and Treatment of Transvestism and Cross-Dressing
Diagnosis and traditional treatment
Treatment of people who identify as cross-dressers by health-care professionals may have been the norm because transvestism has often been pathologized by being defined as an illness by sources such as the DSM (Dzelme & Jones, 2001). Traditionally, cross-dressers have received a diagnosis and treatment from such disciplines as psychologists, social workers, nurse practitioners, physicians, and psychiatrists (Bullough, Bullough, & Smith, 1983). A person who cross-dresses is, oftentimes, identified as having the individual pathology of transvestic disorder by health-care professionals utilizing the DSM and researchers (Arcelus & Bouman, 2000; Beatrice, 1985; Brierley, 1979; Bullough, 1991; Docter, 1988, 1993; Dzelme & Jones, 2001; Fagan et al., 1988; Person & Ovesey, 1978). However, some cross-dressing males may be transvestic with nonspecific psychopathology. Not all cross-dressing behavior is considered pathological, but there may be a pathology which coexists with the cross-dressing behavior (Beatrice, 1985). There have been no significant differences between people who identify as cross-dressers and those who do not cross-dress in reported or observed psychiatric symptoms (Bentler & Prince, 1970; Lukianowicz, 1959).
Many theories have been utilized in order to find the motivation and potential disorder(s) in order to explain the incentive of transvestites’ cross-dressing. There, however, has been a great deal of confusion and contradictions. Some researchers have indicated the propensity for cross-dressing is derived from neurotic obsessions and compulsions (Hamburger, Stürup, & Dahl-Iversen, 1953; Lukianowicz, 1959; Stekel, 1930). Others have described transvestism as part of a compulsive personality, not necessarily a neurosis (Bentler & Prince, 1969; Randell, 1959). Researchers have found some people who identify as cross-dressers who specifically derive fetishistic pleasure from the female clothing only and not the act of cross-dressing (Baker, 1969; Benjamin, 1966; Pauly, 1968; Peabody, Rowe, & Wall, 1953; Randell, 1959; Stoller, 1971). Fetish, erotic, or sexual arousal, however, is not always the motivation to cross-dress, especially in later life when the sexual or fetishistic urge diminishes but the desire to cross-dress remains (Buhrich, 1978; Buhrich & McConaghy, 1977b; Roth & Ball, 1964; Wheeler, Newring, & Draper, 2008). The sexual excitement or fetishistic arousal seems to be prominent in adolescence and early adulthood, with a tapering off into a sense of relaxation as well as stress and anxiety reduction (Frances & Wise, 1987; Person & Ovesey, 1978; Pomeroy, 1975; Stayton, 1996).
Cross-dresser’s fears
According to Shaffer, Barclay, and Redman (1989) and Pomeroy (1975), people who identify as a cross-dresser already have a frequent fear they are abnormal. It is not uncommon for a person who identifies as a cross-dresser to fear their cross-dressing activity may be discovered. Cross-dressing rarely disturbs others, except in cases where the client and his cross-dressing behaviors are discovered (Dzelme & Jones, 2001; Stayton, 1996). Fear of being discovered is not a surprise due to the potential consequences that could occur if others knew of the cross-dressing behavior (i.e., marital strain, family ostracization, divorce, loss of friends and supports, and loss of employment; Bullough & Bullough, 1997; Prince & Bentler, 1972).
Wheeler, Newring, and Draper (2008) found people who had sought treatment for their cross-dressing behavior reported more adverse consequences than those who had not sought treatment. Frances and Wise (1987) report most clients presenting in therapy with main concerns related to cross-dressing usually do not wish to assuage the cross-dressing behavior. Behavior therapy has been found to be generally unsuccessful and cross-dressing men will not usually continue to pursue individual therapy (Frances & Wise, 1987). Assisting the cross-dresser in integrating their choice to cross-dress as part of their identity may be crucial.
Just as there is an ever-increasing tendency to integrate social and biological aspects in explaining sexual behavior and motivation (Andersen, Cyranowski, & Aarestad, 2000; DeLamater & Hyde, 1998; Toates, 2009; Wallen, 2000), there is an increased need to integrate the treatment of clients who cross-dress as well (Pomeroy, 1975). Lukianowicz (1959) believed the attitudes of the social environment need to be considerate and nonjudgmental toward a person who prefers to cross-dress; and therapy can assist the cross-dresser in developing a compromise between the urges to cross-dress and the social restrictions.
Since cross-dressing is considered as an alternative behavior in society, introducing the strategic therapeutic viewpoint can be of assistance to a person who identifies as a cross-dresser. Jackson (1967), a forerunner of the strategic therapy approach, introduced the concept of conventionalism instead of the existence of the idea of normal. Jackson (1967) doubted the existence of the state of normal, rightly so. Jackson (1967) proposed replacing the word normal with the word conventional. Therefore, a person who is a cross-dresser would then be normal in an unconventional or alternative way in the current cultural environment.
People Who Identify as a Cross-Dresser in Counseling
Treating a person who identifies as a cross-dresser requires counselors to be accepting, suspending personal judgment, of a client’s cross-dressing behavior and own distinctive manner of personality and sexual expression (Carroll, Gilroy, & Ryan, 2002; Ettner, 1999; Shaffer, Barclay, & Redman, 1989). Counselors are ethically bound to become knowledgeable about transvestism and assist cross-dressing clients to find sensible ways to manage life situations involving alternative behaviors which do not negatively affect others and the best treatment approaches to assist these clients (Shaffer et al., 1989).
Clients who enter into counseling who do not present as mainstream or conventional (Jackson, 1967) are not necessarily abnormal. Cross-dressing may be considered culturally unconventional, but it is not necessarily abnormal or pathological (Bullough, 1991; Shaffer et al., 1989). Thus, care needs to be taken by clinicians when using terms such as transvestite. Clinicians may be expressing or believing, without vocalization, the person is deviant or bad in their behavior choices and implying the person who cross-dresses has an illness or has a disorder (Pomeroy, 1975; Wheeler et al., 2008).
Cross-dressing is not solely associated with gender identity and gender dysphoria. Cross-dressing can also be a portion of fetishistic transvestism, which is specific to sexual preference and sexual expression (Arcelus & Bouman, 2000; Lance, 2002) and gender expression. Just as sexual orientation and gender identity are two entirely different concepts (Money & Ehrhardt, 1972), so are sexual orientation and sexual and gender expression. “The gradations of sex and gender self-definition are limitless … a world of infinite sex and gender identities …” (Feinberg, 1996, p. 101). There may be any combination of gender identity and sexual orientation; the combinations are unlimited (Peo, 1988). Eyler and Wright (1997) made the recommendation of using a gender continuum which consists of 9 points, instead of a binary system of gender identification. This continuum proposes potential gender identities which may range from a female-based identity on one end of the continuum to male-based identity on the other end. Eyler and Wright (1997) place the gender-blended identities, such as alternating between feeling and behaving like a woman and feeling and behaving like a man, near the midpoint of the continuum.
Just as gender identification may be considered on a continuum, feminization in which cross-dressing males express themselves may also be on a continuum (Beatrice, 1985; Toates, 2009) and the act of cross-dressing may cover an extensive range of outward expressions (Wheeler et al., 2008). The continuum of feminization may vary in degrees, such as occasionally wearing female undergarments to dressing completely and constantly in woman’s clothing (Pomeroy, 1975). Cross-dressing may also vary between the “… nondeviant and nonsexual (e.g., men’s wearing utility kilts) to the sexually deviant and criminally disordered (e.g., men’s stealing women’s clothing and achieving sexual gratification from these items)” (Wheeler et al., 2008, p. 276). Although most people who identify as a cross-dresser move from expressing their cross-dressing from fetishistic arousal to a stress and anxiety reducing behavior, this is not always a linear process and clinicians need to use caution when thinking about and treating individuals in a simple linear and blanketed approach (Toates, 2009).
Modern cross-dressing is becoming more understandable as attitudes have changed over the past century toward gender and sexuality (Bullough, 1991). As of late, women have more opportunity to cross-gender lines by wearing colors of their choice, wearing masculine attire, joining military ranks, and playing sports which were once saved for male participation only (Pomeroy, 1975; Wheeler et al., 2008). Women wearing masculine apparel are considered more socially accepted, thus not deemed fetishistic (Pomeroy, 1975; Shaffer et al., 1989; Williams, Sawyer, &Wahlstrom, 2011). Men, however, have not received similar permission to explore female gender roles (Wysocki, 1993) and wearing feminine attire is not considered appropriate, thus the labeling of dysfunction or pathology (Hawkes, 1995; Shaffer et al., 1989). The only area in which men are given social permission to wear feminine apparel is the entertainment industry (Bullough & Bullough, 1997; Hawkes, 1995) or men wearing utility kilts (Wheeler et al., 2008).
Behavior of individuals is fundamentally socially constructed. Although change can occur, socially constructed ideas are often difficult to change or may not change at all (Alderson, 2012; Pomeroy, 1975). Individuals in general are frequently negatively judged by society when their behavior deviates from the perceived socially conventional behavior; however, the cultural perceptions of the Western society seem to indicate a heightened negative judgment when an individual’s behavior deviates from the gender role expectations (Shaffer et al., 1989). Although there has been a progression of change and acceptance over the past century, the sex and gender exploration restrictions of the Western culture may be more pathological than the individual pathology indicated by the DSM (Bullough, 1991).
Conclusion
It is imperative as a counselor educator, counselor, and supervisor to overcome the initial ignorance and misinformation about transvestism and cross-dressing. Because of the available research, the expansion of multiculturalism and diversity in the 2005 American Counseling Association Code of Ethics, and the wellness approach of counseling as profession, more time is required to closely listen to the client’s entire stories in order to treat cross-dressing clients with dignity and respect. The struggle to balance the expression of gender dualities, the male and female mental self-representations can interfere with other life experiences and relationships (Levine, 1993). Becoming correctly educated about the activity of cross-dressing can offer relevant resources for both the client and the counselor. Improvements in the treatment of clients who present as cross-dressers, and family members who love them, can assist in clients feeling more conventional and striving less for a perceived sense of normal.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.