XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

The Process of Informed Consent: The Needs of Patients During Hospitalization

RAVENNA, ANNA R. Italy
Co-author: Rosaria Strampelli (Italy)
E-mail: igf.roma@iname.com

This study is based on the psychological counseling of patients with Gender Identity Disorder (GID) (MtF, FtM) admitted to the Department of Plastic and Reconstructive Surgery at the S. Camillo Hospital, Rome, from October 1998 to February 2001. Three new patients are admitted weekly, one of these for main surgery, the other two are in the completion phase. To these are added patients who need treatment for complications or a final consultation. Three psychological consultations a week are scheduled for each patient. The counseling of patients with GID deals with the individual problems of pre- and post-surgery. These can manifest themselves as increased fear of disappointment or denial of any problem in relation to sex reassignment surgery.

We have focused on the specific needs of individual patients. Counseling, at this point, is an integral part of the process of informed consent in the progress towards eventual resolution. These needs are subjective and therefore cannot be pre-determined, so that dealing with them plays a key role in ensuring the well-being of the individual.

Our study indicates that we can identity four categories or clusters. These define the development of the different types of need and are Clarification, Reassurance, Trust and Independence, to which specific themes correspond and are linked: Listening, Recognition of Legitimacy, Working in Partnership and Support for Self-Determination. These are fundamental to the help given to the patient by the psychologist. Obviously, they are inter-connected and, depending on the individual, can appear at any moment and in various ways but gain a particular relevance during the specific phases of hospitalization. This highlights the complexity of needs pre- and post-surgery.

It is necessary for the psychologist to enable individuals to understand their needs, how they should be fulfilled and to participate actively in their fulfillment. Resources are necessary to develop both the process within the hospital context and the relationship between patients and the professional team.