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LGBTQ Policy Journal

Topic / Gender, Race and Identity

Interview with Dr. Eunice Avilés: Trans* Mental Health Expert and Advocate

The below interview is with Dr. Eunice Avilés, one of the panelists participating in the LGBTQ Policy Journal’s event next Tuesday, February 16, 2016: Mala Mala Film Screening and Trans* Inclusive Policy Discussion. We ask Dr. Avilés some questions about her work and remaining challenges for creating innovative policy solutions for the trans community.

dr eunice aviles

Dr. Eunice Avilés has a doctorate in Clinical Psychology, is a Licensed Mental Health Counselor, a Gender Specialist, a certified Sex Educator, and an AASECT Certified Sex Therapist. She began her career in Puerto Rico performing clinical work and research with children who were victims of physical, psychological and sexual abuse. In 2005 Dr. Avilés moved to Massachusetts where she completed her internship in Clinical Psychology and began her training in gender therapy. In Massachusetts she has served as President of the Human Rights Committee for a residential program for mentally disabled individuals and was an appointed member of The Board of Trustees of The AIDS Foundation of Western Massachusetts. 

Dr. Avilés is the founder of Transcending Identities, an organization committed to improving the quality of life of transgender and gender variant individuals through research, professional training and consulting. She has presented her research results and provided trainings on gender identity issues in the United States and Puerto Rico. Her work with the transgender and gender variant community has also included the evaluation and treatment of children, youth, and adults presenting with gender dysphoria in her private practice.

LGBTQ Policy Journal: tell us about your April 2015 study, Needs, Obstacles, and Action Plan to Satisfy the Needs of the Transgender and Gender Variant Community in Puerto Rico.” What was the reason for conducting the study? How was it implemented? And what were its main findings? 

Dr. Eunice Avilés: On multiple occasions, I communicated with individuals from Puerto Rico who were struggling with gender identity concerns. Through Internet searches, they discovered that I am from the island and work with the transgender community in Massachusetts. These individuals reached out to me hoping that I could help them find a specialist on the island who could support them, since specialists were and still are scarce there. Additionally, in Massachusetts, I began working with transgender individuals who were born and raised in Puerto Rico, where they struggled with not having received any sort of services to address their specific needs regarding their gender identity. One of these cases was of a transgender male in his late 20’s. This person was an inspiration for this project, as he disclosed that he had experienced gender dysphoria since childhood, but, because of his Puerto Rican culture, religion, and societal expectations, he was unable to understand and express how he felt about his gender identity until he was 26 years old. At that time he learned about Gender Identity Disorder through a youtube video. Hearing his story and observing his pain led me to finally decide that I had to do something for this community on my island.

For the above mentioned reasons and because I am very aware that this community is invisible and discriminated against in Puerto Rico, I decided to conduct the study, “Needs, Obstacles, and Action Plan to Satisfy the Needs of the Transgender and Gender Variant Community in Puerto Rico.” The needs assessment was conducted through focus groups. The first group included professionals (psychologists, social workers, etc.) that provide, or have provided, services to the transgender community in Puerto Rico. The second group was comprised of transgender individuals living in Puerto Rico. Through the focus groups, the medical, psychological, legal, and social needs of this community were identified. For example, participants indicated that this community lacks specialized medical and psychological services to deal with their very specific physical and mental health needs. These services are not available, in part, because of the lack of trained professionals in the subject matter. A major concern was the lack of access to the necessary medical treatments for gender transition (gender affirmation) and the lack of health insurance coverage for these treatments. They also identified the need for protocols to address domestic violence situations and police interventions.

Participants also identified obstacles (cultural, religious, legal) that that hinder satisfaction of the community’s needs and provided recommendations to help satisfy these needs.

Where do you anticipate the study will be used? How have you cooperated with Amnesty International on this issue?

The results of the study were initially presented at the Institute of Cooperativism, Social Science Department at the University of Puerto Rico in San Juan with the support of Amnesty International Puerto Rico. The results supported an advocacy report that I developed for Amnesty International Puerto Rico during the Bar Association of Puerto Rico’s public hearings regarding health rights violations. In that paper, I discussed why medical services necessary to treat gender dysphoria should be covered by health insurance. Amnesty International Puerto Rico is currently incorporating the study results into its 2016 annual report.  This allows us to develop an action plan that will improve the quality of life for the transgender community in Puerto Rico.

Since this study’s purpose is to raise awareness of the transgender community’s needs in Puerto Rico, we have also distributed the results to organizations that share the vision of providing needed services to the transgender community. For instance, we shared the results with the Trans Task Force and Familia LGBTT in order to facilitate their process of establishing services for this community.

I envision the results helping to justify new policies that will protect the human rights of the transgender community on the island.

What has it been like to be a practitioner getting involved in policy discussions? Has it impacted your practice in any way?

This is completely new territory for me.  I am a gender specialist, but I am not an expert on the law. I knew that I had to get involved, because it was the only way to help my clients, and this community that has always been invisible and treated as second class citizens.

From a clinical and research perspective, I can say that understanding this community’s needs has allowed me to be aware of the changes that need to be done from a policy perspective. Understanding policy has taught me how to help my clients, has allowed me to understand which services are available, and has helped me realize what laws protect and benefit them.

Furthermore, organizing the needs assessment has given me the credibility to emit an opinion regarding the subject matter and has allowed me to participate in processes to create change. For example, I was asked to revise and provide recommendations for the “Operational and administrative policies and procedures for the employees of the Police Department of Puerto Rico when interacting with transgender and transsexual individuals.”

I know that collaborating to create change will eventually have an impact in my clinical practice as well as enhance my client’s well being.

Tell us about the First Event 2016 Professional Training you conducted. Why is it important? What do you hope will be some outcomes and next steps?

“First Event” is a conference that, for the last 35 years, has brought together the transgender community from New England, other states, and even other countries in a safe, welcoming environment. Historically, this conference has focused on providing educational seminars to the transgender community that discuss their legal rights and options for social and medical transition (medical procedures for gender affirmation), among other topics.  This year was historic because, for the first time, the conference held “Professional Training: Advancing Clinical Competencies, Knowledge, and Critical Skills for Beginning and Advanced Gender Specialists.” This training for mental health clinicians included three tracks: a basic track for mental health practitioners interested in becoming gender specialists, an intermediate track for gender specialists that work with children, and an advanced track where gender therapists learned about diverse issues including, among other topics, “Getting it covered: Advocating for Insurance Coverage” and “Let’s Talk About Sex,” a workshop that I personally developed to help practitioners learn how to conduct sex therapy and sex education with the transgender community. With this professional training, we expect to continue increasing the number of competent practitioners that can provide services to this underserved community.

This first professional training was a success, as attendees expressed how the topics discussed would have an impact on their ability to treat their clients responsibly and with compassion. Despite this, we realize that there are still so many things that need to be done for the trans community, and we predict that these topics will be taught next year. One of the topics under consideration is how to handle gender transition in the school environment. This is a controversial topic with ethical and legal considerations that have not been discussed; as a result, teachers and other professionals are abstaining from assisting students due to the fear of legal implications, but also due to lack of knowledge on how to handle these situations.

We hope to continue training professionals so that they have a better understanding of the situation and will not only collaborate at a clinical level, but will also help us create change so that this community can begin enjoying the same rights as the rest of the population.

How can policy-makers take stock of the needs of a marginalized community like the trans community in Puerto Rico? What are best government practices that you have observed? 

Policymakers need to pay more attention to those that historically haven’t had a voice. They need to be mindful of work such as the documentary Mala Mala, which presents the reality of the trans community, and research projects such as mine.

Despite the historical lack of attention and action regarding the transgender community, there have been policy shifts that will benefit the trans community in Puerto Rico and the United States. Important personalities such as President Obama and Puerto Rico’s Governor Alejandro Garcia Padilla are showing that they care by supporting and developing policies that benefit this community. In Puerto Rico, for example, Governor Garcia signed an executive order that allows individuals to change their gender on their driver’s license. This was a historic change, as it proved that he listened to the community’s need to socially reveal, through their IDs, their true gender so that they could feel not only congruent, but safe. In the United States, President Obama made a big statement by becoming the first president to mention the word “transgender” during a speech and by creating an “all-gender restroom” within the White House complex. He acknowledges the existence of these individuals and gives them their rightful place: next to everyone else—not in isolation.