QUESTION

Devin is an 8-year-old natal male who is brought to counseling by his mother, Teresa. Devin’s parents

are Caucasian and their socioeconomic status is middle class. Devin’s father, Richard, has always been

the primary financial provider. Teresa and Richard have been married for 14 years and also have two

younger daughters, ages 6 and 4.

Devin was born and raised in the southeastern United States. He was raised by his two biological

parents. His paternal grandparents are both alive and live in California, which prohibits frequent visits.

Devin’s maternal grandfather died when he was an infant, and his maternal grandmother lives nearby.

His grandmother visits frequently, babysits on a regular basis, and advises Teresa on parenting matters

Thus, the primary adult influences in Devin’s life are his parents and his maternal grandmother.

Devin’s parents have been together since high school and neither have had any other marriages or

significant intimate relationships other than with each other. Teresa describes them as “traditional,” and

the description of their marital relationship implies a patriarchal dynamic. Richard does not allow Teresa

to work outside of the home and has an expectation that she will keep a lovely home and raise

respectful children. Richard has a rigid parenting style and says that “the Bible and the belt” make the

rules in his house. Teresa has a more permissive parenting style and generally works to avoid conflict

with Richard at all costs. She presents as a loving parent who adores her children but yields to the

directives of her husband. Teresa worries about how strict Richard is, but defers to him in accordance

with their conservative Christian views. The entire family attends a Baptist church every Sunday and

Wednesday. Teresa teaches vacation bible school in the summer and is active in the “women’s circle.”

Teresa reports that she is bringing Devin to counseling because he shows a pervasive tendency to “do

things like a girl.” She also reports that when Devin is encouraged to participate in activities that are

stereotypically associated with boys, Devin becomes upset and may scream a refusal or withdraw and

sulk. These behaviors have occurred for as long as Teresa can remember, and both she and Richard are

worried that “something is wrong with him.” They tolerated his behavior at home and dismissed it as

something he would “grow out of” or associated it with having only female siblings to play with.

However, when church members began making comments about the behavior, Richard insisted that he

“get some help.” Teresa admits that she and Richard were both embarrassed by the comments and

snickering of fellow church members, and this propelled them to take action.

Devin’s birth and developmental history were uneventful. His mother reports she had a full-term

pregnancy and Devin was born via vaginal delivery with no reported complications. He sat up, took his

first steps, and was toilet trained at developmentally appropriate times. Devin has no current health

problems and takes no medication. His mother reports no known food or environmental allergies. His

past medical history did not include any hospitalizations or chronic illness.

He has historically thrived in school, developed friendships easily, and was responsive to early-learning

skills. He has performed academically in the top 25% of his class. He is currently in the third grade and in

a regular classroom with all passing grades. Since entering third grade, Devin has shown a decreased

interest in age-appropriate male relationships. He has been on the receiving end of some teasing,

especially by male peers, and has cried to his mother that he does not want to go to school. His grades

have declined from A’s and B’s to B’s and C’s. He has no history of disciplinary problems at school and

has never been suspended.

He attended a couple of counseling sessions with the school counselor when he was in second grade,

but he has not participated in any other counseling and has never had a medication evaluation. When

Teresa addressed her concerns with the pediatrician, the physician told her to “keep an eye on him.”

Teresa describes him as “effeminate, with manners and body movements more like a girl than a boy his

age.”

When asked for examples of Devin’s effeminate behavior, Teresa reports that he “tosses his hair like a

girl.” She emphasizes that he has never expressed interest in any contact sports or rough-and-tumble

play “like boys are supposed to.” According to Teresa, when he was about 4 years old, Devin would state

that he wanted to grow up to be a woman. He insists on sitting to urinate and refuses to wear boys’

underwear, preferring instead to wear his sisters’ panties. When his mother tries to insist, Devin reports

that he “doesn’t need a hole in the front.” Devin also refers to his penis as “disgusting.” He frequently

asks his mother if he can dress in her clothes, and he routinely plays dress up with his sister’s princess

costumes. He regularly wears a towel or a scarf on his head to simulate long hair. He enjoys putting on

makeup and playing dress up, and his fantasy play typically involves playing female figures such as

“mother.”

In terms of social relationships, Devin prefers to play with his sisters, though he will play with younger

male children during church youth activities. He struggles to relate to the boys in his class at school and

chooses to sit in the classroom at lunch with his female classmates. Devin is very affectionate toward his

mother and avoidant of his father. Devin especially likes going to visit is maternal grandmother who is

very loving and allows Devin to play freely as he chooses.

Answer the follow AFTER READING THE CASE ABOVE.

SECTION I

Introduction/Client Summary:

Presenting Problem: (Include the client’s own words about why the services are needed and how the primary problem is affecting the client, including behavioral, cognitive, emotional, and physiological symptoms; analyze the life span of the client for appropriate sexual development.)

Family History: (Include biological family members, describe what it was like growing up in this family, and include substance-abuse and psychiatric history of family members if appropriate.)

ANSWER

“Gender Expression and Identity Exploration in Childhood: A Case Study of Devin’s Journey”

Introduction/Client Summary

Devin, an 8-year-old natal male, has been brought to counseling by his mother, Teresa, due to concerns about his behavior and gender expression. The presenting problem revolves around Devin’s preference for activities and behaviors stereotypically associated with girls rather than boys, which has led to comments and snickering from fellow church members, causing distress for both Devin and his parents. Devin’s parents, Teresa and Richard, are Caucasian, married for 14 years, and follow conservative Christian views. Richard exhibits a rigid, patriarchal parenting style, while Teresa is more permissive but defers to Richard’s directives. The family attends a Baptist church regularly, and Teresa teaches vacation bible school.

Family History

Devin’s family consists of his parents, Teresa and Richard, and two younger sisters, aged 6 and 4. The family maintains a middle-class socioeconomic status, and Richard is the primary financial provider. Devin’s maternal grandfather passed away when he was an infant, and his maternal grandmother is actively involved in the family’s life, providing regular babysitting and parenting advice to Teresa. Devin’s paternal grandparents live in California, making frequent visits challenging.

The family’s dynamics reflect a traditional and patriarchal structure, with Richard having conservative views on gender roles and expectations. He does not allow Teresa to work outside the home, expecting her to maintain the household and raise respectful children. The family’s religious beliefs play a significant role in their lives, with regular church attendance and active involvement in church activities. Despite their conservative views, Teresa has some concerns about Richard’s strict parenting style but tends to yield to his directives to avoid conflict.

Devin’s Birth and Developmental History

Devin’s birth and developmental history were uneventful. He reached developmental milestones on time and has no current health issues or known allergies. He has thrived academically and socially in school, but recently, his interest in age-appropriate male relationships has declined, and he has experienced teasing from male peers, impacting his school performance.

Presenting Problem and Sexual Development

The primary presenting problem is Devin’s expression of gender identity, which his parents perceive as effeminate and not conforming to societal expectations of typical male behavior. Teresa reports that Devin shows interest in activities typically associated with girls, such as playing dress-up in princess costumes, expressing a desire to grow up to be a woman, and refusing to wear boys’ underwear. Devin also expresses discomfort with his male genitalia, referring to it as “disgusting.” These behaviors have been present since a young age and have caused concern for his parents, leading them to seek counseling.

In analyzing Devin’s life span, it is crucial to consider appropriate sexual development, including gender identity exploration. At 8 years old, children typically begin to solidify their gender identity, understanding themselves as boys or girls. Devin’s behaviors may indicate a fluid or questioning gender identity, which requires sensitive and supportive exploration to better understand and respect his experiences.

Conclusion

Devin’s presenting problem revolves around his gender expression, which does not align with traditional societal expectations of male behavior. The family’s conservative views and religious beliefs may contribute to their concerns and desire for counseling. Understanding Devin’s life span and appropriate sexual development is essential to provide comprehensive support and guidance in exploring his gender identity. The counseling process will aim to create a safe and nonjudgmental environment to address Devin’s concerns and foster understanding and acceptance within the family dynamics.