Comparing the Effectiveness of Reality Therapy and Group Schema Therapy on Interpersonal Communication Skills of Patients with Gender Identity Disorder

The term transsexualism or transsexualism became common from the gender change of an individual named George Jangensen to Christian Jangensen in 1952. Then the term transgender was replaced by gender identity disorder. People suffering from gender identity disorder are those who have a disorder in recognizing their gender identity. In their minds and psyches, they see themselves as the other sex and believe that they were wrongly born as a man or a woman because they are infatuated with their hidden identity. People suffering from sexual boredom imagine themselves with the soul and spirits of the opposite sex. They are not transgender in adulthood. Conversely, many people who become transgender adults did not experience gender non-conformity as children. Most adults with gender identity disorder state that they felt different from other children of the same sex as children, although many of these patients cannot find the origin of this difference in retrospect. Many of them say that they have widely identified with the opposite sex from the very early years of life, and this identification has become more obvious in adolescence and adulthood. The genetic causes of gender dissatisfaction are under study, but no possible genes have been identified in this field, and chromosomal changes are uncommon in the population of transgender people, case reports of identical twins have shown that in some twins there is synchronicity regarding gender issues, and in others, this Synchronization not seen. A variety of approaches are underway to understand gender dissatisfaction. These approaches include information from imaging studies that show changes in white matter pathways, cerebral blood flow, and cortical activation patterns in patients with gender dissatisfaction, but the results of these studies have not been replicated. In adults who receive a diagnosis of gender dissatisfaction, the rate of depressive disorders, anxiety disorders, suicidal thoughts and behavior, self-harm behaviors, and drug abuse is higher. The rate of suicidal thoughts during the lifetime of transgender people is about 40%. The minority stress model predicts the increase of mental illness in groups that are stigmatized, discriminated against, and abused to a greater extent than others. DSM-5 reports suggest that individuals with late-onset gender dissatisfaction may have more distress and doubt about gender reassignment surgery and less satisfaction after the procedure. Treatment for adults who identify as transgender can include psychotherapy to address gender issues, hormone therapy, and surgical treatment. Surgical and hormonal interventions may reduce depression and improve the quality of life for the treatment of these people. While patients suffering from sexual boredom are completely healthy physically, they face a lot of problems mentally. The definitive treatment for this disorder is sex reassignment surgery, which is a very expensive and difficult operation, and at the same time, since it is not possible to create internal sex organs and gonads, only the appearance of the genitals is changed. This article intends to take steps to improve the mental condition of these people by teaching psychological treatment approaches, for this purpose, it compares the effectiveness of reality therapy and schema therapy on the communication skills of patients with a gender identity disorder. The study aims to compare the effectiveness of reality therapy and group schema therapy on the interpersonal communication skills of patients with a gender identity disorder.

This study was conducted as a semi-experimental design with a pre-test-post-test design and follow-up with a control group. The research population is all people with gender identity disorder who referred to the Shiraz forensic center in 2020-2021, whose disorder was diagnosed by a forensic doctor, and due to the impossibility of reaching all of them in a targeted manner, there were 30 out of 195 people. People were selected by available sampling method and were placed in two experimental (15 people) and control (15 people) groups. First, Russell et al.'s social isolation questionnaire (1980) was taken from both groups, then the experimental group was trained in reality therapy and schema therapy for 8 sessions, and the control group did not receive training. Again, the communication skills questionnaire was administered after reality therapy and schema therapy training, and it was repeated in the 3-month follow-up, and the data were analyzed by descriptive and inferential statistical analysis.

A significant difference was seen in the loneliness reduction component of the control group with the intervention group of reality therapy and schema therapy at a significance level of 0/01. Therefore, the reality therapy approach has been effective.

The results showed that reality therapy can help these people to pay attention to themselves as the origin of their actions and deeds, and by emphasizing the inner motivation and sense of responsibility to perform the behavior, they can increase the feeling of self-worth and reduce the feeling of loneliness. Social isolation during some rapid and sudden changes is considered normal and is not interpreted as maladjustment, but when it chronically hinders success and progress in normal tasks and functions of life, it can It has very harmful emotional, social, and even physical consequences. Social isolation is a threat to the mental health and psycho-social functioning of a person. Studies show that both those suffering from male-to-female sexual boredom and those suffering from female-to-male sexual boredom describe themselves as individuals who are isolated from society and their basic emotional needs are faced with problems. This situation may be caused by their self-restraint, which has been imposed on them for years due to social deprivation and not understanding their need to be accepted as a member of the other sex. Reality therapy is based on the basic assumption that people are motivated to change when they are convinced that their current behavior will not get them what they want. They believe that they can choose behaviors that bring them closer to their desires and goals. The goal of reality therapy is to cultivate acceptance of responsibility in the individual and create a successful identity. The individual identifies the behavior that he is trying to correct, his whole being. He focuses on it and does not make excuses for rejecting his responsibility. In this approach, an effort was made to make a person know the short-term and long-term goals of his life, define them clearly and evaluate the ways to reach his goals. Choose the methods that will lead to more favorable results and experience a more positive feeling towards yourself. Since transgender people are often on the margins of social activities, many of their abilities have room for growth. Efforts to empower them in social relations can be effective in this direction. At the same time, heterosexual people must develop their capacities. Themselves and by avoiding committing deviant behaviors, develop their social skills in front of people. The application of reality therapy techniques could help them in this field. Considering the impact of this research on gender identity individuals, it can be applied to other statistical groups and societies. It should be noted that this research has limitations that reduce its generalizability. Among these cases, we can mention the small size of the sample, the non-randomness of the sampling, and the fact that the samples are limited to one location, which is due to financial, human, time, etc. limitations, and shows the need for further extensive research.