Chad is a thirty-one year-old white male. Currently he is married and is employed in the health fitness realm. His non-verbals (teariness, sitting on edge of couch, fidgeting) indicated some anxiety as well as depression; throughout the session he had good eye contact with a semi-open body posture. He perceives his primary difficulty at this time to be the decision of his wife to leave him for another man.

Chad is the younger of two boys. Born with hermaphrodite status, his parents decided to raise him as a girl. Although this choice seemed acceptable to his parents, from the time he was a young child, Chad states that he battled with issues of pre-adolescent sexuality, self-image and severe depression. As he grew into a teenager he began having feelings toward women, and believed he was a lesbian. To deal with these issues he began cutting himself and asked his parents to intervene. At this time they declined, forcing Chad to seek his own medical counsel. As a result of these decisions Chad attempted to switch his gender unsuccessfully three times. As each of these attempts failed was faced with issues of excessive absence from school, depression, physical sickness and a sense of alienation from his parents. To help him accept his status as a woman Chad's parents also increased his hormones and sent him to a psychiatric hospital after he turned sixteen, where he received electric shock treatments. At the end of these treatments Chad left his home and sought psychiatric counsel that would aid him in switching his gender.

Commenting on these events, Chad states that his parents still call him by his childhood name, Chris. He believes that he was ‘sacrificed' to preserve his father's reputation as a conservative minister. Overall, he believes his parents and brother are very ‘disappointed and disapproving' of his choice to switch genders, which has caused the family to have limited contact with one another.

At the age of twenty-nine Chad underwent surgery to remove his penis in order to remove several benign tumors, which had been caused by fluctuations in hormones in Chad's system. At this same time Chad also married his current wife Jennifer. The two had had a ‘very intense' relationship and decided to wed shortly after meeting one another. During their marriage Chad has had several short-term Internet affairs. Although these relationships have been primarily long-distance Chad has also traveled to meet and spend time with each of these women. At the present time Jennifer is also having an affair with a co-worker, which may have resulted in a pregnancy.

In addition to these events Chad is also facing two criminal charges. As a result of these charges Chad spent one week in the Monroe County Jail, due to his medical history the jail was unsure which portion of the jail to place Chad in; resulting in his nickname ‘the thing'.

Chad describes a history of unstable and chaotic relationships and believes he ‘hangs out with weird people' in order to gain acceptance and normalize his life. This instability and craving for acceptance also appears to adds to his use of ‘poor judgment', and attraction to ‘needy people'. Both Chad and Jennifer project their own sense of neediness (e.g.: loneliness, fear, depression, confusion, etc.) and may be at the same level. Emotionally Chad describes a cycle of self-hatred (including past self-mutilation), anger (throwing things when upset) and some compulsivity (workaholic, ‘fitness freak'). Above all of these feelings however, is a sense of despair that Chad has deep within him because ‘No one believes in him' and he is unsure whether he has faith in himself.

1. What are the spiritual implications for this client?

2. Is the use of religion functional or dysfunctional?

3. What spiritual interventions might be appropriate?