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ABSTRACT
This is an interview study with 32 British and Swedish health professionals who worked in multidisciplinary teams (MDTs) that delivered care for children and adults with intersex variations, otherwise referenced in biomedicine as disorders of sex development (DSD). The present qualitative analysis focuses, first, on the health professionals’ talk about their team and, second, on their talk about contributions of the psychologist in the team. Although all of the interviewees referred to their team as a MDT, their talk reflected an overwhelmingly unidisciplinary, medicalised knowing and talking of intersex variations. This understanding prefigures service priorities and dictates clinical processes. Psychologists were said to be important, but their contributions were typically considered more relevant after medical interventions and, however valuable, were understood as optional. Above all, psychological contributions were conceptualised in such a way as to preclude strategic applications of psychological theories and research to re-think variations of physical sex development and the care process. The present analysis suggests a need to substantially re-work relationships between team members and reflect on the overall care ethos in order to engage patients and families psychologically. Until then, DSD specialists may be more accurately described as working in a multi-professional service than providing integrated MDT care.
Acknowledgments
We are grateful to the 32 participants for their dialogue and hope that our interpretation of the key processes identified in their conversations will inform future developments of integrated MDT care. Thanks are also due to University of Oslo Department of Psychology for covering the fieldwork costs of the interviewer and last author.
Details of ethics approval
The study was approved by NHS National Research Ethics Service (reference: 11/LO/0384).
Disclosure statement
No potential conflict of interest was reported by the authors.
Correction Statement
This article has been republished with minor changes. These changes do not impact the academic content of the article.
Notes
1. Hereafter referred to as the Consensus Statement. Note, however, that other consensus statements have been published subsequently (Cools et al., Citation2018; Lee et al., Citation2016).
2. Excerpts from the code Psychologist Role in relation to vaginal construction have been published in an article for a gynaecological readership (see Roen, Creighton, Hegarty, & Liao, Citation2018).
3. Transcript notation: [ ] = significant pause; […] = text omitted; [text] = text substituted for clarity.
4. Androgen insensitivity syndrome (AIS) is a condition whereby an XY foetus lacks receptors to respond to androgens. Internally, the individual has testes and a smaller vagina and does not have ovaries, womb and cervix. Depending on whether the individual has the complete (CAIS) or partial (PAIS) form of AIS, appearance of the external genitalia may be female-typical or somewhere along the female- and male-typical spectrum.
5. For critical discussions of DSD genetics and implications see Griffiths (Citation2018) and Sparrow (Citation2013).
Additional information
Notes on contributors
Lih-Mei Liao
Lih-Mei Liao is a consultant clinical psychologist and chair of adult clinical health psychology at University College London Hospitals, UK. She approaches research and practice within a critical psychological framework. Her most recently published co-edited book is Female Genital Cosmetic Surgery: Solution to What Problem?
Katrina Roen
Katrina Roen is a professor of sociology at University of Waikato, New Zealand and leads the SENS collaboration which works across Scotland, England, Norway and Sweden and takes a critical psycho-social approach to health care for children and young people born with intersex characteristics or diverse sex development.