Information Many people suffer from mental health problems, such as depression, anxiety, post traumatic stress disorder, etc. once or more often in their life. Sometimes support from family, friends and neighbours can help to come to terms with these difficult situations, but sometimes professional help in form of counselling or psychotherapy is needed to clarify and overcome these feelings and difficulties. Talking about mental health problems can be hard and many people are reluctant to admit to others that they are experiencing such difficulties. In cases, where mental health problems or psychological distress are due to problems related to the area of gender or sexuality, this is even more the case. As a result, patients with such difficulties often tend to suffer silently and keep their problems to them selves for weeks, months or even years. Over time, the distress may worsen and often affects other aspects of life as well (e.g. relationships, family life, etc.), forming a vicious circle of taboo, shame and unhappiness. Counselling and Therapy can help to break this vicious circle and to find solutions or new ways of coping with the situation or problem. Lisa offers confidential counselling especially to adolescents and adults or to parents of affected children with following difficulties or problems: Sexual traumatisation More often than known, children, adolescents and adults become victims of sexual abuse, sexual violence or rape. In cases where sexual abuse takes place in childhood and adolescence, the perpetrator is mostly known to the victim (e.g. family member, neighbour, care taker), which makes it even more difficult for the victim to speak about the crime, even after many years and/or in adult life. Adults who experience sexual abuse or violence often do so within their relationship or marriage. In cases where subjects are attacked and raped by a stranger, violence and physical harm are often also a big issue and a further source of traumatisation. In many cases, it takes a very long time for victims to be able to talk about what happened to them, and some might have even never opened up to any one at all. The psychological effects of sexual abuse and sexual violence are various and can affect the victims seriously throughout their whole life. It is very common, that victims become depressive, anxious, develop body or self consciousness problems, sometimes including self harming behavior and suicidal thoughts and tendencies. Psychological support and counselling can help to deal with the effects of the traumatisation (especially feelings of shame, guilt, (self-)hatred and anxiety) and can help to come to terms with this difficult experience and reduce its impact on every day life. Counselling can also be very beneficial for parents with a sexual traumatized child, as they are often highly distressed as well (often regarding feelings of shame, guilt, self accusation, feelings of failure as a parent, etc) and are often unsure how to deal with their child. Problems or difficulties regarding sexual orientation While nowadays homo- and bisexuality is broadly accepted and tolerated within society, still many prejudices exist on an individual level and many gay, lesbian and bisexual people experience intolerance, stigmatization and rejection throughout their lives. These negative experiences can lead to psychological distress and problems, especially, if such attitudes and feelings come from the own family, colleagues or close friends. Other aspects that can cause great distress are the process of "coming out", which is often highly feared, family issues or relationship problems. Problems or difficulties regarding gender identity For most people, gender identity is clearly and unquestionably male or female from birth to death. But for a small number of people, this does not have to be the case. Gender identity issues or uncertainties can arise in early childhood (e.g. little boys who insist on wearing girls clothes), in adolescence (youths who are unsure who or what they are, often linked with aspects of sexual orientation) or in late adult life. Gender identity uncertainties do not necessarily result in a wish for sex change (such as in transexualism), in fact, this is mostly the exception. In most cases, they can be best described as special "life-phases", in which questions and insecurities regarding identity, sexuality, sexual orientation, etc. play an important role. Gender identity issues can lead to psychological distress (e.g. regarding feelings of alienation, experience of intolerance, insecurities, self consciousness, etc.) but can also mean distress for parents, who are worried about their child's behavior, as well. Psychological support and counselling can help to clarify feelings of insecurity and deal with the resulting psychological distress. It can also be beneficial for parents with young children with gender identity issues, helping them to get a better understanding for their child's situation. Sexual Dysfunctions Sexual Dysfunctions are sometimes due to physiological or medical issues (e.g. epilepsy, side effects of certain medication, etc.) but are very often a psychological problem and can cause psychological distress for the affected person, but for the partner or spouse as well. Most common problems in males are premature ejaculation, erectile dysfunction (impotence) and loss of libido. Females often suffer from loss of libido, vaginism (spasm of the vagina which prevents penetration), and problems with orgasm. Sexual problems can occur from the very beginning of sexual activity, but very often have their onset after months or years without any sexual problems. As sexual difficulties and problems mostly not only affect one person, but occur within relationships, counselling can take place alone, but also together with the partner. Disorders of Sex Development ("Intersexuality" or "Hermaphroditism") DSD or "Intersexuality" is defined as a medical condition, in which not all sexual characteristics of the body (e.g. chromosomes, hormones, internal and external genitalia) correspond to just one sex. There are many different forms of intersexuality or "DSD" with different underlying causes. The most common forms are Congenital Adrenal Hyperplasia (CAH), complete and partial Androgen Insensitivity Syndrome (CAIS or PAIS), Gonadal Dysgenesis and Disturbances of the Androgen Biosynthesis. But other variations of sex development (e.g.. Turner Syndrome or Klinefelter Syndrom) or often also subsumed under this umbrella term. In some cases, DSD/intersexuality is diagnosed at birth, e.g. when the genitalia look unusual or the child can not clearly be classified as boy or girl (e.g. small penis but also vaginal opening). But in some cases DSD is not apparent until puberty, when for example menstruation in a so far "normal" girl fails to set in or a masculinisation of a girl takes place. DSD is mostly surgically and medically "corrected" through genital surgery and hormone therapy. In many cases, this is experienced as helpful by the patients, but in many cases (especially when multiple and repeated examinations and surgical measure are carried out), negative physical and psychological side effects also occur (e.g. genital infections, sore scar tissue, genital insensitivity, feelings of shame, identity insecurities, etc.) which can lead to great distress for the affected subject. Other aspects which can cause distress are topics like shame and taboo, infertility and sexual insecurities and problems in adult life. Psychological support and counselling can help find solutions or new ways of coping with these feelings and problems, but also to become a better understanding for the specific intersex/DSD condition, its causes and effects, as well as a better understanding for the own identity as a male, female or intersexed person. For parents of children with DSD/intersexuality, counselling can help to get a better understanding for their child's situation and give them room and a place to deal with their very own concerns, worries and feelings, too. Transsexuality Some people have the feeling, that they are trapped in the wrong body and that their gender identity does not correspond to their biological sex. In some subjects, this feeling persists since earliest childhood (and is mostly kept uncovered until teenage or adult life), but it can also become manifest in adolescents or adult life. Transsexual people wish to change their biological sex and do this by cross dressing (privately or in public) and by undergoing medical and surgical treatment. (Transsexuality is not to be confused with transvestism, in which cross dressing is primarily linked with sexual arousal). Transsexual people often suffer from a great amount of difficulties, insecurities and problems throughout their lives, which can lead to great psychological distress. Problems and difficulties can involve the process of "coming out", intolerance, rejection and stigmatization from family, colleagues or society in general, lack of medical options and care, pre- and post surgical issues, etc. Counselling can help to deal with the psychological distress and find better ways of coping, but can also help, accompany, and support the individual throughout the difficult stages of sex-change.