Treating Transgendered Students: A Philosophy About Acceptance, Love, Patience & Truth
The three competencies of multicultural counseling are an awareness of one’s own assumptions, values, and biases; knowledge of the worldviews of culturally diverse groups and individuals; and skills to determine and apply culturally appropriate intervention strategies. I can think of no better way to approach the subject of treating transgendered students than to share a story that that highlights the first cultural competency. This story was candidly told to me by the Co-Owner & Clinical Director of Evoke Therapy Programs, Dr. Brad Reedy.
"I have been seeing the same therapist for the last 16 years. In addition to being a deep and loving person, she is one of the most courageous people I have ever known. I owe so much to her. Each week, I go back to therapy to find myself or to remember what I forget as I face the world with all it demands. Each week, she finds me again, and through that experience I am able to recapture myself. But this is the story about a short period of time when I stopped seeing her.
In 1999 I thought it time to find a therapist. I had met J.D. Gill through supervision at an outpatient clinic I worked at treating sex offenders. His supervision and instruction was powerfully personal and insightful. When I was looking for a therapist, I reached out and started my work with him. I could write pages about his skill and the impact his therapy had on my wife and I. However, the reason I am sharing this is because a few years into my work with him, he announced he was a “she.” He would be transitioning, with surgery and medication, to bring her anatomy into congruence with her identity. I was shocked and confused. I admired the courage it took her to make such a decision, but I felt as though I was losing him. I asked a lot questions hoping to make sense out of it. I asked why the need for surgery. She was in her 60’s and what was the difference after all these years? Surely gender was not about our “parts.” Couldn't he just think of himself as a female with male body parts? Women who have a mastectomy aren’t any less female after the surgery. But he explained, mostly though listening, that he was going to become who she had always thought of herself as: a woman. Others might judge her or think her a “freak” but she did not want to die without living her life as a woman.
“He” was dying, I thought, and I experienced deep grief. I told her that I would be looking for a new therapist and I stopped seeing her for several months. I never looked for a therapist. I didn’t want to start over. Then, something came up in my life where I really needed to see someone. I could think of no other person but J.D. It didn't matter to me whether she was a male or a female. She was just J.D. (now I call her Jami). And what better person to be able to help me find and keep my real self in the face of pressures from the outside world.
These days, when I talk with her about some shame or some part of myself I am afraid to reveal for fear of rejection or some other consequence, she smiles and offers playfully, “I have no idea what it is like to hide part of myself to fit in, but I can imagine…” "- Brad Reedy
My teacher once stated “counseling is counseling, no matter who the client is or what the issue is about” and in the same breath announced “LGBTQ client’s may present some unique issues that are important to address.” I realized much later that she wasn’t just trying mess with our already weak and fractured minds; she was actually letting us know that we were not as ill prepared to work with this population as we had probably felt. We already had a general knowledge of counseling from which we could draw to help us understand and assimilate the information we would receive. We just weren’t aware of it or how to go about doing it. This is the message I relay to parents and others when asked about issues related to gender identity. Gender and sexual issues are very charged in our culture, and garner a special kind of discomfort or shame. Yet, these issues aren’t all that different from the many other issues we face regularly as therapists, parents, caregivers, role-models, friends, etc.
It is our job to get to know children and embrace their uniqueness. This connection provides children with a strong sense of self and a source of resiliency. This attachment contributes to their sense of wellbeing. Shame is often triggered when children show us something we were not allowed to show or to feel as children. We tend to over-identify and take on the judgments of others when children struggle and don't travel the road that other’s believe they should be traveling. Having someone we care about struggle to express their identity, whether it is related to gender or not, is an opportunity to provide unconditional love and support. We can provide them insulation against the social climate that often contributes to mental health and addiction issues that accompany this dynamic.
To begin to understand the issues surrounding gender identity, it’s important to understand that gender is a social construct. Many other cultures have more flexible and fluid ideas about gender. To highlight this concept, we need look no further than how children born with ambiguous genitalia (at a rate higher than the rate of Down’s Syndrome) are treated. In most cases, doctors will perform surgery to reconstruct genitalia to conform more towards one sex organ or the other. This reassignment is more arbitrary than most people understand. There are currently many countries that ban this gender assignment surgery at birth, foregoing the desire to fit everything neatly in a box and accepting the natural variance that is commonly appreciated in so many aspects of life.
Our society has a binary concept of gender. Most believe there are only two options: female or male. Gender is the one human characteristic that we don't accept as being on a continuum. Furthermore, many believe gender is a function of the XX or XY chromosome, yet in reality the development of gender is mostly determined by the prenatal release of the mothers’ androgen. In the first trimester (around week 8) the mother releases an androgen wash that starts the fetus on a path towards developing a penis or a vagina. Later, the mother releases another androgen wash that influences the fetus’ brain to develop more towards female or male (yes, there is a difference). So it is easy to understand how a child can be born with a male brain and female genitalia or vice versa.
Different cultures have various expectations, norms and roles for gender. In Western Culture, gender and sexual issues are infused with a great deal of shame. This shame leads us to feel uncomfortable with ambiguity. This discomfort is not dramatically different than our discomfort with many unique characteristics in people. The struggle for a transgendered individual to find a sense of belonging is very similar to all the children we work with at Evoke. They must either conform to others’ expectations or risk unthinkable isolation. The challenge for parents and society to accept these children is a parallel process to accepting other (non-pathological) characteristics in children. Evoke takes a progressive stance on treating transgendered teens and young adults with mental health and addiction issues. I always wondered what I would have done, what I would have felt, if I had grown up in Nazi Germany or during the time when this country accepted the idea of slavery. While those issues are obvious to any reasonable person today, would I have had the ability to see the problems with those philosophies at a time when entire countries accepted such atrocities?
Many might be offended by Evoke’s stance of accepting transgendered students into the group of their identified gender. Some parents and professionals will respond with anxiety or confusion. Change is scary and when old definitions of the status quo are challenged, it can produce anxiety. Our position is to support not only all LGBTQ clients but to provide a climate of acceptance and love for everyone’s uniqueness. Those who suffer from shame, depression, low self-worth or other mental health issues related to these differences will find a place to be themselves without the need for symptoms to mask the associated pain of being different. May we all have patience for others and for ourselves. To those who don’t fit in with what mainstream society defines as “normal,” we welcome you. To those who are confused in an age where social constructs are being deconstructed, we offer our love and patience. And in so doing we hope for the same grace.
I currently have a transgender student in my group. He didn’t openly come out as transgender when he shared his life story with the group, but dropped a subtle hint as if needing to test the group’s level of support (checking how well they were listening) as well as covertly reaching out for the group’s help. The students picked up on this and inquired more about it. Eventually he mumbled the word “trans” and a student caught it and quickly asked him when he “came out” and what it was like. After a discussion that involved a lot of listening and learning, one of the students asked if he requested to be placed in this specific group. “No, they knew where to put me” was his response. Another student replied, “Well they put you in the right group!”☺