Information via accrediting organization American Association for Marriage and Family Therapy.
Transgender is an umbrella term for people who identify as a gender that is not the same as the sex they were assigned at birth, as well as for people who do not fit into dominant and binary expectations of gender (Ansara, 2010). People with a broad range of gender identities and experiences can fit under this umbrella term, including, but not limited to, people with the following identities: agender, pangender, bigender, non-binary, gender non-conforming, gender creative, polygender, genderqueer, genderfluid, two-spirit, trans men, trans women, people of transgender history. This means that there are many ways of being transgender. Therefore, assumptions cannot be made about a person identifying as transgender. For instance, assuming someone who identifies as transgender is interested in changing their gender expression from one end of the gender binary spectrum to the other, such as male to female, might be inaccurate for some people and accurate for others.
The prefix of the word, “trans-“, comes from Latin and it means “across from”. In this case, it indicates someone who identifies their gender somewhere across from their sex assigned at birth. The prefix, “cis” also comes from Latin and it means “on the same side”. Cisgender is a term used to indicate people whose gender identity and sex assigned at birth align, and are on the same side. For example, a cisgender man would be someone who was assigned male at birth and identifies as male, and a cisgender woman would be someone who is assigned female at birth and identifies as a woman. (Blumer, Ansara, & Watson, 2013).
Clients of transgender experience and identities, as well as their families, seek therapy for multiple reasons, not always focused on gender-related concerns. Thus, family therapists cannot assume that gender is at the center of a family problem. Family therapists, however, need to be familiar with and knowledgeable of gender issues in order to identify when/if such concerns may be intersecting with other issues, for all clients. Trans people can and do, of course, seek therapy for gender and/or transition related concerns. Some of those concerns may include: gender questioning and exploration, assistance with social, legal, and/or medical transition, and relational difficulties.
Clients interested in gender questioning and exploration recognize a dissonance around identity or might be experiencing gender dysphoria, but they may not know what to do about their feelings. When clients seek therapy while questioning their gender identity, it is important for family therapists to adopt a client-centered stance, understanding that different clients view the issues differently. Because there are many possible trans identities, experiences and expressions, when clients do not have a clear picture of how they wish to express gender, family therapists can assist them in exploring possibilities. It is also important for therapists to be aware of the impact of dominant and binary ideas of gender on clients who are questioning and exploring their own gender identities, expressions and roles. The goal of therapy is to find an expression of gender that feels most genuine and authentic for the client, given their own sociocultural and geographic contexts. During this exploration process, therapists often assist clients in developing social connections and finding community.
With gender-questioning clients, therapy also includes a critical examination of societal, cultural, and familial constructions of gender, opening up options outside of the dominant cisgender female and male identities, if those are what the client wants. It is important to note that many trans people are also comfortable with binary identities and expressions. The role of the therapist then is to encourage clients to consider all possibilities so that they can make informed choices.
Some people may decide to pursue social, legal and medical transition, while others might only pursue some or none of these options. Therapists can offer opportunities to discuss what the impact of choices around transition would be and to examine whether clients’ desires stem from their own experiences or dominant cultural and societal expectations. It is important to consider that clients’ wishes might be challenged by issues such as financial and/or healthcare access. Therapists can then help in supporting clients managing those challenges, as well as in reminding them that there are many different expressions of gender identities, expressions and roles.
Other clients seek therapy with the primary goal of obtaining support with their transition processes. These clients usually have a clear vision of gender transition and therapy is often focused on assisting them with this goal. In these cases, family therapists work to ensure that clients have the emotional stability and social support needed to cope with the challenges of transition. Due to society’s binary gender conceptualization, trans clients are subject to the stress of stigma, cisgenderism and transphobia. Similar to many other marginalized communities, trans people experience higher levels of depression, anxiety, suicidality and substance issues, due to the impact of societal oppression. Therapists can support their trans clients in managing their mental health symptoms appropriately, so that they can make grounded and centered decisions about transitions and face any accompanying stress. Having therapeutic support during these processes can be vital to trans clients’ mental and emotional well-being.
Trans clients might also seek therapy for relational issues. In these cases, the family or partner of the trans client are typically involved in therapy to address whatever relational issues might be impacting them. For example, although some parents do not react negatively to their child’s disclosure of a trans identity, other parents have described it as a profound, personal crisis, characterized by strong emotions such as shock, confusion, devastation, fear, and grief. Partners of trans people may have similar responses if they were unaware of their partner’s trans identity; however, many partners are supportive and couples may seek therapy to deal with the implications of transition, like a new definition of the relationship, sexually related possibilities, or reactions from extended family (Iantaffi & Benson, in press). Family therapists working with trans clients and their families can both acknowledge and normalize the impact of those issues on their clients and their families, especially in the context of dominant cultural and societal expectations.
Due to societal and cultural stigma and oppression that trans clients still face in the United States, they need social support. This support may come from inside and/or outside the family system. When adequate support is not found within the family, therapists can assist clients in finding alternative support systems, such as continued therapy, connections with other trans people, friendships, and online support. When working with minors, it is also important for family therapists to highlight to families how their support is a protective key factor for their children.
When trans clients make body modifications or start to socially transition, their identity might become more apparent to people in their lives, whether or not the client discloses their identity. Given societal lack of understanding and support, gender transition can be a process often characterized by stress and misunderstanding. For example, clients may face opposition in the workplace, such as conflicts over which bathrooms they may use. Therefore, the role of family therapists may include advocating, educating, and consulting with employers, co-workers, teachers, family members, neighbors, and friends. It is important for family therapists to be familiar with both federal and state level legislation affecting trans clients.
In cases where family members are angry, intolerant, and/or rejecting of the trans identity or experience of a client, sessions may sometimes not include the trans family member. Family therapists can serve as a sounding board for negative emotions, educators of family members on transgender issues, and as guides for exploration of new understandings of trans identities, experiences, expressions, and roles of an individual. Therapists can assist family members to: seek information, exposure, and support; understand gender dysphoria and trans experiences; understand dominant societal and cultural ideas of gender; help navigate how to disclose the information to others with the trans client’s consent and respecting their agency and desires in this area; and realize that the trans person remains a family member who deserves and needs love and support. Once family members have had time to process some of their own experiences around the disclosure, family therapy including the trans person, may help families repair and redefine relationships, foster healthy communication of emotions, and nurture closeness.
Written by Alex Iantaffi, PhD, and Markie L. C. Twist, PhD
Ansara, Y. G. (2010). Beyond cisgenderism: Counselling people with non-assigned gender identities. In L. Moon (Ed.), Counselling ideologies: Queer challenges to heteronormativity (pp. 167-200). Aldershot, United Kingdom: Ashgate.
Blumer, M. L. C., Ansara, Y. G., & Watson, C. M. (2013). Cisgenderism in family therapy: How everyday practices can delegitimize people’s gender self-designations. Journal of Family Psychotherapy, 24(4), 267-285. doi: 10.1080/08975353.2013.849551
Iantaffi, A., & Benson, K. (in press). Sex is for every body: Trans affirming sex therapy. In S. Green, & D. Flemons (Eds.), Quickies: The handbook of brief sex therapy. New York, NY: W. W. Norton & Company.
The National Center for Transgender Equality
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Information via accrediting organization American Association for Marriage and Family Therapy.