FINDING A TRANS POSITIVE INFORMED CONSENT MODEL THERAPIST WHAT YOU NEED TO KNOW

About supporting trans, non-binary or gender variant clients. WHAT YOU NEED TO KNOW

Am I transgender, non-binary, different or just me?

What does it mean to be trans? To be gender variant? To be non-binary? Or to just be different? Or to just be me or to just, be you? How do you know your are Trans? There are many pieces of the puzzle of gender identity and gender expression. We find ourselves living with gender stereotypes, smothered by gender roles, and trying to play a part we don’t feel comfortable playing. We might struggle to understand who we are and what we should or want to look like. 

Well, that is one part of being Trans identified. There is also another part, and that is the part of you that you love, the part of you that you celebrate. Your questions are not with your gender identity or your gender expression; rather, it is with others, sometimes family members or friends, and sometimes employers or other relatives. There is someone close to you who are unable to see the strength and positivity within yourself, and they choose not to celebrate or honour your true self. 

And then there are Trans people who can live in two genders and they can celebrate themselves as both genders and/or neither gender. For many Trans identified people it’s a process of affirmation as we walk our path and discover who we are. For Indigenous People, those people who live in two genders, they are Two-Spirit People. Two-Spirit Indigenous People have been given the gift of two spirits by the Creator, and when identifying oneself as Two Spirit, a balance is created between the two worlds. 

Why do I struggle with these thoughts?

Trans people have questions about how and why they are walking a gendered path. It is normal to have inside talk and conversations about who they are, even as they are questioning their own sense of self. Have. Transpeople always have their own questions, and they might feel there is no one they can talk to because they just do not feel safe. This can be especially difficult when they want to have these difficult questions with the people they love and care about, because they don’t know how they might respond. I have worked with many trans people who have struggled with such issues, and yes, I know how difficult this process can be. Often times, this struggle might influence us to try and fit into a gender presentation that other people think we should be living, rather than us trying to live in the gender we know we are. 

This struggle is a normal process that we go through, as we try and understand who we are, while we hang in there with the gender we were assigned at birth. This struggle produces us to discover our strengths, and as we move forward, our assigned gender clashes with our gender identity and we might say, “I cannot do this anymore.” Consequently, we change ourselves and we search out support.

How do I find this support?

To find the support you are searching for, you want to look for a therapist and ask lots of questions. In fact, you want to ask the therapist the same questions you have been asking yourself, and you want to ask the therapist questions about them and what do they know or understand about Trans People. You  ask the questions because the therapeutic support that you need must include the therapist’s capacity to help Trans people through specialized mental health support. Additionally, you want to know more – is the therapist trained to work with gender variant people; and what is their expertise? I would also add there is another important requirement of gender therapy that most of my clients have told me – and that is being able to talk to a counsellor who has the lived experience as a transgender or gender variant person. I also feel this is important. My research and professional experience have taught me there are many cisgender therapists working with transgender people, and they know little about trans people and they haven’t worked on their genderism. Trans clients have told me therapists who do not have a lived experience want to relate their clients trans identity to their past trauma or to some imperfection within themselves that the therapist can fixed. 

What questions should I ask?

Gender therapy is more than just looking at the social, mental, emotional, and physical needs of transgender people or of anyone who might be questioning their gender. Gender therapy is about helping clients understand gender dysphoria, and it is also about providing anti-genderist education, which specifically addresses the genderism that trans people face. It is also meant to help clients who are looking for gender affirming support, to access such support, to access treatment or affirming surgeries and any other type of affirming interventions, such as getting their name or gender change. Gender therapy can also be accessed by anyone, such as families or friends of transpeople, as they might be trying to learn about and understand gender identity and gender expression. 

No one is safe from genderist micro aggressions that come out of genderism. Someone who is cisgender (like a female-bodied person who doesn’t like to wear makeup), can feel oppressed by someone who might think all female-bodied people should wear make-up. So remember, some general therapists may have received basic gender diversity education and training, however, it may not be enough to provide adequate support. It also rules out anyone who may be advertising themselves as a gender-affirming therapist or a gender specialist simply because they believe they are accepting of 2SLGBTIQ+ people. This attitude can be seen as Professional privilege- the fine art of taking up space for Transpeople who cannot speak for themselves or their communities. This professional privilege may come from the fact that cisgender social workers do not recognize their own genderism or understand the struggle trans people face on a daily basis.

Consequently, it is important to ask your potential therapist what continuing education, workshops, or training have they received. Do they have professional supervision or can they access professional consultations. You want to know if they have learned about not only gender identity and gender expression, but also learned about trans people in general. And one more question – ask 

Some general questions to ask a potential therapist.

  1. How do they provide a safe space for 2SLGBTIQ+ people?
  2. Do they have any transgender, gender variant or nonbinary clients right now?
  3. How many years of experience do they have working with transgender clients?
  4. Are they qualified to provide support letters, and how do they do them? 
  5. What is the fee?
  6. Do they offer a sliding scale fee?
  7. Is there a minimum number of sessions? 
  8. There are a number of forms to fill out, do those forms cost extra?
  9. Can the sessions be done by online video?
  10. Do they offer other services, such as trauma support, or help for anxiety or depression?
  11. Do they give priority to anyone from the @SLGBTIQ+ community?

What should therapists not do?

  1. They should not tell you who you are
  2. They should not diagnose you
  3. They should not tell you “You are doing your gender wrong” or “You cannot act that way.”
  4. They should not tell you “You are doing your gender right”
  5. They should not use your dead name, just because it’s on your file.
  6. They should not assume you know their gender. They should identify their gender when they first talk to you.;
  7. They should never refer to you by the wrong pronoun (this does recognize that they might misgender you with the wrong pronoun, but they should know to just correct themselves and carry on).
  8. If they cannot help you by provided the proper information that you need, they should refer you to someone who can help you

A side bar on gatekeeping of transpeople and access to services

All gender therapists, social workers, nurses, doctors, and mental health professionals are gatekeepers. Being a gatekeeper means we are obligated to follow rules that are set up by the medical establishment or the policies of our own workplaces or even rules within our professional associations. Despite us being gatekeepers, we are also guides, we guide ocial workers or therapists are there to guide clients, so they can find their own strengths that they need to self-determine their own gender journey. After seeking counselling and after discovering what you needed to discover, you may be at the stage where you pursue medical intervention to help alleviate your gender dysphoria. This is where you may find a therapist who is not gender positive block your path to wellness. So those therapists who misuse their power, engender gatekeeping, by creating obstructions that might prevent you from obtaining your goals. While all social workers gatekeep, social workers have the ability to make it as easy as possible and to outline where the blocks are and to help clients get around these roadblocks. Clearly, misappropriating power by gatekeeping is problematic, and it usually only furthers the discrimination that transgender, non-binary, and gender variant people face every day. Gender variant people need to be aware of gatekeeping and as above ask a therapist questions about how they avoid or certainly minimize gatekeeping. Do not allow the therapist to try and control you through a gatekeeping process and make you feel like you have to agree with them to access the services that you need. 

Challenge gatekeeping with Informed Consent Model of Care

Lastly, be aware of how you can challenge gatekeeping by knowing about models that empower and do not disempower you. There are two models that can be used in conjunction with each other:

  1. Informed Consent Model of Care – The therapist works within a framework of equality and understanding, by working with gender variant, non-binary, and transgender clients to access hormone treatments and surgical interventions without having to endure a mental health evaluation or feel like they have to defend their gender in a court of law. In other words, this model is framed around a trans person’s own individual agency and their own autonomy. Not to someone’s perceived readiness and to someone’s judgement of someone’s appropriateness. 
  2. Trauma Informed Care – The therapist must have trauma awareness, place an emphasis on safety and trustworthiness, allow for opportunity of choice, collaboration, and connection, and lastly offer strengths-based counselling and skill building.

The Informed Consent Model of Care is an upgrade from the Standard Model of Care (Version 7 – released in 2012), which was recommended by the World Professional Association for Transgender Health (WPATH). The Informed consent models of gender therapy and transgender healthcare focus on an individual’s agency and autonomy as opposed to readiness and appropriateness, which was a focus of the Standard Model of Care (V.7). Consequently, therapists need to have the education and understanding so they can offer Trans and non-binary clients enough information and options, they will be able to make a completely informed decision about their trans health care. 

While northern Ontario has limited resources available, as compared to southern Ontario, there are doctors and medical clinics who do offer trans health care that is centred on an Informed Consent Model of care.