Queering the Body: Working with Transgender Youth

1. Queering the Body: Working with Transgender Youth MHA Conference 2017 Heidi J. Dalzell, PsyD, CEDS KaytiProtos, LCSW

2. Establishing Safe Space • Amnesty • Confidentiality • Participation • Respect • Non-judgment • Curiosity • Others?

3. Jay’s Story

4. Corey’s Story • - 16 y/o high school student, high-achieving  • - Hispanic background • - Gender dysphoria, anxiety disorder • - Gender fluid identity 

5. New Gender Norms • How to best serve clients • Be informed => Get informed • Be non judgmental and sensitive • Ask, honor, apologize Used with permission of Sean Baker, LMFT

6. We all have:

8. You Can’t Tell Gender or Sexual Identity Just by Looking

10. Challenges Specific to Non-Binary Youth • The National Transgender Discrimination Survey, 2011 (6450 transgender respondents): • Harassed/bullied in school (51%) • Victim of physical assault (61%) • Victim of sexual assault (64%) • Delayed/did not access medical care due to discrimination (33%) National LGBT Health Education Center The National Transgender Discrimination Survey, 2011 (6450 transgender respondents

11. Is it Just A Phase? • Several studies have shown that youth who are insistent, persistent and consistent that their gender identity is different than their assigned sex at birth are unlikely to change their minds. • Affirming their gender identity is essential to their happiness and health. Used with permission of Sean Baker, LMFT

12. Is it Just A Phase? • Youth who do not identify as gay or straight, or male or female, can be angered by anyone who thinks their sexual orientation or gender identities are experimental or transitional. Used with permission of Sean Baker, LMFT

13. Coming Out Process • Coming Out to Self (Lev, 2004, Transgender Emergence) • Awareness • Seeking Information/Reaching Out • Disclosure To Significant Others • Exploration, Identity and Self-Labeling • Decisions on Transitioning and Body Modification • Integration • Coming Out to Family • Acceptance is a process; some never adjust • Parents may feel they have “lost” a son or daughter • Reactions may manifest in ways such as refusing to use preferred gender pronouns, names, etc. • Organizations such as PFLAG very helpful

14. Body Image/Embodiment Guided Imagery

15. The Experience of Embodiment Construct • 5 Dimensions and ranges from positive to negative experiences • Body Connection and Comfort (Joy, Pride) • Agency (Physical, Voice) • Desires (Appetite, Sexual Desire) • Attuned Self Care (Physical, Emotional, Relational, Meaningful Passions • Resisting Objectification Niva Piran, 2016

16. Body Image and Transgender Youth • Persistent identity messages incongruent with the physical body • Inner sense of the self versus external self • Struggle between accepting internal self and suppressing it (acceptance/belonging, current relationships) • Fear of societal/familial reactions • Body functions e.g., menstruation, breast size

17. Transgender Youth At Highest Risk for Eating Disorders

18. Body Image and Gender Non-Conformance “I felt by all the outward attention people paid to my appearance only heightened an insecurity that I felt I couldn’t tell anyone; I was a girl, but I wanted to be a boy. When my puberty began, my insecurities with my physical appearance became my obsession. As my body grew into a curvy female form I let go of the fantasy of turning into a boy and surrendered to the idea that I’d forever be uncomfortable in my own skin. My curves made me feel fat. My curves scared me.” Ryan K Sallans, Transitioning Towards My Destiny

19. Why are those outside the Gender Binary At Risk? From quantitative and qualitative studies: • Transgender people may use disordered eating behaviors to suppress or accentuate particular gendered features • Striving for weight loss may be a way for transgender individuals to conform to ideals of slimness/attractiveness • Transgender men and women use weight loss to suppress secondary sexual characteristics Diemer et.al. (2015)

20. Why are those outside the Gender Binary At Risk? • Internalized negative messages/beliefs about oneself • Minority stress: experiences of violence contributing to PTSD, which increases vulnerability to an ED • LGBT Body image ideals NEDA Fact Sheet

21. Barriers to Treatment/Support • Lack of availability of treatment • Lack of eating disorder knowledge/awareness from those who work with transgender youth • Lack of knowledge of gender issues among ED-specialists NEDA Fact Sheet

22. Questions for Reflection/Self-Evaluation • How did you feel the first time you went to see a new therapist? • What did the provider do that helped make you more comfortable? That made you uncomfortable? • Imagine you have concerns about your gender identity, or are transgender. How do you feel about the initial visit? • How would you feel if the provider asked you about your sexuality or gender in a non-judgmental way? Natl LGBT Education Center

23. Understanding Cis-PrivilegeHow Would You Feel if: • You had to live a secret life to protect your job or family? • You were a target of violence for passing as your preferred gender? • You had to fear harassment or violence for using a public bathroom • In seeking counseling services you might encounter someone who refused to treat you or pathologized you due to your gender identity? • You may be asked to undergo therapy to “convert” an important aspect of yourself. Natl LGBT Education Center

24. Guidelines for Clinicians • Familiarize yourself with terms/diversity of identities within transgender community • Refer to clients by preferred name/pronouns • Listen to how people describe their own identities and partners; use the same terms • Realize that many have had past negative experiences and may perceive “slights,” even when not intended • Avoid asking questions out of curiosity; only ask what you need to know Natl LGBT Education Center

25. Environmental Factors

26. Environmental Factors Client information documents • Legal Name: ____________ Preferred name: ______________________ • Sex Assigned at Birth: □M □ F □ Intersex□Other___________________ • Gender: ___________________________________________________   • Preferred Pronoun: □ He/Him/His □ She/Her/Hers □ They/Their/Theirs □ Other_________________

27. Body Image Work • Important Questions • What is the client’s current body image? Relationship to his/her body? • How does the trans youth value their body? How do they take care of it, take pleasure in it? • How do they deal with other people’s perceptions versus what they see or what they wish they could see? • Does that change if they are able to change their body (e.g. through hormones, surgery) Shirley Katz, 2011

28. Body Image Work • Support youth in recognizing that although their biological “parts” may not match their gender identity, it’s the inside that counts (body acceptance is key) • Self-worth as a person; focus on inner view of self • Positive qualities outside of body • Some F-M may “bulk up,” if done consciously is ok; some M-F may want to be slimmer. Key: moderation and support • Joy in recognition as preferred gender rather than biology • Loving self-care

31. Even More Activities • Journaling – A Moment When My Body Feared Less, A Joyful Moment I Experienced in My Body, Anger Letter, Poetry • Movement – “Moving Attitudes” • My Body – Associating to body and witnessing by group members • “I Sing My Body Electric Especially When My Power is Out” by Andrea Gibson

32. Resources • Eating Disorders in LGBT Populations www.nationaleatingdisorders.org/eating-disorders-lgbt-populations • Dececo, Looking Queer • International Journal of Transgenderism • NEDA – Gender Outside the Binary series • National LGBT Education Center • Pepper – Transitions of the Heart • Sallans – Second Son