Out On The Couch
Moving Towards Trans and Nonbinary-Affirmative Therapy Practice
As psychotherapists, we know that transphobia’s pervasive social impact affects our clients and our own internal worlds. This results in transgender and gender nonbinary (TGNB) folx internalizing society’s gender-normative attitudes and lays the groundwork for them to develop negative attitudes about themselves and their communities, which can ultimately lead to poor mental health outcomes (Babine et al., 2019).
I reviewed these resources for clinicians to help them address internalized transphobia; this term is used, for the purposes of this article, to mean phobia toward and discrimination against trans binary and non-binary individuals. In doing so, I encourage all of us to use our positions of power to educate community members including educators, employers, health care providers, and other support service staff who work with TGNB folx. It is incumbent upon us to help ensure that our clients are offered LGBTQIA+ affirmative care in every aspect of their lives (Babine et al., 2019). The resources listed in this article are a call to action to all providers offering care to the TGNB community; my hope is that we can consider these readings to create a more inclusive and gender-just world in which TGNB folx can live fully.
This review comes from my perspective as a white, able-bodied, licensed clinical therapist and nonbinary art therapist. I encountered some difficulties in reading through these books because they hit close to home for me and in relation to the everyday trauma my TGNB clients face. I recommend that other TGNB therapists and clients working through these books take breaks and engage in self-care practices when needed. Fortunately, Hoffman-Fox has included a Self-Care Checklist on page xxxi in their workbook, reviewed in this article.
Interactively Challenging Internalized Transphobia Through Workbooks
Transphobia is deeply rooted in a cis-hetero, capitalist, western settler-colonial political system, and it will take a much more organized response to address than filling out a workbook. But we can start by addressing internalized transphobia in ourselves, thus moving towards challenging it on a larger scale.
Exploring my Identity(ies): Interactive by Van Ethan Levy, LMFT
Written by a queer, non-binary, trans, AFAB (assigned female at birth), NBPOC (Not Black Person of Color) who uses the pronouns Van/they, Exploring my Identity(ies): Interactive asks clinicians to address their privileges, power, biases, and the stereotypes they have absorbed, and how these are intrinsically linked to internalized transphobia. Van engages the reader immediately by asking the reader “Who am I?” as a starting point to encourage vulnerability. This helps readers reduce shame and examine all the ways in which they have internalized negative messages about the TGNB community.
The workbook offers clinicians actionable steps to confront and address their internalized transphobia by breaking down language in an interactive format. This allows them to deepen their understanding of the ways in which internalized transphobia impacts us and our clients on both individual and systemic levels (Soto & Garman, 2018). The book names how internalized transphobia takes hold of us via unconscious bias by absorbing messages from our cis-focused society that shames, criticizes, and dehumanizes TGNB people. These messages, some overt and some subtle, serve to exclude trans people from full participation in life and are especially harmful to TGNB people trying to live freely in our world (Lighthouse Inc., 2020).
Levy (2020) closes the book by offering clinicians ways to be better allies. They challenge how our inflated academic egos are informed by the experiences of mostly white cis-hetero folx, rather than through the lens of the many marginalized TGNB folx fighting for their lives. The author recognizes that this is a lifelong practice for clinicians, and recommends approaching social issues with an intersectional lens.
You and Your Gender Identity: A Guide to Discovery by Dara Hoffman-Fox, LPC
Written by a white, queer, nonbinary mental health counselor who uses the pronouns Dara/they/them, You and Your Gender Identity: A Guide to Discovery offers affirmation to readers in a person-centered way, wherever they are in their own gender journeys. Hoffman-Fox breaks down the journey into three accessible stages: 1) Preparation, 2) Reflection, and 3) Exploration. In stage one, Hoffman-Fox (2017) speaks directly to removing the stigma of putting labels or diagnoses on ourselves, which one may find a healing experience due to the historical precedent of the DSM labeling TGNB folx with a “mental illness.”
Using this workbook, I felt as if I was creating my gender memoir, inspired by what Hoffman-Fox would consider “hands-off mentors”; this type of mentor is someone with whom you won’t be interacting on an individual or personal basis (Hoffman-Fox, 2017). I was excited to learn about this concept, as my own experience with hands-off mentors has led me to discover TGNB folx to whom I look up and relate. These mentors have assisted me in understanding my own nonbinary identity as well as my TGNB clients’ experiences.
Stage two speaks directly to how internalized transphobia manifests in our internal world beginning in childhood, when the adults around us began to censor and police our genders. The section breaks down such experiences by ages including childhood (ages 3 to 11) and adolescence (ages 12-17), with a reflection piece describing how some TGNB people experienced their gender at each age. Hoffman-Fox touches on the impact puberty has on young TGNB folx, and how this feeds into gender dysphoria and affects both their development and mental health. For cis-hetero clinicians who may not have questioned their gender and who, unlike many TGNB young folx, experienced puberty simply as a rite of passage, this section of the workbook may be very eye-opening.
In stage three, Hoffman-Fox encourages readers to reflect on how they feel about their gender in the present; the reader may take on an explorer role to deepen their understanding of their gender and gain agency in defining their gender identity through various questions. Hoffman-Fox notes the many barriers one may face in their gender exploration in terms of financial stability, relationships, resources, and health care, noting that no exploration process is right or better than another. It’s about tapping into the reader’s unique strengths and abilities (Hoffman-Fox, 2017). In this section, Hoffman-Fox offers the reader actionable ways to combat internalized transphobia by journaling and recognizing when one engages in internalized transphobia, reframing it to positive self-talk about one’s gender. At times I struggle with the idea that, by the end of this chapter, readers will unearth, gather, and digest enough information about themselves to gain a deeper understanding of how to define their gender identity (Hoffman-Fox, 2017). The author’s recognition of how one’s experience with their gender as a life-long multifaceted and complex exploration resonates more deeply with me.
The Queer & Trans Resilience Workbook: Skills for Navigating Sexual Orientation & Gender Expression by Anneliese Singh, Ph.D., LPC
The third workbook I reviewed is The Queer & Trans Resilience Workbook: Skills for Navigating Sexual Orientation & Gender Expression by Anneliese Singh, Ph.D., LPC, a South Asian multiracial Sikh queer and genderqueer femme clinician who uses she/they pronouns. Singh’s workbook speaks to the crucial skills TGNB folx need to build resiliency skills to thrive in a trans- and queerphobic world that demands conformity (Singh, 2018). Singh’s workbook centers intersectionality with TGNB folx and speaks to myriad LGBTQIA+ identities such as same-gender-loving, asexual, omnisexual, monosexual, polysexual, and pansexual, many of which may get overlooked by clinicians as well as by the general population. Further, Singh discusses the importance of developing a sense of body positivity, which the other workbooks do not address. Singh describes actively valuing one’s body and with whom one decides to share their body (Singh, 2018).
Singh’s workbook describes ten resilience skills for LGBTQIA+ folx to develop. A few of these skills include You Are More Than Your Gender and Sexual Orientation, Knowing Your Self Worth, Affirming and Enjoying Your Body, and Building Relationships and Creating Community. Each section offers a resilience exercise to encourage the reader to practice these skills, and many of the practices borrow from cognitive behavioral therapy with an added queer lens. One example is how to use positive self-talk to affirm one’s gender, and as a way to reframe negative thoughts about it.
Too often we focus on the ideas of self-care with TGNB clients to heal and manage pain inflicted on them via micro- and macroaggressions from our heterosexist and transnegative society. But we may fail to offer actionable ways to build up resiliency, like assertiveness skills, to empower our clients to survive and thrive. When discussing self-care with our TGNB clients, we must talk about cultivating resilience and how to develop skills to build up their confidence, communication, and self-esteem to navigate life in the face of discrimination and adversity (Singh, 2018). This workbook speaks to gender liberation to celebrate, respect, affirm, love, and recognize the value TGNB folx across the lifespan bring to our society, along with the power of enacting mutual aid efforts, as a way to develop resilience and create stronger communities.
Final Thoughts about Workbooks Addressing Internalized Transphobia in Clinicians
I found these workbooks to be engaging and useful, and I appreciate that they were created by clinicians who are themselves a part of our TGNB community. They share their own pain from having to navigate a cis-heteronormative society and the joy of experiencing gender liberation. Too often, books about LGBTQIA+ clients are authored by cis and/or heterosexual folx who are white/white-passing, of middle to higher socioeconomic status, neurotypical, and able-bodied. They come up with their own biased conclusions about our TGNB community members.
At the same time, I do reflect critically on who creates these books. I recognize how the language used in these workbooks about affirming queer experiences comes from queer folx in positions of power. They may, at times, use too much vocabulary from academic circles, a stark contrast to the reality of trans, nonbinary, and gender non-conforming folx who are fighting to survive (Levy, 2020). I wonder who gets to engage in these books, and who even knows they exist. Too often, TGNB folx–especially TGNB folx of color–are in constant survival mode, facing housing and food insecurity, compared to cis and hetero folx. Black trans womxn are being murdered at alarming rates each year. Are clinicians expecting TGNB folx to use workbooks in therapy, homeless shelters, or community mental health settings amid a deadly pandemic, one disportionately impacting BIPOC?
I note how my own position of privilege has exposed has me to the wonders of queer theory; I can see the benefits of these works in clinical practice with clients exploring their gender and internalized transphobia, which too often holds our TGNB clients back from embracing all the ways of being in our world. Each workbook speaks to the role that shame and guilt play in shaping one’s experience with internalized transphobia. Hoffman-Fox takes it one step further to break down shame and guilt and explore how each negatively impacts TGNB folx’ existence. Furthermore, shame and guilt together form a powerful force that perpetuates gender trauma in our society and leads our TGNB clients to isolation, censorship, and submission into a binary. Clinicians must work through shame and guilt with their clients across the gender spectrum because of the relentless grip this combined force can have on one’s gender identity.
At the core of these workbooks is their commitment to combat transphobia and their demand for others to recognize transphobia–even if unaware of their engagement in it–which will get us closer to ending it (Levy, 2020). This means no more dead TGNB folx as a result of inequitable access to basic human rights created by a transphobic society. The workbooks can serve as a set of armor for our TGNB clients to learn how to experience positive self-growth (Singh, 2018) that helps them thrive and affirms their identity.
To fully grasp and address internalized transphobia, mental health professionals need continuing education that includes listening to the stories created by TGNB community members outside of the academic sphere of clinical practice. This will help providers continue to develop more TGNB-affirmative therapy practices. In my next article, I will review memoirs from TGNB artists who speak to their lived experience of navigating a cis-normative society and recount the ways in which they have developed resilience strategies to address both socially imposed and internalized transphobia. Additionally, I will offer takeaways, resources, and further recommendations to address internalized transphobia.
A Therapist’s Guide to Navigating & Overcoming Internalized Transphobia. Lighthouse. (2018). https://blog.lighthouse.lgbt/overcoming-internalized-transphobia/
American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. American Psychologist, 70 (9), 832-864. DOI: 10.1037/a0039906
Babine, A., Torho, S. S., Fizpatrick, O., Kolodkin, S. R., & Daly, L. (March 2019). Dismantling Stigma in the Transgender and Gender Non-Conforming Community. The New York Transgender Advocacy Group.
Hoffman-Fox, D. (2017). You and your gender identity: A guide to discovery. Skyhorse Publishing.
Levy, V. (2020). Exploring my Identity(ies): Interactive. Self Published.
Singh, A. (2018). The Queer and Transgender Resilience Workbook Skills for Navigating Sexual Orientation and Gender Expression. New Harbinger Publications.
Garman, S. & Soto, M. (Hosts.) (2018-present) Transform: Beyond the transition. [Audio Podcast]. Stitcher. https://www.stitcher.com/show/transform-beyond-the-transition
Check out our Continuing Education Courses on Transgender Affirmative Therapy
13 Signs You Need to Decolonize Your Practice with Trans Clients:
Paying Attention to Your Colonization-Connected Behaviors
This two-part series is intended to first reflect on the ways in which transgender and gender nonbinary (TGNB)-affirming clinicians perpetuate harm connected to colonization, then to present actionable ways of moving toward decolonization and gender liberation. I am a queer, white, able-bodied, and “cis-ish” person (i.e., I do not feel discomfort in my body or with she/her pronouns, though I struggle with the construct of “womanhood”). I am an uninvited guest occupying the land of the Narragansett & Wampanoag people in what is now called Rhode Island in North America (note: I strongly recommend learning more about Indigenous culture, e.g. the All My Relations podcast).
While social justice movements tend to focus on addressing the oppression of marginalized communities, decolonization involves a discrete and critical understanding of settler colonization and the movement toward reparation of land and resources (Tuck & Yang, 2012). I cannot discuss decolonization without acknowledging that I benefit from stolen land and resources as well as oppressive systems that are violent toward Indigenous and Black communities, including that of mental health care. MarleyAyo LLC (2020) defines decolonization as the “intentional repairing and reclaiming of ancestry, traditions, and values lost or violently disrupted by colonization and the transatlantic slave trade.”
“…colonization was a direct attack to our physical AND spiritual beings…they cut off a line to that ancestral knowledge and almost guaranteed that history would be lost.” – Decolonizing Gender (jackson & Shanks, 2020)
The history of settler colonization has deep roots connected to white supremacy and racism, anti-blackness, transphobia, fatphobia, and essentially any system, community, or person that vilifies, criminalizes, punishes, rejects, and erases those who at first glance seem “different” (Morgensen, 2012). For additional context, you can learn more about the 4 I’s of oppression in this Healing While Black podcast episode. Also, consider learning about the characteristics of white supremacy culture, which can show up in any group or organization as a reflection of the attitudes and behaviors of all people (regardless of race)–for example, believing there is only one right way to do something.
The construct of gender liberation expanded on the work of Ignacio Martín-Baró, a social psychologist who lost his life because of his revolutionary work; see Helping Queer Clients Become Their Own Liberators (Spector, 2020) for more details. Gender liberation involves shifting our focus from basic gender affirmation with the TGNB community toward liberation by addressing power dynamics, advocating for systemic and social change, and freeing ourselves and our clients from the systems of gender oppression (Singh, 2016; note: Anneliese Singh is a phenomenal speaker, writer, and researcher in this area–see also her TedX talk). This includes an awareness that the concept of “transness” itself is a historically white construct, meaning that gender fluidity and diversity existed and were accepted for centuries prior to settler colonization (e.g. A Map of Gender-Diverse Cultures; see also The Platypus Poem by J Mase III).
I have chosen not to explore these constructs more deeply because a) individuals who have experienced that history and live it every day do not need an explanation, b) it’s not my place to tell their stories, and c) there are many other appropriate sources that do so (e.g. Adrienne Maree Brown, Rachel Cargle, & Alok V Menon). It is my responsibility to listen, learn, and do better to honor the voices, bodies, and land that have been telling the story for years and continue to do so.
“Cisheteropatriarchy holds its roots in colonialism, and dismantling and unlearning these Western agendas forced upon us is a necessary action in the liberation of all oppressed peoples. If we are to obliterate white supremacy, a key component of that necessary project is recognizing and dismantling transphobia as an ongoing destructive phenomenon directly rooted in colonialism.” (Paramo, 2018)
Some clinicians may be completely new to these concepts and what this work looks like. Other clinicians may already be doing this work more intentionally. Still other clinicians may have no choice but to do this work because of their own personal experiences of marginalization, oppression, and intergenerational trauma.
13 common forms of colonization-connected behaviors in your clinical work with TGNB people
To be clear, it would be toxic allyship to consider completing a ‘checklist’ as the way to do this work, given the need for decolonization to be a long-term commitment. Decolonization work is ongoing with the intention of returning land, resources, and opportunities to the populations from which they were taken, as well as supporting Indigenous and Black communities as they continue to navigate intergenerational and present-day trauma.
Regardless, it may be helpful to reflect on possible warning signs of colonization-connected behaviors in your clinical work with TGNB people, including the following:
1. Limited historical knowledge
(e.g. relying on mostly white and/or cisgender people and systems to teach you what you need to know about settler colonization, antiracism and gender; understanding a lot about trans identities but less about working with BIPOC clients; having little understanding of how colonization, white supremacy, and fatphobia intersect with gender)
2. Exploitation of BIPOC and/or TGNB people
(e.g. expecting BIPOC and/or TGNB experts to train/consult with you for free; asking TGNB and/or BIPOC clients to explain things to us; using before-and-after photos of TGNB bodies without considering the potential felt objectification and dehumanization)
3. Relying on diagnosis and “the written word”
(e.g. doubting someone’s knowledge of their gender because of their developmental stage or another diagnosis like autism; noticing yourself getting bogged down by what is written in the DSM, WPATH manual, or trans guidelines; focusing on whether or not someone meets the criteria for gender dysphoria to accept their TGNB identity)
4. Performative/toxic allyship
(e.g, telling yourself that you are anti-racist while rarely engaging in action steps that help you to learn, grow, and change in movement toward anti-racism; privileged ‘allies” jumping to judge others who make a mistake when talking about race/gender without inviting them into a conversation; expressing how important this work is but not being willing to pay for consultation/supervision/training to improve competence).
Deborah Plummer’s work talks more about how to take anti-racist allyship to the next level.
“Achieving a healthy white-identity resolution and feeling racially secure enough not to exhibit racial superiority does more for eradicating racism than just being an enlightened ally.” ~Plummer, 2020
5. Shame and shutting down
(e.g. feeling frustrated about how hard it is to to “keep up” with the movements and language; defensiveness and/or shame reaction when you make a mistake; dismissing or challenging a perspective shared by a BIPOC and/or TGNB colleague or client about their experience; feeling offended/hurt by a client’s decision to see a “lived experience” clinician)
6. Treatment barriers
(e.g. limited treatment access; high cost of full fee; not taking insurance or having an inaccessible sliding scale range; and/or requiring multiple sessions for a surgery assessment without transparency and collaboration)
7. Saviorism and lack of humility
(e.g. believing that if you don’t do this work, no one will; not seeking training/consultation/supervision when you have a growth edge, i.e. room for improvement; frequent signaling to your TGNB and BIPOC clients, colleagues, and friends the extent of your allyship)
8. Poor boundaries
(e.g. taking on additional clients for extra money; not saying no to people because we feel guilty; not prioritizing our own self-care and work-life balance)
“…it should not be forgotten that one of the privileges of whiteness is having a gender that is defacto more legitimate and more coherent because of the binary framework in which it necessarily exists.” -binaohan, 2014
9. Colonized gender norms
(e.g. making an assumption about a client’s desired gender destination; encouraging forms of social/physical expression that someone hasn’t asked for; using any language/identifiers for gender/body part/surgery etc. that the client hasn’t already expressed or without checking that the language feels okay for them)
10. Colonized race-related norms
(e.g. failing to acknowledge the impact of colonization; assuming that all clients desire and feel safe coming out in all spaces; being unaware of resources that are specific to BIPOC TGNB people; using research and clinical interventions that have not been normed on BIPOC people)
11. Colonized body and ability norms
(e.g. reinforcing the racist history of fatphobia and diet culture by encouraging a client’s attempts at weight loss via dieting; focusing on client weight as a potential barrier to surgery rather than framing from the perspective of medical fatphobia and helping to advocate for client needs; making an assumption about a client’s health status based on their weight and/or eating habits; using ableist language, making assumptions about someone’s capacity to do something, or limiting communication and processing methods). Please see Fearing the Black Body (Strings, 2019).
12. Time and outcome expectations
(e.g. using language that suggests a “full transition” or “complete surgery”; assuming that trans men want to be masculine; finding yourself thinking that clients are moving too slowly and pushing someone to come out to their family and friends)
13. Insisting on comfort
(e.g. having a shame reaction and apologizing excessively when you make a mistake or client provides feedback; mentioning how hard it is to keep up with the language; not bringing up racism or anti-Blackness unless the client mentions they are struggling with the sociopolitical climate; addressing your privilege in the room the first time and then not bringing it up again)
Decolonizing Mental Health is Hard: Take a Moment of Reflection
Notice what comes up in your body and how it feels as you reflect on the above examples. Did you notice any feelings of shame? Embarrassment? Discomfort? Denial? Guilt? Relief? Irritation? Uncertainty?
After checking in with your body, consider how these examples are connected to your clinical training and approach to treatment, your knowledge of history or lack thereof, and your worldview.
I believe that a clinician’s ability to wholeheartedly and effectively serve the TGNB population requires ongoing critical awareness, examination, and acknowledgment of the following:
- A likely skewed lens of the world: past, present, and future
- Your approach to treatment: personally, professionally, and systemically
- How you operate around privilege and oppression inside and outside of the therapy room
- The history of settler colonization, enslavement, and genocide; white Western education, research, training; and lingering medical and mental health care trauma
- The ways in which you continue to benefit from and engage in the perpetuation of those systems that have caused harm or, for those who belong to historically marginalized communities, the ways in which you have internalized the impact of those systems
As you continue to move through this work, you will uncover the countless ways in which colonization is woven into the fabric of our personal and professional lives, which has a direct and ongoing impact on the oppression of marginalized communities. Those in power may seem to benefit in terms of resources and capitalism. But the psychological, emotional, and intergenerational impact of colonization affects everyone, not just TGNB, BIPOC, and other marginalized communities. We all will benefit by working toward racial, gender, and body liberation, as well as striving for decolonization through supporting Black and Indigenous communities to reclaim their ancestry, values, land, and rights.
“If Black women were free, it would mean that everyone else would have to be free since our freedom would necessitate the destruction of all the systems of oppression.” – Taylor, 2017 (in How We Get Free: Black Feminism and the Combahee River Collective)
In the next and final installment of this series, I will further discuss actionable ways to begin transforming your work with TGNB clients. I want to reiterate that this work is multifaceted and is not meant to focus on completing a list of “to-dos.” Rather, it is an opportunity to reflect on your practice and the ways in which you can continue to do better and to help heal the harm caused by our ancestors and our modern-day systems.
Please see below for an extensive list of resources created by TGNB folx and/or BIPOC* who expand on these topics. Another resource list will be provided at the conclusion of my next article as well.
*Note: For the purpose of this article, TGNB indicates transgender and gender nonbinary populations. The use of BIPOC sometimes represents Black, Indigenous, and People of Color (i.e., non-white people), and at other times it represents Black and Indigenous people of color primarily (Code Switch episode, Meraji & Escobar, 2020). When discussing BIPOC communities in this article, I am referring to the Black, Indigenous, and other communities of color who experience ongoing marginalization and oppression in relation to the colonized history of the Western world, including the intergenerational impact from their ancestors.
Resources for decolonizing your clinical work
- binaohan, b (2014). decolonizing trans/gender 101. biyuti publishing.
- Strings, S. (2019). Fearing the Black body: The racial origins of fat phobia. New York University Press.
- Taylor, K-Y. (2017). How we get free: Black feminism and the Combahee River Collective. Haymarket Books.
- Monyee´, T. (Host). (2020 – Present). Shaping the shift. [Audio podcast]. Producer unknown. https://shapingtheshift.com/podcast
- Quiana & Misty. (Hosts). (2020 – Present). Healing while Black podcast. [Audio podcast]. Producer unknown. http://healingwhileblackpodcast.podbean.com/
- Wilbur, M. & Keene, A. (Hosts). (2019 – Present). All my relations. [Audio podcast]. Producer unknown. https://www.allmyrelationspodcast.com/
Electronic print & audiovisual resources:
- Colorado Funders for Inclusiveness and Equity (COFIE). (2010). The four I’s of oppression. Adapted for use by the Chinook Fund. http://www.coloradoinclusivefunders.org/uploads/1/1/5/0/11506731/the_four_is_of_oppression.pdf
- jackson, k. & Shanks, M. (2017). Decolonizing gender: A curriculum. [Zine] https://www.decolonizinggender.com/
- Mase III, J. (2018, Aug 15). Platypus poem: Zone of rarity [Video]. YouTube. https://youtu.be/mnNguCYwx1U
- Meraji, S.M. & Escobar, N. (Hosts). (2020, September 30). Is it time to say R.I.P. to POC? [Audio podcast episode]. In Code Switch. NPR. https://www.npr.org/2020/09/29/918418825/is-it-time-to-say-r-i-p-to-p-o-c
- Okun, T. (n.d.). White supremacy culture. Dismantling Racism. https://www.dismantlingracism.org/uploads/4/3/5/7/43579015/okun_-_white_sup_culture.pdf
- PBS. (2015). A map of gender-diverse cultures. https://www.pbs.org/independentlens/content/two-spirits_map-html/
- Plummer, D.L. (2020, June 5). Not a racist? Then let’s be better antiracist. https://www.dlplummer.com/blog/not-a-racist-then-lets-be-better-antiracist
- Spector, M. (2020, Sept. 9). Helping Queer Clients Become Their Own Liberators. The Affirmative Couch. https://affirmativecouch.com/helping-queer-clients-become-their-own-liberators-liberation-psychologys-critical-contribution/
- Tedx Talks. (2015, June 30). Tedx Georgia State – Anneliese Singh – Trans liberation is for everyone. [Video]. YouTube. https://www.youtube.com/watch?v=-onhIoDRMdM
- The Martín-Baró Initiative for Human Rights. (n.d.). About Ignacio Martín-Baró. The Martín-Baró Initiative for Human Rights. http://martinbarofund.org/about/ignacio/
General Websites & Social Media Accounts:
- Brown, A.M. (writer/thought leader/podcaster, she/they) (n.d.). Adrienne Maree Brown. [@adriennemareebrown]. [Instagram profile, Website]. http://adriennemareebrown.net/
- Cargle, R. (public academic & writer, she/her). (n.d.). Rachel Cargle. [@TheGreatUnlearn, @TheLovelandFoundation, @Rachel.Cargle]. [Website, Instagram profile]. www.rachelcargle.com
- Mase III, J. (poet & educator, he/him). (n.d.). J Mase III. [@jmaseiii]. [Instagram profile, Website]. www.jmaseiii.com
- Menon, A.V. (author/speaker/performer, they/them). (n.d.). Alok V Menon. [@alokvmenon]. [Instagram profile, Website]. www.alokvmenon.com
Decolonization. (2020). By MarleyAyo, LLC. [Definition]. In Thea Monyee´ presents: The Blacker the brain – Free to heal – Decolonizing our practices. www.marleyayo.com
Morgensen, S. L. (2012). Theorising gender, sexuality and settler colonialism: An introduction. Settler Colonial Studies, 2(2), 2-22. https://doi.org/10.1080/2201473X.2012.10648839
Peramo, M. (2018, July 17). Transphobia is a white supremacist legacy of colonialism. Medium. https://medium.com/@Michael_Paramo/transphobia-is-a-white-supremacist-legacy-of-colonialism-e50f57240650
Singh, A. (2016). Moving from affirmation to liberation as psychological practice with transgender and gender nonconforming clients. American Psychologist, 71(8), 755-762. https://doi.org/10.1037/amp0000106
Tuck, E. & Yang, K.W. (2012). Decolonization is not a metaphor. Decolonization: Indigeneity, Education, & Society, 1(1), 1-40. https://www.researchgate.net/publication/277992187_Decolonization_Is_Not_a_Metaphor
Learn more about transgender and gender nonbinary affirmative therapy
with Megan Tucker, PsyD
By Rachel Gombos MSW, LISW
Please note that this article contains content related to sexual trauma.
In this article, the first in a three-part series about kink-aware therapy, I will lay the groundwork for practitioners to gain an understanding of BDSM and key concepts such as consent and negotiation. Many may believe that BDSM represents bondage, dominance, and sadomasochism practiced during sex–yet these encompass only a small portion of the practices present in the BDSM and kink communities. After emerging in the late 80s and early 90s, the term BDSM itself has gone through a transformation as of the early 2000s (Taormino, 2012) to become more inclusive.
With the passage of time and availability of content on the Internet, the use of BDSM as an umbrella term has expanded to reflect the history of kink vocabulary and the wide variety of practices it encompasses. These include bondage and discipline, domination and submission, and sadism and masochism. While the differences among them may not be immediately clear, these terms are neither mutually inclusive nor exclusive, and kink activity is not limited to sexual experiences.
BDSM has traditionally been pathologized through psychiatric diagnostic manuals such as the DSM (Reiersøl & Skeid, 2006), the effects of which are evidenced by report data. For instance, Kolmes, Stock and Moser (2006) report a concern among consensual BDSM participants that they will receive biased care from mental health professionals. This information was gleaned from a survey administered to both BDSM-involved individuals who have received psychological services and to mental health professionals themselves.
There are a number of reasons why a client might not disclose their participation in kink and BDSM to a provider. Regardless of the context, remaining affirming and empowering combats the classical psychoanalytic and medical traditions of pathologizing BDSM and kink. Because of this, along with evidence suggesting that kinky clients may fear that providers will focus on their “unconventional” sexual desires instead of their concerns, it’s essential that providers become familiar with some basics of kink-affirming therapy.
Moser and Kleinplatz (2004) propose that when therapists accept their clients’ sexuality, clients are empowered to focus on their own concerns rather than defend themselves. The client’s BDSM practices are not “curable,” and any connected distress and dysfunction needs to be understood in the context of discrimination and stigma.
Creating safety in therapy allows clinicians to dispel harmful myths surrounding kink and trauma, and where necessary, to facilitate healing through the basic tenets of kink: consent, empowerment, autonomy, advocacy, and fun. There are two common but contradictory myths, neither more damaging than the other, that prevent many clients from talking about kink with their therapists. Learning about these myths is a way to challenge provider bias, and constitutes a great step toward developing kink awareness. The first is that trauma inherently causes kink, and the other is that you cannot engage in kink if you have a trauma history.
In consideration to the first myth, I refer to a lesson from my undergraduate psychology course regarding a twin sibling study. The study stated that a set of identical twins were separated at birth and both were obsessively clean. When asked why they thought they had this trait, one sibling reported that they had learned it from their adoptive parents. The other stated that their adoptive parents were so dirty that they vowed to never be this way. Perpetuating the connection of experience to meaning not only reinforces shame, but creates a space in which therapists may potentially pathologize a person’s existence. It can be a function of human nature to look back over our lives to find meaning and significance, yet the narratives we choose are not always rooted in a truth of cause and effect. Truthfully, we do not know why individuals develop the fetishes or kinks that they do.
The second myth regarding trauma histories proposes that engaging in kink will cause further harm and will be addressed at length in my next article.
Navigating Kink: The Basics for Kink-Affirmative Therapists
It is important that clients who are first realizing their interest in kink educate themselves before taking action. This is the only safe way to engage in kink. Similarly, therapists require education regarding kink dynamics in order to provide kink-aware therapy and provide a safer space for clients. Consensual kink upholds partner/personal consent, limit setting, and full disclosure of the risks that exist in a kink dynamic, as well as other important considerations that help keep each participant safe.
Let’s explore the extensive communication surrounding consent, limits, safewords, aftercare, and risk awareness that create a foundation for a healthy sexual dynamic.
Here is a terrific guideline to consent that is as easy as FRIESS* from Planned Parenthood (2020). I’ve added an extra S for an important factor you may encourage your clients to take into consideration.
*Sober (C. Cathers, personal communication, November 22, 2020)
Consent is freely given when it does not entail any degree of coercion, threat, or intimidation and it is reversible. This means that consent can be retracted at any time; consenting parties have the right to change their minds. Consent can only be considered informed and specific when every participant is aware of and agrees upon what is going to happen, what would be okay if it happened, what cannot and will not happen, and where, when, and how events are to take place. Think of kink-informed consent like a contract that outlines the expectations and understandings clearly for everyone.
Sober has been added as a reminder that if any participant is under the influence of mind-altering substances, consent cannot be freely given (C. Cathers, personal communication, November 22, 2020).
Within BDSM communities, practices are always understood to be Risk-Aware and Consensual. You may see activities commonly referred to as RACK:
For example, if a client wants to engage in impact play or any other kink activity such as spanking, caning, flogging, etc., that is great! First, it is important to learn some basic human anatomy so they know where it is safe to give and receive impact before they attempt impact play. Education first upholds awareness so that each participant knows how to create an interaction that is safe while still understanding the risks that are involved in any type of BDSM and kink activity.
There are wonderful educational books and Internet-based resources out there. Two of my personal favorites for fun education are SM 101: A Realistic Introduction by Jay Wiseman and videos by Evie Lupine, which you can find on YouTube. Please keep in mind these are not substitutes for completing accredited CE courses or learning from kink educators, but they are a great start. Remember that risk-aware kink practices are meant to keep everyone safe and enjoying themselves.
Negotiation, if done properly, is a collaboration towards a common goal: each partner’s pleasure. Negotiation always comes before a kinky interaction and includes factors like participants’ wants, needs, and soft and hard limits. Soft limits look like activities one is willing to try under the right circumstances, but that must be discussed and agreed upon before trying. Meantime, hard limits are the ones to which a participant says, “No, I am not interested in trying this at all under any circumstances.”
To unpack this a little further, negotiation is multifaceted and will include information such as the logistics of who will be involved, in what capacity, and in which roles. Everyone’s responsibilities must be considered further through the negotiation agreement. A thorough negotiation will also include safety information, including any injuries or illnesses, triggers, psychological limitations, and safewords. If you have further interest in learning about limits or encouraging a client to discover theirs, there are wonderful tools available; my personal favorite is the The Yes, No, Maybe Workbook by Princess Kali.
Discussing and utilizing safewords is another essential aspect of kink safety. Use of a safeword communicates to all participants that a change or complete stoppage of play is needed. A few recommendations include making sure that the word is something easy to remember, but also something that you would not normally utter during kink or sexual activity. Deciding upon a nonverbal gesture is another important consideration, as some activities render a person unable to speak. Gestures can range from a hand signal to a double tap on one’s partner. Working with safewords can be a great exercise in helping clients learn boundary setting and communicating needs.
When kinky play ends, aftercare allows all participants to feel safe, connected, and cared for. This can facilitate a sense of being grounded, an important factor considering the mental and physical “drop” that is described after the rush of endorphins experienced during play. No matter a participant’s role, drop can be experienced and may include aches and pains, feelings of guilt, and sadness or fatigue. This experience is normal and a routine of aftercare can help restore balance. Aftercare looks different for everyone in the same way that drop does, but often includes cuddling, reassurance, praise, a drink of water, or even a warm bath. It can be helpful to elucidate in the therapy room that asking partners what they need after play lays a foundation for stability and connectedness.
While this article does not comprise a definitive list of all things kink, or even all of the basics, I hope it will serve as a starting point as to why kink is healthy and why we should be talking about it in therapy. In the second part of this series I will explore further how having a kink-aware practice reduces stigma, and how we can increase our comfort in working with kinky clients whose past experiences have included trauma.
A Few General Resources for Kink-Affirmative Therapists:
American Sex Podcast with Sunny Megatron
Kolmes, K., Stock, W., & Moser, C. (2006). Investigating Bias in Psychotherapy with BDSM Clients. Journal of Homosexuality, 50(2/3), 301–324. https://doi.org/10.1300/J082v50n02_15
Kleinplatz, P., & Moser, C. (2004). Toward Clinical Guidelines for Working with BDSM Clients. Contemporary Sexuality, 38(6), 1–4.
Reiersøl, O., & Skeid, S. (2006). The ICD diagnoses of fetishism and sadomasochism. In P.J. Kleinplatz & C. Moser (Eds.), Sadomasochism: Powerful pleasures (pp. 243262). Harrington Park Press.
Sexual Consent. (2020). Planned Parenthood. Retrieved November 23, 2020 from https://www.plannedparenthood.org/learn/relationships/sexual-consent
Taormino, T (2012). The Ultimate Guide to Kink: BDSM, Role Play and other Erotic Edge. Cleis Press Inc.
The stress and anxiety wrought by the COVID-19 pandemic may be universal–so many of us face fears of the virus itself, not to mention job loss, illness striking our loved ones, and myriad missed social, professional, and financial opportunities–but all of us experience these differently. Just as everyone’s mental health needs are unique, therapy is not one size fits all. LGBTQIA+ clients in particular need to work with therapists who can understand and validate the unique experiences impacting their emotional wellbeing. Although no one is immune to the detrimental psychosocial effects of the pandemic, LGBTQIA+ clients can face some identity-specific challenges that make affirmative therapy especially crucial at this time.
These include extended time with family of origin and overall decreased social interaction. Pandemic-induced social isolation can hit LGBTQIA+ individuals harder, as many queer and trans people have strained relationships with their families of origin and thus rely heavily on friendships and chosen families for support. Being stuck in toxic family environments due to the pandemic, and enduring sustained lack of contact with friends, can constitute a dangerous combination for any client. LGBTQIA+ people living with family members who don’t respect their gender identity or sexuality may find their mental health negatively affected. This experience can also contribute to dysphoria and has been linked to substance abuse (Newcomb, 2019).
Further, lack of social connection is linked to suicidality, for which LGBTQIA+ populations are already at higher risk (Kaniuka, 2019). Prolonged feelings of loneliness can be self-perpetuating; when we feel disconnected, we might start to doubt our ability to connect with others, and we avoid opportunities for socializing out of fear. Happily, ongoing therapy sessions with a therapist who “gets it” and makes us feel seen can serve as a form of connection and help break the cycle of isolation. As we know well, the therapist’s office should be the one place in which clients don’t have to worry about appearing awkward or facing judgment. It can serve as a safer space in which a client can brush up on rusty social skills and build confidence.
Finally, more free time and solitude can make space for greater self-reflection, which may in turn bring up complex emotions in clients just discovering their sexuality and/or gender identity. It’s important for therapists to welcome discussions of these realizations with curiosity and validating support, whether we fully understand them or not. Other difficult topics that can emerge during extended periods of solitude and self-reflection–the trauma related to minority stress that so many LGBTQIA+ people face, for instance–may be challenging to navigate on one’s own but can provide rich fodder for the virtual therapy room as well.
Simply put, now more than ever, LGBTQIA+ clients need therapists who can treat them without bias. They may be coming into sessions with a lot of self-doubt about their gender identity and/or sexuality. They may have wanted support before now, but perhaps did not feel confident approaching a provider due to the double stigma of being LGBTQIA+ and having a mental health condition. If you are an affirmative provider who is welcoming a client like this into your practice, congratulations on ensuring a safer space. Taking the time to get training in best practices for working with LGBTQIA+ communities makes you an invaluable resource for clients and a genuine lifeline during this unbelievably challenging time.
Alessi, E. J., Dillon, F. R., & Van Der Horn, R. (2019). The therapeutic relationship mediates the association between affirmative practice and psychological well-being among lesbian, gay, bisexual, and queer clients. Psychotherapy (Chicago, Ill.), 56(2), 229–240. https://doi.org/10.1037/pst0000210
Feder, S., Isserlin, L., Hammond, N. Norris, M., & Seale, E. (2017). Exploring the association between eating disorders and gender dysphoria in youth, Eating Disorders, The Journal of Treatment and Prevention, 25:4, 310-317, DOI: 10.1080/10640266.2017.1297112
Johnson, K., Vilceanu, M. O., & Pontes, M. C. (2017). Use of Online Dating Websites and Dating Apps: Findings and Implications for LGB Populations. Journal of Marketing Development and Competitiveness, 11(3). Retrieved from https://articlegateway.com/index.php/JMDC/article/view/1623
Kaniuka, A., Pugh, K. C., Jordan, M., Brooks, B., Dodd, J., Mann, A. K., … & Hirsch, J. K. (2019). Stigma and suicide risk among the LGBTQ population: Are anxiety and depression to blame and can connectedness to the LGBTQ community help? Journal of Gay & Lesbian Mental Health, 23(2), 205-220.
Newcomb, M.E., LaSala, M.C., Bouris, A.,Mustanski, B., Prado, G., Schrager, S.M., & Huebner, D.M. (2019). The Influence of Families on LGBTQ Youth Health: A Call to Action for Innovation in Research and Intervention Development. LGBT Health, 6:4, 139-145. DOI: http://doi.org/10.1089/lgbt.2018.0157