Out On The Couch
I am Black, gay, and a social worker. I work in a recovery center where I help individuals attain and maintain their sobriety. I have had experience on both sides of the “social service” table, and my personal and professional experience has given me access to the elusive community of crystal meth users.
A friend of mine who experienced addiction once asked me to accompany him to a Crystal Meth Anonymous (CMA) meeting. Upon our arrival, the room buzzing with conversation, I noticed that my friend and I were two of only three people of color in the space of about 25 people. When the meeting opened up the floor to share, the only other person of color present shared about a tough time he was going through and broke into tears. He was raw in the moment, and as much as I wanted to walk over and console him, I froze. No one approached him.
I didn’t know what to do at that moment. So I waited until after the meeting and then I pulled him aside. He shared that this wasn’t the first time he had a breakdown or breakthrough in a CMA meeting, and that he didn’t expect comfort because no one had ever comforted him before. He went on to say that even in a room filled with people who share the same pain, he still felt alone.
Racism: the elephant in the room
This is not unusual: within the larger gay community, I often hear stories of cultural difference–that in these spaces of “inclusion,” there is an elephant in the room that many refuse to acknowledge or address. Many of the white men in this room were on dating and hookup sites advertising their attraction to men of color; they plastered their desire for “BBC” (big black cocks) all over these apps, accompanied by the capital letter T as a silent signal to meth users. Why is it so difficult for these same individuals to console someone in an emotional state of need? Is it because they don’t see our value outside of the bedrooms? Wealthy white men’s fetishizing and desire of Black men‘s bodies while using is not uncommon, and they dangle crystal meth like a carrot hoping for a treat from their trick.
I remember being in these rooms and feeling afraid, embarrassed and mostly alone. These dark emotions fueled my desire to use so that I could lower my inhibitions and allow myself to engage in these humiliating experiences. All for Tina. These sex rooms were eerily similar to that CMA meeting room, but here, the white men couldn’t keep their hands off me, nor anyone who looked like me. When I finally crossed paths with those who shared my same hue and were also users, I discovered that we shared that same experience. That’s when I decided to look for help, which wasn’t easy.
Addiction as a disease of isolation for Black gay men
It can be difficult as a Black gay man who has suffered from addiction, whether current or in the past, to find community support. Black crystal meth users have a harder time because it is widely seen as a “white man’s drug.” The Black gay men with whom I have worked often express their fears of sharing about their struggle with addiction even with their friends. With the fear and shame of their addiction, most of these men succumb to one of the most dangerous symptoms of crystal meth addiction: isolation.
Connection is a pillar in the Black community. Connection informs how we give and receive love, how we communicate, and also how we feel valued. Connection bonds the value and friendships that we create with our chosen families. Chosen families are an essential part of the LGBTQIA+ community; they enable us to find the support and love that our biological families might not provide. Crystal meth addiction can be detrimental to these connections, forcing the men who use it to suffer in silence. They may not share about their addiction because of how they will be viewed, or for fear of becoming the subject of the latest gossip.
Unfortunately, that fear became my reality. I had reached out for help from someone I thought was part of my circle of support, only to end up being grist for the rumor mill. These experiences severed my trust in people, scaring me from looking for help. I was afraid of sharing more with old friends, for fear that they would repeat the same behavior. I also struggled with making new connections, afraid that they would somehow find out about my addiction and want nothing to do with me.
On being both client and service provider
It took some time, but I was able to connect myself with services; I credit my professional experience with helping me locate resources. My background in linking consumers to community supports like Medicaid and substance abuse programs became my reality. I was on the other side of the table, having been in the position of both client and provider.
I am confident that many out there can maneuver beyond their addiction and locate the necessary support to begin their own journeys to sobriety. However, there are so many others who are unable or are too discouraged by the daunting process.
Applying for Medicaid and enrolling in substance abuse treatment programs can be tasks within themselves. Fortunately, organizations like the D.C.-based Us Helping Us and Whitman-Walker Clinic offer streamlined services for MSM with crystal meth addiction, help with applying for health benefits, and much more. In New York, there is the Ike & Tina meeting, which centers the experiences of Black queer and trans folx seeking recovery.
But there is a tremendous need for culturally sensitive program models offered on a national level, along with greater accessibility of culturally cognizant therapists. Affirmative therapy provides safer spaces in which to unpack one’s life experiences, which is essential for anyone in or seeking recovery. My love for my profession plays an instrumental role in my search for the best way to support those with addiction. However, beyond this passion for the work that I do, my reach as an individual is limited.
It is time to tailor, on a larger scale, recovery services to our clients’ cultural experiences and needs. Community and mental health providers must seek training specifically designed to address the intersections of addiction and culture. Continuing education is vital for any and all of us providing services to clients whose multiplicity of identities and experiences we recognize and respect. In addition to pursuing ongoing training to create a workforce rich in cultural humility, providers should engage in advocacy efforts to ensure the creation and funding for recovery programs that will meet our clients where they are and propel them forward. There is much work ahead for affirmative providers!
In my third and final article in this series, I will explore the resources available to help practicing clinicians address the intersections of culture and addiction.
“Not everything that is faced can be changed; but nothing can be changed until it is faced.” – James Baldwin
Lee, C., Oliffe, J. L., Kelly, M. T., & Ferlatte, O. (2017). Depression and suicidality in gay men: Implications for health care providers. American Journal of Men’s Health, 11(4), 910–919. https://doi.org/10.1177/1557988316685492
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. https://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://www.youtube.com/watch?v=mnNguCYwx1U&feature=youtu.be
- 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 M. Tucker, PsyD