Out On The Couch
Decolonizing Your Practice with Trans Clients:
Actions Steps and Resources
As a reminder, my goal in writing this two-part series is to reflect on the ways in which TGNB-affirming* clinicians contribute to colonization (Part 1), while also offering, in this article, actionable ways of moving toward decolonization and gender liberation.
You may be familiar with what is now called the Multicultural & Social Justice Counseling Competencies (MSJCC; Ratts et al., 2016). The original elements of knowledge, attitudes and beliefs, and skills originated in 1992 (Sue et al.), and the most recent expansion added the emphasis of taking action.
This model emphasizes that our work needs to transcend the clinical skills and interventions we have been taught. We need to engage in our own self-reflection, navigate the power dynamics that are inherent in every session, and better understand and advocate for change within the very systems that perpetuate the problems our clients are facing.
As mentioned in Part 1, 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
- Your approach to treatment
- How you operate around privilege and oppression (both personally and professionally)
- The history of colonization and enslavement, as well as white supremacy
- The ways in which you have benefited from various systems and/or internalized the intergenerational harmful impact of those systems
If you are unsure of how to transform your clinical work with TGNB people to work toward gender liberation with a lens of decolonization, here are some action steps and values you might find helpful:
“History has its eyes.” Actively educate yourself, acknowledge, raise awareness, and work to change historical systems of oppression related to ability, race, gender, and body diversity. Aim to move beyond affirmation and “multicultural competence” to better understand your own colonized behaviors, as well as each client’s internalized transphobia and racism, and help clients move toward liberation. Antiracism Daily can be a helpful resource in this regard.
OWN YOUR ROLE AND RESPONSIBILITY. SAY THE THING.
We have a responsibility to acknowledge the impact of our racial and gender identities, the actions of our ancestors, our mistakes, our humanness, and our own innate strength and power; I recommend checking out Nora Alwah’s Ted Talk. We also have a responsibility to be authentic and transparent, and to believe what our clients tell us is their lived experience.
Validate client experiences rather than attempting to empathize with an experience of oppression for someone with a marginalized identity you do not hold. Bear in mind that sometimes our clients may not feel able to tell us or ask for what they need, especially if they’re accustomed to making those in positions of power feel more comfortable.
VALUE LIVED EXPERIENCE AS EXPERTISE OF THE SELF.
Decenter your privilege of the expectation of comfort from others. For those of us in positions of power/privilege, we become accustomed to systems and interactions being shaped around our needs, so it creates a dynamic in which those in marginalized bodies spend their lives making us comfortable (e.g., when Black people “code switch” in white spaces). Center your client’s feelings and experiences. Clinically, trust your clients’ awareness and knowledge about what they need and want.
Professionally, seek opportunities to learn from those who have lived experiences with their own BIPOC and/or TGNB identities. Honor their lived experience without questioning their training, education, and competence. And pay them for their time! For example, Sonny Jane talks more about this.
PRACTICE SELF-COMPASSION AND CULTURAL HUMILITY.
Check your shame at the door. We improve with openness to being wrong, trying, failing, and doing better the next time. Following a mistake, shame can lead to inaction and avoidance due to thoughts of being “not enough” and fear of judgment.
On the other hand, guilt allows us to accept responsibility, act to address the hurt our behaviors have caused, and learn from our mistakes for future interactions. You are imperfect, and that’s okay. You can still strive for excellence in TGNB care. Learn more about TGNB self-compassion.
USE A TRAUMA-INFORMED LENS TO HEAL, REST, AND SEEK JOY.
To effectively support TGNB clients, pay attention to both your and your clients’ minds and bodies using a trauma-informed lens. Bodies of all races carry the intergenerational trauma of our ancestors, and it is much more difficult to create a culture of liberation and internalized antiracism without first healing and resting our bodies. I recommend Resmaa Menakem’s book My Grandmother’s Hands; you might also check out The Nap Ministry on Instagram.
Also, part of healing is uncovering moments of joy and pleasure, both for yourself as well as your clients. For example, encourage your clients to be on the lookout for gender euphoria, which entails experiencing a strong sense of comfort and/or joy during an imagined or actual moment of connection and authenticity in one’s gender identity, body, and/or expression. There’s more about this in Laura Kate Dale’s forthcoming book Gender Euphoria. Make sure to celebrate all of the tiny victories in addition to holding space for dysphoria and marginalization. For more information about this, I recommend Adrienne Maree Brown’s Pleasure Activism and Anneliese Singh’s The Queer & Transgender Resilience Workbook.
“UNSCHOOL” AND ANTICIPATE A LACK OF CLOSURE.
We may never achieve some predetermined maximum level of knowledge, awareness, and language expertise. But we can work to expand ourselves beyond the “schoolishness” of doing what we’ve been taught in Western and colonized systems of education and psychology. For example, Akilah Richards’ work examines unschooling as a path to liberation (2020).
BE PATIENT. TRUST AND VULNERABILITY ARE EARNED OVER TIME.
White supremacy, racism, anti-Blackness, transphobia, and colonialism have impacted the world for centuries. It is a naïve privilege to believe that the work of one person alone can break down the barriers. Safety is not universal. Trust has to be earned.
Clinically, we cannot rush connection, courage, trust, affirmation goals, or growth without a cost to ourselves and/or our clients. It is not surprising that our clients distrust us at first; only if and when it starts to feel safer, they may slowly open themselves up to becoming more vulnerable.
CONNECT AND NURTURE YOURSELF.
Connect with other social justice-minded professionals who espouse the values of anti-racism and anti-oppression, such as Inclusive Therapists and Joy and Justice Collaborative. Follow and support the work of healers who actively engage in the work, such as Alisha McCullough, Sonalee Rashatwar, and Haley Jones.
Communities that work together toward these shared goals create a sense of belonging and healing together. We also need to set and maintain boundaries to ensure we are appropriately recharging, checking in about our needs and wants, and creating an environment that best allows us to do effective work.
CHECK YOUR VALUES.
Examine how true racial and gender liberation would serve you, rather than worrying about what it might “take away.” When this work feels hard, do you pull back or move through? Do your words, behavior, commitment, and expenditures stand in line with what you say you value? For example, consider the impact of supporting organizations such as Psychology Today that have problematic histories related to race, gender, and bodies.
You might reimagine your practice policies, fees, structure, and paperwork when reflecting on the ways in which you are reinforcing colonization. For example, please see here and here for a discussion of sliding scales as a tool for economic justice. Also, I highly recommend considering the GALAP Pledge, in which mental health providers commit to offer free or insurance-based access to gender-affirming surgery assessments from an informed consent lens.
Finally, consider whose voices are missing from your education, training, and ongoing work to improve your competence with marginalized populations. Are you centering yourself and/or those in positions of power, or pulling back to make space for marginalized voices?
LEAN INTO DISCOMFORT.
If you’re doing this work, chances are that you will often feel uncomfortable. Discomfort is not bad just because we experience relief when we move away from it. It is not others’ responsibility to make us comfortable, to lead us down the “right” path, etc. View discomfort as an opportunity to get curious (you might check out this radical anger podcast episode)!
Consider that many people experience discomfort when first exploring the sexist and racist history of fatphobia, the harmful impact of diet culture, and the ableism inherent in much of our society. (For more information, see this writer’s related articles here and here; I highly recommend reading The Body is Not An Apology and Fearing the Black Body.) But the joy and grounding that comes from liberating ourselves and our clients from those harmful systems is worth the work!
Though most of my early knowledge and training comes from white Western ideas and people, I have grown the most from queer, fat, TGNB, and BIPOC intersectional mentors, thought leaders, educators, clinicians, and other healers. I am a radically different (and better) version of myself when I am in community with others who hold similar values of anti-racism, body, race, and gender liberation, and restorative/reparative justice. So I can’t emphasize enough how important it is to expand upon this article with the intense heart and body work that comes with decolonization, restorative justice, and liberation.
*Note: For the purpose of this article, TGNB indicates transgender and gender nonbinary populations, though you may come across other “umbrella” acronyms. No acronym will fully represent all experiences of gender diversity, so when referring to individuals, you should always use whatever language feels best for your client. 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.
As a reminder, there are approximately two dozen recommendations and resources listed in Part 1 in addition to the ones below. These constitute just a sampling of the vast amount of information available, and my recommendations are based on my personal experience, growth, and perception of their helpfulness. Lean into what resonates, and know that there are alternatives for anything that doesn’t.
- GALAP Pledge (A group of mental health providers in the US who have committed to offering free or insurance-based accessible referral letters for gender affirming surgery). https://thegalap.org/
- Inclusive Therapists (A mental health professional directory, community, & justice movement). [@inclusivetherapists]. https://www.inclusivetherapists.com/
- Joy & Justice Collaborative (A healing and mental health professional community, education events, & justice movement). [@joyandjusticecollab]. https://www.joyandjusticecollab.org/
- The Blacker the Brain (Thea Monyee´ of MarleyAyo LLC is building a community of multidisciplinary practitioners & creatives to decolonize mental health/healing/wellness work). [@TheBlackerTheBrain]. https://marleyayo.com/unlearning
Media & Web Resources:
- Alwah, N. (clinician, she/her). (n.d.). Nora Alwah. [@noraalwah]. [Website, Instagram profile]. www.noraalwah.com
- Breland-Noble, A. (clinician/vlogger, she/her). (n.d.). Couched in Color with Dr. Alfiee. [@dralfiee]. [Instagram profile, YouTube channel]. https://www.youtube.com/c/CouchedinColorwithDrAlfiee
- Cardoza, N. (editor). (2020 – present). Anti-Racism Daily. [@antiracismdaily]. [Online newsletter, Instagram profile]. https://www.antiracismdaily.com/
- Feder, S, & Scholder, A. (Director & Producers). (2020). Disclosure: Trans Lives on Screen [Documentary]. Field of Vision.
- Finch, S.D. (coach & writer, he/they). (n.d.). Sam Dylan Finch. [@SamDylanFinch] [Website, Instagram profile]. www.samdylanfinch.com
- Hersey, T. (founder/blogger/coach). (n.d.). The nap ministry. [@thenapministry]. [Instagram profile; Blog]. https://thenapministry.wordpress.com/
- Jane, S. (peer support/lived experience counselor, they/them). (n.d.). Lived Experience Studio[@LivedExperienceCounsellor]. [Website, Instagram profile]. www.livedexperiencestudio.com
- Jones, H. (LPC-intern & content creator, they/them). (n.d.). [@the_queer_counselor]. [Instagram profile]. https://www.instagram.com/the_queer_counselor/
- McCullough, A. (clinician, she/her). (n.d.). Black and Embodied. [@blackandembodied]. [Instagram profile, Website]. www.blackandembodied.com
- McNeil, Toliver, M., Grinnell, M., & Wiltey, J. (Hosts). (2019 – Present). The melanated social work podcast. [Audio podcast]. Producer unknown. https://melanatedsocialwork.buzzsprout.com/
- Melanated Social Work (clinicians/podcasters). (n.d.). [@MelanatedSocialWork]. [Instagram profile, Website]. https://melanatedsocialwork.buzzsprout.com/
- Menakem, R. (clinician/author, he/him). (n.d.). Resmaa Menakem. [@ResmaaMenakem] [Website, Instagram profile]. www.resmaa.com
- Mullan, J. (clinician/author, she/her). (n.d.). Jennifer Mullan – Decolonizing Therapy. [@decolonizingtherapy] [Instagram profile, Website]. https://www.drjennifermullan.com/
- Rashatwar, S. (clinician/lecturer/organizer, she/they). (n.d.). Sonalee Rashatwar. [@TheFatSexTherapist]. [Website, Instagram profile]. www.sonaleer.com
- Richards, A. (writer/coach/podcaster, she/her). (n.d.). Raising Free People. [@fareofthefreechild]. [Instagram profile, Website]. https://raisingfreepeople.com/
- Taylor, S.R. (writer/poet/thought leader, she/they). (n.d.). The Body is not an Apology. [@SonyaReneeTaylor, @TheBodyIsNotAnApology]. [Website, Instagram profile]. https://thebodyisnotanapology.com/
- Toler, M. (Host). (2020 – Present). Hearing our own voice. [Audio podcast]. Producer unknown. https://www.melissatoler.com/podcast
Learn more about transgender and gender nonbinary affirmative therapy
Alwah, Nora. (2020, October 26). Reclaiming our power: Making ourselves seen [Video]. TEDxCU. https://www.youtube.com/watch?v=mYi42ydUe7Q&feature=emb_logo
binaohan, b (2014). decolonizing trans/gender 101. biyuti publishing.
Brown, A. M. (2019). Pleasure activism: The politics of feeling good. AK Press.
Cunningfolk, A. (2015, Aug. 11). The sliding scale: A tool of economic justice. Worts + Cunning Apothecary. http://www.wortsandcunning.com/blog/sliding-scale?rq=sliding%20scale
Cunningfolk, A. (2018, Apr. 23). How to make the sliding scale better for you & your clients. Worts + Cunning Apothecary. http://www.wortsandcunning.com/blog/a-better-sliding-scale
Dale, L. K. (anticipated, 2021). Gender euphoria: Stories of joy from trans, non binary and intersex writers. [Book preparing for print]. Unbound: United Authors Publishing Ltd.
Gender euphoria. (n.d.). In Gender Wikia. https://gender.wikia.org/wiki/Gender_Euphoria
Guenther, J. (2018, October 21). Psychology Today magazine loves white people: Especially beautiful and thin white women. Therapy Den. https://www.therapyden.com/blog/psychology-today-magazine-loves-beautiful-thin-white-women
Hemphill, P. (Host). (2020 – Present). Finding our way. [Audio podcast]. Producer unknown. https://prentishemphill.com/new-page-4
jackson, k. & Shanks, M. (2017). Decolonizing gender: A curriculum. [Zine] https://www.decolonizinggender.com/
Menakem, R. (2017). My grandmother’s hands. Racialized trauma and the pathways to mending our hearts and bodies. Central Recovery Press.
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
Ratts, M. J., Singh, A. A., Nassar-McMillan, S. N., Butler, S. K., & Rafferty McCullough, J. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development, 44(1), 28-48. https://onlinelibrary.wiley.com/doi/10.1002/jmcd.12035
Richards, A. (2020, Oct. 20). Raising free people: Unschooling our way to intergenerational healing. In Joy & Justice Collab: Empowered Learning Summit. [Presentation].
Singh, A. S. (2018). The queer & transgender resilience workbook: Skills for navigating sexual orientation & gender expression. New Harbinger Publications, Inc.
Strings, S. (2019). Fearing the Black body: The racial origins of fat phobia. New York University Press.
Sue, D. W., Arrendondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Multicultural Counseling & Development, 20, 64-88. https://onlinelibrary.wiley.com/doi/10.1002/j.2161-1912.1992.tb00563.x
Taylor, S. R. (2021). The body is not an apology: The power of radical self-love. (2nd ed.). Berrett-Koehler Publishers.
Tucker, M. (2019, June 19). At the intersection of fat and trans. The Affirmative Couch. https://affirmativecouch.com/at-the-intersection-of-fat-trans/
The Allied Minds Collective (2020, July 31). Psychologist’s stance on the “vilification of Karens” exposes the inequities embedded within mental health care. Medium. https://firstname.lastname@example.org/psychiatrists-stance-on-the-vilification-of-karens-exposes-the-inequities-embedded-within-c76a35622aee
Tucker, M. (2019, November 22). Helping TGNB young adults build self-compassion. [Webinar Training]. The Affirmative Couch. https://affirmativecouch.com/product/helping-transgender-and-gender-nonbinary-young-adults-develop-self-compassion/
Tucker, M. (2019, November 27). Helping queer and trans clients navigate fatphobia during the holidays. The Affirmative Couch. https://affirmativecouch.com/helping-queer-and-trans-clients-navigate-fatphobia-during-the-holidays/
Tucker, M. (2020, Aug 4). Deactivating psychology today and moving forward. https://www.wholeheartedpsych.com/post/deactivating-psychology-today-moving-forward