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
By Briana Shewan, MFT
In order to prioritize femme voices, all quotes in this article are from femmes.
Positionality makes a big difference in femme identity: Please note I am a cisgender, white, thin, millenial femme from an upper-middle class background formally trained as a psychotherapist.
Have you ever wondered if you’re femme? Have you been circling around femme identity for a while without knowing if it fits? Are you unsure if you get to call yourself femme? Maybe you’ve heard “femme” more and more and you’re curious about it?
Femme is a beautiful, complex identity. What it looks like, means, and encompasses is different for each of us. I’m sure for many femmes there’s a sense of resistance at my attempt to categorize the identity here. I don’t mean to imply that being femme fits into one specific box! In fact, quite the opposite is true. Femme is all about stepping outside of traditional femininity. Spoiler! I’m getting ahead of myself.
Rather, this article is intended to broadly clarify femme identity by exploring its common themes. As the term “femme” becomes more widely known than ever before, it’s helpful to distinguish what it isn’t, and what it is (I’m a therapist; I’m choosing not to end on a negative note). Whether you share it as a resource for starting more nuanced conversation in your community or you wait until no one’s around to see you secretly explore the magic of femme essence, this article is for anyone who isn’t sure how they relate to it. May you be a baby femme in the making!
What Femme Isn’t…
A Straight Identity
Not all queer-identified femmes agree on this, but many, including myself, strongly feel that femme is a queer identity. Therefore, to be straight and call yourself femme is appropriative. . This is because to do so erases the history of femmes in queer liberation movements and its political identity as it relates to heteronormativity, and perpetuates femme invisibility for those who are queer identified (Barrett-Ibarria, 2017). In reference to femme invisibility, Alaina Monts states “…I do think that a lot of it has to do less so with any sort of purposeful femme erasure in queer communities (although that is extremely prevalent), and much more to do with the fact that it’s an identity being co-opted by folks who aren’t queer… Part of me wonders if femme invisibility has less to do with us being mistaken as straight and more to do with the fact that straight people are trying to be us” (Monts, as cited in Chung, 2016).
“It’s possible that femme’s resonance may be partly due to our current political climate, and the resistance it represents to the toxicity of masculinity” (Barrett-Ibarria, 2017). It’s important to note that, despite its wider current-day political relevancy, femme isn’t a trend. It’s history dates back to the 1930s within queer of color ball culture (Buchanan, 2018). To identify as femme while straight dismisses its historical, political, and cultural significance.
Synonymous with Femininity
Although femme and femininity are closely related, they aren’t interchangeable. Femininity refers to the socially constructed idea of what is feminine and isn’t necessarily queer, whereas femme is, in a sense, the queering of femininity – not just identifying as queer, as I’ve already discussed, but the embodiment and embracing of queerness in the full meaning of the word. This key differentiation is why it’s so important for femme to stand on its own (Tonic, 2016).
As Cassie Donish clarifies, “The term ‘femme’ does not simply mean ‘feminine’; it is used in queer circles to designate queer femininity, in a way that’s often self-aware and subversive. It’s both a celebration and a refiguring of femininity” (Donish, 2017).
“I see femme as the rebellious teenage daughter of femininity,” distinguishes Chung. “Femme is the process of taking the feminine words that were placed in my body, words like ‘soft, weak, quiet’ and transforming them into: ‘wild, loud, confident’… When I broke up with femininity and embraced femme, I felt strong and confident and powerful…” (Chung, 2016).
Every Feminine-Presenting Queer Woman
Self-identified femmes and feminine-presenting queer women are all feminized people and, as such, experience being devalued in our patriarchal society (Buchanan, 2018). That being said, not every feminine-presenting queer woman identifies as femme. Madeleine said, “Anyone who is girly/feminine is not necessarily femme. Femme is an identity; feminine and girly are descriptors” (Urquhart, 2015).
The term femme can be used loosely without understanding how someone self-identifies. There is value in both someone claiming femme identity, and not claiming it. You can’t assume that a queer woman is femme because they are assumed feminine-presenting.
…And What Femme Is!
Yes it is!
“…Among the LGBTQ+ community, femme is a descriptor that can feel as inherent to someone’s identity as lesbian, bisexual, or genderqueer,” writes Kasandra Brabaw (Brabaw, 2018). Femmes may have any gender identity; some consider femme their gender identity, whileother femmes may have a different gender identity (such as transwoman, nonbinary, cis-woman, genderfluid, agender, etc.) and consider femme their gender expression (“femininity” aligns with gender expression in that it encompassess behaviors, mannerisms, appearance, etc. within a certain cultural context).
Additionally, there are femmebois, tomboy femmes, femme daddys, femme dykes, etc. who use language to describe their femme identity even more accurately. Other femmes reject these categorizations altogether. “Ultimately, ‘femme’ is about breaking binaries. It’s about subverting cultural expectations. It’s about being more than one thing. It’s about queerness,” sums up Tonic.
An Intentional Relationship to Your Femininity
Many femmes consider their identity to be an intentional expression of their femininity as opposed to one that adheres to typical constraints of feminine performance. Rather, femmes creatively and uniquely celebrate the parts of themselves that would otherwise be suppressed, denied, or defined for them. “As long as normative gender roles exist there will be an urgent need for people, femmes included, to push at their boundaries,” writes Heather Berg, Gender Studies professor at USC (Barrett-Ibarria, 2017).
Femme’s relationship with femininity is one of reclamation and transcendence. It’s about agency. “The whole point of [being femme], for me,” states Cassie, “is to break people away from their assumptions. I don’t like the strict rules of traditional femininity, but I don’t want that to mean that I can’t be feminine at all” (Urquhart, 2015).
Femme’s expression of femininity can be both fierce and hard as well as tender and soft and everything in between. It often challenges larger notions that equate femininity to vulnerability and vulnerability to weakness. “Our culture hates femininity, calls it weak. Our culture is inept at nurture and care, terrified of vulnerability and softness—all things that are squarely in the femme’s handbag. To indulge in femme culture is actually to be brave, and to have strength,” states Maurice Tracy (Donish, 2017).
Its Own Identity
Today femme is proudly an identity that is not defined in relation to anything else. “I didn’t self-identify as femme until I met other queer folks who helped me see that femme is its own identity,” states Artemisia FemmeCock. “Femme is intentional; it’s a way of simultaneously challenging and celebrating femininity. It recognizes that I identify with aspects of femininity but don’t identify with the heteronormative system that trivializes and demonizes them” (Donish, 2017).
Femininity is often defined in relation to masculinity and positioned as its opposite, whereas femmes don’t see themselves within this binary. Femme pushes back on misogynistic ideas that feminized people are defined through a patriarchal lens or male gaze. Femme is glorious all on its own.
Unique to Each Person
“From the invisibility queer femmes can feel in some lesbian circles to the sharp vulnerability inherent in being a trans woman, no two femme-identified individuals share the same experience of what it means to be femme,” says Joss Barton (Donish, 2017).
For many femmes, their identity encompasses more than their sexuality and gender. It is the entirety of their queerness existing in a capitalist, white supremacist society. Femme identity is often strongly linked to class due to its significant historical context as a working class lesbian identity in the 1950s and ‘60s. Leah Lakshmi Piepzna-Samarasinha said:
Ableism lifts up a white, able-bodied, traditionally feminine, middle-class body as the ‘right’ way to be femme. Because of ableism in the movements I’m part of, it took me years to find a disability justice community where I didn’t have to closet my disability in order to still be femme. My cane, sexy non-stiletto boots and bed life are femme now because of the labor of disability justice comrades. Many of them, like Patty Berne of Sins Invalid, are deeply femme (Pérez, 2014).
As Macarena Gomez-Barris, chair of the Social Sciences and Cultural Studies department at Pratt Institute explains, “In some communities, femme identity also symbolizes a rejection of whiteness, a term used to represent decolonized womanhood” (Barrett-Ibarria, 2017).
In fact, black femme scholar Kimberlé Crenshaw coined the term “intersectionality” in 1989. “Intersectionality is a tool for the experiences of black women which are “greater than the sum of racism and sexism” (Crenshaw, 1989, p. 140).
Of course, there’s also femme relationships, sex, and aesthetics. One femme may be a kinky monogamous top who only dates other femmes; another may be pansexual and polyamorous. One femme may feel strongly about shaving, while another may feel strongly against it. One femme may refuse to leave the house without makeup and hair in perfect order, another may be ambivalent about glitter (gasp!).
As Laura Lune P. says, “I’d like for the myth that femme only looks one way to be smashed. Femme doesn’t only mean red lips, sky high heels and perfectly manicured nails (although it can most certainly mean that). Femme means whatever you want it to mean for yourself and however you want it to look like if that gender feels like home to you” (Pérez, 2014).
Barrett-Ibarria, S. (2017, December 20). Who Gets to Identify as ‘Femme’? from https://www.vice.com/en_us/article/xw4dyq/who-gets-to-identify-as-femme
Brabaw, K. (2018, June 20). A Brief History Of The Word “Femme”. Retrieved from https://www.refinery29.com/en-us/femme-lesbian-lgbtq-history
Buchanan, B. (2018, March 19). Women and Femmes Unite! – Blu Buchanan – Medium. Retrieved from https://medium.com/@BlaQSociologist/women-and-femmes-unite-30ec59e6a658
Chung, C. (2016, July 18). What We Mean When We Say “Femme”: A Roundtable. Retrieved from https://www.autostraddle.com/what-we-mean-when-we-say-femme-a-roundtable-341842/
Crenshaw, Kimberle. “Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics,” University of Chicago Legal Forum: Vol. 1989: Iss. 1, Article 8. Available at: http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8
Donish, C. (2017, December 04). Five Queer People on What ‘Femme’ Means to Them. Retrieved from https://www.vice.com/en_us/article/d3x8m7/five-queer-people-on-what-femme-means-to-them
Pérez, M. (2014, December 3). Femmes of Color Sound Off. Retrieved from https://www.colorlines.com/articles/femmes-color-sound
Tonic, G. (2016, August 24). The Difference Between Femme & Being Feminine. Retrieved from https://www.bustle.com/articles/166081-what-does-femme-mean-the-difference-between-being-femme-being-feminine
Urquhart, E. (2015, March 12). Not Your Great-Aunt’s Girly Lesbian. What Does Femme Mean Today? Retrieved from https://slate.com/human-interest/2015/03/femme-lesbians-shouldnt-be-defined-by-their-butches.html