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13 Signs You Need to Decolonize Your Practice with Trans Clients

Posted: 1-7-21 | Megan Tucker

Image of trans flag and genderqueer flags with fists in the air representing therapists decolonizing their practicing with transgender and gender nonbinary clients

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 

Books: 

  • 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. 

Podcasts:

Electronic print & audiovisual resources:

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 

References

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

Two hands making a heart; one hand has trans flag colors and the other has genderqueer flag colors to represent self compassion for transgender and gender nonbinary clients

Blocks in black and white saying stress above bloacks saying resilience in transgender flag colors representing gender minority stress and resilience in transgender and gender nonbinary clients

 

About The Author

Megan Tucker

Megan Tucker, PsyD

I'm a licensed psychologist with a small private practice, in addition to full-time work at a university counseling center. My specialty is working with queer, trans, and gender non-binary people, focusing on topics such as relationships, sex, trauma, oppression, anxiety, and helping many folks to access gender affirming care.

https://www.wholeheartedpsych.com

Are you Femme? What Femme Isn’t and What it is.

Posted: 2-15-19 | Briana Shewan

What Femme Isn't, and What It Is

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!

Queer

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).

References

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

About The Author

Briana Shewan

I am a femme therapist and I love working long-term, relationally, and one-on-one within my queer community! I started my private practice Mophead Femme Therapy in San Francisco, CA in 2017. Now, it’s virtual, full-time, and deeply fulfilling.