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How to Help Clients with Queer Impostor Syndrome

Posted: 8-19-20 | Madeline Hodgman

How to Help Clients with Queer Impostor Syndrome

Keywords: queer, LGBTQ, LGBTQIA, impostor syndrome, impostor, cognitive behavioral therapy, CBT, core beliefs

I thought I identified one way, but now I’m not sure. What if this really was just a phase?

I’m afraid I won’t like all of the changes medical transition will cause to my body. What if I’m not really trans?

Can I still be bisexual if I’ve never dated someone of the same gender?

Our clients seek therapy for a variety of reasons, but commonly, they are struggling to mitigate their own core beliefs with external influences. These may include family, friends, partners, or society at large–for LGBTQIA+-identified folks, how we see ourselves can often conflict with how the world interprets us. This type of invalidation can lead to self-doubt for many people, even making them question whether they are frauds or impostors. As therapists, our goal is to help clients identify and challenge their negative core beliefs, to challenge these external influences and find internal validation.

The theory of Impostor Syndrome originates from a 1978 paper from Georgia State University that examined the phenomenon in more than 150 “high-achieving women” (Clance & Imes). The authors found that in their psychotherapy practices, women often presented with “scholastic honors, high achievement on standardized tests, praise and professional recognition from colleagues and respected authorities,” yet did not report “an internal feeling of success” (Clance & Imes, 1978). Rather, these clients felt like “impostors,” as though they were given undue praise or accolades they did not deserve.

In recent years, Impostor Syndrome has entered the lexicon as a common experience among millennials. A 2013 article by Weir at the American Psychological Association examined the experiences of graduate students and suggested that for many, there is “‘confusion between approval and love and worthiness. Self-worth becomes contingent on achieving.” This attitude is compounded by factors like gender, sexuality, disability, class, and race, with impostor feelings being a strong predictor of future mental health problems among college students of color (Cokley et al., 2013). 

Similarly, impostor feelings often pop up in psychotherapy with millennial clients, particularly those with one or more marginalized identities. In our culture, certain roles or industries are often referred to as a “boys’ club”–as these spaces were built by and designed for white, heterosexual, cisgender men, anyone who varies from this norm can feel like they don’t belong. Higher education is just one example of a much more global dynamic.

For LGBTQIA+-identified people, impostor feelings are often less about achievement and more about community. Many people find comfort in the use of labels or identity words–such as gay, lesbian, bisexual, transgender, genderqueer, gender non-binary, and more–to describe themselves and their sexuality and gender. For someone who is just starting to explore their identity, finding a community of people who have been where they are can be healing and fulfilling. But what if none of the labels fit quite right? Or what if your experience differs from that of your friend, or even of your partner? 

Though it is often said that “comparison is the thief of joy,” human beings are prone to noticing the similarities and differences between themselves and others. It can feel isolating to know that how you identify differs greatly from someone else. But this is where we as therapists can employ cognitive behavioral therapy to help our clients change their thinking and develop their senses of internal validation.

One example might be a therapist working with a client who identifies as a cisgender woman and a lesbian. At the first appointment, the client shares, “I’ve only dated women since coming out in college. Lately I’ve noticed myself looking at men differently than before, and it’s confusing. If I’m attracted to guys, am I still a lesbian?” 

From what this client is saying, she sees the problem as confusion about her identity. It is worth exploring with the client what being a lesbian means to her, and furthermore, what it would mean if she were to identify differently. Often, this is where impostor feelings start to surface: if I’m not this, then what? I must have been faking. I don’t really belong here. 

Using the framework of cognitive behavioral therapy, clarifying the client’s core beliefs about herself can be helpful. These are deeply held feelings that are central to our being, and that influence how we see and interact with the world. Core beliefs can be positive or negative, such as “I am worthy” or “I am unworthy,” “I am safe” or “I am unsafe,” “I am good enough” or “I am not good enough.” For this client, the core belief underlying her impostor feelings may be related to belonging, or feeling like she does not belong in her community of friends–or safety, from feeling like she is on the outside.

After isolating a client’s core beliefs, one CBT intervention that can be utilized would be fact-finding, asking the client to provide as many pieces of evidence as they can why their belief is true or untrue. Using our same example, if this client’s impostor feelings trigger the core belief that she does not belong in her community because she is questioning her identity, the therapist and client can list a number of examples of evidence to the contrary. 

“Well, my friends will still be my friends no matter what. They have always supported me. That wouldn’t change,” the client offers. “And even if I did have a boyfriend someday, that wouldn’t make me straight. I wouldn’t think that about somebody else in my position.” By talking through this fact-finding process, the client is starting to challenge and reconstruct her core belief of belongingness. It may also be helpful to have a client write down thoughts, beliefs, and evidence in a journal between sessions. This can be a helpful reflective exercise and also encourage clients to use their coping skills outside of therapy.

Core belief work is not always easy, nor is it a quick fix for impostor feelings. Therapy sometimes makes things worse before they get better, and clients can sometimes unearth deep-seated issues in therapy that take time, effort, and dedication to work through. That does not make their effort any less valuable, however, and small changes in the client’s self-perception should be noticed and praised. There may be certain situations or stages of life in which a client feels old impostor feelings starting to emerge again. When they do, it is important for the client  to remember that they have control over their own thoughts and feelings, and that they can reconnect with their positive core beliefs.

References

Clance, P. R., & Imes, S. A. (1978). The Impostor Phenomenon in High Achieving Women: Dynamics and Therapeutic Intervention. Psychotherapy: Theory, Research and Practice, 15(3), 241-247.

Cokley, K., Mcclain, S., Enciso, A., & Martinez, M. (2013). An Examination of the Impact of Minority Status Stress and Impostor Feelings on the Mental Health of Diverse Ethnic Minority College Students. Journal of Multicultural Counseling and Development,41(2), 82-95. doi:10.1002/j.2161-1912.2013.00029.x

Weir, K. (2013). Feel like a fraud? GradPSYCH, 11, 24. doi: https://doi.org/10.1037/e636522013-001

 

About The Author

Madeline Hodgman

I am a bisexual femme social worker living in the Midwest on Erie and Mississauga land with my partner, dog, cat, and many plants. I love cooking, baking, sewing, knitting, and other DIY-making projects. Lately I’ve been thinking a lot about sustainability, and have been making my own homemade alternatives to reduce the single-use plastic and paper product usage in our house.

Maintaining Hope & Self-Compassion for LGBTQIA+ Clients During Covid-19

Posted: 4-22-20 | Megan Tucker

Maintaining Hope & Self-Compassion for LGBTQIA+ Clients During Covid-19

By now, we are all experiencing the impact of the ubiquitous trauma and stress surrounding COVID-19 in some way. What might have started with a distal awareness of the problem quickly snapped to a reality that the world will forever be changed by this virus. You might have also noticed the varying “stages of grief” through which our clients and we ourselves are shifting, the unfortunate stage of denial being the one that has caused the most irrevocable damage to the world.

On the one hand, many may find the universality of this experience comforting–it is rare that everyone on the planet understands the same thing to some degree. The current situation presents a valuable opportunity for emotional validation and a sense of common humanity (i.e., increased self-compassion due to awareness of the common human experience of suffering). It often takes personal experience and connection to a situation to increase empathy and compassion, and we are seeing a lot of that right now. 

On the other hand, I wish there was this strong of an empathic connection and worldwide response to problems like climate change, the murder of black and brown bodies, and the impact of capitalism on class disparities. Interestingly, each of these intersects with the effects of COVID-19, especially the disparity of the impact on (and deaths of) black folks in our country.

No matter how we process and move through this situation, many feel its impact as a trauma. While we work to validate our clients’ experiences and help them make sense of something entirely unprecedented, it is also important to remember that this situation impacts different people very differently. The disparities affecting various marginalized populations are amplified during this time. It is crucial to acknowledge the potentially devastating impact on the LGBTQIA+ community, especially on transgender and gender nonbinary (TGNB) individuals, many of whom are no strangers to trauma and grief. More background on this can be found in The Affirmative Couch’s course Gender Minority Stress and Resilience in Transgender and Gender Nonbinary Clients

Here are examples of how our LGBTQIA+ clients might experience a compounded impact of grief and/or trauma related to COVID-19:

Physical distancing in unsafe and/or unaffirming living situations

  • College students who were suddenly asked to leave campus
  • Those in domestic violence or other abusive home environments
  • People who have not disclosed or come out to their families/housemates

Social isolation

  • Being physically distant from one’s chosen family or an affirming environment (e.g., at a university)
  • Being unable to explore communities or experiences that might be affirming, such as closed, limited, or postponed LGBTQIA+ centers and Pride month activities

Lack of resources to access safe space and online support

  • Limited resources to pay for stronger Internet connection, or lack of multiple devices
  • Lack of privacy or safe space to seek online support or therapeutic help
  • Food, housing, or job insecurity during this time

Factors specific to TGNB people

  • Canceled or postponed lifesaving gender-affirming surgeries
  • Barriers to beginning gender-affirming hormones, monitoring bloodwork, and receiving preventative affirming healthcare
  • Risk of misgendering via phone/video and distress/dysphoria of seeing one’s face via video conference
  • Inability to affirm one’s gender expression due to lack of support and/or awareness of other household members
  • Limited or no access to gender-affirming haircuts (i.e., hair can make or break someone’s experience of dysphoria on a given day)
  • Increased body insecurity and disordered eating in response to the fatphobia strengthened by this crisis; you can read more about this in my article At the Intersection of Fat & Trans

The impact of each of these concerns is amplified for those with intersecting marginalized identities related to, for instance, race, class, ability, and mental/physical health status. To make matters worse, many of our clients experience anticipatory grief for the continued losses ahead as well as for the uncertainty of when things will “return to normal.” Here are some ways in which we might help our LGBTQIA+ clients, especially members of the TGNB community, to navigate this situation and find ways to practice self-compassion, gratitude, and hope. 

Boundaries: This is not an “opportunity” for people to do the things for which they don’t usually have time. “Productivity porn” is shame-inducing for many who are experiencing this situation as a trauma. It is okay to limit time spent on consuming the news and social media. To paraphrase an important sentiment, this is not just remote work. You are at home during a pandemic crisis and attempting to work.

Validation: Acknowledge to your clients that employing all self-care strategies possible still may not help beyond simply keeping them afloat during this time. Surviving a traumatic experience takes an extreme emotional and physical toll, and it’s okay if clients’ eating habits and bodies change, if they sleep more than usual, and if they struggle to get work done. 

Self-compassion: I can’t emphasize enough how important it is for our clients to be mindful and self-compassionate. Whatever thoughts, feelings, and behaviors emerge during this time make sense given the impact of collective traumas. Even if someone acts in a way that is inconsistent with their values, they are still worthy of self-nurturance and connection. You can learn more about these concepts through The Affirmative Couch’s course Helping Transgender and Gender Nonbinary Young Adults Develop Self-Compassion

Little moments of joy and gratitude

  • Ask clients to reflect on a vulnerable moment where they were able to nurture themselves or others
  • What was one show/movie/podcast/song that made them smile or laugh? 
  • What is one thing they’re looking forward to in the upcoming week? 
  • What are three things about the past week for which they felt most grateful?
  • Direct them to some of the many inspirational, hopeful, and positive ways in which people have been expressing themselves and creating via social media. 

Finding meaning and connection

  • Can clients volunteer virtually? Reach out to someone who is more isolated? Offer to drop off groceries for an elderly neighbor?
  • What creative talents might be employed to help others? 
  • Engage clients in storytelling and/or writing–expressive writing exercises like these can be particularly useful–to help work through their feelings
  • If they have financial resources, what organizations might benefit from their support?
  • Connect virtually with supportive others, especially in spaces that are queer- and trans-affirming. Balance their socializing with meaningful conversation and moments of fun
  • Help your clients explore whether local or statewide LGBTQIA+ organizations are running online groups and support spaces, and/or offering other forms of connection

Hope for the future (i.e., not focused on a specific time when things return to “normal”)

  • Who is the first person a client can’t wait to hug again?
  • What restaurant are they excited to go to first?
  • For students, how will it feel to step back onto campus again?
  • What is the first event/trip/appointment they’re looking forward to rescheduling?

A final note: These points are important for clinicians to keep in mind as well. We need these reminders now more than ever. Most of us are not at our best right now, and it is foolish to pretend to our clients that we are. This is a time for us to hold that we are all human, and that authenticity models for our clients why it is important to be less hard on themselves for struggling. At the very least, consider reading this “Dear Therapists” blog post

References

Berinato, S. (2020, Mar 23). That discomfort you’re feeling is grief. Harvard Business Review. Retrieved from https://hbr.org/2020/03/that-discomfort-youre-feeling-is-grief 

Thebault, R., Tran, A.B., & Williams, V. (2020, Apr 7). The coronavirus is infecting and killing black Americans at an alarmingly high rate. The Washington Post. Retrieved from: https://www.washingtonpost.com/nation/2020/04/07/coronavirus-is-infecting-killing-black-americans-an-alarmingly-high-rate-post-analysis-shows/?arc404=true  

Patton, S. (2020, Apr 11). The pathology of American racism is making the pathology of the coronavirus worse. The Washington Post. Retrieved from: https://www.washingtonpost.com/outlook/2020/04/11/coronavirus-black-america-racism/

Tucker, M. (2019). Gender minority stress & resilience in TGNB clients. Retrieved from: https://affirmativecouch.com/product/gender-minority-stress-and-resilience-in-transgender-and-gender-nonbinary-clients/

Tucker, M. (2019) At the intersection of fat & trans. The Affirmative Couch. Retrieved from: https://affirmativecouch.com/at-the-intersection-of-fat-trans/

Ahmad, A. (2020, Mar 27). Why you should ignore coronavirus-inspired productivity pressure. The Chronicle of Higher Education. Retrieved from: https://www.chronicle.com/article/Why-You-Should-Ignore-All-That/248366

Tucker, M. (2019) Helping TGNB young adults develop self-compassion. The Affirmative Couch. Retrieved from: https://affirmativecouch.com/product/helping-transgender-and-gender-nonbinary-young-adults-develop-self-compassion/

Pennebaker, J.W., Blackburn, K., Ashokkumar, A., Vergani, L., & Seraj, S. (2020). Feeling overwhelmed by the pandemic: Expressive writing can help. The Pandemic Project. Retrieved from: http://exw.utpsyc.org/#tests

Katy (2020, Mar 21). Dear therapists. Navigating Uncertainty Blog. Retrieved from: https://navigatinguncertaintyblog.wordpress.com/2020/03/21/dear-therapists/

About The Author

Megan Tucker

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.psychologytoday.com/us/therapists/megan-tucker-somerville-ma/280796

Helping Queer and Trans Clients Navigate Fatphobia During the Holidays

Posted: 11-27-19 | Megan Tucker

Collage with Happy Holidays, Food, and a person's hands bound by measuring tape

As we approach winter and prepare for “hibernation,” diet culture often kicks into high gear.  Family meals, holiday parties, and New Year’s resolutions surround us, regardless of whether we celebrate, and become fertile ground for fat shaming. The “holiday season” is already hard enough for many LGBTQIA+ folx*. It can also be an exceptionally dangerous time of year for fat folx, as well as those who experience disordered eating. (Note: See my previous article, At The Intersection of Fat & Trans, for further descriptions of fatphobia and weight stigma).

*Folx is an alternative spelling of folks, meant to represent inclusivity in a way similar to terms such as womxn and latinx.

Did she just say fat? 

Yes, you read that correctly. “Fat” is not a bad word, though it’s often wrapped in a framework of shame. How often do those with larger bodies get unsolicited weight management or weight loss advice? When a person says, “Ugh, I’m so fat,” how quickly do we jump in to dismiss their experience and try to make them feel “better”? Our response to a friend who has lost a significant amount of weight (e.g., “wow, you look great!”) differs  significantly from the response to a friend who has gained weight (e.g., “I’m concerned about your health”). The messages we get from diet culture, the media, and most other humans is that fat=lazy, bad, ugly, and unhealthy, versus thin=fit, good, desirable/attractive, and healthy. 

But surely queer and trans communities are more accepting?

Unfortunately, members of LGBTQIA+ communities have not quite embraced fat liberation yet. Many activists and theorists have spoken to fatness as a queer and feminist issue, as well as discussing fatphobia in the queer and trans community (e.g., Mollow, 2013). For example, consider trans and nonbinary folx who feel pressure to shrink their bodies to avoid being misgendered, gay men who indicate “no fats, no femmes” on their dating profiles (Conte, 2018), and queer women who are called fat bitches or fat dykes when they turn down someone’s advances. As in most intersectional social justice work, the impact is often worse for people of color (Strings, 2019). For further reading, please see Fearing the Black Body by Sabrina Strings (2019).  Mollow writes, “Anti-racist, feminist, and queer activists must make fat liberation central to our work; we need to explicitly and unequivocally reject the notion that body size is a ‘lifestyle choice’ that can or should be changed” (for further reading, please see The Bizarre and Racist History of the BMI; Your Fat Friend, 2019).

What should I keep in mind for my clinical work? 

During the holidays, people are bombarded with messages on how to avoid weight gain, ways to “eat smart” during holiday meals, and what workouts are most effective to keep one’s body at its “best” (read: smallest). If all else fails, resolution season arrives with plenty of reduced-fee gym memberships, exercise programs, and diet plans. Many gatherings with family and friends are centered around food. Unfortunately, those in our immediate circles often believe our food intake and how our bodies have changed since they last saw us are fair game for dinner conversation. This behavior is almost always a wolf in sheep’s clothing–fat shaming and food policing thinly veiled by “I care about your health.” It also often connects to the commenter’s insecurity and their own internalized fatphobia or beliefs about what their body should look like, what they should be eating, etc. While these experiences happen to people of all shapes and sizes, this kind of commentary is more frequent and insidious for fat folx, as most people are conditioned to believe that we are less worthy if we are fat or at risk of becoming fat. LGBTQIA+ people, who already approach the holidays feeling worried about various family dynamics, lack of acceptance, and/or outright homophobia/transphobia, might need support to develop a game plan. (Note: Please also check out earlier pieces written about this topic by Chastain, 2014a; 2014b; Mollow, 2013; Murphy, unknown; Raven, 2018; and Rutledge & Hunani, 2018.)

Here are some possible topics to bring up with your clients:

 1) Make a choice about attending, if optional. With my LGBTQIA+ clients, we first consider whether going to visit certain family members and/or attending various holiday events is physically and emotionally safe. If not, could they spend the holiday with chosen family? If there is no ideal alternative or the person is sure they want to go, I empower their decision and encourage them to approach the situation with a grounded sense of self, giving themselves permission to step back and engage in self-care as needed; see #6 below.

2) Define boundaries and potential consequences. This part is crucial. Boundaries are as simple as what is okay and what is not okay. Help your client identify their boundaries and the potential consequences if those boundaries are crossed. Make sure they feel comfortable following through with these (e.g., don’t threaten to leave if it’s not a feasible option). For example, “What I’m eating is fine. Please stop commenting on my food choices. If it happens again, I’m going to excuse myself from the table.” Encourage them to practice the boundary setting in advance, preparing for best versus worst case scenario with particularly difficult individuals. Finding the humor, even if they’re the only one in on the joke, can sometimes help. You might check out Oh, Boundaries (Oh, Christmas Tree) Song Adaptation (Chastain, 2016).

3) Pregame conversations. Once the client knows what their boundaries are, they might consider reaching out to trusted family, friends, or the event host in advance. For example, they could send a text or blind copy email that says, “Hi family, just a reminder that I am working on loving my body at all sizes and practicing intuitive eating. My body has also changed slightly since I started taking hormones, so please do not make any comments about my food choices, my body, or my weight when I am home next week. Appreciate your understanding – see you soon!” This gives those individuals an opportunity to prepare and learn more rather than responding defensively in the moment. If this approach may not be well received by everyone in attendance, could the client identify one or two trusted folx who will have their back if the conversation turns to weight and body talk? 

4) Address internalized fatphobia. One of the toughest parts of resisting fatphobia and diet culture is our cultural internalized stigma and belief that fat is bad. Help your clients see the roots of fatphobia in racism, misogyny, and oppression (that is, while remaining attentive and attuned to their experiences of internalized body shame). Remind your clients that no one has the right to comment on their body or food choices. If they struggle to comfort and care for themselves, you might ask them to imagine those external comments and internal shame narratives impacting a close friend or a young sibling. Food is not good or bad. Being fat is not bad, and body size is not a determinant of health, worth, or desirability. We can feel uncomfortable with certain parts and features of our body (hello, dysphoria) without harming or hating the parts of our body that help us to survive. Bodies experience natural fluctuations in weight throughout the year. People can make whatever choices they want about their bodies and food. That includes making decisions for themselves about whether to engage in diet behavior or body modification, as well as whether to embrace fat liberation, health at every size, and intuitive eating philosophies. It also might include examining their social media consumption to critically examine which accounts activate internalized self-judgment and shame while shifting toward those that engage in transformational and affirming conversations about bodies, fashion, and food.

5) Prepare ways to respond.  Helping our clients advocate for themselves is an important component of recovering from diet culture and internalized fatphobia. LGBTQIA+ people have often been expected to perform in certain placating ways when interacting with hurtful others. “Too often we get the message that as [LGBTQIA+ people], it’s our responsibility to always be ‘on’–to always advocate for the cause, or to behave ‘properly,’ or to keep the peace. We’re told that it’s our job to endure demonizing sermons and degrading misgendering in the name of ‘dialogue’ or whatever. But we don’t have to.” (Murphy, unknown).

 Therefore, when responding to fatphobic comments and questions such as, “Should you really have a second serving?” each person needs to think about what might work best for them depending on whether they’d like to shut the conversation down or potentially open it up for further dialogue. Here are some examples: 

  •        Short & sweet, then continue to eat (e.g., “Yes, I should.”)
  •       Humor & sarcasm (e.g., “If I want to talk to the food police, I’ll call Pie-1-1”; Chastain, 2014)
  •       Firm boundaries (e.g., “I get to make my own food choices – it’s not okay for you to comment on them. Please stop, or I will leave the table.”) 
  •       Authentic curiosity (e.g., “What made you decide to comment on what I eat?”)
  •       Reflect on diet culture (e.g., “Isn’t it interesting how shaming it is when we comment on others’ bodies and food choices?”)
  •       Self-reflection (e.g., “Those types of comments are really hurtful, and I know there are times I’ve commented on your food choices as well–I’d like us to stop doing that.”) 
  •       Reframe and shift (e.g., “I wonder if you think those types of comments come from a place of caring. They actually make me feel shame and the desire to pull away from you. Let’s focus on catching up and enjoying our time together.”)
  •       Ignore and move through discomfort – It is always an option to decide not to respond, not to speak up, and to instead move through and take care of yourself in other ways. Sometimes this is the safest option emotionally and/or physically.
  •       A potential dilemma – It can be hard to meet family and friends where they are, especially when the conversations are painful. Making the decision to educate someone is always optional, as the other person should take responsibility for educating themselves (and this goes for various other social justice matters, such as racism). At some point, many of us have made value judgments and comments about others’ food choices or body size based on our internalized shame around diet culture and fatphobia. It can take some time and energy to adjust those patterns of thinking. Bottom line: there is a difference between healthy, respectful, and curious discourse versus harmful and fatphobic comments, questions, and behaviors. Hence, the need for boundaries.Queer fat activist Ragen Chastain (2014a) writes, “Loving your body is an act of sheer courage and revolution in this culture. My body is not a representation of my failures, sins, or mistakes. My body is not a sign that I am in poor health, or that I am not physically fit, neither of which is your business regardless. My body is not up for public discussion, debate or judgment. My body is not a signal that I need your help or input to make decisions about my health or life.  My body is the constant companion that helps me do every single thing that I do every second of every day and it deserves respect and admiration. If you are incapable of appreciating my body that is your deficiency, not mine, and I do not care. Nor am I interested in hearing your thoughts on the matter so, if you want to be around me, you are 100% responsible for doing whatever it takes to keep those thoughts to yourself. If you are incapable of doing that I will leave and spend my time with people who can treat me appropriately.  Please pass the green beans.”

6) Have an exit strategy (i.e. self-care plan). In many cases, setting a firm boundary and following through with the consequence should be quite effective. However, sometimes these responses may do little or nothing to stop others from perpetrating harmful microaggressions and fatphobic judgments. In those cases, it is good for your client to have a plan for self-care, considering the following:

  •       Permission giving – If things don’t feel good, can they give themselves permission to be prepared to leave if necessary?
  •       Take space – go for a walk, play with the kids or pets, watch a movie, listen to music, etc.
  •       Get support – Does the client have a friend who “gets it” and can be available to call or text? Or can the client log onto social media and check out some of the dietitians, bloggers, clinicians, and influencers who focus on fat liberation and intuitive eating (see resource list at the end of this article)? 
  •       Practice validation & self-compassion:
  •       Duality: It’s okay to care about someone while also being disappointed or hurt by their behaviors and comments. 
  •       Remember: Setting boundaries is a healthy way to show our expectations of love and respect for people who matter. 
  •       Forgive themselves: It makes sense that they are tempted to go along with the comments–it is hard to speak up against diet culture and fatphobia.
  •       Validation: Many LGBTQIA+ people struggle around this time of year with difficult family interactions; they are not alone. 
  •       Self-nurturance: Clients can use affirmations such as, “I am worthy. I am enough. My body is worthy at all sizes. I deserve to be treated with respect and common human dignity. It’s okay to protect myself from fatphobic comments.” 

How can I continue to learn about fat liberation and radical self-love to support my clients? 

  •       Practice radical body love and fat acceptance–for yourself and others! It doesn’t mean you will successfully love all parts of your body all the time, but it sure will help. 
  •       Consider anti-diet and intuitive eating practices all year round–they can be life changing. 
  •       Actively reduce and aim to eliminate diet talk, which often serves to shame people and essentially teaches us to avoid at all costs becoming a “bad fat person.” 
  •       Rather than praising bodies that have thin privilege or seem to have lost weight, consider finding other ways to let people know we appreciate them. 
  •       Instead of using descriptors that are pathologizing (“overweight” suggests there is a lower weight that is normal/better/good), stick with actual descriptors that help us to understand (such as “fat”). When possible, check in with others about the descriptors that work for them and what words they prefer.
  •       Surround yourself with social media and images of fat people of all races and abilities, appreciating the beauty and diversity of the human body. 
  •       “If previously you have ruled out fat people as potential sexual partners, rule them back in, and rule out ‘fatphobes’ instead” (Mollow, 2013).
  •       Make choices for your body that feel good for you, and only you. Give your body size permission to vary with time, hormones, and many other factors. 
  •       Be mindful of where your clients are in terms of their readiness for discussions related to diet culture and internalized fatphobia; as with any other intervention, gauge helpfulness as well as observing their body language as you move through.

A final note for those of you who are already anti-diet and practicing fat acceptance: It takes so much courage to move through these conversations with our clients, friends, and family members who don’t quite understand (yet!). Keep doing this work, because it matters. You matter. You are worthy. You are enough. Thank you for persisting. 

Suggested Resources:

Online & Social Media (Note: @ = Instagram handle):

@ragenchastain & https://danceswithfat.org/blog; @chr1styharrison & Food Psych podcast; @yrfatfriend; @recipesforselflove & book; @bodyposipanda; @mynameisjessamyn; @jazzmynejay; @livinginthisqueerbody; @mermaidqueenjude; @ihartericka; @thefatsextherapist; @decolonizingtherapy

 NOLOSE – Originally the National Organization for Lesbians of Size – later expanded to include all genders. Has a queer fat-positive ideology. http://nolose.org  

 Strings, S. (2019). Fearing the black body: The racial origins of fat phobia. New York University Press. New York, NY.

 Taylor, S. R. (2018). The Body is Not an Apology: The Power of Radical Self-Love. Berrett-Koehler Publishers, Inc: Oakland, CA.

Your Fat Friend. (2019). The bizarre and racist history of the BMI. Medium – Elemental. Retrieved from: https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb

 References

 Baker, Jes. (2015). How to stay body positive during the holidays: Master list. The Militant Baker. Retrieved from:http://www.themilitantbaker.com/2015/12/the-how-to-stay-body-positive-during.html 

 Conte, M. T. (2018). More fats, more femmes: A critical examination of fatphobia and femmephobia on Grindr. Feral Feminisms: Queer Feminine Affinities, 7.https://feralfeminisms.com/wp-content/uploads/2019/04/3-Matthew-Conte.pdf 

 Chastain, R. Blog – Dances with fat: Life, liberty, and the pursuit of happiness are for all sizes

 McKelle, E. (2014). Cutting fatphobic language out of your life. Everyday Feminism. Retrieved from:https://everydayfeminism.com/2014/04/cutting-fatphobic-language/ 

 Mollow, A. (2013). Why fat is a queer and feminist issue. Bitch Media. Retrieved from:https://www.bitchmedia.org/article/sized-up-fat-feminist-queer-disability 

 Murphy, B. (unknown). 8 queer tips to get through the holidays. Queer Theology. Retrieved from: https://www.queertheology.com/queer-holiday-tips/ 

 Raven, R. (2018). 6 ways to deal with fat-shaming during the holidays, from someone who knows what it’s like. Hello Giggles. Retrieved from:https://hellogiggles.com/lifestyle/health-fitness/6-ways-to-deal-fat-shaming-during-holidays/ 

 Rutledge, L., & Hunani, N. (2018). Take it from dietitians: Holiday diet advice shouldn’t be fatphobic. Huffington Post. Retrieved from: https://www.huffingtonpost.ca/lisa-rutledge/holiday-diet-advice-weight-loss_a_23621979/ 

 Tucker, M. (2019). At the intersection of fat and trans. The Affirmative Couch Out on the Couch. https://affirmativecouch.com/at-the-intersection-of-fat-trans/  

 

About The Author

Megan Tucker

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.psychologytoday.com/us/therapists/megan-tucker-somerville-ma/280796

Listening to our Transgender Clients: The Fear is Real

Posted: 11-20-19 | Jacob Rostovsky

November 20th has been known since 1999 as the Transgender Day of Remembrance (TDOR). On this date, across the world, ceremonies and vigils are held to remember transgender individuals we lost to murder and suicide in the past year. Often somber and emotionally  triggering, TDOR allows the community to gather and honor individuals whose stories are often ignored or incorrectly told. As this day approaches, I often think of Marsha P. Johnson. 

Johnson, a transgender black woman, has long been credited within the queer and trans community for being the person who threw that first brick at Stonewall (Feinberg, 1996) and the creator of STAR, an LGBTQ+ youth shelter. Many don’t know that Johnson was an activist from early on in her life, fighting for gay rights and visibility instead of assimilation (Chan, 2018). After high school, she spent her days on the streets of New York, learning to survive and being repeatedly sexually assaulted and harassed (Chan, 2018). But the assault, harassment, and oppression she experienced due to her sexuality, gender identity, and skin color didn’t stop her for standing up for what she believed in. Knowing firsthand the discrimination the often-ignored transgender community suffered, she took an active role in ACT UP (https://actupny.org/), helping to speak out for HIV+ individuals and give a voice to people  of color who were dying from the disease (Jacobs, 2016). Johnson was an inspiration to transgender individuals, especially to those of color. Her tragic death is frequently regarded as the first “notable” and documented murder of a transgender person in the United States.

In 1992, shortly after the New York City Pride Parade, Johnson’s body was found floating in the Hudson River (Feinberg, 1996). The cops ruled it a suicide, despite many people’s protests that Johnson was anything but suicidal and eyewitness reports that she was being harassed earlier during the day they believed she had died (Feinberg, 1996). The case was limitedly investigated and never solved. The media portrayed Johnson as a trans woman who was a sex worker and a drug user, leaving out the truths of her activism and every other aspect of her life (Feinberg, 1996); it is likely that had she been a cisgender white woman, media coverage would have been vastly different and much wider.  Johnson’s voice, something she worked so hard to give herself while navigating major oppression in her lifetime, was taken away. Even worse, her killers were never found; to this day, minimal effort has been put into solving her murder.

You may be wondering what this has to do with psychology, and how Johnson’s death can show up for you, as a clinician, in the therapy room with your transgender clients. Well, it’s simple: the reaction of the public to Johnson’s death parallels how many transgender individuals feel about what their lives are worth to the rest of the world. It also relates to  transgender people’s sense of whether others care about their safety. As a clinician who has worked in the community in varying capacities, I can attest to the fact that transgender people feel that their lives don’t matter. There is a constant threat of insufficient safety and feelings of protection, especially under the Trump administration when it seems as if transgender rights are under attack daily. 

Almost every week I hear about another transgender individual, usually a trans woman of color, who has been murdered or found dead under mysterious circumstances. In many of these cases the killer is never found, or if they are, they are not named. The media often misgenders the victim, and very little coverage is given in the first place. My trans clients come to me with fear in their voices, wondering if they will be next just because they are living their authentic truths. Worse, and heartbreakingly, clients sometimes find that this fear is accompanied by wondering whether or not anyone would even care if they were gone, and if they deserve being killed due to being transgender. 

Furthermore, clients have to navigate safety in many other aspects of life. Transgender clients have told me that they often don’t feel safe in their jobs and have a fear of being fired; what’s worse, nobody in their workplace will do anything to help when they are feeling threatened. I have heard about clients being assisted when buying shoes or clothing, and fearing that a salesperson will “find them out” and make a scene. Clients can  fear for their safety in terms of secure housing and access to other social welfare services, the loss of which threaten their ability to survive. 

So how can we, as clinicians, help with these fears? Certainly, the wrong thing to do is to try to make excuses for others or diminish the situation, because these fears are real. Also, if you are a cisgender therapist, there is no way to fully understand what your client is going through. It is best not to try to relate or use comparisons to other marginalized communities. I have heard of individuals telling their therapists about the fear of shopping, and the therapists suggesting in response to “shop online,” unsolicited advice that comes across as invalidating. 

But then what is the right thing to do? First, validate the fear, which is constantly present. Ask questions. What does this fear look like to them? How does it show up in their lives? Secondly, address the fear and help empower your client to find ways to protect themselves. While we do not teach our clients physical self-defense techniques, we can certainly teach them mental defenses. Find positive self-talk and coping techniques when encountering non-life threatening yet mentally damaging situations. Third, help your client devise safety plans and locate resources. Is there someone they can call any time of the day, or put on alert when they are encountering any new or potentially triggering situation? Is there an emergency line they can reach that they know they can trust? Having access and knowledge to trans-affirmative resources can be life saving.

With all of that said, November is always a difficult month for the transgender community. Whether or not your client is aware of this fear on a daily basis, we cannot deny that the number of deaths we recognize during TDOR and the number of clients facing fear seem to increase annually. November is filled with a constant reminder to be vigilant and that the fight is far from over. As clinicians, we must recognize this and do everything  we can to support our clients in the most affirming way possible.

References

Chan, S. (2018). A transgender pioneer and activist who was a fixture of Greenwich Village street life. The New York Times. Retrieved from https://www.nytimes.com/interactive/2018/obituaries/overlooked-marsha-p-johnson.html

Feinberg, Leslie (1996). Transgender Warriors: Making History from Joan of Arc to Dennis. Boston, MA. Beacon Press

Jacobs, S. (2012). DA reopens unsolved 1992 case involving ‘saint of gay life’. New York Daily News. Retrieved from: https://www.nydailynews.com/new-york/da-reopens-unsolved-1992-case-involving-saint-gay-life-article-1.1221742

About The Author

Jacob Rostovsky

I’m an associate marriage and family therapist practicing in Los Angeles. When I’m not running between my many associateships I likes to relax and spend time watching reality television, reading fiction novels and spending time with my fiancé and pets.

https://www.jacobrtherapy.com

Trans Women ARE Women

Posted: 8-26-19 | Rachel Jones

trans women

By Rachel Jones, MA

NOTE: Throughout this article, I will refer to different gender identities including non-transgender women and transgender women. Every person has a gender identity, which is separate from the sex assigned at birth. Non-transgender or non-trans describes a person whose gender identity is the same as the sex assigned at birth–for example, someone who identifies as female and was assigned female at birth (GLAAD, 2019). Cisgender is another term used in replacement of non-trans, but it will not be used in this article for the sake of centering on transness and to avoid centering cisgender as the “norm” (GLAAD, 2019). Transgender or trans describes a person whose gender identity is different from the sex assigned at birth–for example, someone who identifies as female and was assigned male at birth (GLAAD, 2019). Distinguishing non-transgender women and transgender women throughout the article is solely for the purpose of pointing out perceived differences in a clear manner, and NOT to suggest that either term makes someone more of a woman than the other.

Women’s Equality Day

In the United States, August 26, 2019, will mark the 46th annual Women’s Equality Day. In the 1970s, President Nixon and the US Congress appointed August 26 to be Women’s Equality Day to commemorate the nineteenth amendment (Greenspan, 2018). In 1920, the United States government allowed women the right to vote, ratifying the nineteenth amendment that declared voting rights would not be denied on the basis of sex or gender (U.S. Const. amend. XIX). Today, millions of people across the country continue to advocate for women’s equality. However, a major aspect of mainstream feminism seems to be forgetting something pretty important. The battle for women’s equality has not been won if the only winners are white, non-transgender women. Mainstream feminism’s definition of a woman must be inclusive of transgender women, women of color, queer women, and other women in marginalized groups – otherwise, it is simply not feminism. In recent years, major feminist-driven events such as the Women’s March more explicitly and affirmatively include women of color and queer women in their mission, but transgender women continue to be blatantly left out of the major feminist discourse (Anti-Defamation League, 2017).

Similar to the experiences of non-transgender women vying for equal rights, transgender women experience dramatic disparities in civil liberties, legal protections, and cultural equity (Grant et al., 2011). Unlike non-transgender women, transgender women don’t have millions of privileged people fighting alongside them with the goal of equality. Instead, trans women are banned from women’s locker rooms, unprotected in public restrooms, left out of feminist manifestos, mocked by government representatives, and robbed of basic human rights to safety and respect. Many self-proclaimed feminists gleefully join their peers at Pride parades, yet express outrage when a trans woman hopes to share safe spaces.

A women-only space cannot be labeled safe if trans women are not allowed in that space–or are at risk of harassment or other hurts in that space. Equal pay for women has not been achieved if non-trans women receive higher wages than their transgender sisters. The quality of women’s healthcare has not been enhanced if clinicians are only trained to care for non-transgender women and their bodies. Misogyny has not been defeated if trans women are still being misgendered and pronouns are not respected or affirmed. Refusing to acknowledge trans women in the rulebooks of feminism makes it difficult to apply the narratives we work so hard to rewrite. Is the team really winning if half the players have been benched or disqualified?

Transphobia and Feminism

Transphobia is a driving force attempting to keep trans women out of feminism. While transphobia is often seen as a politically far-right driven attitude against transgender people, a popular subgroup of modern feminism has been loudly promoting transphobia across the country. This subgroup of radical feminism is often referred to as trans-exclusionary radical feminism or TERF and is considered a hate-group by many since its mission seems to promote transphobia and transmisogyny (Lewis, 2019). TERF ideology argues misogyny can only affect people with ovaries, uteruses, and vaginas, claiming trans women cannot be targets of misogyny (Dembroff, 2019). Furthermore, this group of radical feminists states trans women “by definition” are not “adult human females” and therefore “no trans woman is correctly categorised (sic) as a woman” (Stock, 2019). Other group members have acknowledged the decision to purposely misgender trans women, stating that using she/her pronouns for trans women is a “courtesy” they rarely extend (Bindel, 2019). Radical feminists have gone so far as to argue transgender women identify as female in order to “infiltrate women’s spaces” and assault or harass non-trans women (Kacere, 2014).

These infuriating and inflammatory messages spew misinformation and hate, and can lead to dangerous misunderstandings. No transgender woman casually goes through the costly and trying physiological, social, professional, and emotional transitions.Transitioning often is motivated by wanting to feel affirmed in one’s gender identity, avoiding repression, combating suicidal ideation or dysphoria. In fact, research shows approximately three-quarters of trans women who transition experience an increase in psychosocial well-being and quality of life (Hess et al., 2018). Transgender people do not transition for the sake of harming or harassing others, and it is upsetting that such a statement needs to be spelled out. Non-trans women experience blatant inequality in the United States, and there are many ways to address those inequalities while involving trans women. In fact, it is almost impossible to effectively approach feminist issues if the female population is being separated into trans and non-trans women.

Feminism Must Include All Women

Equal Pay. Although the nineteenth amendment was a major feat in the fight for equal rights, it was by no means the end of inequality for women in the United States. In 2018, women in the US earned on average 81.1 percent of their male colleagues’ weekly earnings (Hegewisch & Hartmann, 2019). When broken down by race and ethnicity, this gap became even bleaker. White women, Black women, Hispanic (sic) women, and Asian women earned 81.5 percent, 65.3 percent, 61.6 percent, and 93.5 percent respectively of their white male colleagues’ earnings (Hegewisch & Hartmann, 2019). Objectively, these disparities are alarming.

Workplace Discrimination. While precise numbers on transgender wage earnings are lacking, research findings on the experiences of transgender women in the workplace are nothing short of disturbing. More than one in three transgender women have lost a job due to gender identity or expression, and over half have been denied employment due to being transgender (Grant, et al., 2011). Furthermore, 32 percent of transgender people have been “forced to present in the wrong gender” to keep their job (Grant et al., 2011). Because of the lack of legislature protecting gender identity and expression in the workplace, transgender people experience unemployment and insufficient income at rates three times the national average (Grant et al., 2011). As feminists fight for equality in the workplace, it is vital to be aware of these experiences of transgender women in addition to the more widely publicized inequities of working non-transgender women. Due to the intertwined intricacies, we cannot fix one issue without facing the other. The fight for women’s rights and equality have been going on in the United States since its conception, and all women deserve advocacy.

School. 21 percent of school-age transgender girls are sexually assaulted at school because of their gender identity, and 22 percent had to change schools due to mistreatment (James et al., 2016). Over 20 percent of non-trans girls experience some form of harassment or bullying in school, and eight percent avoid attending school due to feeling unsafe (Hess et al., 2015).

Homelessness and Poverty. Over 20 percent of trans women of color reported homelessness in the past year due to gender identity, and many were denied access to shelters due to being transgender (James et al., 2016). For trans women of color, the rates of homelessness rise to around 50 percent (Human Rights Campaign, 2018). Non-trans women have higher poverty rates than men, and non-trans women of color have higher poverty rates of approximately 25 percent (Hess et al., 2015).

Sexual Violence. Five percent of all transgender people have been attacked by strangers and almost 40 percent of transgender women have been sexually assaulted at least once in their lifetime (James et al., 2016). Furthermore, trans women of color make up 80 percent of all anti-transgender homicides (Human Rights Campaign, 2018). Approximately one-fifth of non-trans women experience sexual violence or rape in their lifetime (Hess et al., 2015). For Native American and multiracial women, those numbers jump to one-third (Hess et al., 2015).

Hate Crimes. In addition to widespread transphobia and the disturbing inequities in many other areas, transgender women experience inequality, misogyny, and oppression perpetuated by an obscene lack of civil protections. Almost two-thirds of states have laws protecting non-transgender women against hate crimes, while less than half include biases against gender identity and transgender people in their legislature (Human Rights Campaign, 2018). In the United States, there are on average five hate crimes against transgender people for every single hate crime targeting non-transgender women (Federal Bureau of Investigation, 2017).

These statistics are not for the sake of creating a “who has it worse” narrative. Rather, they are presented to point out that transgender women need feminism and feminist support, too. There are intrapersonal and community-level implications for empowerment that come from having a strong network of peers who support and understand each other’s experience (Labonté & Laverack, 2008). In order to boost this empowerment through trans inclusionary feminism, non-transgender women must be willing to share some of the power they already have (Labonté & Laverack, 2008). If we create a hierarchy of women and ban certain women from safe spaces, the meaning of feminism becomes lost entirely.

How Clinicians Can Help Fight Transmisogyny

Therapists and doctors are not immune to transmisogyny; and following clear guidelines to affirm all patients can help prevent it. When running support groups for women, it is imperative to explicitly include transgender women. If trans women are not allowed in a women’s group, it promotes the warped narrative that trans women are not “real” women. The same goes for asking for a patient’s “real” name, the name the patient uses to introduce herself, the name she chose to affirm her gender identity, is her real name. The name on the patient’s original birth certificate does not automatically become her “real” name. Prioritizing what a piece of paper says over the patient herself is a perfect example of transmisogyny, and it is completely avoidable. Being a trans-affirming clinician requires an agreement that trans women did not “become” or “turn into” or “choose to be” women, but truly are women. When in doubt, trust the patient’s first-hand account, and affirm her identity as she defines it. Listen to women.

Including trans women in feminism is not a dramatic shift and requires nothing more of non-trans feminists than the ideals they fight to uphold: respect, equality, and reciprocal support. Trans women are women––it’s that simple.

References

Anti-Defamation League. (2017). What the women’s march teaches us about intersectionality. ADL Blog. Retrieved from https://www.adl.org/blog/what-the-womens-march-teaches-us-about-intersectionality

Bindel, J. (2019). It’s time for progressives to protect women instead of pronouns. Quillette. Retrieved from https://quillette.com/2019/06/14/its-time-for-progressives-to-protect-women-instead-of-pronouns/

Dembroff, R. (2019). Trans women are victims of misogyny, too–and all feminists must recognize this. The Guardian. Retrieved from https://www.theguardian.com/commentisfree/2019/may/19/valerie-jackson-trans-women-misogyny-feminism

Federal Bureau of Investigation. (2017). Hate crime statistics: Incidents, offenses, victims, and known offenders by bias motivation. U.S. Department of Justice. Retrieved from https://ucr.fbi.gov/hate-crime/2017/topic-pages/tables/table-1.xls

GLAAD. (2019). Glossary of terms–transgender. GLAAD Media Reference Guide.

Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. National LGBTQ Task Force. Washington, DC: National Center for Transgender Equality.

Greenspan, R. (2018). On Women’s Equality Day, here are 3 things to know about the suffrage moment. Time. Retrieved from https://time.com/5372770/womens-equality-day-2018-facts/

Hegewisch, A., & Hartmann, H. (2019). The gender wage gap: 2018 earnings differences by race and ethnicity. Institute for Women’s Policy Research. Retrieved from https://iwpr.org/publications/gender-wage-gap-2018/

Hess, C., Milli, J., Hayes, J., Hegewisch, A., Mayayeva, Y., Roman, S., Anderson, J., & Augeri, J. (2015). The status of women in the states: 2015. Washington, DC: Institute for Women’s Policy Research.

Hess, J., Breidenstein, A., Henkel, A., Tschirdewahn, S., Rehme, C., Teufel, M., Tagay, S., & Hadaschik, B. (2018). Satisfaction, quality of life and psychosocial resources of male to female transgender after gender reassignment surgery. European Urology Supplements, 17(2), e1748. https://doi.org/10.1016/S1569-9056(18)32062-1

Human Rights Campaign Foundation. (2018). A national epidemic: Fatal anti-transgender violence in America in 2018. Washington, DC: Human Rights Campaign Foundation, Public Education & Research Program.

James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.

Kacere, L. (2014). Why the feminist movement must be trans-inclusive. Everyday Feminism. Retrieved from https://everydayfeminism.com/2014/02/trans-inclusive-feminist-movement/

Labonté, R., & Laverak, G. (2008). Health promotion in action: From local to global empowerment. New York, NY: Palgrave Macmillan.

Lewis, S. (2019). How British feminism became anti-trans. The New York Times. Retrieved from https://www.nytimes.com/2019/02/07/opinion/terf-trans-women-britain.html

Stock, K. (2019). Doing better in arguments about sex, gender, and trans rights. Medium. Retrieved from https://medium.com/@kathleenstock/doing-better-in-arguments-about-sex-and-gender-3bec3fc4bdb6

U.S. Const. amend. XIX.

About The Author

Rachel Jones

I am a Licensed Marriage and Family Therapist working in private practice, specializing in treating individuals looking for support with LGBTQ+ related issues, anxiety disorders, addiction, and personality disorders.

http://www.racheljonestherapy.com/

At the Intersection of Fat & Trans

Posted: 6-19-19 | Megan Tucker

fatphobia

By Megan Tucker, PsyD

Keywords: Transgender

I am a fat, queer, able-bodied, neurotypical, white, and cisgender femme person (note: cisgender = my gender is congruent with the gender I was socially assigned). I’m well aware of societal expectations for the way my body should look, to express my gender consistent with white womanhood, and to engage in romantic and sexual relationships in a certain way. I also know that the bar for being seen, respected, and accepted for who I am would be sky high if I was a fat, autistic, disabled, polyamorous, transgender feminine person of color.

Most of the research conducted with people who are fat and/or trans has been with white, able-bodied humans, so any negative impact I discuss related to fat trans folks is likely even more detrimental for people of color and for those with chronic illness and/or disabilities. I write this as a person with privilege who aims to learn more, and educate others about systems of oppression and power, while also advocating for human rights and dignity. I am personally familiar with experiences of fatphobia and sexism, and I have a specialty in counseling trans and gender nonbinary (TGNB) people.

Weight Stigma, Fatphobia, & Microaggressions:

When you see a slim person jogging down the road, do you think, “good for them!?” When a slim person walks along the beach in a bikini, do you think, “ugh, they shouldn’t be wearing that!?” When you notice that a slim friend has gained weight, do you say, “oh wow, you’ve gained weight? What are you doing?” I’m guessing most of us don’t, so why would it be OK for us to judge or comment on fat bodies? The short answer: it’s not OK. Basically never. Just like it’s never OK for us to comment on trans and gender non-conforming bodies.

The National Eating Disorders Association (NEDA, 2018) defines weight stigma as discrimination or stereotyping based on a person’s weight (also referred to as sizeism). Weight stigma is known to increase body dissatisfaction, which is a leading risk factor for disordered eating. NEDA clearly states, “the best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness.” Many people who struggle with body image and disordered eating got messages along the way that shamed their bodies and/or food choices, suggesting they weren’t good enough just the way they were.

Fatphobia, the fear and/or hatred of fat bodies, is an extension of sizeism. Many of us have learned not only that thin is the ideal, but that being fat is to be avoided like the plague. We are constantly exposed to messages that thin = good and fat = bad (e.g., TV and movies, comments from our parents, health & wellness marketing, conversations with our friends, and health insurance companies offering wellness discounts). Brené Brown’s research found that a) appearance and body image and b) being stereotyped and labeled are two of the 12 most common triggers for shame (Brown, 2007). This hatred and fear of fatness becomes internalized and spreads like wildfire in the ways we talk about ourselves, evaluate ourselves compared to others, and judge others’ bodies and food choices.  Three questions you might ask yourself to examine your weight bias are: 1) Do I engage in negative body talk? 2) How do I feel about bodies of different sizes? and 3) How do I feel about the concept of weight gain for myself? (Chastain, 2018).

We can’t talk about stigma and fatphobia without also talking about microaggressions, which Sue (2010) defined as “commonplace verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative insults to a target person or group.” The very nature of microaggressions is that they are often unintentional and unacknowledged slights, leaving the recipient to process those thousands of tiny moments that invalidate that person’s very existence.

For example, when someone says to a friend who has lost weight, “wow, you look great,” it is thinly veiled as a compliment that covers up the deeper diet culture judgment, “your body is more desirable now that it is thinner.” When someone watching you eat X food says, “I don’t eat X – it’s bad for you,” what it really suggests is, “be careful eating that food – you wouldn’t want to become fat and/or unhealthy. In fact, the conflation of weight with health and “concern for health” is one of the more common ways that people (especially health providers) justify weight-related microaggressions. Sadly, what often gets in the way of health for fat folks is the very structural oppression they face by those who believe people are unhealthy because they are fat (Lee & Pausé, 2016).  

At the Intersection of Fat & Trans

When we talk about the above concepts in relation to fatness, they also hold true for other identities that experience oppression, e.g., race, gender, ability, sexuality, etc. TGNB folks experience transphobia, cissexism, cis-heteronormative expectations, and pressures to fit into (white) binary understandings of gender, i.e., what it supposedly means to be a man or a woman. Because TGNB people are often valued based on how well their bodies “fit in” to these expectations, it follows that they would also be held to standards of body size, shape, and weight. Adding weight stigma to the other pressures that a TGNB person experiences along with their own struggles with their body is like a shaken soda bottle of oppression waiting to explode.

Here are several ways that a TGNB person might experience the cumulative and harmful effects of sizeism and fatphobia in the context of their transness:

  • A trans masculine person eats as little as possible to shrink his body and appear more androgynous by reducing the width of his hips & the size of his chest
  • A nonbinary person hesitates to go to the gynecologist for worsening pelvic pain, because when they initially brought it up, the doctor said the pain was weight-related.
  • A transfeminine person fears going out on a date, because she can’t blend enough with her large belly.
  • An agender person has to search endlessly for affordable clothing that both fits their large body and also feels congruent with their gender.
  • A genderqueer person wants to fly without drawing attention to themself, but they face ridicule when going through the security body scanners and then are looked at with disgust while walking down the airplane aisle due to their body size.
  • A trans woman’s doctor does not refer her to get treatment for her Anorexia, because he reasons that restriction might help her to lose weight.
  • A trans adolescent is extremely uncomfortable in their body due to the compounded effects of going through puberty as a fat person.
  • A pregnant trans man gets mistaken for being fat and doesn’t get the emergency medical care he needs (note: an article was recently published about this exact situation at usatoday.com).
  • A trans person arrives for their consultation appointment for gender affirming surgery, but the armchairs in the waiting room are too small for them to fit, the exam room table cannot hold their weight, and they soon find out that the surgeon has a maximum BMI requirement.
  • A trans college student gets the courage to go to the gym and build muscle for his upcoming top surgery, but then is fat shamed by other students at the fitness center.

It is so crucial to be mindful of the ways in which weight stigma and fatphobia intersect with the policing of trans and nonbinary bodies. Don’t trans folks already have enough to worry about with their internal struggles to find peace and affirmation with their bodies? Why do we pile on societal constructions of what they should and shouldn’t look like, that they should and shouldn’t eat, and pressures to modify their bodies to be more feminine (i.e., thin and curvy in the “right” places) or masculine (i.e., thin and muscular)? Why do we expect TBNB people to not only modify their bodies to societal standards, but to do it without developing an eating disorder or increasing hatred toward themselves? We need to do better in making space for TGNB folks of ALL sizes, shapes, expressions, and food preferences. Everybody and every body is worthy of respect and human dignity.

The Greater Impact

The impact of sizeism and fatphobia are pervasive and insidious. For example, adolescents who are teased for their weight are 2-3x more likely to consider and attempt suicide (Eisenburg et al. 2003). TGNB folks, especially transfeminine people and people of color, are significantly impacted by the pressure to fit into gender appearance ideals (i.e., white, light skinned, thin, & young with straight hair; Patton, 2006) that reflect the binary norms of femininity or masculinity.

Here are some ways that TGNB people are impacted by these pressures compared to cisgender people:  

  • Increased body dissatisfaction and frequent body checking
  • Risk of dissociation from or hatred of certain parts of their bodies
  • Increase in disordered eating or weight and shape control behaviors, including binge eating, fasting, vomiting, and laxative use
  • Weight loss to suppress secondary sex characteristics and/or
    • For transfeminine people, to achieve the thin ideal
    • For transmasculine people, to slow or stop the menstrual cycle
  • For TGNB people with a high BMI, even greater rates of body dissatisfaction and disordered eating
  • For transfeminine people, increased experiences of sexual objectification
  • Greater risk of mental health struggles due to the stigma of being trans and/or fat
    • e.g., desire for weight change increases reported history of suicide attempts and self-injury
  • Risk of negative social consequences, stigma, and safety concerns when physical features are not in line with societal expectations for their gender

(Algers et al., 2010, Algars et al., 2012; Diemer et al., 2015, Gordon et al., 2016, Hepp & Milos, 2002; Jones et al., 2016; McGuire et al., 2016, Peterson et al., 2017; Sevelius, 2013; Vocks et al., 2009; & Witcomb et al., 2015)

It’s not  surprising that trans folks are afraid to seek medical care from providers who often invalidate them while also imposing guidelines and hoops for them to jump through in order to seek some semblance of gender affirmation/congruence. When you’re fat, that fear increases. And don’t get me started on providers who recommend weight loss as a treatment for anything, regardless of gender. Would you pay to participate in a treatment program that had a 95-98% failure rate and led to most people going back to pre-treatment symptoms within 3-5 years? I hate to be the bearer of bad news, but if you have ever joined a weight loss program or gone on a fancy diet to lose weight, that’s exactly what you’ve done.

Though many TGNB people experience disconnect and dissatisfaction with their bodies, some reconnect with themselves and improve body satisfaction by altering their body, for example, through gender affirming surgery and hormones, body art/tattoos, and/or exercise. Gender affirming treatment, increased body satisfaction, and perceived social support from family, school, and friends help to reduce the risk of disordered eating (McGuire et al., 2016; Testa et al., 2017; Watson et al., 2017). Some find ways to reject the cultural ideals by creating their own unique gender expression, and those who have a more integrated gender identity are more likely to report social awareness, social acceptance, and body satisfaction (McGuire et al., 2017).

So What Can I Do?

Munro (2017) explains, “we live in a world that resists the notion of fatness as a facet of body diversity; as such, fat bodies are rarely represented in a positive light. Fatness is labeled as a disease and the treatment is eradication.” Social change movements for fat acceptance and body liberation are working to challenge and change this cultural mindset, but the journey is long and difficult – like transness, many are afraid of those who are different, those who do not fit the social norms, and those whose bodies challenge our internalized beliefs and fears.

Here are some ways I believe we can work to support our fat TGNB friends and fellow humans:

  1. Don’t comment on someone’s body parts, body size, food choices, or changes in weight. Ever. Check in when you’re thinking of complimenting someone – is there any chance that the compliment is a veiled microaggression?
  2. Practice empathy and compassion for others. Many TGNB and fat folks may struggle to love and accept their bodies, which can be a source of significant pain. “Empathy is the antidote to shame.” (Brown, 2007).
  3. While you’re at it, why not practice self-compassion and be mindful of the way you talk to yourself? “The act of giving yourself some grace is the practice of loving the you that does not like your body.” (Taylor, 2018, p. 114)
  4. Don’t assume that a TGNB person wants their body to be in line with binary constructions of femininity & masculinity. People have every right to exist in their bodies in whatever way works (or doesn’t work) for them.
  5. Dig into fat positive movements and literature (note: while there are some body positive (bopo) spaces that address fatphobia, not all bopo spaces are as fat accepting as they should be). Recommendations include:
    1. Ragen Chastain, https://danceswithfat.org/ blog
    2. Sonya Renee Taylor, The Body is Not an Apology book
    3. Rachel Wiley, Nothing is Okay book
    4. Christy Harrison, Food Psych podcast
    5. Alison Rachel, Recipes for Self-Love book & instagram
    6. Some awesome humans on social media: bodyposipanda; mynameisjessamyn; jazzmynejay; alokvmenon; ihartericka; po.rodil; ashleighthelion, and tessholliday.
  6. Be critical of the way that mass media portrays TGNB people, fat people, and TGNB fat people. Then, “dump the junk” (Taylor, 2018).
  7. Read up on intersections of transness with various identities, including size, health, race, ability, spirituality, sexuality, etc. so that your TGNB friends don’t need to teach you about their experiences.
  8. Check the privilege you carry in the world, whether you are cis, white, straight, able-bodied, healthy, wealthy, Christian, slim, etc. or any of the various intersections of these.
  9. Seek out medical and mental health providers who are fat positive and work from a Size Acceptance and Health at Every Size (HAES) perspective (Bacon, 2008; Chastain, 2012).

A Final Note

To those who are trans and fat, I see you. You are worthy, even when society doesn’t always communicate that to you. Everyone deserves to have love and compassion for the vessel that gets them through this world, even when you don’t like all parts of that vessel. You deserve to dress and express in ways that make you feel good about yourself and in clothes that fit your body, no matter what size you are. You deserve to access gender affirming care from providers who view fatness as a descriptor rather than an epidemic. You deserve to be gentle to yourself on good days, on bad days, and on in between days. There are people out there who will love and accept you at all sizes, in all gender presentations, and for all of the beautiful intersections that make up your identity. You are worthy.

References

Algars, M. Santtila, P., & Sandnabba, N. K. (2010). Conflicted gender identity, body dissatisfaction and disordered eating in adult men and women. Sex Roles, 63, 118-125.

Algars, M., Alanko, K., Santtila, P., & Sandnabba, N. K. (2012). Disordered eating and gender identity disorder: A qualitative study. Eating Disorders, 20, 300–311. doi: 10.1080/10640266.2012.668482

Bacon, L. (2008). Health at Every Size: The Surprising Truth About Your Weight. Benbella Books, Inc: Dallas, TX.

Brown, B. (2007). I Thought it was Just Me [But it Isn’t]: Making the Journey from “What Will People Think?” to “I am Enough.” Avery/Penguin Random House: New York, NY.

Chastain, R. (2012). Are health at every size and size acceptance the same? Article retrieved on 6/10/19 from https://danceswithfat.org/2012/09/28/are-health-at-every-size-and-size-acceptance-the-same/

Chastain, R. (2018). Three questions to work on weight bias. Article retrieved on 6/10/19 from https://danceswithfat.org/2018/06/12/3-questions-to-work-on-weight-bias/

Diemer, E. W., Grant, J. D., Munn-Chernoff, M. A., Patterson, D. A., & Duncan, A. E. (2015). Gender identity, sexual orientation, and eating-related pathology in a national sample of college students. Journal of Adolescent Health, 57, 144-149.

Eisenberg, M. E., Neumark-Sztainer, D., & Story, M. (2003). Associations of weight-based teasing and emotional well-being among adolescents. Archives of Pediatrics & Adolescent Medicine, 157(8), 733-738.

Gordon, A. R., Austin, S. B., Krieger, N., White Hughto, J. M., & Reisner, S. L. (2016). “I have to constantly prove to myself, to people, that I fit the bill”: Perspectives on weight and shape control behaviors among low- income, ethnically diverse young transgender women. Social Science & Medicine, 165, 141-149. doi: 10.1016/j.socscimed.2016.07.038

Hepp, U., & Milos, G. (2002). Gender identity disorder and eating disorders. International Journal of Eating Disorders, 32, 473–478. doi: 10.1002/eat.10090

Jones, B. A., Haycraft, E., Murjan, S., & Arcelus, J. (2016). Body dissatisfaction and disordered eating in trans people: A systematic review of the literature. International Review of Psychiatry, 28, 81–94. doi: 10.3109/09540261.2015.1089217

Lee, J. A., & Pausé, C. J. (2016). Stigma in practice: Barriers to health for fat women. Frontiers in Psychology, 7: 2063.

Munro, L. (2017). Everyday indignities: Using the microaggressions framework to understand weight stigma. The Journal of Law, Medicine & Ethics, 45, 502-509. doi: 10.1177/1073110517750584

McGuire, J. K., Doty, J. L., Catalpa, J. M., & Ola, C. (2016). Body image in transgender young people: Findings from a qualitative, community based study. Body Image, 18, 96-107. doi: 10.1016/j.bodyim.2016.06.004

National Eating Disorders Association (NEDA) (2018). What is weight stigma? Definition retrieved on 5/20/19 from https://www.nationaleatingdisorders.org/weight-stigma.

Patton, T. O. (2006). Hey girl, am I more than my hair?: African American women and their struggles with beauty, body image, and hair. National Women’s Studies Association Journal, 18(2), 24-51.

Peterson, C. M., Matthews, A., Copps-Smith, E., & Conard, L. A. (2017). Suicidality, self-harm, and body dissatisfaction in transgender adolescents and emerging adults with gender dysphoria. Suicide and Life-Threatening Behavior, 47(4), 475-482. doi: 10.1111/sltb.12289

Sevelius, J. M. (2013).  Gender affirmation: A framework for conceptualizing risk behavior among transgender women of color. Sex Roles, 68(11-12), 675-689.  doi: 10.1007/s11199-012-0216-5

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Taylor, S. R. (2018). The Body is not an Apology: The Power of Radical Self-Love. Berrett-Koehler Publishers, Inc: Oakland, CA.

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About The Author

Megan Tucker

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.psychologytoday.com/us/therapists/megan-tucker-somerville-ma/280796