On Being a Gender-Affirming Clinician

As many of you know, October 11, 2019 is National Coming Out Day and marks the beginning of Pride Season here in Atlanta. This is a wonderful time for supervisors and clinicians to take into consideration their preparedness to work with gender minorities. 

A gender minority is someone whose gender identity differs from the majority of society. In the context of gender, this may include someone who is non-binary, gender queer, gender non-comforming, agender, bi gender or transgender. This list is not exhaustive, there are many other identities people may hold. 

Gender? Sex? It can be confusing. Let’s quickly break it down:

Sex refers to anatomy. It includes the genitals, reproductive organs, chromosomes and hormones. People’s sex assigned at birth can be male, female or a person can display differences in sexual development at birth, which includes roughly 60 conditions in which a person’s sex is not clear, this may also be referred to as intersex.

Gender is the interrelation between our body, our identity and our social presentation. For a more expansive definition please visit www.genderspectrum.org. 

More and more individuals are exploring their gender identity and presentation. As clinicians, it is important for us to be able to communicate to our clients our skills around working with gender minorities. With graduate programs placing little to no emphasis on the behavioral healthcare needs of gender minorities and Georgia having the fourth largest population of transgender individuals, we all have the ethical obligation to ensure we have expanded our knowledge in this specialized area. In addition to completing continuing education and self guided reading, we should be able to clearly communicate our competency levels to our clients, colleagues, supervisees and supervisors. This writing will review one way in which you can measure your level of competency and methods for developing new skills in this area. 

When communicating with my clients and assessing the competency of those under my supervision and those I consult with, I begin with a model for working with gender as outlined by Adam A. Sauceda, MA, LPC-S, RPT of Helotes Texas. The model can be found on his website: https://www.synchronicity-counseling.com/approaches-to-working-with-gender. The model is included here with permission from the author for your reference. 

Unaffirming:

Does not have knowledge of transgender and/or gender diverse identities

  • Feels using a person’s chosen name and pronoun may be giving credence to mental illness

  • Believes genitalia determines someone’s gender

  • Believes identifying with a gender other than the gender assigned at birth is due to mental illness

Neutral:

May or may not be interested in learning more about transgender identities

  • May or may not have interacted with transgender people

  • Is undecided on whether to refer to someone by their birth name or chosen name

  • Is unsure if gender is determined by genitalia or other factors

Novice:

Has very limited or no knowledge of transgender or gender diverse identities

  • Has very limited or no interaction with gender diverse or transgender people

  • Is interested in learning about different models of working with transgender people 

Friendly:

Has limited knowledge of transgender identities and is willing to learn more

  • Has interacted with transgender and gender diverse people and is respectful of client’s gender expression and identity

  • Feels comfortable being around transgender and gender diverse folks

  • Has created an LGBTQIA+ affirming environment via literature on a website or supportive materials in the office 

Affirming:

Has some knowledge of gender diverse identities and refers to clients with correct name and pronouns, has gender affirmative intake documentation

  • Has developed limited clinical skills through training, consultation, or readings to help a client with initial exploration of their gender

  • Understands the history of transgender and non-binary people’s relationship to the medical and mental health community

  • Has knowledge about the impact of transphobia and the various ways it impacts healthy development

  • Has begun to study intersectionality, privilege, and explored their own views of gender and gender roles

  • Believes gender diversity and gender expression of all kinds is healthy and a sign of a healthy society

  • Office staff is gender affirming, if applicable

Competent: (Affirming plus, may also identify themselves as a Gender Therapist) 

A licensed mental health clinician who has obtained education, training, consultation, clinical experience, and engages in ongoing continuing education in working with a gender diverse caseload

  • Able to provide psychoeducation to clients regarding social and medical changes to their gender

  • Continued learning about intersectionality and their own experience of privilege such as, cisgender, heterosexual, race, education, class, etc

  • Experience writing a variety of letters of support for clients to receive gender affirming medical care

  • Knowledge of local resources (i.e. support groups, endocrinologists, affirming providers) and national resources (i.e. WPATH, Trans Lifeline, Transgender Law Center)

​It is important that you are able to communicate your abilities to your clients in a way that is clear and transparent. Communicating a level of competency that is not accurate places your client at risk for re-traumatization or cost ineffective services. Knowing when to refer out to a gender affirmative or competent clinician or when to seek consultation as you develop your skills is the most ethical approach. 

Where do you and your supervisees or colleagues fall on this spectrum? What additional training might you need? As we at Modern Path prepare our 2020 training schedule please provide us feedback related to what training you would find useful in the area of gender.

Nick Marzo