Transgender, Politics & Psychotherapy

by Dr. Karen Ruskin on May 16, 2016

No matter what side of the political isle you are on, it is quite obvious that government influences us as a people. It seems as such that decisions, big decisions with consequences, at times are being driven not by thought felt clinical analysis, rather by a power (government) that is driving how the school system responds to their students’ needs, how clinical therapists interact in the counseling office, how the medical profession deals with patients, how parents interact with their children . . .  and the list goes on. The specific topic I am addressing in today’s blog through a Psychotherapeutic lens, is to voice my concern about the recent topic being addressed in the news that boys who identify as girls and vice versa must be allowed to use the bathrooms and locker rooms and shower stalls of their choosing. Specifically, it is my opinion that a 15 year old boy and girl should not be standing naked before one another in a locker room, that’s it, my humble therapeutic opinion. In my work with children and families as a therapist for over 20 years, this simply does not present as the best therapeutic plan.

Additionally, it seems as such that therapists are stuck between a rock and a boulder. The overall message I wish to relay in this article today is: as therapists our role has always been to help our clients to ask themselves difficult questions, to help them to help themselves explore and process their statements they believe as fact so that they can ultimately self-confront and understand fully their thoughts resulting in clarity and empowerment. Our role has never been to blindly affirm what our client says. And I am seeing before me a culture in which that is what some therapists are doing, that is what our schools are starting to do, the medical profession, parents, . . . I believe politics may be playing a role in influencing this blind affirmation rather than critical thinking and exploration. Let’s not bring politics into the therapist’s office.

As a Psychotherapist, specifically a Marriage and Family Therapist – I was trained in systemic thinking, utilizing critical thinking analysis in understanding the full system and how one part of that system, whatever the system may be, is important. We must not be ignorant in understanding that each one part within a system is affected by each other part and so forth with life changing impact and specific and serious consequences. In this case, the system here in America includes; kids and families, the school system itself and all of the staff and students within the school, doctors including private offices and hospitals, government, therapists, everyone and all people and organizations you can think of is a part of the system, our system.

Body Dysmorphic Disorder

I’d like you to take a moment to consider the following case scenario. Imagine that a 100 lb 5’7” woman comes into counseling. During session she states that she’s fat and plans to get liposuction. Should the therapist blindly agree to this because she “feels” fat? Or is the therapist to consider this is a body dysmorphic disorder? What is the therapist’s role? Is it possible that when it comes to gender identity, that there is such a thing as: gender identity disorder, and as such therapists should consider this point? Or rather if a teenager reports she “feels” like she should have been born a boy, does that mean the therapist should take that as is and not explore further? Does this mean that she should be allowed to urinate in the boys bathroom or the girls bathroom, depending on how she is feeling during her journey of gender identity discovery? Therefore on Monday she should change her sanitary product if she is menstruating in the boys bathroom since she feels like a boy, but on Friday when she is feeling like a girl she should urinate in the girl’s bathroom? Or should a different therapeutic treatment plan be established? These are difficult questions to ask, and not easy answers to be had.

Gender Identity vs Sexual Identity

Let’s consider the girl who feels like she should have been born a boy because she has masculine tendencies and dresses more masculine but in reality she comes to discover in young adulthood that it is not that she is transgender. Rather she comes to discover that she is a lesbian and simply had not discovered what it is to be a female on her own terms during her youth? Allow me to explain. Consider this, an 11 year old girl is struggling with her gender identity. She feels like she should have been born a boy. She identifies with being a boy, dresses like a boy, is masculine in her mannerisms, has a short hair cut, etc. What if parents reinforce her feelings and the school reinforces it resulting in her using the boys bathroom? What if she continues to use the boys bathroom school year after school year, but in reality, it is not that she is struggling with her gender identity? Gender identity and sexual identity are two different topics, not to be confused with the other. In this case scenario, as she ages, and becomes sexually interested in a partner in college she comes to discover that she identifies with calling herself more butch in a lesbian relationship and discovers how to be a female on her own terms.

Imagine if this child, instead of taking blindly her statement at age 11, if rather her statement is explored and talked about? How will her childhood be experienced and who does she become as a teenager and an adult if there’s no exploration and rather her statement simply becomes a statement of fact as she uses the boys bathroom and showers with boys? Are we not making it more confusing for her?

The Voice of Children

Take a moment to consider another scenario. A girl comes for counseling because she is sad because her parents are going through a divorce. She is also feeling stressed out about it. While talking she also mentions that school has been stressful this week, even though normally school is her safe haven where she excels academically. When the therapist asks her why school has been stressful, she explains. She reports that she has been holding in her urine each day since early in the week. When asked why, she explains that at the beginning of the week while in math class she had to use the restroom. So she got a pass and went down the hall to the girl’s bathroom. When she got back from the bathroom the teacher got mad in front of everyone in the class asking her why she took so long to go to the bathroom that she missed a lot of the class. She didn’t want to explain but she felt pressured from the teacher to explain. Therefore, in front of the whole class she explained: “there were 2 boys in the bathroom that said that they identify as girls, so they get to be there but I felt embarrassed to pee where they would hear me pee.” The client explained to the therapist that she understands that the boys feel like they are girls, so therefore they get to use the girls bathroom, but for her they still do have boy parts. So she tried to wait until they were done chatting, but it was taking too long so she went down to the other level to the other girl’s bathroom. The teacher said she is being hurtful to the transgendered students to not feel she can use the same bathroom as them. The girl asks the therapist: “what about my feelings? Don’t they matter? I feel like if I say anything about how I feel then people think I am being mean, like prejudiced against the transgendered.”

What’s a therapists role? Is the therapist to reinforce the teacher’s perspective which is directly tied into what is going on in the climate of our political culture?

Is the voice being heard by the child who wants to urinate or shower where others who have the same private parts urinate and shower? Is she to be considered a transgender-phobic or prejudiced to transgendered people if she wants genital privacy?

Just as children and adults are at times afraid to have a voice if it presents as different from what is deemed currently acceptable, my concern is that therapists are feeling trapped in session not exploring out of a similar concern.

What’s a Therapist’s Role in Counseling?

How are we helping children if we blindly agree to their feelings about their gender? How are we helping someone with body dysmorphia if we blinding agree to their decree about their weight? These are a two different examples to make a point. And the point is that as therapists our role has always been that when someone comes in with a struggle, we ask important questions, to help them to help themselves take a hard look at their situation. We ask difficult questions and through dialogue there’s an exploration process to confront what may be inaccurate and self-harming beliefs. It is through the therapeutic process that a person can either come to validation and acceptance of one thought and the closure of another. It is the clients’ answers to therapeutic questions that leads to major changes in their life, outcomes and consequences based upon actions that they take due to the answers they have come up with. As therapists our role is quite often to help people to explore, without judgement. And other times it is to share with the clientele we are working with our observations if we see something objectively factual that is important for them to consider for their mental health and wellness. The change I am seeing is that rather we are now blindly affirming what a client says. Why?

As therapists we must feel confident to give our clients what they need, which is to play the role of therapist. Which means: provide a safe space, a therapeutic environment to explore, confront, and address options and different potential scenarios and realities ultimately leading to an understanding of self and healthy mindful actions based on thoughts with clarity due to a discovery process. An environment that is non judgmental yet does not blindly accept a statement of feelings as fact and rather offers a space to explore possibilities of varied realities where the client ultimately makes their determination based upon insight and thought is imperative. Therapists must not fear that because a topic is political in the news that it has to be political in the therapists office.

To have our clinical work being influenced by political topics being addressed in the news and not utilizing our clinical skills is less than ideal. Therapists are not immune to the affect governmental involvement has for we are part of the system and thus affected and influenced just as schools are, medical doctors, etc. Yet, as therapists we must be mindful of not falling into the trap of blindly affirming.

Thoughts to Consider

Below are a few talking points/thoughts to consider on the topic of transgender.

  •  As therapists are we all really ready to state with fact and slam a gavel with conviction (if one had such a gavel) that children’s early experiences of gender identification are fixed? It is important to be supportive of transgendered people receiving the medical care, support and rights they deserve. Both points co-exist not one or the other. How can we as a culture understand both, not one or the other?
  • Let’s be mindful of the possibility of social contagion phenomenon.
  • It is important to consider the normal process of identity struggles youth experience, at times gender identity, along with experimentation of one’s sexuality. Specifically let’s note that it does not become confused with a label of transgender and help youth and parents understand for some it is an exploration experimentation process, and for others it is identity.
  • I have observed that some parents feel they cannot go through a process of exploration in family counseling, because if they don’t jump on the bandwagon of immediate acceptance that what their child states is fact, then their child feels unsupported and thus unloved.

Gender Identity

Although it is a very small percentage of the population that is reported struggling with what their gender identity is or report they are not struggling with it and rather clearly define themselves as transgender, I believe that this is a real challenge. (I invite you to check out a blog article I wrote in September of 2011 entitled: Chaz Bono: Do let your kids watch Dancing With The Stars).

I believe that for many within this small percentage of those of whom state they are transgender, there are serious emotional problems co-existing that need to be addressed and attended to. Going through a transformative process physically to become the gender you feel yourself to be may not bring the results of self love and acceptance and wholeness one yearns for. A therapeutic journey of self discovery and understanding is imperative and thus I do strongly advise individual counseling, family counseling, and a support group if one is struggling with gender identity.

I hope my readers find this article helpful. As a therapist writing about a topic that is in the news is hard, as it can be misunderstood and taken from a political lens. Yet this article is not intended as such, as I am a Psychotherapist and that is the lens in which I view all things. 

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