Association for Women in Psychology
Salt Lake City, March 8-12, 2000
LEARNING FROM MY TRANSGENDERED CLIENTS
Beth A. Firestein, Ph.D.
Introduction
Like the majority of my feminist psychotherapist colleagues, I came to my work with transgendered clients through the side door. My formal preparation as a psychologist never included any reference to the transgendered and transsexual population, much less any guidance as to how to work ethically, knowledgeably, or compassionately with such an individual should they happen to stumble across my doorstep and become a client. As mentioned earlier, those of us who incorporate feminist perspectives into our psychotherapy work or who practice as feminist therapists are being increasingly sought out by sexually diverse and differently gendered clients. I think this happens in part because we routinely address gender as an important lens to apply in understanding psychological issues and because we treat sexuality issues as important and valuable areas of exploration and understanding.
For those of us who are actively involved in working with and serving gay, lesbian, and bisexual populations, the developing political affinity between BLG and transgender folk can rather naturally bring us into contact with those questioning concepts of gender and exploring issues of gender identity. Other clients exploring gender issues may stumble upon us in a purely accidental fashion. But once it becomes known that a therapist works in a compassionate and effective way with transgendered clients, word of mouth usually ensures further referrals. Many transgendered clients have had one or more unfortunate experiences with biased or unknowledgeable therapists. Many fail to seek help at all due to their fear of being misunderstood and mistreated.
My own journey of involvement began when I was formulating my vision for the book I edited, entitled Bisexuality: The psychology and politics of an invisible minority, which was published by Sage in 1996. In this book, I talk about the need for a paradigm shift within our field—the need to move away from dichotomous models of understanding sexual and gender identities toward multi-dimensional, fluid models of understanding sex and gender. I provisionally named the new paradigm the LesBiGay/Transgender affirmative paradigm, and my inclusion of Transgender in the name of the paradigm was both conscious and deliberate. I recognized that both bisexuality and transgender identity defy dichotomous conceptualizations of identity and sexuality. I invited two highly intelligent and visible leaders of the male-to-female and female-to-male national organizations serving the transgendered, cross-dressing, and transsexual populations to team up and co-author a chapter to explore the intersection of gender identity and bisexuality.
The publication of that chapter and of my book initiated a series of events that has led me to become increasingly involved in providing support and clinical assistance to the transgendered population. These wonderful people have been my clients and my teachers. I have learned, and continue to learn, a tremendous amount from my contact with these brave and incredible individuals. These people are living lives that defy easy description or explanation, lives that are not easily lived. Currently, I work with a diverse range of clients presenting with gender concerns. Working with these clients has been a source of fresh learning and considerable challenge. In this presentation, I would like to share with you some of the many things I have learned from my transgendered clients and some of the ways I have been challenged to grow, both as a person and as a professional.
Phases of Development as a Therapist to Transgendered Clients
First, I would like to share a little about what I see as the stages of my growth as a therapist dealing with transgendered issues in my clients. One thing I discovered was that reading about gender identity was one thing and sitting across from a biological male cross-dressed as a woman is another experience. Until I began working with individuals and leading the transgendered support group, my only exposure to transgendered and transsexual individuals had been through the caricatures of media portrayals and the few transgendered folk I had come across at national and international conferences on bisexuality or in gay pride marches.
Initially, I felt uncomfortable sitting across from a man wearing make-up, skirts or dresses, and sometimes wigs. The stretch involved when clients were not cross-dressed was sometimes even more challenging. Depending on their own stage of self-exploration and self-acceptance, clients often prefer to be addressed by their femme name in therapy, even when they are dressed in attire appropriate to their biological sex. It was initially a challenge for me to address a client in male attire by her femme name, but I recognized it as critically important to that client’s emotional well being that I do so. After all, outside of the safety of the therapy room, transgendered and transsexual clients feel the pressure of constant and unrelenting invalidation of their core sense of self—that is, that their internally felt gender exists in sometimes dramatic opposition to their external, daily gender expression.
My process of developing comfort as a therapist working with TG clients also involved seeking out reading material and educational information about transgenderism, transsexualism, and cross-dressing. I have had many very intelligent, energetic, and resourceful clients who have turned me on to resources that were available to help me deepen my understanding of the transgendered experience. Denver is also fortunate to have an incredible resource called the Gender Identity Center that makes high quality information, outreach, and programming available to the population of Colorado. They sponsor a nationally recognized conference, the Gold Rush, that brings in a variety of medical experts, psychological experts and activists to educate, support and empower the transgendered population and those who are trying to serve this population. Attending events where I could converse and spend time around a number of cross-dressed and full-time living gender folk has gradually and continuously increased my comfort with this population. Seeing some of the same individuals over time and getting to know them as individuals increases that comfort level even more and normalizes diverse ways that people have of expressing gender.
Finally, my experiences in working with transgendered individuals, leading the monthly Gender Support Group for the past 2 ½ years, and listening to a cross-section of voices of cross-dressing, transgendered, and transsexual clients, authors and activists has led me to a place of relative comfort in my work with transgendered clients. The most difficult challenges I have faced to date have revolved around embracing my role as “gate-keeper” with clients who are ready to move toward full-time living and SRS (Sex Reassignment Surgery). I consider the responsibility of writing a letter of support for an individual who intends to undergo radical body modification and genital reconstruction to be an enormously weighty responsibility and the prospect of doing so still causes me considerable anxiety. So far, I have only had a couple of clients who have progressed that far under the auspices of our therapy relationship.
Listening to Transgendered Voices
One of the most valuable outcomes of my work with transgendered clients is coming to deeply understand their experience of the world. At times, it has been a real stretch for me to grasp their phenomenological realities. I would like to share with you, anonymously, some of the voices of my transgendered clients, as they struggle to articulate various aspects of their experience to me and to one another.
Regarding the issue of fear, one male cross-dresser remarked, “Now that you’ve taken the first step and admitted that you have a problem, the only thing you can’t do is nothing.”
Commenting on what joy he found in his feminine role, a cross-dressing, bisexual man stated, “I am who I am and I feel good. I’m thankful that I am able to enjoy the presentation of femininity. I am grateful to have these friendships. I enjoy being with a man as a woman.”
When I asked members of the transgender support group what they like about being transgendered, these were some of the remarks:
“No more civil war.”
“I get to mess with people’s heads.”
“I like the wide range of roles and expressions.”
“Overcoming half a century of fear, guilt, and shame, I had to stare fear in the eye or fear would never go away.”
“I’m not going to run and hide like a criminal. I’m a proud human being. I like freedom.”
One individual with a strong impulse toward activism commented, “What I really enjoy is making a difference. I get upset when things are wrong and I try to change them.”
Not everyone felt as positive about the experience. Others comments:
“I would like to be born in the right (female) body to begin with. I don’t like being transgendered.”
“I’m doing what I can to just fit it.”
“It’s better to be looked up to than to be looked down on; I have no desire to be like this.”
Those having high levels of self-acceptance sometimes move beyond even having the need to successfully “pass” as a member of the other sex. These individuals view a transgendered or transsexual identity as completely valid and different from being a “woman” or being a “man.” They take pride in being who they are and expressing gender in non-conforming ways, even if they can be “read” (i.e. identified as attempting to present as a different gender than their biological sex). One such person said,
“If you’re passing, you aren’t helping.”
Many individuals cannot successfully pass. Those who cannot pass and are still take pride in who they are seek a level of cultural acceptance that goes beyond passing. Those who are able to find that acceptance within the broader culture “help” by broadening the range of acceptable forms of gender expression thereby making more room for the rest of us to express ourselves in diverse ways.
Challenges of Working with Gender Clients
I have encountered a number of significant challenges in working with my differently gendered clients. First and foremost has been the “stretch” involved in understanding my gender clients. Just as exclusively heterosexual people have trouble understanding and really grasping the experience of being gay, and both gay and lesbian identified men and women have difficulty grasping the experience of being bisexual, those of us whose gender identity corresponds to our assigned gender and birth sex often have difficulty understanding the experience of those whose sense of gender differs from their assigned gender. As a woman-identified genetic female who has never questioned my gender identity and has always loved being a woman, the concept of not feeling that one’s gender identity is congruent with one’s birth sex was a very foreign idea, and initially quite troubling. It has been easier for me to relate to the transgender experience out of my experience of my own bisexuality. Transgender expression moves us beyond the two-gender system; bisexuality moves us beyond the two-gender system of loving.
Some of my greatest challenges in working with gender clients have come around the actual challenges of the therapy work. These have taken several forms. I have felt the challenge of supporting clients and validating their self-perceptions in the face of frequently overwhelming social invalidation. Few of my clients’ family members or friends usually support them in their preferred gender identity choice. My clients frequently face incredible levels of misunderstanding, ridicule and hostility in the homes and work places should they reveal themselves to others or attempt to live full time in their preferred gender role. Often I am place in the position of supporting a client to take risks to be authentic which are likely to yield multiple negative real-life consequences (risk of losing a job, a spouse, or relationships with their own children). While these risks can also occur with other clients who move toward authenticity and self-empowerment, these risks are much more profound and have far-reaching implications for my gender clients. The risks of “coming out” transgendered are not unlike the risks of coming out gay, lesbian, or bisexual, but the transgendered identity is even more stigmatized and even less well understood than LesBiGay identities currently are in our culture.
This circumstance frequently leads me as a therapist to support clients as they struggle with complex issues related to privacy, secrecy, and deception. Most of my clients “pass” as typically gendered in their jobs and in their families. Many maintain a “secret life” involving cross-dressing, self-adornment, body modification, and sometimes hormonal treatment while still functioning and passing as their biological sex. These issues continually challenge my personal and professional values around honesty and authenticity, particularly in intimate relationships or marriage. The issue of coming out to one’s children is also a complex issue confronting many people with gender issues.
Another challenge revolves around issues of advocacy and dual roles. Some of my transgendered clients have lost jobs, lost families or been chronically suicidal. Some have ended up on SSI Disability, either due to medical or psychiatric disabilities, or both. It has been my experience that many of my gender clients are so “starved” for validation that I feel a strong desire from some of them for me to become more involved in their lives and in their political movement. I do what I can, but it has been challenging for me to struggle with the limits of my time and energy to invest in this arena when I also have commitments to so many other issues and causes. I feel appreciated, but I often feel that I am letting them down because I am unable or unwilling to do more. Of course, the pull is not there at all with some of my clients and strongly there with others depending on their level of dependency needs, degree of isolation, and degree of personal activism. Some of my most powerful, self-accepting and activist clients are the ones I feel the strongest pulls from and feel the most guilt and conflict about with respect to what I am able to give. Finally, there is also the issue of how various forms of psychopathology interact with gender identity concerns and how to treat the individual’s pathology without pathologizing the gender identity issue. There are many other challenges I could name but I will save these for the discussion.
What I have learned from my transgendered clients
In summary, I have found my experience in getting to know and working with differently gendered clients to be immensely rewarding, fascinating, and challenging. I have been challenged to balance, and to help clients balance subjective and objective realities with an awareness of the socially constructed nature of both of these. I have come to believe that the transsexual experience originates largely from a body-centered truth that sometimes defies ready or obvious external validation. I have learned to honor my clients’ subjective truth even when it is at variance with the objective data of my senses.
With my differently gendered clients I have learned about other difficult and authentic ways of living that are different from my own, yet I have also found strength for my own coming out journey in the power of theirs. My transgendered clients are some of the bravest, funniest, smartest, and most persevering people I have ever known. I have learned a lot about managing a stigmatized identity in a hostile culture and validating one’s right to a place in that culture—making a place for oneself in that culture even in the face of threatened disapproval, alienation, ostracism, discrimination, or violence. I have learned a great deal from my gender clients about the journey from self-rejection to self-acceptance—from the “dark night of the soul” to “gender celebration.” I have learned about coming home to one’s self.
I applaud my clients for their courage and their willingness to journey into the unknown regions of their being, for their trust in allowing me to facilitate their journey, and for their willingness to hear and know the complex and sometimes difficult truth of their own being. May we all have such courage.
SELECT BIBLIOGRAPHY ON GENDER ISSUES*
Bem, S. L. (1993). The lenses of gender: transforming the debate on sexual inequality. New Haven: Yale University Press.
Bornstein, K. (1995). Gender Outlaw: On men, women and the rest of us. New York: Vintage Books (Random House).
Bornstein, K. (1998). My gender workbook. New York: Routledge.
Butler, J. (1990). Gender trouble: Feminism and the subversion of identity. New York: Routledge.
Brown, M.L. & Rounsley, C.A. (1996). True selves: Understanding Transsexualism. San Francisco: Josey-Bass.
Califia, P. (1997). Sex changes: The politics of transgenderism. San Francisco: Cleis Press.
Chodorow, N.J. (1994). Femininities, masculinities, sexualities: Freud and beyond. Lexington: University Press of Kentucky.
Franzini, L.R.; Casinelli, D.L. (1986). Health professional’s factual knowledge and changing attitudes toward transsexuals. Social Science and Medicine 22, 535-539.
Gagne, P. & Tewksbury, R. (1998). Conformity pressures and gender resistance among transgendered individuals. Social Problems 45, 81-101.
Kirk, S. & Rothblatt, M. (1995). Medical, legal and workplace issues for transsexuals: A guide for transformation. Blawnox, PA: Together Lifeworks. (P.O. Box 38114, Blawnox, PA 15238).
Kockett, G. & Fahrner, E.M. (1988). Male-to-female and female-to-male transsexuals: A comparison. Archives of Sexual Behavior, 17, 539-546.
Price, J. (1985). Psychotherapy with transsexuals: Do we need a new approach? Journal of Contemporary psychotherapy, 15, 5-19.
Rudd, P. (1999). Crossdressing with dignity: The case for transcending gender lines. PM Publishers, Inc., P.O. Box 5304, Katy, TX 77491-5304. www.pmpub.com
Wilchins, R. A. (1997). Read my lips: Sexual subversion and the end of gender. Ithaca, NY: Firebrand.
*Many thanks to Monique Pauling and Alisa Beaver, from whose excellent March 1999 bibliography I drew many of these citations.