Transgender is an umbrella term for people who
identify as a gender that is not the same as the sex they were assigned at
birth, as well as for people who do not fit into dominant and binary expectations
of gender (Ansara, 2010). People with a broad range of gender identities and
experiences can fit under this umbrella term, including, but not limited to,
people with the following identities: agender, pangender, bigender, non-binary,
gender non-conforming, gender creative, polygender, genderqueer, genderfluid,
two-spirit, trans men, trans women, people of transgender history. This means
that there are many ways of being transgender. Therefore, assumptions cannot be
made about a person identifying as transgender. For instance, assuming someone
who identifies as transgender is interested in changing their gender expression
from one end of the gender binary spectrum to the other, such as male to
female, might be inaccurate for some people and accurate for others.
The prefix of the word, “trans-“, comes from Latin and
it means “across from”. In this case, it indicates someone who identifies their
gender somewhere across from their sex assigned at birth. The prefix, “cis”
also comes from Latin and it means “on the same side”. Cisgender is a term used
to indicate people whose gender identity and sex assigned at birth align, and
are on the same side. For example, a cisgender man would be someone who was
assigned male at birth and identifies as male, and a cisgender woman would be
someone who is assigned female at birth and identifies as a woman. (Blumer,
Ansara, & Watson, 2013).
How can Family Therapy Help Transgender Clients?
Clients of transgender experience and identities, as
well as their families, seek therapy for multiple reasons, not always focused
on gender-related concerns. Thus, family therapists cannot assume that gender
is at the center of a family problem. Family therapists, however, need to be
familiar with and knowledgeable of gender issues in order to identify when/if such
concerns may be intersecting with other issues, for all clients. Trans people
can and do, of course, seek therapy for gender and/or transition related concerns.
Some of those concerns may include: gender questioning and exploration,
assistance with social, legal, and/or medical transition, and relational
Types of Gender Issues
Clients interested in gender questioning and exploration recognize a dissonance around identity or might be experiencing gender dysphoria, but they may not know what to do about their feelings. When clients seek therapy while questioning their gender identity, it is important for family therapists to adopt a client-centered stance, understanding that different clients view the issues differently. Because there are many possible trans identities, experiences and expressions, when clients do not have a clear picture of how they wish to express gender, family therapists can assist them in exploring possibilities. It is also important for therapists to be aware of the impact of dominant and binary ideas of gender on clients who are questioning and exploring their own gender identities, expressions and roles. The goal of therapy is to find an expression of gender that feels most genuine and authentic for the client, given their own sociocultural and geographic contexts. During this exploration process, therapists often assist clients in developing social connections and finding community.
With gender-questioning clients, therapy also includes a critical examination of societal, cultural, and familial constructions of gender, opening up options outside of the dominant cisgender female and male identities, if those are what the client wants. It is important to note that many trans people are also comfortable with binary identities and expressions. The role of the therapist then is to encourage clients to consider all possibilities so that they can make informed choices.
Some people may decide to pursue social, legal and
medical transition, while others might only pursue some or none of these
options. Therapists can offer opportunities to discuss what the impact of
choices around transition would be and to examine whether clients’ desires stem
from their own experiences or dominant cultural and societal expectations. It
is important to consider that clients’ wishes might be challenged by issues
such as financial and/or healthcare access. Therapists can then help in
supporting clients managing those challenges, as well as in reminding them that
there are many different expressions of gender identities, expressions and
Other clients seek therapy with the primary goal of
obtaining support with their transition processes. These clients usually have a
clear vision of gender transition and therapy is often focused on assisting
them with this goal. In these cases, family therapists work to ensure that
clients have the emotional stability and social support needed to cope with the
challenges of transition. Due to society’s binary gender conceptualization,
trans clients are subject to the stress of stigma, cisgenderism and transphobia.
Similar to many other marginalized communities, trans people experience higher
levels of depression, anxiety, suicidality and substance issues, due to the
impact of societal oppression. Therapists can support their trans clients in
managing their mental health symptoms appropriately, so that they can make grounded
and centered decisions about transitions and face any accompanying stress.
Having therapeutic support during these processes can be vital to trans
clients’ mental and emotional well-being.
Trans clients might also seek therapy for relational
issues. In these cases, the family or partner of the trans client are typically
involved in therapy to address whatever relational issues might be impacting
them. For example, although some parents do not react negatively to their
child’s disclosure of a trans identity, other parents have described it as a profound,
personal crisis, characterized by strong emotions such as shock, confusion,
devastation, fear, and grief. Partners of trans people may have similar
responses if they were unaware of their partner’s trans identity; however, many
partners are supportive and couples may seek therapy to deal with the
implications of transition, like a new definition of the relationship, sexually
related possibilities, or reactions from extended family (Iantaffi &
Benson, in press). Family therapists working with trans clients and their
families can both acknowledge and normalize the impact of those issues on their
clients and their families, especially in the context of dominant cultural and
Ways to Support People Identifying as Transgender
Due to societal and cultural stigma and oppression
that trans clients still face in the United States, they need social support.
This support may come from inside and/or outside the family system. When
adequate support is not found within the family, therapists can assist clients
in finding alternative support systems, such as continued therapy, connections
with other trans people, friendships, and online support. When working with
minors, it is also important for family therapists to highlight to families how
their support is a protective key factor for their children.
When trans clients make body modifications or start to
socially transition, their identity might become more apparent to people in
their lives, whether or not the client discloses their identity. Given societal
lack of understanding and support, gender transition can be a process often
characterized by stress and misunderstanding. For example, clients may face
opposition in the workplace, such as conflicts over which bathrooms they may
use. Therefore, the role of family therapists may include advocating,
educating, and consulting with employers, co-workers, teachers, family members,
neighbors, and friends. It is important for family therapists to be familiar
with both federal and state level legislation affecting trans clients.
In cases where family members are angry, intolerant,
and/or rejecting of the trans identity or experience of a client, sessions may sometimes
not include the trans family member. Family therapists can serve as a sounding
board for negative emotions, educators of family members on transgender issues,
and as guides for exploration of new understandings of trans identities,
experiences, expressions, and roles of an individual. Therapists can assist
family members to: seek information, exposure, and support; understand gender
dysphoria and trans experiences; understand dominant societal and cultural
ideas of gender; help navigate how to disclose the information to others with
the trans client’s consent and respecting their agency and desires in this area;
and realize that the trans person remains a family member who deserves and
needs love and support. Once family members have had time to process some of
their own experiences around the disclosure, family therapy including the trans
person, may help families repair and redefine relationships, foster healthy
communication of emotions, and nurture closeness.
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Written by Alex Iantaffi, PhD, and Markie L. C. Twist, PhD