About Being a Gender-Inclusive Therapist
Like most things therapy, gender operates in the gray. Gender is a social construct whose definitions have ebbed and flowed throughout human history based on culture, conflict, and colonialism. American conceptions of gender are different from Latinx conceptions of gender are different from First Peoples’ conceptions of gender are different from tribal Africans’ conceptions of gender, and so on and so forth.
So for the purposes of the remainder of this conversation, we need to establish some basic clarifications and definitions. Part of the confusion is that most of us have been taught that sex and gender are the same thing, which isn’t true.
Sex has to do with the complicated combination of genitals, hormones, and chromosomes that each person has. The words we assign to sex typically are female, male, and intersex: chromosomally, females are XX, physically, they have a uterus, and hormonally, they have higher levels of estrogen; chromosomally, males are XY, physically they have a penis, and hormonally, they have higher levels of testosterone. Intersex folks may have chromosomal, physical, or hormonal differences outside the typical female and male norm; being intersex is a naturally occurring phenomenon in humans and isn’t considered a medical condition.
Gender has to do with the expectations, characteristics, and standards about how people are supposed to act. People with male bodies at birth are expected to act like “men” and people with female bodies at birth are expected to act like “women.” But what do those words – men and women – really mean? And what are those expectations, exactly? Who decides how “men” and “women” are supposed to act and what actions and behaviors are attributed to each category? What happens if you transgress gender expectations? And nevermind the transgender erasure that’s happening right now, because, whew! I have so many questions! (Don’t worry, we’re going to get to it – I promise.)
The difficulty is that each person’s understanding of how to perform gender – including my own – is different based on their individual life experience. It’s impacted by how our parents performed gender and what their expectations where, what the media told us about gender and what it meant to be a “man” or a “woman,” religious messaging around gender, the things our peers said and did, what our teachers and coaches said about gender, etc., etc. We are exposed to gender performance and expectation every minute of every day because everyone we come into contact with (in person, online, through the media) is performing it, too – only through their own lens. So when I say gender is a social construct, this is what I mean. We think there is a “right” way to perform gender, but there can’t be because each of us does it differently.
When I do workshops and trainings around these topics, I’ll often ask what it means to be a “man” or a “woman.” Here are some of the responses I typically get:
Man: tough, masculine, emotionless, breadwinner, detached, strong, aggressive, angry, head of household, dominant, responsible, analytical.
Woman: emotional, nurturing, mother, caretaker, kind, physically weak, submissive, communicative, catty, dramatic, expected to make sacrifices.
It ain’t cute. And it ain’t accurate.
And it gets even less cute when we layer on social expectations about gender expression – basically, the outward performance of our internalized understanding of our own gender. How we wear what it means to be a woman or a man or neither or all.
Gender expression has changed and expanded significantly for women folk in that they can wear pants (gasp!) and clothing that is deemed more traditionally “masculine” without too much a threat of violence (thank you, Katharine Hepburn). Male bodied humans who have a more effeminate presentation or who wear feminine clothing are at a higher risk of violence. This is because the Western default for acceptable gender expression – even among folx who are androgynous – is masculine. So people who don’t fall in line with that masculine expectation – i.e. transgender women, nonbinary folx, and all the other beauties under the trans umbrella who transgress masculine-centered gender norms by celebrating and expressing their femininity – are often the targets of microaggressions, harassment, and outright violence – sometimes so extreme that people are murdered.
As of July 25, 2019, there have been 12 known murders of transgender people in this country, and ALL of them are black women. So when we talk about privilege and oppression and intersectionality and how various types of oppression intersect in this country, race always supersedes other identities. We see race before we see anything else. And then we see gender – usually on the cisgender man/woman binary. And based on those two variables, we make a lot of assumptions about the person in front of us: what their childhood was like, whether they’re rich or poor, whether they have a college degree, how many sexual partners they’ve had, how many kids they have, what their eating habits are, the list goes on and on…
So what does it mean for me to be a gender inclusive therapist?
It means that I try my hardest not to make assumptions about any of my clients; I don’t know anything until someone tells me.
It means that my definitions of gender are not the same as those of anyone sitting on my couch, regardless or whether they are cisgender or trans, because my experience of gender has been different from theirs.
It means that a person’s gender isn’t a presenting problem or a topic to be addressed until they tell me it is.
Being gender inclusive means I ask a person’s pronouns on my Contact Form or before they arrive at my office for the first time. Not their preferred pronouns because that term insinuates that there are other, more socially appropriate pronouns than the ones the client has given me. A person’s pronouns are their pronouns. And that’s it. Those pronouns may be fluid. They may change from session to session. But in that moment, when that person is sitting on my couch asking me to see them, I use the pronouns they give me because in that moment, those are the ones that fit.
Similarly, I try to make sure that all correspondence I send my clients reflects their affirmed names and pronouns. Again, not their deadnames or the names that are on their driver’s licenses or insurance cards, but the ones that actually reflect who they are.
If I’m working with minors, I ask what they want me to call them in front of their parents. Kids and teens aren’t always out or it’s not always safe to call them by their affirmed name, so I always check in; they appreciate that I’m looking out for their safety, so it helps build the therapeutic alliance, too.
I correct myself if I misgender someone. It happens, even for “gender inclusive” therapists. It’s awkward, and I definitely turn red and facepalm, but I apologize, correct myself, and move on. Stuttering and stammering and being overly apologetic makes the error about me and my discomfort instead of saying “sorry, I slipped,” using the correct pronoun, and keeping the focus on the client.
Being gender inclusive means not commenting on a client’s body or gender presentation – unless I like their shoes or shirt or new hair color. But really, folks put so much effort into expression and presentation as a means of dealing with dysphoria or trying to pass that often, commenting will negatively reinforce all the messages they’ve been force fed about fitting into the binary. If something changes about a client’s expression, I get curious about it, and we explore what those changes mean to them.
Being gender inclusive also means doing the research and staying up-to-date on language. Some of the terms that were popular five years ago are offensive now, and it’s my responsibility to know and use current knowledge. It’s also my responsibility to check in with my clients about the terms they use and what those words mean for them. For instance, Latinx is not a term that all queer people of Latin origin use. Nor is the term queer, for that matter – a cognate doesn’t even exist in the Spanish language. Everyone’s experience and understanding of gender and gender terms is different, and the only way to bridge the gap is to ask.
Last, being gender inclusive means that I have to reflect on my own biases about folx with genders different than my own and work to grow my understanding of people whose experiences are different from mine. Just because I’m queer and non-binary doesn’t mean that crazy little thought bubbles don’t occasionally pop into my head; I’ve been socialized to be heterosexist and transphobic just like everyone else in this country. I have to work hard to actively undo decades of harmful socialization around topics related to identities different from my own, and that work happens all the time, but nobody’s perfect.
So to be the therapist I want to be and the human I strive to be, I sit, I listen, I research, I reflect, and I do what I ask my clients to do: I do the work.