Working Competently with
Transgender and Gender Non-
Conforming Clients
Nicole Borzelleca, M.S., MHC
Mental Health Counselor

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Gender is a powerful force that informs many of our daily interactions. This includes our work with clients. In order to be fully present with and understand our transgender and gender non-conforming clients, we need to open our minds and become educated on basic concepts, terminology, and best practices. This workshop will be an introductory experience aimed at increasing your competency when working with clients who are "outside the gender box".

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 General lack of knowledge
 Utilization of counseling
 Suicide rates

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 Sex vs. Gender
 Key Terms
 Case Illustration
 Competencies
 Creating a Trans-Friendly Practice
 Trans* Students’ School Experience
 What You Can do

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. G
• Biological
SEX
• Chromosomes
• Anatomy
• Secondary sex characteristics
• Male & Female
• Existence of Intersex conditions
GENDER
• Cultural
• Socially constructed
• Gender roles
• Gender identity
• Masculine & Feminine
• Existence of various gender identities

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ID
. S
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Gender Identity
• Gender identity refers to a person’s internal sense of being male, female or something else.
• Gender expression refers to the way a person communicates gender identity to others through behavior, clothing, hairstyles, voice or body characteristics.
Sexual Orientation
• Sexual orientation refers to an individual’s enduring physical, romantic, and/or emotional attraction to another person.

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Transgender is an umbrella term for persons whose gender identity, gender expression or behavior does not conform to what is typically associated with the sex to which they were assigned at birth.

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• Cisgender
• Genderqueer
• Gender non-conforming
• MTF & FTM
• MAAB/FAAB
• Transsexual
• Crossdresser/Transvestite
• Androgynous
• Intersex
• Transition
• Passing
• HRT
• SRS
• Gender-neutral pronouns

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Used to described people who are not trans or gender variant; whose gender identities, presentations, and behavior match the sex they were assigned at birth.

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Those who identify their gender as falling outside the binary constructs of
“male” and “female.”

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Behaving and appearing in ways that are considered atypical for one’s gender.

MTF
• male-to-female
• An individual who was assigned male at birth, but has a female gender identity.
• transwoman

FTM
• female-to-male
• An individual who was assigned female at birth, but has a male gender identity.
• transman

FAAB female assigned at birth

MAAB male assigned at birth

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Historically used to refer to individuals who have medically and legally changed their sex, or who wish to do so.

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/T
Those who wear clothing that is traditionally or stereotypically worn by another gender in their culture. The term transvestite, though still preferred by some, is not generally considered PC.

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A combination of masculine and feminine characteristics.

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The general term used for a variety of genetic, hormonal, or anatomical conditions in which a person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male.

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Refers to the complex process of authentically living one’s gender identity, often but not always including leaving behind one’s assigned birth sex. A transition may include coming out to one's family, friends, or co-workers; changing one’s name or gender markers on legal documents; hormone therapy; and possibly (though not always) some form of surgery.

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Some people who have transitioned no longer consider themselves to be transsexual or transgender and rather identify only as a man or a woman (occasionally “of transgender experience”). Others identify as a trans man or a trans woman for remainder of their life. Some consider the term transition to be offensive and prefer the terms “gender affirmation”. It is best to ask clients what they prefer.

HRT
Hormone Replacement Therapy - sex hormones (androgens for transmen and estrogens for transwomen) are administered for the purpose of bringing one's secondary sexual characteristics more in line with their gender identity.

SRS
Sex Reassignment Surgeries include procedures by which a person's physical appearance and function of their existing sexual characteristics are altered to resemble that of the other sex.

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A person's ability to be perceived as the gender they identify as.

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A pronoun that is not associated with a particular gender, and that does not imply male or female.

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P

A PATHOLOGY?
The inclusion of gender identity disorder in the DSM has been a highly controversial topic. Some contend that the diagnosis inappropriately pathologizes gender noncongruence and should be eliminated, while others argue that it is essential to retain the diagnosis to ensure access to care. The DSM-5 replaced the diagnostic name Gender Identity
Disorder with Gender Dysphoria. It was stated that the aim was to avoid stigma while still ensuring clinical care.

DSM-5 G
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In order to received the diagnosis, there must be both:
• A marked incongruence between one’s experienced/expressed gender and assigned gender.
• Associated clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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• The issues facing transgender people are not the result of a mental illness, but rather a reaction to the social stigmatization and discrimination that they must face.
• These stressors affect their physical and mental health.

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• Transgender persons do not typically share their minority status with their family of origin.
• Not only do they not share their status, but they are often times rejected (at least at first) by their family.
• All of these stressors have the ability to lead to depression, anxiety, substance abuse, suicidality, etc.

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• 22-year-old Caucasian transgender female. MAAB. MTF.
• “Came out” and began her transition at age 20.
• Sought counseling within a couple of months of beginning HRT.
• Presented with major depression with suicidal ideation.
• Issues with family’s reaction, or lack thereof.
• Currently struggling with depression, low self-worth, feelings of isolation, and daily stressors.

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Divided into 8 Competency Areas:
1.
Human growth and development
2.
Social and cultural foundations
3.
Helping relationships
4.
Group work
5.
Professional orientation
6.
Career and Lifestyle
7.
Appraisal
8.
Research

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• Understand the the importance of using appropriate language- name & pronouns.
• Don’t make assumptions about sexual orientation.
• Recognize the complex effect of stigma and discrimination.
• Understand the influence of familial factors.
• Empower client and work to build coping skills to help deal with these difficulties.
• Be aware that there may be concerns that are not genderrelated.
• Create an affirming therapeutic relationship that fosters trust.

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LGBT C
2008 S
• The therapeutic relationship was found to be the most important factor.
• Therapists are more helpful when they are knowledgeable, appropriate, and affirming in dealing with client’s sexual orientation and gender identity.
• Helping clients explore choices related to their identity in a nonjudgmental way, while not imposing any values onto them has a positive impact.
Israel, T., Gorcheva, R., Walther, W.A., Sulzner, J.M., & Cohen, J. (2008). Therapists’ Helpful and Unhelpful Situations With LGBT Clients: An Exploratory Study. Professional
Psychology: Research and Practice. 39(3), 361-368.

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-F
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• Have gender neutral bathrooms available
• Provide information on hormone replacement therapy or other related services/resources
• Provide training for other helping professionals and staff
• Acknowledge your own gender identity and explore your privilege as a cisgender person

RESOURCES
• www.apa.org/topics/lgbt/index.aspx
• www.counseling.org/Resources/Competencies
/ALGBTIC_Competencies.pdf
• www.wpath.org/
These are listed in your packet.

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E XPERIENCE IN S CHOOL

2011 N
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Hostile School Climate
Absenteeism
Lowered Education Aspirations and Achievement

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Biased remarks and Physical Harassment/Abuse
• 61.4% heard negative remarks about gender expression (not acting masculine or feminine enough) frequently or often.
• 56.9% of students reported hearing negative remarks about gender expression from teachers or other school staff.
• 63.5% felt unsafe because of their sexual orientation, and 43.9% because of their gender expression.
• 60.4% of students who were harassed or assaulted in school did not report the incident to school staff, most often believing little to no action would be taken or the situation could become worse if reported.
• 36.7% of the students who did report an incident said that school staff did nothing in response.

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31.8% missed at least one entire day of school in the past month because they felt unsafe or uncomfortable.
Students who experienced higher levels of victimization because of their gender identity were more than twice as likely to have missed school in the past month than those who experienced lower levels(53.2% vs. 20.4%).

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Lowered Education Aspirations and Achievement
Students who experienced higher levels of victimization in school because of their sexual orientation or gender expression were more than twice as likely to report that they did not plan to pursue anypost-secondary education
(e.g., college or trade school) than those who experienced lower levels (10.7% vs. 5.1%).

2011 N
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C
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Gay-Straight Alliances
Inclusive Curriculum
Supportive Faculty
Comprehensive Bullying/Harassment Policies &
Laws

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-S
A
• Gay-Straight Alliances (GSAs) and similar student clubs can provide safe, affirming spaces and critical support for
LGBT students.
• GSAs also contribute to creating a more welcoming school environment.
• Students hear fewer biased remarks, feel safer, encounter fewer incidents and more often report incidences that do occur.
• Yet, less than half (45.7%) of students said that their school had a GSA or similar student club.

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• A curriculum that includes positive representations of LGBT people, history, and events (i.e., an inclusive curriculum) can promote respect for all and improve LGBT students’ school experiences.
• Similar results to having a GSA
• Yet, only 16.8% of students were taught positive representations about LGBT people, history, or events in their schools.

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• The presence of educators who are supportive of LGBT students can have a positive impact on the school experiences of these students, as well as their psychological well-being.
• Students with support in schools feel safer, attend classes more often, have higher GPAs and higher aspirations.
• Although almost all students (95.0%) could identify at least one staff member supportive of LGBT students at their school, only about half (54.6%) could identify six or more supportive school staff.

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• Policies and laws that explicitly address bias-based bullying and harassment can create safer learning environments for all students by reducing the prevalence of biased behaviors.
• Comprehensive policies and laws — those that specifically enumerate personal characteristics including sexual orientation and gender identity/expression, among others — are most effective at combating anti-LGBT bullying and harassment.
• However, only 7.4% of students reported that their school had a comprehensive policy (i.e., that specifically included both sexual orientation and gender identity/expression).

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New York State law protects students’ right to:
• be free from discrimination and/or harassment on the basis of their gender identity or because some aspect of their appearance or behavior does not match stereotypes associated with their gender identity or their sex assigned at birth.
• wear clothing that corresponds to their gender identity and expression.
• Play on sports teams
• Use the bathroom and locker room that corresponds with their gender identity
• http://srlp.org/resources/fact-sheet-transgender-gender-nonconformingyouth-school/

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• If a student talks to you about their gender identity, listen in a respectful and non-judgmental way.
• Do not “out” a young person or disclose their gender identity to another without permission.
• Always refer to transgender and gender nonconforming students appropriately using correct pronouns & names.
• Urge teachers to incorporate positive information about transgender issues into curricula.
• Avoid perpetuating gender stereotypes.
• Intervene and take action when students use gender-specific terminology to make fun of each other.

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* F
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• Arrange for transgender awareness training for faculty, staff, and administrators from a qualified communitybased trainer
• Create gender neutral restrooms
• Create gender-neutral and / or mixed gender spaces
• Start or help to grow a GSA/LGBTQA
• Ensure that employment opportunities at your school are open to transgender and gender nonconforming people

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• The Massachusetts Transgender Political Coalition created a best practices for trans* youth in the school system. http://www.masstpc.org/wp-content/uploads/2013/02/MTPC-2013-K-12-
Best-Practices.pdf
• Sylvia Rivera Law Project www.srlp.org
• Transgender Day of Remembrance (TDOR), which originated in 1998, is an annual observance on November 20th that honors the memory of those whose lives were lost in acts of anti-transgender violence. You can find where your nearest TDOR event is by going to http://www.transgenderdor.org
• GLSEN has a student action page with many resources for transgender students’ rights and great ways to help students become educated and involved in the community. It is also a wonderful resource for educators. www.glsen.org/students/tsr Learn how to be a visible ally to LGBTQ youth http://glsen.org/safespace