June marks PRIDE month, a time to celebrate the lives and contributions of LGBTQIA+ individuals. We certainly have a great deal to celebrate and to remember, such as:
- Protesters and uprisers who fought for equity during the Stonewall Riots and marched for equal rights in the National March on Washington for Lesbian and Gay Rights
- Scientists and artists who laid the foundation for LGBTQIA+ liberation
- Activists and policymakers, who advocated for laws affirming LGBTQIA+ identities as part of the human experience
Yet, as we celebrate the progress made, we must also recognize the work left to be done for LGBTQIA+ liberation, particularly for gender diverse individuals.
Gender Diversity Defined
Gender diverse is an umbrella term, referring to individuals whose gender identity differs from socially constructed gender norms. Gender diversity encompasses a variety of gender identities (i.e. gender queer, gender creative, gender non-conforming, transgender, etc.). It serves as a more positive and inclusive term for non-cisgender identities than other terms because it recognizes gender as fluid without reinforcing binary gender norms.
Gender diverse individuals experience discrimination across their various life domains, one of which is the health care system. As counseling clinicians, we must take responsibility in creating a non-judgmental space for gender diverse individuals, educating ourselves about gender-affirmative health care, and advocating for policies supporting gender diverse individuals.
Creating Safe Spaces
Developing an inclusive environment starts outside of the therapy room:
- As counseling clinicians, we can list “LGBTQIA -Affirming” on our websites and note our commitment to equitable care for gender diverse individuals.
- At intake, we can ask gender-inclusive questions to gather information. For example, we can ask clients for their “chosen name” in addition to “legal name,” and include a blank option for “sex/gender” for someone to accurately describe their gender.
- Instead of binary restrooms for cisgender men and women, we can label bathrooms as “All-Gender,” welcoming gender diverse individuals.
- When providing handouts or giving presentations, we must take care in ensuring the information is gender inclusive. We must ask ourselves, “Do statistics, examples, and interventions reflect and consider the experiences of all genders?”
Developing an inclusive environment deepens in the therapy room:
- When our clients share their gender identities with us, we must validate their experience and give them space to explore and discuss as little or as much as they feel comfortable.
- If we are unsure of whether a gender diverse client would like to explore gender identity as part of their treatment, we can simply ask.
- We can ensure gender diverse clients know we welcome exploration any time they would like to do so and share additional resources for them to explore on their own if they so choose.
Developing an inclusive environment continues beyond the therapeutic encounter through the provision of resources:
- Trans Lifeline: 877-565-8860. Offers emotional and financial support to gender diverse individuals
- The Trevor Project: TrevorLifeline (866-4-U TREVOR or 866-488-7386). Trevor Chat, the online messaging service, or TrevorText.
- National Suicide Prevention Lifeline: 800-273-TALK (8255)
- GLAD (GLBTQ Legal Advocates and Defenders)
- Trans Youth Handbook: Provides legal guidance for gender diverse youth
- Transgender Legal Services Network: Assists gender diverse individuals navigating legal issues
The Power of Pronouns
After confirming our clinics and institutions utilize welcoming language and signage for gender diverse individuals, we must continue to foster inclusivity through everyday communication. For cisgender individuals, pronouns may seem like menial words thrown within sentences, but for gender diverse individuals, pronouns hold power. To translate the power of pronouns to our clinical environments, we can incorporate pronouns into the most subtle places, such as beneath our signature line in our emails and when introducing ourselves to clients and colleagues. When working in a group setting, encourage participants to share their pronouns to open the space for gender inclusivity.
- Ask gender diverse clients the pronouns they would like in their medical chart and the pronouns they would like us to use in our communication with their loved ones or other providers.
- Some gender diverse individuals have not yet come out to members of their family and may prefer not to have their parents find out their gender identity via an email or phone call from their provider.
- If someone identifies as gender diverse, they, and only they, deserve to share this information with whomever they choose, and we must keep such information confidential unless told otherwise.
Gender Diverse Health Matters
To effectively support gender diverse clients, we must seek education and training on gender-affirmative health care. According to The National Transgender Discrimination Survey, 50% of gender diverse individuals reported having to educate their health providers about their medical care, and 19% reported being refused medical care due to their gender identity. It is not the responsibility of our clients to teach us about gender diversity. As clinicians, we must commit ourselves to learning about gender diversity and its intersection with other cultural identities and their health by:
- Attending training opportunities
- Conducting research on gender diverse populations
- Reading literature on gender diversity
- Listening to our gender diverse colleagues
Because of the stigma society places on gender diverse individuals, mental health issues disproportionately affect the gender diverse community compared to their cisgender peers.
- Gender diverse individuals experience anxiety and depression at nearly 10 times the rate of cisgender people.
- According to a 2019 study, 54% of gender diverse youth reported considering suicide and 29% attempted suicide.
These statistics highlight the need for gender-affirmative healthcare. Our work as healthcare providers can make a difference in the lives of gender diverse individuals. Research suggests providing gender-affirming care, increasing social support, and reducing discrimination decreases suicidal ideation and behaviors and improves overall psychological wellbeing.
As with all identities, gender diverse identities do not stand in isolation; they intersect with one’s religious, racial, sexual orientation, socioeconomic, ethnic, ability status, and other identities. We must seek to understand the ways one’s various identities influence how they are perceived and how they perceive the world. For example, transgender women of color are subject to transphobia, sexism, and racism, thus making them more susceptible to income, housing and health disparities. Black, transgender women experience unemployment at a rate about four times higher than the general population; they experience homelessness about five times more than the general population, and they attempt suicide twice as often compared to the general population. These statistics emphasize the importance of using an intersectional approach in our work to ensure we understand the overlapping layers of oppression and how they contribute to the wellbeing of those with whom we work.
From Clinicians to Advocates
As we continue to build our cultural humility when working with gender diverse individuals, we must transform our knowledge into action. By taking collective responsibility for the injustice experienced by gender diverse individuals, we can begin to identify injustice in our own organizations, advocate for more equitable treatment of gender diverse clients, and implement inclusive practices. As counseling clinicians, we hold power in research, education, and practice to inform social policy to ensure we dismantle systems of oppression and rebuild more equitable ones. We must develop an awareness of the stigma within the health care system and actively seek to dismantle it.
As you continue the journey toward advocacy, please feel free to check out the following resources for more information:
- The World Professional Association for Transgender Health (WPATH)
- National Center for Transgender Equality
- The Sylvia Rivera Law Project
Emma Deihl works as a family therapist with children and adolescents in a partial hospitalization program in Minneapolis, Minnesota. Emma earned her bachelor’s degree in English and Psychology at Luther College in Decorah, Iowa, and she completed her master’s degree in Clinical-Counseling Psychology at the University of Minnesota – Duluth. Her research interests include the effects of stigma on LGBTQ+ individuals and people living with HIV/AIDS, mental health treatments for gender diverse individuals with eating disorders, and the impact of diet culture on marginalized communities. In her spare time, Emma loves creative writing, hiking, reading, and traveling.