SPECIAL FOCUS : GENDER-AFFIRMING CARE
Gerald was provided with specific gender roles according to his sex-assigned at birth and wasn ’ t able to be fluid in his precontinued from page 9
Tatum not only received support from their parents regarding affirming their authentic nonbinary self , but also received guidance on navigating gender-affirming practices from their older sibling .
— Gerald — 43 years old transgender man ( works in the tech industry )
He lived most of his life as a cisgender lesbian and didn ’ t begin to discuss his gender identity until he was in his mid-30s . He experienced clinical depression , and he typically self-medicated with hallucinogens and alcohol . He was the youngest of six children , with a large age gap between him and his oldest sibling .
In his upbringing , little about gender diversity was discussed ; one core memory of his was when he dressed as a male superhero and expressed joy in being a “ superman ” and then was gently , and immediately , redirected as being a “ supergirl .” This stifled him for many years as he continued to be conditioned into traditionally appropriate behaviors and mannerisms for a girl , and later a woman .
When discussing specific work anxieties , the client alluded to an internal conflict of advocating for himself . As he described this need , it was clear that he was worried about how other people in the workplace would see him , namely identifying negative feminine stereotypes . Gerald started in this position as his authentic self , and at this point he passed 100 percent of the time as male . Once we were able to identify the internalized messages of women not being able to assert themselves in the workplace , we were better able to process the gender-roles that he was conditioned to follow . sentation , with the exception of being labeled a “ tomboy .” Later in his development of self , he was able to get support from his married partner to begin his gender-affirming journey and this was met with support from his family members .
Even after aligning with his authentic masculine self , he continued to question his actions and behaviors in social spaces , as what he would like to do would go against the feminine gender-role expectations he had been conditioned to follow . This presents self-doubt in social situations and an increase in anxiety in social settings . While he is fully affirmed in his work and family lives , he continues to question how he should show up in these spaces .
Recommendations for Social Change
The client cases above provide further evidence on how long some people are socialized in gender roles that don ’ t align with their authentic selves and the impact that has on self-concept — for some , long after affirming their authentic gender identity . The environment in which one is raised and conditioned can have longlasting effects and be compounded by gender-minority stress . While counselors can only navigate the impact of experiences with clients , they can also understand the importance of systems that can benefit from social change .
In agreement with Bem ’ s work , when working with parents who are seeking services and support for their children , LCMHCs can advocate for parenting toward androgyny . Using this approach for gender-curious children creates opportunities for openness for children to explore who they are without penalty . They will be more likely to learn more about their gendered-selves without feeling silenced ,
and it creates an opportunity to de-gender careers , roles , and expectations .
Even though many LCMHCs may not believe that they are able to provide gender-affirming counseling , we are all trained to do the work . While some specific procedures and practices may be new , we are all able to be empathetic and validating in the space with our clients , and as always , the relationship is key . For those who feel undertrained , there are many opportunities to receive such training , continuing education , and / or certification through the World Professional Association for Transgender Health ( WPATH ).
In addition to advanced training , it is also important that LCMHCs understand the impact of legislation that would restrict access to gender-affirming care . While countless bills and laws are introduced in each state during each legislative session , we know that gender-affirming care improves the mental well-being of those who receive this type of care . In addition , being part of an inclusive school environment improves the trust that can be developed between gender-diverse students and other adults as well as their well-being .
Recommendations for Licensed Clinical Mental Health Counselors
There is currently no specific genderaffirming theory or practice that LCMHCs can align with in our clinical work . Rather , it is important for counselors navigating gender-affirming mental health care to learn not only about the social issues , laws , and medical processes for genderdiverse clients , but also to find a counseling approach that prioritizes the relationship with the client . continued on page 11
10 The Advocate Magazine 2023 , Issue # 3 American Mental Health Counselors Association ( AMHCA ) www . amhca . org