This is the latest in a series of interviews with APA Books authors. For this interview, David Becker, an APA Books Development Editor, talked with Anneliese Singh of the University of Georgia and lore dickey of Northern Arizona University.
Note: The opinions expressed in this interview are those of the authors and should not be taken to represent the official views or policies of the American Psychological Association.
Anneliese A. Singh, PhD, is an Associate Professor at the University of Georgia and co-founder of the Georgia Safe Schools Coalition and Trans Resilience Project. Her work is centered on studying and strengthening the resilience of TGNC people, particularly TGNC youth and people of color.
lore m. dickey, PhD, is an Assistant Professor and Doctoral Training Director in the Department of Educational Psychology at Northern Arizona University. His research focuses on understanding the transgender experience, which includes studying sexual identity development and nonsuicidal self-injury.
Together, Drs. Singh and dickey cochaired the APA task force that developed the Guidelines for Psychological Practice With Transgender and Gender Nonconforming People. The goal of these guidelines is to enhance psychologists’ cultural competence and help them provide trans-affirmative care, which is characterized by awareness, respect, and support of TGNC people’s identities and life experiences. Their latest book, Affirmative Counseling and Psychological Practice With Transgender and Gender Nonconforming Clients, expands on those guidelines, offering helpful advice and strategies for providing trans-affirmative care to TGNC clients.
gender pronouns and name that I want people to use when referring to me. I do this with cisgender clients too. What is affirmative counseling and psychological practice with transgender and gender nonconforming (TGNC) clients? How does it differ from other common approaches with these populations?
Anneliese: This is a great question that often comes up for mental health practitioners. They may want to do the “right thing” when working with trans people, but are not quite sure how to do that—so lore and I defined affirming transgender counseling and psychological practice in the Introduction to our book as practice that is culturally relevant and responsive to TGNC clients and their multiple social identities, addresses the influence of social inequities on the lives of TGNC clients, enhances TGNC client resilience and coping, advocates to reduce systemic barriers to TGNC mental and physical health, and leverages TGNC client strengths. (Singh & dickey, 2017, p. 4)
We wanted to define it so that the roles of psychologists involve being social change agents who make sure the settings and societies in which they work are trans-affirmative, as well as emphasizing the importance of supporting the development of trans resilience and affirming all the social identities that trans people have (e.g., race/ethnicity, class, disability, spirituality/religion).
What are the most common errors that mental health practitioners make, or misconceptions they might have, when working with TGNC clients?
lore: There are several errors that a mental health provider might make. The first is assuming that a person has a binary gender identity. The second is making the assumption that a person wants medical treatment, especially gender affirmation surgeries. Another mistake is using the wrong name or pronoun. When this happens, the provider should admit the mistake. This signals to the client that the provider realizes they used the wrong name or pronoun, and takes the pressure off of the client as they do not need to correct the provider.
Some TGNC people might be reluctant to enter into therapy for fear of being pathologized or misunderstood. What can a mental health practitioner do to create a safe and welcoming environment for an anxious TGNC client in the first session?
Anneliese: Yes—this is a very common experience trans people have due to the history that the counseling and psychological field has had of pathologizing trans identities. From diagnosis and gatekeeping (e.g., writing referral letters for hormones and requiring excessive control over the transition process) to experiencing discrimination within counseling sessions and the challenges of accessing mental healthcare (e.g., lack of insurance, finding a trans-affirmative provider), many trans people are anxious about what they may experience with a provider. Trans communities are very strong and connected, so there are often also stories of bad experiences with mental health providers that may be known within the community as well. The best thing a mental health practitioner can do is to get out into the community, participate in community events, learn from trans community organizers and activists about what is most needed in their communities and the common issues they face. The key here is to learn much as you can about how to create safe and welcoming environments.
Next, during the first client contact, explain the approach to trans-affirmative counseling you use and any other considerations a client should be aware of that you require (e.g., number of sessions). During my first contact with clients who need a letter of referral for hormones, I emphasize that my counseling approach is to assist them in accessing the care that they want, and one session is usually enough for just a letter; however, they may want to engage in more sessions to support them during their medical and social transition, and that is something we can talk about along the way. I also emphasize that my role is to advocate for them along the way, and that exploring internalized trans-negativity and multiple identities from an empowerment perspective are important aspects of how I work with clients. It is also important for me to tell clients why I am asking certain questions, instead of just gathering typical assessment data. Because the community has experienced so much trauma, this approach is critical to developing an atmosphere of trust and to build rapport. From the first contact, I also share my own
You chose the photos that are featured on the book’s cover because they are TGNC affirming, and you have noted that media portrayals of TGNC people can often be inaccurate or pathologizing. What portrayals did you want to avoid, and why are they problematic? Are there any particularly prevalent tropes or stereotypes that you have noticed?
lore: As with most anything the media uses to tell a story, they prefer the most sensational images—that is what sells papers. The images that don’t tell the sensational stories are ones that show trans people who have ordinary lives. When the only images you see of trans people are those of White people—this is a problem. When trans woman are hypersexualized—this is a problem. When nonbinary individuals are reported to be confused about their identity—this a problem. When the only news you see about trans men are images of a pregnant person—this is a problem. We worked with a renowned photographer to find images that portray “everyday” trans people.
Both of you cochaired the task force that developed APA’s Guidelines for Psychological Practice With Transgender and Gender Nonconforming People. What was that experience like, and how did it influence your book?
Anneliese: Cochairing the APA trans guidelines was an interesting experience! It was important to make sure we added racial/ethnic and gender diversity amongst our 10-person task force, as well as having a variety of disciplines represented within counseling and psychology (e.g., practitioners, researchers). We consulted with a wonderful team of trans community organizers and activists along the way in the development of the text as well. All of these things had an influence on the text, as we wanted it to have a very intersectional and practice-based approach.
In terms of how the text differs from the guidelines, we were restricted in the guidelines development process from highlighting social justice and advocacy as much as we would have liked to do based on our own personal ways of practicing and engaging in research. Therefore, the book is very much informed by research, but it is also informed by the calls to our field that trans community organizers and activists have issued. The role of psychologists as social change agents is much more centralized in the book. We also had a wonderful group of authors—including public health and community perspectives on trans-affirmative counseling.
We hope this book de-mythologizes trans mental healthcare and makes it more accessible for mental health practitioners to get training and see how they can change the world for the better by doing trans-affirmative care.
What still needs to change in the field of psychology in order to fully address the needs of TGNC people?
lore: This is such an important question. In no particular order: Gender Dysphoria needs to be removed from the DSM and placed in the ICD codes as a medical condition so it is not listed as a mental health diagnosis implying that gender diversity or that gender dysphoria is a disorder. Providers must be sanctioned when they engage in reparative therapy with gender nonconforming clients, and providers must be trained to work with gender diverse people.
Singh, A. A., & dickey, l. m. (2017). Introduction. In A. A. Singh & l. m. dickey (Eds.). Affirmative counseling and psychological practice with transgender and gender nonconforming clients (pp. 3–18). http://dx.doi.org/10.1037/14957-001