Guest Article

Trans and in Therapy?

Van Ethan Levy, LMFT, LPCC

What should trans folx expect? What should therapists know?

Just like most people entering therapy, trans, non-binary and many more non-cis folx are not only entering therapy to address and/or explore gender/identity. We are often looking to build coping skills, learn to regulate, unlearn internalized harmful messages, stop self gaslighting, find the power we possess within, differentiate between systematic oppression versus self-blame, and so much more.

And like most other people, as trans, non-binary and many more non-cis identities folx enter into therapy, we are often seeking someone to help us understand ourselves. However, we often lack the awareness that the person providing us care may not have the ability to provide this type of support, due to the lack of competent training that mental health providers have access to in unlearning our internalized transphobia. And we ALL – including trans, non-binary people – have internalized transphobia, since we absorb the messaging of the society in which we live.

Oftentimes therapists have the mentality that they are safe for all people despite race, color, abilities, class, and so much more. This can be harmful when our privilege prevents us from creating a safer space for others. We all constantly engage in micro/macroaggressions, and the majority of the time we are not aware of the harm that it is causing. In fact, when we exist in a mentality that we are a safe person, that is the moment that we are certainly a person who is causing harm because our privilege and ego prevent us from being aware that we are causing harm.

A couple of years ago, I wrote an article addressing the ways in which navigating the mental health field as a trans, non-binary and many more non-cis identities person can be incredibly difficult. Rather than rehashing information that is there, I will provide a link to that article: Navigating Mental Health as a Trans Non-Binary Person. Once you have read the article, if you are a therapist, please circle back to continue to read the rest of this one.

Here are some things you can do as a therapist: 

1. Trust the person trusting you enough to share or not share. 

2. Believe our realities as people and do not question them. 

3. Remember that often times there is no solution, and trying to find or help us find a solution is not always viable. Instead, holding that space of pain, fear, anger and so much more is what is healing.

An example is that I will always be misgendered (on the phone, in the store, at a restaurant), no matter where I go. Holding that pain, suffering, anger, and much more is what is going to be affirming and create a safer space for me, versus attempting to find a solution and/or challenge that a mental health provider may label as a “cognitive distortion.” My cognitions are not “distortions,” my realities are real, and I have every right to feel any and all emotions every time it happens, even with the knowledge that it will always happen. 

4. Do your own internal work to address the anxiety, discomfort and much more that comes up when engaging with someone that you may feel “has no solutions,” or “is unwilling to accept,” or “change thought patterns,” or “is someone who has another crisis of the week,” or so many other harmful labels that are given. 

5. Know that you really know nothing, even within what you know. It is our clients who will always know what is best for them. Even if we are not able to be aware of how the person’s understandings and/or engagements are what is best for the person, know that that person is the one who knows.

6. Know that trans, non-binary and many more non-cis folx experience suicidal ideations, sometimes even on a daily basis. This does not mean that a therapist needs to jump to institutionalization, which can add more trauma and harm especially for folx who have been historically marginalized.

Instead, safety plan. Safety plans are more than just who to call. They are about what creates safety for the person, which can look like finding beverages that are comforting to the person, safer people, safer clothes, safer spaces, comforting temperatures, supportive textures, or regulating noises. Lean into the sense that tends to be soothing for the person and expand on that to have a working list that the person can take to utilize.

Base the safety plan on what the person has shared, not on what you perceive is best for the person. That includes things with which you may not agree, like smoking pot, masturbating, engaging in an orgy and/or other forms in which the person consistently finds comfort and safety, does not worsen their experience, and does not create non-consensual harm for others.

Therapy is not about inserting ourselves and beliefs into the experiences of others. Therapy is about meeting clients where they are at and providing a safer and consistent landing space. The more we take ourselves, our assumptions, and our “knowledge” out of the equation, the more we can truly be that space.

Van Ethan Levy, MA, LMFT, LPCC, (they) (elle), a trans and non binary therapist, is a queer, non binary, trans, socialized as female, nBPOC (not Black Person of Color), who is autistic, and has dynamic disabilities amongst many more historically excluded identities. Van provides consultations and trainings on trans and non binary identities, is the organizer of the 2022 Virtual International Do Something: Identity(ies) Conference, authored the interactive book, Exploring My Identity(ies), and produced the Documentary, Do Something: Trans & Non Binary Identities, Website: VanEthanLevy.com