Heeding the Call

Heeding the Call

Responding to the needs of those whoidentify as trans/GNC

BY TYNAN POWER PHOTOS BY SHANA SURECK

Hunter Swanson, M.S.W. ’09, calls his experience of therapy during his gender transition process “a nightmare.” Swanson, who was assigned female at birth (AFAB), paid out of pocket to see a therapist in order to obtain a letter required to begin the medical process of transition from female to male. After six months, the therapist balked at writing the letter, saying she wasn’t comfortable holding that kind of power over someone’s life. “My decision to go into social work was largely prompted by my own mostly negative experiences in therapy, especially those having to do with transition,” said Swanson, who practices in Greenfield, Massachusetts. “I don’t know that I’ve ever had a therapist who I would describe as totally trans-competent.”

Shannon Sennott, M.S.W. ’08, an SSW adjunct instructor, works with numerous transgender and gender non-conforming (GNC) clients in Northampton. After witnessing the ways trans/GNC people were often ostracized in queer and lesbianowned spaces in New York City, she knew she wanted to work with clients around concerns related to gender justice and the effects of transmisogyny.

“When I got to SSW, there were no institutionalized supports for trans/ GNC students or interns as they moved into their placements and navigated learning in classrooms,” said Sennott. “I started Translate Gender, Inc., as my community practice project to bring gender awareness and advocacy to institutions and organizations, particularly colleges and mental health organizations.”

Individual experiences prompted Hunter Swanson, M.S.W. ’09 to dedicate his social work career to those in the western Massachusetts’ trans/GNC community.

Aleah Nesteby serves an increasing number of trans/GNC clients in her office at Cooley Dickinson Hospital.

A lot has changed. In recent years, there has been a shift in awareness and inclusion of trans/GNC individuals in social work and the culture at large. At SSW, this has included the formation of a student-faculty team to compile trans-related resources, hiring transgender educator Davey Shlasko as a Sotomayor Fellow focusing on gender, disability and race intersectionality, and the creation of gender-neutral locker rooms in the fitness center.

For therapists working with trans/ GNC people, treatment recommendations have shifted as well. In 2011, the World Professional Association for Transgender Health (WPATH; formerly the Harry Benjamin Gender Dysphoria Association) issued the seventh version of its non-binding Standards of Care for Gender Identity Disorders (“Standards of Care”). The WPATH Standards of Care are

widely used as guidelines for mental and physical healthcare of trans/GNC individuals. The current standards recommend that trans/GNC individuals seeking hormone therapy or surgery obtain letters from therapists attesting to the client’s gender identity, length of treatment by the therapist, suitability for medical treatment and informed consent. Many medical providers require such letters, making it necessary for trans/GNC patients to seek therapy in order to obtain medical services. This therapy can provide needed support for trans/GNC individuals, however it can also be perceived negatively as an expensive and timeconsuming hurdle.

The required letters also place the therapist in the role of “gatekeeper”— a position some therapists, such as the one Swanson saw, do not welcome. Others, like Simon Weismantel,

M.S.W. ’14, who sees clients at The Juniper Center in Chicago, seek ways to minimize the power that rests in their hands.

“I am clear with my clients that I am not a gatekeeper in the way clinicians were 20 years ago,” said Weismantel. “I try to bring them into the processes that were once the sole province of a ‘gatekeeper’ provider, such as including my clients in the editing and approval process of their own HRT and surgery letters.”

An alternative model used by some providers is the “informed consent model.”

Aleah Nesteby, a nurse practitioner who is the director of LGBTQ Services at Cooley Dickinson Healthcare in Northampton and an adjunct instructor at SSW, uses the model in her work treating over 350 trans/GNC patients.

“The informed consent model emphasizes the importance of the client making the most educated decision possible about their healthcare,” said Nesteby. “I think therapy is great, and often very helpful, but I don’t make it a mandatory condition of treatment. I think that one of the misconceptions about informed consent is that clients do not get therapy. I’ve found that most of my patients have already seen a therapist prior to coming to my office, regardless of whether it is required or not.”

The right therapist can have a lasting impact, as was the case for Alexis Lake.

“I had a really good social worker, Dr. Maureen Osborne, who I worked with for a number of years before it was possible for me to transition,” said Lake, who obtained her M.S.W. in 2009 and counts SSW adjunct faculty among her mentors. “She helped me decide that I wanted to go to social work school and be a therapist. She modeled what a good therapist is.”

Initially, Lake didn’t intend to specialize in work with trans/GNC clients.

“I was afraid of the bias I had of my own experience and getting in the way of other people figuring out their own path,” said Lake. “Over time, I figured out that my experience—not so much the details of how I did it, but the experience of how to do it—was actually helpful. People need a therapist who can hold their hand, hook them up with resources.”

“Currently, there aren’t enough trans/GNC-informed clinicians to meet the need, so that service gap encouraged me to stay engaged in micro social work with this population,” Weismantel said.

“I wanted to offer [clients] something that I did not have, which was a role model,” said Kelly Wise, M.S.W. ’12, Ph.D., who is based in Brooklyn. “When I was growing up, there were no trans people to speak

of. There was no one to look up to, no one to offer hope that you can live a happy and fulfilling life and be trans. All I heard were scary narratives about what happens to ‘those people.’”

“I have seen an increase in trans/ GNC people needing a therapeutic space in which their bodies and souls are safe,” said Danna Bodenheimer, M.S.W. ’05, who practices in Philadelphia. “This requires significant attention on the part of a clinician or an agency. The absence of these safe spaces is profound and troubling.”

Of course, gender isn’t always the primary or only reason trans/GNC people seek counseling.

“Some of my trans/GNC clients come in with gender identity as a presenting issue, but more often it is not the presenting issue,” said Bodenheimer. “Rather, they are hoping that a therapist can work with them in a way that decentralizes what they have experienced as a clinical fixation on their gender identity.”

Social workers need to be able to respond to changing therapeutic needs in trans/GNC populations—including trans-competence in working with children and adolescents.

“As people are coming out as trans or GNC at younger ages, I have seen an increase in the need for work with children, teens and their families,” said Weismantel, who started Gendernauts, a support group for trans/GNC teens that has been replicated around Chicago.

There’s an increase at the opposite end of the age spectrum, as well.

“The upswing in media coverage and representation of trans folks has also brought adults later in life into therapy to explore long-suppressed gender identity issues,” said Weismantel.

“Insurance companies starting to cover trans-related procedures has also really increased people’s need for therapy [to obtain necessary letters],” added Swanson.

Sennott also sees an increased need for competency in treating trans/ GNC individuals as part of larger family units.

“I am a couples and family therapist by training and have noticed that there is an increase in need for both types of therapy in the context of TGNC/

nonbinary experiences,” said Sennott. “Years ago, if someone came out as trans, it was an expectation that they would be shunned or have to leave their family, partner or children. Now that is not the case.”

Social workers also see a shift in nonbinary trans identities explored in therapy.

“I have definitely seen more self-identified nonbinary or GNC patients in the past five years,” said Nesteby. “Even people who are comfortable working with a binary trans person might find themselves feeling unsure when working with someone who identifies as genderqueer, agender, etc. It behooves us to learn more and get comfortable with nonbinary people.”

Brooklyn-based Kelly Wise, M.S.W. ’12, Ph.D. aims to be the role model for his trans/GNC clients that he once sought, yet never found, as a youth.

“We all have the freedom to do gender (or not do gender in the case of a-gendered people) in our own, unique ways,” said Weismantel. “That is a gift from the trans community to the cisgender population—the expanding of gender possibilities for everyone.”

The need for education isn’t limited to those who plan to work with trans/ GNC people. Nesteby feels that all care providers should be familiar with the basics of trans/GNC identities.

“Even if they don’t end up seeing many trans people, they may end up

seeing parents, friends or partners of trans people—and they will need to draw on that understanding and sensitivity,” she said.

“The bottom line is that ongoing continuing education is important,” says Lake, “even for trans therapists. The way I did it is not the way it’s being done anymore, and to be stuck in the old way isn’t providing real service.”

That also means that social workers should know their limits.

“If you don’t know what you’re doing, refer out,” said Lake. “It’s not fair to learn how to do it with the client.”

Beyond the individual clinician, there are other shifts in social work that are needed in the coming years.

“On the agency level, I have spoken with many clinicians who have all the skills and information they need, but the structures and policies of the agencies they work in prevent them from doing so,” said Sotomayor Fellow Shlasko. “Agencies are still largely built on the assumption that all clients— and staff—will be cisgender men and women, and thus unintentionally exclude trans people from participating in the full range of services available to cisgender people.”

“There is a tendency in social work—as in medicine—to prioritize the expertise of those in the field over the knowledge trans people have about their own experiences,” said Shlasko. “I would argue that the field needs to get braver in inviting trans social workers, as well as other trans people, with relevant expertise and skills, to educate social workers on the strengths, realities, needs and potentials of trans individuals and communities—even if it is not always comfortable.” ◆