https:/.../2019-03-01_CS_pt4.mp4

Hello, greetings.

You have found a clinician...

>> And a statistician.

>> Yeah. And this is in fact
the clinician and the statistician.

I'm Kirsten Bradbury, and this is --
>> I'm Greg Hixon.

>> Greg Hixon. And we're here today
to talk about another set of these

APA guidelines for practice.

And I'm really excited about this.

This is actually the third set of
these that we've done,

and this time we're gonna be talking about
"Guidelines for Psychological Practice".

This is the formal title, "Guidelines
for Psychological Practice

with Transgender and Gender-
Nonconforming People".

And this was published
by the APA in 2015,

and I think there's a lot of really
good stuff here.

>> Wow.
>> I'm really excited about this.

>> Oh that's good, that's good.

>> How are you feeling about it?
>> I'm glad you're excited.

I am nervous.
>> Nervous.

>> I'm very, very nervous.

The news cycle was not particularly
kind to me insofar as the preparation

for this episode is concerned.

'Cause there was something in
the news that kind of struck me

with respect to this, so uh...

>> There's a lot in the news about,
you know, transgender

and gender-nonconforming
issues right now.

What was the particular thing
that got you this time?

>> Well the thing that got me this time
is I don't know how many of y'all

follow tennis or anything like that,
but Martina Navratilova,

a very famous tennis player, one of --
probably one of the three greatest

tennis players in the history of tennis.

She's somebody -- she came out --
she was one of the best players

in the world in the 1970s, 1980s,
and came out as a lesbian back then,

of course long before...

(cross talk) She was actually -- she was
very pioneering actually, in that regard.

One of the very first people to come out.

>> So she's in the news related to
gender-nonconforming?

>> And recently -- yeah, now recently
she's -- she's been an advocate

for LGBTQ issues, you know,
for the last 30 years or so.

But she said some things in the last
couple of weeks

about transgender people and their --
how fair it is, whether it's fair or not,

I suppose, for them to be competing in
women's events like the Olympics

and other various international
competitions,

and she faced -- she has faced
a lot of backlash for her comments.

And I mean to the extent -- you know,
various folks are accusing her of

quote-unquote "not getting it,"
they kicked her off of various

advisory boards and so forth,
and I have to say, you know,

with that kind of thing as a
backdrop, it's like --

this is somebody who's actually lived
a life and actually has like three decades

or so of you would think relevant
experience and bank roll, you know,

banked up credibility and all that.

And if that can happen to her,
my goodness, what can happen to me?

I've got no bank roll, I've got no credit,
I've got no credibility

with regard to these issues, you know.

So I'm scared. I'm nervous.
I'm very nervous.

>> Well I can tell you that I'm not
feeling very nervous about this.

And I guess I come at this
from a really different perspective.

So my background in this, first I feel
like we should declare --

I'm cisgendered, I'm female,
I feel like I'm a woman,

and that's consistent with all of --
all the stuff is all consistent.

And that certainly doesn't give me
any epistemic privilege,

any ability to have any special
knowledge of gender nonconformity.

But I have been working with transgendered
and gender-nonconforming people

since 1995, and I have a lot of
pretty extensive professional experience

in this area at this point.

I kind of ignore the news cycle a lot,
so I don't -- I don't actually get exposed

to a lot of those kind of day-by-day
kinds of things that happen in the news.

But of course I'm very aware that this is
a very fraught topic right now.

And it's quite true that one of the
things I did to prepare for today

in terms of this project that we're doing,
and right, this class,

one of the things I did to prepare
was I sort of talked to kind of

every gender-nonconforming person
that I'm aware of knowing

and try to kind of get, you know, what
are their perspectives on some of these

different kinds of issues and guidelines
that we're here to talk about today.

And the thing of course that really
struck me about that,

and I wasn't surprised to find this,

was that actually there's a huge
diversity of opinion, right,

that there's really not just one way
that we would say that

transgender or gender-nonconforming
people think about issues of any kind,

including issues related to gender.

And that we have to be able to really
incorporate that diversity

into the way that we try to understand
what's going on with this topic.

>> Which is certainly something
kind of interesting.

I actually find, you know, this document
that we're discussing this week,

as well as the ones that
we've discussed elsewhere,

it's kind of interesting in a way that
it's basically, you know,

a prescription for a -- various,
you know, various types of people

or various categories of people.

But then everybody within that
is an individual,

and so you kind of have to
recognize that in how you're

approaching everything with them.

Now when you talked to every
TGNC person that you know...

>> Indeed.

>> Did you -- and got this
diversity of opinion,

how did you handle that?

Is that -- 'cause I mean the thing that
strikes me from the whole

Martina Navratilova thing is that
it's such a volatile topic,

people can get very -- people are very
animated, very emotional about it.

So how do you handle that?
Do you ever...

>> Well you know, I think your
general clinical orientation

will really help you here.

And you know, of course I think we're
mostly speaking to clinicians today,

and it is the case that one of the
things that I was really concerned about

when I first read through these
guidelines was that so few of us,

so few clinical psychologists are
apparently well-trained

in transgender and gender-
nonconforming issues, you know?

That they're really -- it's a minority
of us who are trained in these areas

in graduate school.

That's gotta stop.

This absolutely is -- in fact, we'll jump
to the last guideline first, right?

In fact yeah, the very last guideline,
guideline 16 in fact says

"Psychologists seek to prepare trainees
in psychology to work competently

"with TGNC people."

And this is -- of course
it's really critical

that as we're training to be clinicians,
we actually get the training

in these specific areas so that we're
not just kind of floundering around

and kind of guessing about what it is
that we're supposed to be doing.

And so I actually found that even though
I have quite a lot of experience

clinically in this topic, even for
somebody with that amount of

experience, there were some
good things in here.

And certainly if you don't have
extensive experience,

even if you have a lot of clinical
experience but you don't have

a extensive experience
working with this population,

I think that you'll find that these
guidelines are really worth a read.

I think it's about, what, 35 pages
of reading, something like that.

And they do really emphasize here,
you know, a couple of basic things

before we actually really jump in
in earnest these specific guidelines,

I want to make sure to mention that
they do of course draw the distinction

between standards and guidelines.

These standards of course are
consistent with the ethical guidelines

that are put out by the APA,

but they are not actually standards
in the sense that they are enforceable.

These particular guidelines for practice
are in fact aspirational.

These are things that they recommend
that all psychologists be doing,

but of course we would not say that
you necessarily have to be doing

every single one of these things.

Then they also draw the distinction
between practice guidelines

and treatment guidelines.

And I think this is actually an important
thing for us to mention just for a second,

and that is that the treatment guidelines,
treatment guidelines are going to be

client-centered, and are going to be
specific to a particular clinical problem

or clinical population,
whereas these guidelines,

these practice guidelines
are much broader.

These guidelines apply to education,
and research, and advocacy,

and all of the different activities
of a psychologist,

not just clinical practice, although they
do also apply to clinical practice.

And so I think that that, you know,
that's an important distinction,

especially because they pointed out
to us -- and I'm gonna go ahead

and read this bit officially.

They pointed out to us where we can
find treatment guidelines,

actual treatment guidelines,
not just practice guidelines, right?

But if in fact you're saying to yourself,
I need more, I need to really know

a lot more nitty-gritty specifics
about how to be a clinician

doing particular treatments with
individuals who are gender-nonconforming,

then you will want to seek out the
guidelines set forth by the

World Professional Association for
Transgender Health Standards of Care.

So they have these standards
of care that are set by

the World Professional Association
for Transgender Health.

This was published by Coleman and
colleagues in 2012.

And then also, the Endocrine Society.

The Endocrine Society also puts out
a set of treatment guidelines

related to gender nonconformity.

So if in fact you find yourself actually
treating, in clinical practice,

people from this population,

and you're not familiar with
these treatment guidelines,

I definitely recommend that
that be something that you do

to go out and expand
your knowledge that way.

>> That sounds like an awesome resource,
I'm glad you shared that with everybody.

>> Yeah, there you go.

>> If I could circle back for a minute,
you mentioned guideline 16

about you know, we need to train
the future generation of psychologists

in this area.

What fraction of the population
basically is in the TGNC...

>> You know, that's a
really good question.

They gave us a couple,
and I love of course

the statistician is going to pull us back
to a little bit of epidemiology

and that kind of thing.
>> Sorry.

>> No, it's good.
It's really important.

You know, and I think that it's -- they
really emphasize here in this document

that it's very difficult to obtain
an accurate estimate

of this population, right?

That counting them is really difficult

and that there are a number
of reasons for this.

And there are things that especially
researchers and other people

who are working in the social sciences
and working to gather data, right,

really need to think about how it
is that we're asking questions

about sex or gender, right?

That there are still way too many
research studies that actually have

the option is male or female.

Which are you? Check here.

And that particular way, of course,
of organizing things

completely makes
this population invisible.

We have no idea how many of them
there are if we don't even ask, right?

So they did say that it looks as though
we have at least 0.5% of the population,

something like this,

and that they definitely expect
that that's and underestimate.

Now, I think also you have to
think developmentally here,

and that this is one of the
number-one kinds of messages

that comes out of this document,

is that we really have to be thinking
about how transgender

and gender-nonconforming issues
affect people

throughout the entire lifespan, right?

So we have to have a lifespan
developmental approach.

And I believe this is actually --
one of the specific guidelines

is in there, right?
>> That is one of the guidelines,

that's like guideline 8
or something like that.

>> Yes, indeed.

That's right, is to have this specifically
lifespan developmental approach.

And I do find that -- I do believe that
we are seeing an increase,

and I think that the data will
bear me out over time on this,

but that we don't have
good data yet on it,

that we really are seeing an increase
in the number of people

who feel comfortable
to identify in this way.

That we are going to see increasing
prevalence estimates still for a while,

partly in the same way that we saw
increasing prevalence estimates

of sexual orientations other than
heterosexual for quite a long time

when we started to really kind of
cross our T's and dot our I's

on that type of social science research.

We really started to get an expanded
understanding of how many people

started to feel more comfortable actually
telling us that they're in those groups.

So I really believe that
we're gonna start to see that.

I also see just from
my own clinical practice,

you know, I work with
adolescents a great deal.

And I see quite a few now who
really have a very different

conceptualization of gender entirely.

And that actually feels to my like one of
the most important things that this

set of guidelines brings us to,

and for a conversation that really
does need to happen,

sort of boils down to this idea of
gender as a non-binary construct.

I am finding that many of the
adolescents that I work with

come to this idea very easily.

Much more easily than their
parents did,

that the idea of gender as being
non-binary,

the idea of gender as being
non-categorical, actually.

As just being a continuum, right?

And so here we are wandering into a
statistical construct for sure.

You know, right? Like there's this
continuum of gender,

and we would say that there are
all these different points along it,

and that we've kind of clustered
together several of these points

and have kind of put them
into categories, right?

But that those categories
actually are artificial,

that they don't actually represent
the diversity that exists

along that continuum.

>> Right, I mean you know, if you're
going to think about it sort of

in a dimensional sort of statistical
kind of way,

I mean I think it would be a legitimate
question to even say

is there even just one dimension there?

There may be multiple
dimensions at work here.

So -- but that's great that it's actually
a conceptualization that seems to be

coming more naturally to younger
people nowadays than ever.

>> Well I think that they have --
you know, this to me really brings us

to guideline 1.

So let's step back for a second and --
before we launch really into describing

fully guideline 1, I do want to
mention that this --

I feel like these guidelines were
particularly well produced,

that they're very well organized,
that it's very well written,

and I was really kind of impressed with
the composition of the committee.

I felt like they did a much better job
of really attending to the idea

that in fact people who are sitting
on this committee and who are

charged with coming up
with these guidelines,

that we need to have significant
representation of people

from that actual population.

And I believe half the committee actually
self-identified as being transgendered

or gender-nonconforming.

And so that to me was a huge advance,
was something that I was like oh,

we have got to see that.

That's really good that the
committee actually did that.

>> That is really good.

I did not focus for even a second
on the composition of the committee,

but I will -- I'll echo
exactly what you said.

I actually found this document to be
much, much better structured

than the others, which were fine
I suppose, but --

>> Yeah, they were okay.

>> But just in terms of the content
and the structuring of this one,

this one seems to have a lot more --
it's really got it together

and it's really, really a very
worthwhile read, I think.

>> I think that's right.

And you know, the piece here,
the other kind of element of that

with the quality of it has to do
with the research that they looked at.

And frankly this committee had the
hardest job, I think --

>> Yes.
>> -- of the three, right?

In terms of like, how much research
is actually out there.

And yet I feel like they did a really
good job of finding all of the resources

that they could to really give us really
good quality information about that.

>> Right. And they do make an
excellent point about that in here.

There's a good paragraph
or two frankly about the --

I mean, this is kind of
a new area of research.

I mean you talked earlier about training
the next generation of clinicians

and researchers and that sort of thing.

It's a very new area of research,
and so they actually pointed out

that you know, in many cases the
number of studies is kind of small.

Sometimes the nature of the studies
themselves, they're kind of low-end

studies inherently, because we're
dealing with a fraction

of a percent, maybe,
of the population. Right.

So you've got to work with, you know,
who you have access to.

And so it's small ends.

And of course you can't have random
assignment and that sort of thing

that we really like from sort of an
experimental research perspective.

We love that sort of thing, and we
sometimes get it in many other

areas of clinical practice, but it's not
something that we can rely on here.

>> This is a lot more
observational, I think.

>> Exactly, exactly.

So even though they -- they authors
here clearly had a much more challenging

job dealing with what is a relatively
small amount of research

and research that is in many cases
based on small ends and observational

and whatnot, they really did
an excellent job, I think,

organizing it and outlining it
and framing it for us.

So are there some --
>> So let's jump in.

I want us to talk about these
different categories first.

So one of the things that they did
that were really good organizationally,

I thought, was that they divided
the different guidelines,

and there are what, 16 guidelines I think.
>> 16.

>> We got some chunky list of
guidelines there.

Those 16 guidelines
are actually categorized

into several larger categories.

And so I want to go ahead first
and just tell you what those

different categories are,

because I think that that's
really important.

They did really a great job with that.

So the first category is foundational
knowledge and awareness.

And in fact there are several guidelines,
four guidelines that fall under the

foundational knowledge and
awareness category.

Then after foundational knowledge
and awareness,

they have three guidelines on stigma,
discrimination, and barriers to care.

Obviously three very important topics
having to do with this population.

Then they have a whole category on
lifespan development

that also has two different guidelines
underneath -- you know,

sort of subsumed within it.

Then we have the category assessment,
therapy, and intervention.

Obviously I think a very useful
category for our audience today.

This was definitely a category that I
was like ooh, I want to get in there

and know what all those guidelines are.

And then of course we have research,
education, and training.

And those are where the last two
guidelines are contained.

And so I think that, you know,

even if you don't memorize
every single guideline,

one of the things to really
notice is that they really are

emphasizing these different areas
of knowledge, right?

That you really need to have some
foundational awareness,

and there this is where this whole
concept of gender as a non-binary

construct comes in.

That is guideline 1.

Guideline 1 says,
"Psychologists understand

that gender is a non-binary construct

that allows for a range
of gender identities,

and that a person's gender identity
may not align with sex assigned at birth."

Now, this sounds very basic.

And it is, right, in the sense that
it's very foundational.

And I like the fact that they call it
foundational knowledge and awareness,

because if you don't have this in place,

something really basic
needs to happen

before you would really be competent
to work with this population.

This population is heavily stigmatized
and harmed by the idea of gender

as a binary construct,

and so it would be really
bad for them if in fact --

you know, really harmful and
potentially even iatrogenic, right,

where you're actually providing
harm in an attempt to help,

if in fact you take gender as
that binary construct

and you present that way of
thinking about it,

that worldview on gender
as being the correct one.

And so I think that this is, you know,
obviously something that

most of the people who have come
to us today to listen,

I think are already going
to be there, right?

>> I would imagine so.

>> Preaching to the choir
there a little bit.

>> But if you're not,
it's time to get there.

>> It is time to get there,
that's exactly right.

And this very much brings us to the other
guidelines within that category, right?

So guideline 2 says that
psychologists understand --

it's another knowledge-based,
another understanding-based guideline --

that we understand that gender
identity and sexual orientation

are distinct but interrelated constructs.

Now you know, this is definitely something
that kind of feeds us back into

your conversation about
Martina Navratilova, right?

Because of course she was out
as a lesbian,

not necessarily out as a transgendered
or gender-nonconforming person.

>> Correct.
>> But in that era,

to be a female tennis player
playing the way that she was,

I think she was often viewed as
gender nonconforming.

That there's even a way in which it
was like, threatening to people.

They would think of her as like --
>> I think so, yeah.

>> Right, as kind of a half woman,
half man kind of thing in some way.

Which is of course not fair to her, she
gets to determine her own gender identity.

That's not up to us to do.

>> It was actually a different tennis
player that got called a half man, but --

Was that Amélie Mauresmo?

I'm sorry, but...
>> Wow.

>> Yeah, actually Martina Hingis

who was the number-one player
in the world at that point

when Amélie Mauresmo was an
up-and-coming promising player,

and ultimately Amélie Mauresmo won
a couple of Grand Slam tournaments,

but Martina Hingis said,
after losing to her one time,

she said it's not really fair to play
against half a man.

>> See? This is where we go.
>> Yeah. But that's right, it's --

>> The stigmatizing aspects of this
whole thing are just constant

for people in this population.

Like, I feel like it's very difficult
I think for cis individuals

to really even understand how much
stigma they encounter.

Of course, and this is going to be
coming up in our whole category

of stigma, discrimination,
and barriers to care, right?

So guideline 3 says that psychologists
seek to understand how gender identity

intersects with other cultural
identities of TGNC people.

And this is something that comes back
to definitely a commonality

in all of the different guidelines
that we've seen so far,

that they really emphasize for us,

that this particular thing that
you might know about a person

is only one thing to know about them,

and that you have to overlap that
knowledge with other categories

that they might be in.

And particularly, of course, transgendered
individuals are already going to be facing

so much stigma and so much
discrimination

that we really have to be cautious about
things like double jeopardy.

That the fact is that if in fact you are
also a person of color for example,

if you are also poor, if you are
also less educated,

if you are also in any of the more
stigmatized categories

demographically within our culture,

this is also something that can absolutely
make life much more difficult for people.

>> Yup. The interaction
of all those different identities.

>> That's right, exactly.

All right, and then last but not least
within of course our first category

of foundational knowledge
and awareness,

which really to me in some ways
is the most important category.

Like, this is where
we talk about attitudes,

this is where we talk about the fact
that the worldview has to be

a safe worldview that the clinician has.
>> Exactly, right.

I mean if you don't have
this particular kind of worldview,

this broader understanding,
a more modern understanding

of what gender is all about,

then you really are not in a position
where you're going to be able to offer

appropriate services to people.

>> That's right. And where I think
you're going to end up being

inadvertently stigmatizing,
you know, really frequently.

So if any of these guidelines,
these first ones that we're going over,

if any of these really land you hard,
I definitely think that a personal

exploration process is probably
one of the best concepts.

A little therapy might be a good idea.
>> What a wonderful way to put that.

I like that. I like that a lot.

>> And then here's this last one.

"Psychologists are aware of how
their attitudes about

and knowledge of gender identity
and gender expression

may affect the quality of care
they provide for TGNC people

and their families."

So this of course kind of
opens us (inaudible)

not just for the individual, right?

Because of course the TGNC individual
needs to have good, responsible,

and non-stigmatizing care.

But it also is mentioning their families.

And this is the first moment within
the document where we actually say,

notice that that stigma is going to
also affect the other people

who are related to this person.

That in fact this stigma could affect
the children of these individuals,

could affect the spouses
of these individuals,

could affect the parents and the sisters
and brothers, and you know,

all the people who are close
to these people.

>> In fact it's almost
guaranteed to, right?

In a way that some of the other
things that we have discussed,

you know, girls and women,
men and boys --

>> That's right, all these social forces.
>> Yeah, this one is almost guaranteed

to be a very significant influence
on the entire network of relationships

that a person is in, right?

>> That's right. I think so much so
that one of the things

that they do emphasize,
and I'm glad that they do this,

is that they emphasize that being
transgendered or gender-nonconforming

is not in and of itself
in any way pathological.

>> Right.

>> There's nothing about that that
we think actually needs fixing, per se.

But instead that we really are more
focused on the problem being outside

of those individuals.

That the problem is how
they're treated, right?

>> Exactly. It's how the world
interfaces with them.

>> That's right.
>> Not that it's an inherent problem,

but it's -- yeah, it's the
interaction of the world

and what the world essentially
impinges upon them in various ways.

>> Yes. And so I think that that's one of
the ways in which the whole diagnostic

question starts to come into play, right?

And it gets to be tricky,
because of course the individual

is who is being labeled clinically, right?

It's the individual symptoms that are
being labeled of course,

not the whole person themselves.

But it's those symptoms
of distress, right?

Like, I feel distressed because my body
is not consistent with my gender identity,

or I'm receiving stigmatizing signals
from outside, or both, right?

And that both of those processes are the
ones that are actually being labeled

when a person comes in, right?

So if we say that someone has
gender dysphoria,

gender dysphoria is the gender
diagnostic label that clinicians use

to describe this
particular set of issues --

then I think there really is
understandably a kind of a set of people

who would say, and this is only, like
we said, one thread within this community,

it's a diverse community with lots
of different points of opinion.

But there are people who have said,
you know, labeling us in this way

is not fair.

You can say of course that you're
labeling our symptoms,

that you're not labeling us
as individuals,

but it is nonetheless the case that
we're the one who's receiving kind of

a label there, when if you're saying
that there's nothing wrong with us,

how come we get the label, you know?
>> That's right.

>> And I think that that's important,
that it is important for us

to be sensitive about that,

and that there are actually many ways
to label issues having to do

with gender nonconformity.

For example, my fellow
clinical colleagues,

you will know that adjustment disorder
diagnosis is also something

that could potentially be used
as a label to describe the stress

that the person is experiencing

in terms of adjusting to
a particular set of stressors,

especially if those things
are short-term

or if they are long-term things
that are ongoing

and are still impinging on the person.

So this is an example of a very
non-stigmatizing diagnosis

that can also potentially capture
some of the elements

of what you're trying to do.

And there are a lot of different issues
related to whether you would use

a particular label with an individual,
both having to do with whether

the person can actually get
insurance coverage

for the things that they're actually
looking to have treated,

and then also whether that insurance
coverage will be considered to be relevant

to what it is that you're
trying to accomplish.

>> My goodness, yeah.

I didn't even think about the whole
insurance angle, really.

I mean, I guess that's something
you all have to watch out for, yeah.

>> We do sometimes.
Absolutely.

Especially if it's something --
for example, for a long time --

and this is something that's changing,
and thank god it is changing --

but for a long time, individuals
who wanted to actually

medically transition their gender,

who wanted to start taking hormones
or have surgeries

or do other things like that,

those individuals actually had to develop
an ongoing therapeutic relationship

with someone in my category or some
other licensed mental health professional

in order to eventually get a letter,
usually after about a year,

that actually said, mother may I?
Yes you may.

Go forward with this,
I support this transition,

this is the real thing,

would be required in order
to validate this as an actual purpose

for that type of treatment and
justify that type of treatment.

Now like I said, luckily we're starting
to get away from that.

>> Yeah, is that changing?
>> It is starting to change,

but I've still had to write these letters.

I mean -- you know, I've been in
practice for a while now of course,

but I think the most recent of these
that I wrote was just a few years ago,

you know, that way.

And that it does grease the wheels
with the insurance comapny

and all of that kind of thing.

So I think there really are still
a lot of issues,

that this is definitely a population
in which we're really far behind socially.

You now, that there's this way in which
I'm like, we got some real change

we still need to make here.
>> Yeah.

>> And that's one of the
reasons why I was really glad

that they talk about advocacy,
you know, as part of the process here.

So, this is our first category.

Foundational knowledge
and awareness, right?

And we have to be aware of how our
own attitudes are going to affect us.

Now, this I think really does pertain
to the other stuff we already talked about

with these different guidelines, right?

Obviously if you are man-hating
and you can't stand men,

and you're like, "I feel
uncomfortable with men,"

you know, being their therapist
might be kind of an issue.

That's something that we
want to think about.

Obviously if you have feelings that are
negative toward a whole category of people

in any way, whoever
that category of people is,

we really want to think about how
those attitudes could really

be dangerous to our clients.

I always say this to my trainees,
I'm like if you don't like kids,

no, don't go working with kids.

There are other populations
that you can work with

that are maybe populations
that you do like, you know?

So I think that this is one of
the ways that I think about this.

>> And you know what, that actually
raises one of the questions

that came to my mind as maybe
kind of a reverse of what you might

really want to talk about with
respect to this.

But how do you go about then
working with somebody who's maybe

anti-TGNC, or...
>> Oh yeah.

>> Has the antiquated set of
attitudes.

Because I mean, yeah.

I mean really this whole document
actually focuses on working with

this particular community,

but how do you work with the folks who --
>> Yeah, with the anti folks.

>> Anti, yeah.
>> People on the wrong side of the fence.

Yeah, and --
>> There's clearly --

there's going to be a mismatch
between your attitudes as a therapist

and I would presume then the attitudes

of virtually every therapist
who's watching us.

>> That's true.
>> And the client. So what do you do?

>> Well there's a lot of opportunity here,
right, for us to think about this.

So in any clinical situation you can
end up having to work with a client

who has discrepant values from yours,

and this is something that
clinicians are trained in,

that we're not going to be able to
just avoid anybody that disagrees with us

or whatever, as far as that goes.

So it's quite true that you do bump
into people like this.

And there are -- there are
kind of two big factors

that I think about most of the time when
I'm working with this particular issue.

One is to make sure that you're
thinking about the context.

You know, whoever that person is
who's disagreeing with you

or presenting these really negative
or potentially toxic kinds of views,

whoever that person is,
they're probably your client,

which means that actually your
responsibility is to that person

primarily in this situation,

and you need to keep your eyes on what
the clinical needs of that individual are.

It may be that gender nonconformity
isn't actual the relevant issue

for you to be talking about.
>> Right, right.

It almost certainly isn't.
>> Well it depends, you know.

And sometimes it's the case that if
in fact the person's views

might be really important for you
to get in for their sake, right?

So if in fact you have a lot of
discriminatory views for example,

and you kind of go around being
maladaptive in the way that you behave

about those views, and get yourself
into fights or that kind of thing,

then that could be something
that I could absolutely say like,

"So, those views seem to be causing
you some trouble," right?

And then it would be about the client
and about that client's needs

in terms of what's best for that person.

So you can go that way with it.

And then the other way
to think about this is that

one of the things I love
about being a clinician

is that I actually have the opportunity to
influence people's views on lots of things

lots of time.

And you can -- you go toward that
in as gentle a way as possible, right?

Like, you're building
a relationship with a person,

you want them to be able to trust you,
you want them to be able to know

that you're not just going to stigmatize
them for their ideas in this sense, right?

But that instead you're going to be
able to work with them even though

you have these differences.

And that when you get to the point
of being able to -- for them to see

that actually you are working with them
even though you have these differences,

that level of tolerance
is just sort of a basic thing

that then opens all kinds of things up.

And it is quite true that I've had
a number of experiences where,

especially when you work with families,

where you are able to really shift
people's opinions about this stuff.

People are not well educated about it.

You know, there'll be lots of people
our age for example

who have not been trained in any way,
have not been involved

in the social sciences or whatever,
and they'll come into a situation

where the first time that they're
even thinking about gender

in any way other than just the
received way for their generation,

whatever that was,

is because a child in their family
is bringing something up, right?

And so they'll come and find me
as a child clinician and say like,

"Ah, what's wrong with this child?"
You know, that kind of thing.

>> And then you have to go through
a real process then of sort of

subtly educating them or bringing
them around --

>> Yeah, working with these
foundational issues, right?

And actually saying, okay, the
foundational knowledge and awareness

needs to be here for this family, right?
For these parents in that sense, right?

>> What a challenging job.

Once again, in almost every
one of these I get to say

what a challenging job you all have.
>> I really just bring him here

to validate all of you.
>> I think so, yes.

So let me once again say, if I don't get
another chance in this particular hour,

y'all have an extremely challenging --
you have chosen a very challenging

career path for yourself.
>> It is challenging, but the piece

that I want to make sure you
really do hear

is that it's also just so rewarding.

You know, it's one of those things
that's just an incredible opportunity

every day to get to actually get
that close to someone

and be able to really influence them
in a way that's positive

and helpful for their entire
development, you know?

That kind of thing's really rewarding.
>> That would be very cool.

Yeah, that family that you just sort
of mentioned, you know,

where hopefully you bring them
to a more well-educated place

where they're all more accepting
of what's going on.

That is a wonderful feeling.
I never get that.

I never get that feeling working
with the numbers that I work with.

>> Not so much (inaudible) consultation.

And that actually really kind of segues
us beautifully into this next category,

right, of stigma discrimination
and barriers to care.

Because it's quite true that
even though it's difficult,

actually I find this particular population
to be incredibly easy to work with.

And part of that is because you're
really dealing a lot of the time

with individuals who have bumped
into elements about themselves

and elements about the world
that help make them wise,

you know, that there's a lot of that.

And then there's also the fact that
you can see a lot of teenagers

like lots and lots of them will come.

There's so much -- the stigma and
discrimination is so blatant,

it's so big, it's so horrible every day
that you can actually provide

a soothing environment for somebody
just by being accepting of who they are.

Like literally just by being like,
"You are welcome here

and I have no problem with who you are,
and just be here on my couch

and let's talk for a little while,"
you know,

that I find this population incredibly
rewarding to work with on that basis.

>> Well you know what, and you just
said something that validates me,

which is nice.

Because I have thought for the longest
time that many of the transgendred

nonconforming members of that
community that I have encountered

in my path through life are some of
the most well-adjusted people.

And I've always said, I've actually
always said I think the challenges

that they have to deal with, you know,
sometimes in their adolescence,

some times later on,
whenever that happens,

you know, seems to --
>> Make them strong.

>> Yeah, I guess what doesn't
kill you makes you stronger.

I guess that's an old saying, but yeah
that's been an observation that I've made.

And I'm obviously a nonprofessional,
but to hear a professional say something

like that is actually very reinforcing.

>> Well I think there are two,
you know, there's another concept

first to bring here, and the fact
that you say like what doesn't

kill you makes you stronger,
you know,

this is an incredibly
vulnerable population.

The rate of suicide, I mean,
it's difficult to estimate accurately.

It is certainly very high.

And when it comes to things like,
you know, how many of these people

report having had feelings
of suicide, it's through the roof,

it's normative, you know?

And so I find that that level
of stigma and discrimination,

it does get internalized,
and that there is a real need.

That pat of what you hear me saying
is that as a clinician I have a softness

for people who have been harmed,
and there is definitely a lot of that.

The trauma load for people in this
population is just incredibly high.

The number of risks that
they face every day,

not just in terms of the security
of their person, right,

their physical safety,
although that is a real concern,

but also in terms of just
the safety of ideas,

the safety of being able to express
yourself, self-expression, you know,

all of that, these things are --
really do impact the mental health

of this population extremely,
and is something that I do believe

that we need to have sort of
normative interventions,

you know, out there.

Like socioemotional learning
interventions in schools,

that kind of thing, in order to try to
normalize for children in this population

and adolescents in particular
in this population.

That actually this is something that we
expect them to bump into issues,

you know, that it's like okay,
we can help you with this.

This doesn't have to be
something that destroys you.

>> Yeah, it does strike me that
this actually -- this is a group

that actually -- it's almost still --
society still almost has an active

element of discrimination.

It's almost accepted --
>> Oh, it does.

>> I mean -- but there are elements of
society where it's mainstream,

kind of almost accepted in some ways

to discriminate against this
particular group of people,

where as I mean, discrimination
against women is officially illegal

and society is kind of coming around.

>> I hope so.
>> And racial discrimination again,

illegal, and you hope society's
kind of coming around,

and I think we make progress in
those areas all the time.

This seems to be -- I mean to my
observation it seems to be behind.

>> Yeah.
>> So the level of discrimination,

I think that -- and stigma that this
group faces is substantially higher.

>> Well, and there's so much
ignorance still about this category

that even inadvertent stigma
happens really a lot, right?

So just the microaggressions alone
that people experience,

you know, every transgendered client
that I've ever worked with

has had some issue around pronouns,
around being called ma'am or sir,

and you know, we're in the South, and
this is definitely a form of being polite.

That there's a way in which people are
trying to be polite actually,

when they say "yes,ma'am" or "no sir."

But that actually of course people
who are gender nonconforming,

a lot of the time it's not just that
you're going to choose the wrong one,

but that neither one of these labels
works for them anyway.

And so I think that, you know,
that that's something that actually

the stigma and the discrimination
happens both from people

who truly have an internal sense
of discrimination against these people,

who really are hostile to this population,
and that is pervasive and is real,

but then there are also a lot of people
who are inadvertently harmed

by those of us who are just being idiots.

That we just don't know what
we're doing, you know,

and that we make these
microaggressive kinds of mistakes.

So I think that this is something that,
you know, if you've even worked with

a few transgendered or gender-
nonconforming individuals,

it is so pervasive that it is by far
the ubiquitous kind of experience.

>> Well even the language, I mean you
mentioned language and the pronouns.

I mean, even the language, the English
language is very gendered.

I mean, there's he and she,
and I mean there's --

>> Yeah, what, "it"?
That's not an option.

>> It -- yeah. "It," I mean I guess from
a linguist's perspective

is intended for inanimate things.

So there is no pronoun for a non --
you know, for a non-binary

gendered person, so the whole --
and language shapes how we think.

>> Yes it does.
>> So it's --

>> I think this is actually one of those
issues with "they," right?

So like, "they" seems to be the one
that overall we're kind of most

getting comfortable with.

Certainly it's now allowed
to be used as a singular pronoun.

Definitely any of you who happen
to be teaching writing out there,

okay, note that this is one of the ways
in which -- this is a good example

of one of those inadvertent kind of
microaggressions that happens out there.

There are still many students who are
being told, when they write a paper

and they use "they" in the singular,
they're being corrected.

They're being told this is not
appropriate grammar, right?

That you can't actually do it that way.

You can. That is officially now the case.

Go ahead and look it up in the Oxford
English Dictionary, it is there.

>> No way, really?
>> Yup.

>> I did not know that.
>> Absolutely, it is now considered

also to be able to be used
as a singular pronoun.

>> Excellent.
>> So -- right.

So progress does get made.
>> There's some other alternative

pronouns...
>> There are some other alternatives.

>> I mean this is actually --
it's kind of strange, it's kind of

an evolving thing, right?

Isn't there like a T-E
or Z-E or something?

>> Yup, "ze" is a pretty common one.

I have one client who prefers
"ze" as their pronoun.

>> Okay.
>> Ze's sir pronoun.

It's always very difficult for me.

Ze is definitely one that I feel like
this is a place where I can start

to get, like, old school
and stumbly, right?

Where I'm like, I do not want
to be one of these people

that inadvertently harms these folks.

I have no desire for that.
>> I don't either.

>> I want our language
to figure itself out

and actually get this worked out.

But it is incredibly hard.

So I find that the "they" is the one
that seems to culturally

be settling in the best,

but that we still have these issues
of like, how do you find out who's --

like, what pronoun people should
be using, right, and that kind of thing.

And there's some debate about that.

My -- when I was looking into this
before we were coming in

to do this today, I did ask a little bit
like the faculty innovation center

for example, and the gender
and sexuality center,

they have various bits and pieces
that they can send

out there to the faculty and to
other people who are interacting

with younger people.

Like, what -- what are we
supposed to be doing?

>> What are we supposed to be doing?

>> And what they say, and this is
consistent with these guidelines,

is because stigma and discrimination
are still so incredibly pervasive,

what you have to really do
is put out there very openly

that you are not in that category.

There have to be ways
that you are saying,

"I'm not one of these stigmatizing people,
I'm not interested in harming you,

I'm interested in using
the correct pronoun,

what is the pronoun that each student
in the class wants me to use?"

That kind of thing.

That that is absolutely
still being recommended.

Now of course we have such large classes
sometimes that that's not going to be --

>> Yeah, that's not going to be
a practical matter in a class of 300.

>> But that in fact, depending on what
it is that you're trying to do

and what the actual nature of
the pedagogy is,

that you really do want to be being
very deliberate about this.

You want to be being very open about this.
Very declarative, right?

That it is part of the way that we have
to advocate for people who are

in an invisible population, is by
being able to say like,

actually I'm visible, I'm not a member
of the invisible population,

and I'm going to go ahead and point out
that these people are invisible.

So I'm not going to just assume, actually,
and assumptions are often a form

of microaggression, right?
>> Sure.

>> I'm not going to assume that the people
in this room that I'm speaking to now

are actually cisgendered individuals
and force the other people who are not

to somehow then make some
declarative statement

and kind of out themselves
in that way, right?

Instead, I'm going to make a declarative
statement that says everybody can choose

their name, everybody can
choose their gender marker,

everybody can choose their pronouns.
What are yours?

And that it should be just as required for
somebody like me or somebody like you

to declare our gender pronouns
and declare our orientation that way

so that it's not just the people who are
in this category who have to do it.

Because that then ends up being
stigmatizing if they're the only ones

who have to do it.
>> Hmm. Interesting.

>> Right, and so this is definitely --
you know, kind of touches back

to those issues having to do
with sexual orientation

and that kind of thing too, right?
Because --

>> So this is -- so you
should always ask?

>> No, I think you should never ask.
>> Never ask.

>> Like that's part of
what's so weird, right?

>> Oh -- so wait, okay, so maybe
>> So like you don't just like

walk up to someone and be like,
"Hey, what are your gender pronouns?"

>> Make an open environment
for people to self declare?

>> That we do it, right, and that it's
modeled that way so that,

you know, for example we would say
everybody's email signature --

I still haven't done this on my
email signature.

>> I haven't either.
>> A little bit of guilt, right?

But I see it, right?

And this is one of the recommendations
that they're making to us now

as faculty members, is go ahead and
actually underneath your email signature,

just put what your pronouns are.

And the more people like
you and me resist doing that,

the more it is that it's only the people
who have some "reason" quote-unquote

to need to declare their pronouns,
right, that we're able to sit

in this more comfortable
privilege that we have

of not having to declare
our pronouns, right?

Nobody's ever asked me
what my pronouns are,

I bet nobody's ever asked you
what your pronouns are.

>> No one has ever asked me
what my pronouns are.

>> Right. And by definition I think that's
because we're putting out gender signals

that other people are just
taking at face value.

That there isn't anything about us
that are making them go like,

"Hmm, wait, what pronoun do
you want me to use?"

And that process of trying
to figure out, "Hmm..."

That in and of itself is going to be
a stigmatizing process.

>> You know, as a bit of
a thought exercise

leading up to our time here today,

I actually thought -- I was thinking
about this whole pronoun issue

and the whole thing --

I assume, I assume that I am referred to
as "he" and "him" and that...

>> That's a safe assumption.
>> But I don't recall --

I honestly don't recall ever having
heard that myself.

I mean, from anybody else.

>> You've never overheard
yourself being talked about?

>> I don't --
>> You'll have to go back to childhood.

You will have had lots of memories
of this in childhood.

Think of a, uh...

Think of a parent-teacher conference.
>> I get to go into therapy.

>> Okay, parent-teacher conference time.
>> Right here, live. Okay.

>> It's only therapy if we have a
therapeutic relationship.

No signed and formed consent form.

>> I'm sorry, my parent-teacher
conferences didn't involve me.

>> So you weren't there, yeah.
>> I wasn't there, no.

>> Children get talked about
in the third person a lot,

and so that's one of the times

when I promise you you were.
>> In their presence?

>> Sure, I promise you you were
talked about in the third person

in a way that identified you as "he."

>> Okay. And I just kind of ingrained
that, incorporated it or whatever.

>> Have you ever been
referred to as "she"?

You would remember that, I bet.

>> I don't think so.
But I don't --

>> I bet you would remember, you know?

>> I don't know, I kind of assume not.
>> Yeah.

>> But I don't hear the pronouns
by which I am referred.

>> Whereas every transgendered person
that I know and have talked to would say

this is a perfect example
of epistemic privilege.

I promise you you have heard your
gender pronouns a thousand times,

a million times, but they were
never inconsistent to you.

They never caused cognitive dissonance.

There was never a way in which you went,
wait, that doesn't describe me.

That shouldn't be me, right?

And instead, I'm sure I've heard my
gender pronouns a thousand times,

right, and it doesn't mean anything.

Whereas everybody that I've worked
with who's in this population

that we're talking about today
would say,

well yeah, I can still remember when
I became aware of the fact

that I was being called
this instead of that,

and that that name didn't work for me,
or that gender pronoun didn't work for me.

That there will be many,
many opportunities

to bump into the fact
that it doesn't work.

That it's because it does work
that it's invisible to you.

>> That's kind of cool.

I mean yeah okay, that's actually --
this is actually super helpful.

(laughing)

>> We hope it will be.
It is intended to be super helpful.

>> Honestly I -- you know, it almost
makes me tempted to kind of

do a little experiment, just tell all
the people around me to just --

when you're talking about --
refer to me as "she".

Just do it. And I don't know... I don't
know what that would do.

I don't know if I'd ever
hear it or whatever,

but do it for a week or whatever.
>> I don't know how people would

respond to that, what a great question.
>> Oh, I don't know either.

But I mean it'd be kind of
an interesting thing.

But you know --
>> Well you do that,

and then we'll do a follow-up.

>> Well yes, maybe we'll do
a follow-up or something.

>> We'll do a follow-up on that.

>> But can I just -- one other thing.
I don't -- in my own head,

I don't think of myself as a he
or a she most of the time anyway.

So I think of myself when I go teach,
or I think of myself when I come here,

or I think of myself when I go play
tennis, or brush my teeth or whatever,

it's not a -- I don't think of myself
as a "he" doing all of those things,

I just think of -- I think of myself
as a "me".

And I mean, and all those things --
>> That sounds privileged.

>> Well possibly. I mean, I don't --
>> I think it is.

I mean, I think it's one of those --
>> If I think of myself as a me --

>> Well no, because masculinity
historically has been the neutral.

It isn't anything. It's neutral.

You are "he," and that could
apply to any person,

it could apply to God,
it could apply to --

Like, "he" is not even a thing, right?
It's the neutral, that then we are

the derivative of.

>> When you brush your teeth,
go play tennis, go teach,

do you think of the person
that's doing that as "she"?

>> Yes.
>> You do?

>> Definitely.
>> I wonder --

>> This is actually --
>> Everyone write in and tell us --

>> We don't actually even have to
wonder about this.

It's actually talked about a lot, and
there's a whole literature on this, so...

>> Not in statistics.
>> No, that's correct. Not in statistics.

>> So please tell me.
>> In clinical psych.

And then also in sociology and
in women's studies

and in other areas like that where
this is actually an examined topic.

It is the case that gender identity
is very different

for people who are put in a privileged
position in whatever society.

So if in fact you're given privilege
related to your gender,

and particularly in our culture
and historically for a long time,

male gender has been
viewed as the neutral.

I still remember, it was certainly
within my lifetime

that we were still writing texts
and papers and so on

that you could use "he" as the,
quote, "neutral" pronoun

that would refer to any human being.

That was completely acceptable.
>> That's been in my lifetime, yeah.

>> Right. And so that's just an example
of the way that kind of thing worked.

When I was --
>> I didn't realize that that actually

was like internalized to that degree.
>> Well said, it is.

That's exactly right, it's internalized.

And so your gender identity
is able to be neutral.

Now, it's not always the case, I think,
that men are always given that privilege.

I think there are lots of other men
who might have more conflict

with their identity in whatever way,
and that's not to say that that's not

possible to have that happen.

But when you speak like that,
it's definitely the case that I'm like,

that's not a new idea.

That's something that actually has
really been looked at a lot

and that we would say that of course
I'm aware of my femaleness

because it has been handed to me
as an important aspect of who I am.

That there's some way in which it
categorizes me and makes me

into a different category
than otherwise, right?

>> But my maleness makes me into
a different category in the exact same --

basically a parallel way to you.
>> The way to think about this would be

that you're male and I'm not male.

Not that you're male
and I'm female, right,

but that you're male and I'm not male.

And that that would be the male,
not male, and it's the opposite of, right?

And that that maleness
is considered very standard.

Now, that's not to say necessarily that
this exactly what is impinging on

your personal experience, because
actually this isn't Greg's therapy

even though it does
kind of seem like that.

But it is the case that this is one of
the ways in which I think

it's particularly dangerous
for those of us,

you know, whatever areas in which
we have been privileged,

we have the danger of not having
the epistemic privilege of being able

to see what the other experience is.

>> You do never -- you never get to
live in somebody else's shoes.

Never. I mean, and you know...

>> Which is why, you know, really what's
very protective for somebody like you,

it's much more being able to come
and say like, so what's that like?

And that sort of questioning stance,
that sort of like, I'm aware of my

lack of knowledge, definitely feeds
into, I think, this whole concept

that they're talking about here
with these guidelines, right?

That being assumptive and actually
saying like, "I know who you are,"

that's very dangerous, with anybody.

And that clinically speaking,
we want to be actually saying,

"Hey, I'm here to learn
about who you are.

"You're here to teach me
about who you are."

Now, one of the things that they
do get into about this though

is that especially with people who are
entering into these transitions

or people who have backgrounds
that have been particularly stigmatizing

in their families and so on,

it could be that the clinician
is actually going --

and the psychologist is actually going
to be someone who's going to help

give them some language around this.

You know, that in fact they may not
be aware of the range of trans

and gender-nonconforming
identities that are available,

they may not be aware of things like,
you know, you could be the person

to actually say gender's on
a continuum, it's not a category.

Like... And that could be knowledge
that they don't have yet,

even though it's so crucial to their own
development that they have that knowledge.

>> And then you get -- yeah, then you
get the joy of getting to educate them

and getting to -- yeah, getting progress.
>> A real beneficial difference.

>> Right, yeah.
>> Beneficence is what we call that.

Beneficence, doing good for
the other person.

>> It's a big word for that.
>> All right. It is.

So, we have a few more minutes,
and I want to make sure that we hit

a couple of these, you know.
>> Need to accelerate a little bit.

>> Oh no, we're doing great.

But you know, there's really a lot here.

That's one of the things about this
that I really like about these guidelines.

They're meaty.
There's really a lot in there.

>> Maybe a second episode.
>> Oh, we might need a second episode.

>> (laughing)
>> You know, gender nonconformity

is such an important topic.

You know, I really feel like one of the
things that they really do emphasize,

and we started here,
is by talking about training.

I was really alarmed to learn how few
people in my category

are actually well-trained in this area.

You know, that many people are not
receiving this kind of education

in graduate school, and many people,
especially if you're not a specialist

in this area, you know, that there are
people kind of specialized in

working with this population,
and those of us who have done that,

you know, are pretty well educated
about these kinds of guidelines,

but that most clinicians may not be.

And so I actually think that what we're
doing right now is really important.

I'm really glad you're here.

>> Is the general clinical training that's
afforded at various PhD programs

at universities, does it incorporate
any of this in a standard program?

>> You know, a standard program
is a good question.

Yes, there will be in terms
of the APA, accreditation,

there will be some level of requirement
that students have, you know,

a course on gender or something
along that line.

But the requirements are
generally relatively minimal,

and it is the case, at least in terms
of the data that they're presenting

us here in this document, it's still
the case that quite a few people

are at least reporting that they
did not receive that type of training

or that they did not receive enough
training to feel comfortable

working with this population, right?
That kind of thing.

And that feels to me like, don't
worry, lifespan development

is possible for us too,
you know?

That I think that it's really important
that you found your way here today

to go ahead and do this as
a continuing education exercise.

It could be that we're mostly
preaching to the choir,

that a lot of people out there are
actually folks who are really

pretty well specialized in this
particular area already

and have lots of experience.

But it could also be that we're talking to
people who are saying to themselves

like, oh, that's an area
of clinical practice

that I was never actually trained in.

Look, here's a continuing education
course that I could take on this.

And that's exactly what
we are here to try to do.

So I do want to mention before
we run out of time,

that part of the recognition that
psychologists have to have

is in this stigma, discrimination,
barriers to care category.

And so I really want to make sure
that we emphasize

that psychologists must recognize --
this is guideline 5 --

"Psychologists must recognize how
stigma, prejudice, discrimination,

"and violence affect the health
and well-being of TGNC people."

So, very important that we
not minimize that,

that we not kind of sweep that
under the rug,

and certainly incredibly important that
we not assume that there has been

no history of trauma in this area.

That in fact you want to assume that
there's been some history of trauma,

and go in and try to find what that was.

And that of course does not mean that
everybody who has --

is gender-nonconforming is actually
even going to be coming in clinically

for that particular thing, right?

It's also the case that gender-
nonconforming persons

can experience the entire range
of mental health experiences.

So for example you could have somebody
who's gender-nonconforming

that comes in because they have
an airplane phobia.

Or something that's, you know,
completely unrelated, right?

And so in those situations,
we really want to make sure

that we're also giving them the quality
of care that we would give to anyone.

>> Absolutely. I do think -- yeah, I think
that's one of the later guidelines

actually, and it did strike me, one of
the points that I think you're probably

going to get to, but I'll just go ahead
and get us there, right --

>> Do it, you get us to is.
>> -- get us there right now, is that

just from the standpoint of
simple attribution theory,

when you have something that's so
central to a person's existence,

it's easy then -- I suppose it's even
easy for the therapist,

and I guess that's what the
guidelines are pointing out,

it's even easy for the therapist then
to attribute whatever's going on

to that very central thing.

So, very easy to make
a misattribution essentially

about the TGNC kind of issues,

when it may be an airplane phobia
or something else.

And so it's very important
to be careful about that.

Again, recognize the full
spectrum of things.

And there may just be
other things going on.

It's not necessarily all about --
>> It may have nothing to do with it.

>> It's not all about the gender aspect --
>> And that's the other aspect of this,

is that they may be
completely well-adjusted.

You know, like you were saying,
we've met lots of people

from this category that actually we
feel like have had some advantage

in terms of their development,
in terms of being able to be like

okay, you're a solid person.
This is really great.

>> Once again, you've expressed
it beautifully, yes.

>> And so I think that there are lots
of ways in which that works.

So assessment therapy and intervention
is one of those big categories.

And here I really want to just emphasize
that these -- all of these guidelines

within this category are things that
you could say and apply

to every client that you see.

So these are things that are not
limited to people who are in

a gender-nonconforming category.

They're certainly applicable to everybody.

But I think they're here mostly to
really emphasize to us

that these are things that we need to
make sure that we are being

fairly attributable to.

So guideline 10 talks about striving
to understand how mental health

concerns may or may not be related
to a TGNC person's gender identity

and the psychological effects
of minority stress, right?

And it could easily be that we have to
remain open to the fact that this person

may be coming and going like,
"Actually I'm so okay with all of that,

"I'm completely fine, and instead I really
want to talk to you about --" whatever.

"My insomnia," or you know, germs,
or you know, whatever it is.

It could be abolutely anything, right?

Then of course they say that
psychologists recognize

that TGNC people --
this is guideline 11 --

are more likely to experience
positive life outcomes

if they receive -- when they receive
social support or trans-affirmative care.

So like all other human beings,

they benefit from the things that
are beneficial to human beings, right?

That in fact we want to make sure that
they are getting social support,

that they are receiving
trans-affirmative care,

and that we would of course expect
that that would be directly related

to how they're doing.

That they're normal in that way, right?

That you would expect the same kinds
of psychological constructions

that happen for anybody,
happen for them.

They have the full range of
human emotion, right?

That there are all these ways that
you can just assume, this is a person.

This is a person.
A gender-nonconforming person.

Very close and dear to my heart,
guideline 13 says that

psychologists seek to understand
how parenting and family formation

among TGNC people take
a variety of forms.

And this is something that I know
any child clinicians that I'm speaking to

in the audience, it is -- you know,
it's not just one member

of the family that's affected
by the gender identity

of the other members of the family.

And that we have to make sure that
we're being sensitive, developmentally,

to all of the different issues that might
actually be relevant in any family,

but that certainly people who are
parenting who identify as TGNC

face special challenges, because
parenting is definitely a time of life

when things become incredibly gendered.

And there are all of these different
gender-related kinds of roles

and it's very heterosexist, right,
we have a very heterocentric

kind of orientation toward parenting.

It is still the case that, you know,
God help us.

People still somehow expect like, a man
and a woman and their biological children.

I don't even know how rare
that is these days.

It was already years ago that we're like,
that's actually a minority position.

There aren't that many people who
are actually in that position, right?

But I think that that's an important
thing not just to recognize

that it comes in a variety of forms,
that families come in a variety of forms,

but to accept all of those forms
that families can come in.

>> Absolutely.

>> All right, so I think we've
reached the end of another hour.

>> No way.
>> I think we're just about -- I know.

It flew by. Because there are so many
important things to talk about here.

You know, there are so many important
things to talk about here.

>> I wondered if we were going to
be able to make an hour out of this.

>> How you wondered this.

I know, we talked about this before.

>> There's more -- I didn't even get
to mention Kate Hudson.

>> Kate Hudson? How interesting.
And I didn't --

>> She's trying to raise a child
without a concept of gender.

>> Oh yes, right.
>> Which is an admirable goal, actually.

>> Is it? That's a good question.
>> Yeah, it seems like a wonderful goal.

But I mean even in discussing it,
she was using the words "he" and "she"

a lot, which is just -- which
was really quite ironic.

But I mean it just speaks
to the whole language thing.

But anyway, yeah. Another hour
has come and gone.

>> So you know, let's make sure that we
give them this sort of, you know,

kind of most important
take-home of this, right?

Because to me, fundamentally,
all of this really is attitudinal.

You need to have knowledge, you need
to go ahead and actually educate yourself

about the populations that you're
gonna be working with.

If you are not experienced with a
particular demographic population,

then you should not be licensed to
practice with them.

You need to have had experience, right?

And we know that.

However, it is the case that we are
all going to make mistakes.

I'm sure there are probably things
that we both said today...

When you write in,
be gentle with us, okay?

We're trying.

There are probably some things we said
that there would be somebody that's like,

that's not okay.

Like, you need to not talk
about it that way.

>> I tried to indemnify myself in advance.
>> You did at the beginning, it's true.

And yeah, you know, for me it's
just really important

that we just acknowledge that you know,
human beings, we make mistakes.

And we're trying.

And that the most important thing --
>> We're doing the best we can.

>> Well and if we really are doing
the best we can,

then that's probably
going to be okay.

You know, that we all do have to
really try to do the best that we can,

and that you need to make sure that
you're really focusing fundamentally

on, what are my attitudes
about this population?

Do I actually have any hang-ups
about who these people are?

And that if you don't, if you're
actually like no, I'm good,

this is great, I'm totally
accepting about this,

then there's really a lot of other stuff
that you can pick up very easily

about how to practice appropriately
with people in almost any category.

But if in fact you have a fundamental
resistance to them,

if you're in any way uncomfortable
with this population,

then definitely that's
what you want to fix.

>> Gotta work on that.
>> That's gotta get worked on.

And because I think that anything
that you slap on top of that

is going to make it difficult to
actually do the right thing.

>> Absolutely. But that's a wonderful
note I think for us to end on.

>> All right, right on.

>> Well, thank you very much

for joining us again.
>> Thanks for being here.

>> Yup. We'll see you next time.
>> See you soon.