Working with gender diverse young people and their families

Working with gender diverse young people and their families

Louise Cooper and Ari Dunphy
26 April 2017

This webinar explored the information and skills needed for practitioners to work effectively with gender diverse young people and their families.

Working with gender diverse young people and their families

Audio transcript: Working with gender diverse young people and their families

Audio transcript (edited)

Hand

Good afternoon everyone and welcome to today's webinar, Working with gender diverse young people and their families. My name is Kelly Hand and I'm acting Deputy Director of Research here at the Australian Institute of Family Studies. I’d like to begin by acknowledging the traditional custodians on the lands on which we meet. In Melbourne, the traditional custodians of the Wurundjeri people of the Kulin nation. I pay my respect to their elders past and present and to the elders from other communities who may be participating today.

Today's webinar will explore the information and skills needed for practitioners to work effectively with gender diverse young people and their families. Before we begin, I need to briefly mention some housekeeping details. One of the core functions of the CFCA information exchange is to share knowledge, so I'd like to invite everyone to submit questions via the chat box at any time during the webinar. We will respond to your questions at the end of the presentation.

We'd also like to continue the conversation we begin here today. To facilitate this, we've set up a form on our website where you can discuss the ideas and issues raised, submit additional questions for our presenters and access related resources. We'll send you the link to the forum at the end of today's presentation. As you leave today's webinar, a short survey window will also open in a new window, we'd appreciate your feedback. 

Please remember that this webinar is being recorded and the audio transcript and slides will be made available on our website and YouTube channel in due course. 

It's now my pleasure to introduce today's presenters. Dr Louise Cooper is a counselling psychologist and child and family practitioner in Drummond Street Services Queerspace team. Queerspace provides affirmative counselling services delivered by LGBTIQ and queer-friendly mental health practitioners. Louise specialises in counselling and supporting transgender and gender diverse adults and young people and their families. 

Louise has been actively involved in establishing several projects promoting the well-being of gender diverse youth through Transgender Victoria and Ygender. She regularly supports the Q Program, an LGBTIQ youth group based in the western suburbs, Melbourne. Louise uses the pronouns she and her. Dunphy is an intern practitioner in Drummond Street services Queerspace team working with individuals and families. 

Ari is currently completing a masters in counselling and psychotherapy at Cairnmillar Institute with a research thesis on frameworks for conceptualising LGBTIQ intimate partner violence. Ari is passionate about the health and well-being of transgender people and seeks to contribute to the collective understanding of gender. Ari uses the pronouns they and them. Please join me in giving Louise and Ari a very warm virtual welcome.

Cooper

Thank you Kelly, can hear the applause.

Dunphy

Thanks, Kelly.

Cooper

I'd like to firstly acknowledge the traditional owners of the land where we meet and pay our respects to elders past and present.  I'd like to thank everyone for tuning into this, it's fantastic that there is so much interest and welcome to you particularly if this the first time that you have decided to find out a little bit more about gender diversity. And I'm really happy that Ari is here too.  You may have seen the photos of the two of us and you’ll notice that  Ari is an awful lot younger than me, in their 20s, and they therefore have a slightly different perspective than I do, I'm in my fifties. 

So this is what we're going to be doing this afternoon. It's really important that when we're talking about gender diverse young people that we talk about the context in which they are living. So there'll be a fair amount of background information here before we go into actually how you can work with these young people. And to just bring a little bit of glamour to proceedings there's a photo of David Bowie and Tilda Swinton. So Queerspace, where Ari and I work … this is a specialist counselling service, it's a service provided by queer identified practitioners and queer friendly practitioners.

Queerspace is embedded within Drummond Street Services. Drummond Street Services has been around for 120 years, it’s a multidisciplinary team and so Queerspace is supported by all these people working in different areas and the whole of Drummond Street works with the whole of family model. 

So why are we doing this webinar, why have you tuned in? Well awareness about gender diversity has increased, I'd say exponentially, over the last few years. This is the front cover of Time Magazine just last month, reporting on a Harris poll taken in the United States that found that 12 per cent of millennials identify as transgender or gender nonconforming.

That's an awful lot of people and there's no reason to think that that figure wouldn't apply to Australia as well. So before we go any further I think it's important to establish some definitions and Ari's going to do this and one of the things about definitions and language is that there has been a lot of change. There is still a lot of change in this area to refine how we are talking about gender diversity. Ari.

Dunphy

Thanks, Lou. Yeah so the first thing that I'll say is that it's really important to get familiar with the language around gender diversity and that yeah, it's changing quite a lot. So, it's important primarily to go with the language that the client  brings - but also to be familiar with the terms here and others as well. First of all, sex and gender are different and that's really important to get clear on. While sex refers to someone's physical characteristics that are usually the basis for how a person's gender is assigned to them at birth, gender identity is how someone feels, who they are, and how they'd like to be treated and referred to by others.

To be intersex means that you fall outside of the male and female binary. 

So where “queer” is an umbrella term to refer to the myriad of ways that sexuality can present, “gender diversity” similarly is used as an umbrella term to talk about the varied ways that gender can be felt and expressed. So "transgender", also called “trans”, is an umbrella term for people whose gender identity falls outside of how they were assigned at birth. So this can - I guess, yeah, how they were assigned at birth when their doctor or parent accidentally conflated sex and gender I suppose.

And "non-binary" refers to people whose gender identity is outside of the boundary of man and woman and there are lots of other words that can be used for this such as "genderqueer”, “agender”, “gender fluid”, for example. So "transwoman", “transman” also get referred to as “trans boy” or “transguy” and “trans girl”, it's important to get clear on the fact that the term used and the gender described in the term used, is the gender that the person is, feels like they are and would like to be referred to as. 

“Brotherboy” and “sistergirl” are used by some Aboriginal cultures as well and not all brotherboys and sistergirls will resonate with the rest of the words here, like “transwomen” or “non-binary”, because those words have emerged out of a western context or culture. So sexuality is different again from gender expression..

I'll talk a little bit about cisgender because that seems important. So “cisgender” is a word that is used to describe someone whose gender identity fits within the gender that they were assigned at birth. So if you're listening to this and you think yeah, I do feel comfortable with the gender that was assigned to me at birth, then this is the word you can use to describe yourself and I guess the important thing- the take-home from that is that by using the word “cis” or “cisgender” or “ciswoman” or “cisman” to describe yourself, that in itself is a supportive act to the trans community because it takes the onus off transpeople to be the ones that are labelled and, I guess, communicates that a transwoman, for example, is just as much of a woman as a cisgender woman is. Does that, I guess, make sense?

Cooper

Yes, yes, that's a very important point

Dunphy

Great.

Cooper

Thanks Ari. I'm wondering if you want to say something about sexuality?

Dunphy

Yeah, so sexuality and gender are totally different. We're talking today mostly about gender but the important thing to say about sexuality I guess is that you can't ever assume that someone's sexuality is going to be a particular thing based on what their gender is. Just the way that that's true for cisgender, that's true for transgender people too. So there's straight and gay and lesbian and bi and queer transpeople and so that is explained a little bit more in this image which gets used a lot in training is the gender bread person.

I think the important thing about this is that it sort of tries to illustrate four different elements, gender identity, gender expression, sex and sexual orientation, describing them as really separate from one another. So a person can sit at any point on these four spots and they don't really necessarily influence one another and even more importantly, I think, the thing to say about that is that as you can see here, underneath each element there it says that these are five of infinite possible variations. So there isn't just one or two or three or four ways that your gender identity can be, or your sexual orientation can be, or the way you express your gender can be, that's really, there's really a lot of diversity there.

Cooper

It's also a very nice illustration to use with young people because it's a gingerbread person. And Ari the point that you make there is that, you know I think for a lot of people and, in my experience, for practitioners who are perhaps for the first time working with someone who is trans or gender diverse, there is a certain amount of fear attached to using the wrong terms, saying the wrong thing and what you say there is that you just need to ask.

If you don't know what words to use, ask and listen very carefully to the language that a person is using and make notes about that language because if you're working with several people, you need to be able to remember it so you don't have to keep asking. It's a very respectful thing to do. So let's go back to Drummond Street for a moment. In 2015-16, we had 144 cases of young people either presenting because of sexuality or gender diversity, presenting with their families.

There's been a 50 per cent increase in gender presentations this year. Of course, the year isn't finished but I do know that the number of people that presented with gender concerns in the first half of the year was doubled in the second half of this year and, yes, we're not finished yet. And the clients are presenting to Drummond Street for counselling and support, they're not presenting for medical treatment.

There are also a lot of trans and gender diverse people at Drummond Street coming there because the space is safe and is used for meetings of various organisations and if you're wondering what the flag is on the right hand side, this is the transgender flag. It's very useful to have that at your reception if you're working with a trans population. 

So just looking at some stats, this study was done by La Trobe University in conjunction with the University of New England a couple of years ago. 189 gender diverse and transgender young people between the ages of 14 and 25 and they found that 40 per cent of these people were identifying with a gender other than man or woman. So this is the non-binary. Other terms are used but I'm going back to Ari how described non-binary, it’s the term these people are most likely to be using.

From this study we find that extremely high levels of abuse are experienced by this young group of people and if you look at that figure, 90 per cent of those who had experienced physical abuse had thoughts about suicide. This same study is showing us the impact of gender diversity on daily life. And if you think that young people are avoiding places like toilets, change rooms, schools, medical services, it's clear that the potential for a young person's development and education and social inclusion is going to be severely affected or can be severely affected by the response from other people, from harassment.

Even if it's not happening, these young people know that harrassment does happen and therefore being out there in the world can sometimes be [frightening and] difficult. I'd also like to say at this point that these stats are particularly negative. They paint a very grim picture but of course when you have a certain percentage of people having difficult times, there's the other half or other group, the people that are trans and gender diverse people that are leading extremely fulfilling and enjoyable, happy, healthy lives.

Going back to the stats again. This is from the United States, an adult [transgender] population, 41 per cent attempting suicide, 57 per cent rejected by families and 78 per cent experienced sexual or physical harassment at school. Now, if we can change that, if we can change the environment, if we can change the family environment, if we can change the school environment, hopefully that top figure of suicide attempts in the future will be lower.

So, Ari, this brings us to how we actually work and if you'd like to tell us what we need to do, what people listening need to do in order to be able to have a service which is helpful, and welcoming I guess, for young transgender and gender diverse people.

Dunphy

Yeah. So I guess in a way this relates to that slide where we saw the kinds of places where people are having to or feeling that they need to avoid. I guess if someone is, in their life, feeling like they have to manage where they go, how they look, and try to plan for how they're going to be treated in the world, it's really excellent if we can provide spaces where that isn't something that they need to do. So the first way to do that is to respect and believe their gender, that it is real and valid even if it surprises you in some way, perhaps because their gender expression is different from what you would expect.

Cooper

Do you want to give an example of that, Ari?

Dunphy

Yeah, so if you say have a client who comes to you and they tell you that they're a boy and you feel surprised because this person looks to you like someone you would assume is a girl because they're perhaps more feminine in manner or presentation and they're attracted to boys, that it's really important to check yourself at that point and go okay well this person is the authority on their own gender, I'm making an assumption here, or have made an assumption here, about their gender and conflating it with gender expression and sexuality. 

So this is a person who is, at this point in their life at least, attracted to boys and is more feminine presenting and that just might mean that he's a feminine gay boy who also happens to be trans and that is just as valid and okay as if he is a cis boy, if that makes sense. And so additionally I would say that it's important to, for young people and trans people to be able to enact some kind of control over their body, presentation and journey and what that means is that there might be things that seem, say, superficial to someone who's cisgender, that for them is a symbol of resistance against a culture that expects them to be a certain way.

Cooper

Yeah and to understand that, I think that last point about enacting control … if you think about the opposite of not having any control about how you express yourself or how you are … I think if anyone thinks about that for their own life, of having absolutely no control about how you express yourself, how you identify yourself … I think everyone would be objecting to other people making those decisions on our behalf.

Dunphy

I would maybe add as well that if someone comes to you and they're at the beginning of their journey as a trans person, that it's important not to, even if it's coming from a place of caring about them and wanting to protect them, it's important not to try to encourage them to do things that are going to help them to pass as cisgender. So it's I guess important not to encourage them to, unless they want to, express themselves in ways that are cis-normative.

Cooper

And the term “pass”?

Dunphy

Yeah. So “pass” is about whether or not someone who is trans passes as a cisgender person essentially. Whether or not their transness is visible to the general population.

Cooper

So you're talking about a trans boy being able to walk down the street and being seen as a cis boy.

Dunphy

Yeah and that's really important for some people for their health and safety and for other people maybe that isn't their goal, maybe their transness is something they are happy to present.

Cooper

And again we come back to no assumptions.

Dunphy

Yeah.

Cooper

So let's look at some of the practical things that can be done in order to be able to create this cultural safety, Ari. I might start firstly by saying that it's really important that the first interaction with a service is friendly and respectful. So I guess as practitioners we tend to focus on what we do in the room with the client but the first encounter for most people is with reception, is on the phone with intake and it's really important that those people working in those areas are also aware of the impact that they have.

I think they probably are aware of this generally but in terms of trans and gender diversity, the importance of using appropriate pronouns, the importance of not making assumptions based on someone's voice, and as someone walks into a service, to see the trans flag or the rainbow flag on reception or to see something on the wall or pamphlets that say you are welcome here, can have a phenomenally welcoming effect for people that are not used to seeing themselves represented at all in places that they go.

Dunphy

Exactly, yeah. So if someone goes into a service and there's an intake form and there's a spot where they're able to represent themself, they can feel like they're allowed to exist as they are and that's important.

Cooper

So it's not just male or female on the form, there are other boxes. The same would go for organisations' websites, that the images are inclusive.

Dunphy

And toilets are really important and particularly that there's at least one unisex or non-gendered toilet easily accessible.

Cooper

And the reason being that people do not want to go into the toilet and feel they are not safe, to have people responding to them in a way that makes them feel uncomfortable because of their gender.

Dunphy

I would say that is particularly true for non-binary people but also transmen and transwomen who do identify with the binary if they don't feel comfortable in those spaces because they're going to be questioned or they're going to feel unsafe in some way.

Cooper

The next piece is the correct use of pronouns, to be asked what pronouns you use and to be introduced with them. Today Ari and myself were introduced with our pronouns and this is a standard practice we have at Queerspace and a practice that I think we will hopefully see more and more of. Again it’s important that no assumption is made that someone's expression indicates the pronouns that they use.

Dunphy

Yeah I think ordinarily it's considered rude to ask someone what their gender is, like in the cisgender world that would be considered rude but for trans people it's really crucial that it can be really respectful and caring to ask them, in a respectful private manner, what pronouns they use.

Cooper

And conversely it can be very distressing for some people to be misgendered, to have the wrong pronouns used. So assume nothing and be open to disclosure, be open to hearing a person's story, hearing about the language that they use and don't be surprised if you hear something that you're not expecting. It's important to talk about privacy obviously with any clients. Important to make sure that any questions that you ask are relevant. What would be a non-relevant question Ari?

Dunphy

Well I was reading a report that said most trans people have the experience with therapists that the therapist really wanted to focus on their gender too much and that they also had concerns and issues that were like those of their cisgendered peers and so allowing them to be whole people rather than just trans people, is important.

Cooper

Yeah if you're trans or gender diverse, you still have other things going on, you still have a family culture, you still have issues with friendships, , you still have issues with siblings, you still have issues with learning perhaps, at school - - - 

Dunphy

You're still passionate about various kinds of things, you still like to play ping pong, or whatever it is that makes you particular.

Cooper

Yeah there are strengths that need to be celebrated, for sure. Given the statistics that we've seen a little earlier, of course it's essential to check in on safety and well-being, to ask those questions that you would with any client … and then have an awareness of your own attitudes. Language, Ari, back to the language.

Dunphy

Yeah so we've sort of covered that bit, but be curious and ask what someone's pronouns are rather than assuming and use a person's own language or help to celebrate the creativity that can come from there being a lack of representative language in current English such as “trans boi” used with an "i", or “agender”, words that kind of mix up different gendered descriptive terms like “broster” or “beautisome”. 

Cooper

Would you like to explain the term “agender”?

Dunphy

“Agender” is I guess a kind of non-binary identity where someone feels that they do not have a gender, which is different from say gender fluid where someone might feel that they move between different genders at different times. Yeah and so when talking with a client about a previous time in their life and this is, I feel like this is important for parents especially, it's generally considered good practice and respectful to use their current name and pronoun even if you're talking about a time in which they weren't out yet as trans or weren't aware.

Cooper

So the old name, the name that was assigned by their parents, is gone?

Dunphy

Yeah, it's gone. Sometimes called a dead name. So we use “assigned female at birth” or “assigned male at birth” rather than “born a girl” or “born a boy” because it's the idea that someone's gender at their birth, time of birth, was given to them and that they didn't choose that and perhaps they'd always felt that they were the gender that they now are able to say that they are rather than that they are changing from one to the other. It's really great if we can talk about the process of becoming or transitioning as something that is to be celebrated and acknowledged as really powerful and important rather than saying things like it doesn't matter, which I guess communicates that it's an issue on some level that you're okay with.

Cooper

So, as a practitioner and working with parents, it's really important to help parents become familiar and comfortable with speaking respectfully about the young person.  And so back to attitudes.  Now, our beliefs influence our attitudes, our attitudes influence our behaviour and our behaviour does have an impact on our clients.  And this is why we've spent so long this afternoon in talking about this background stuff, because our attitudes can, if you want, make or break that therapeutic relationship. This is the Riddle scale, if you have a look at this you might like to think about where you sit in terms of your attitudes towards gender diversity, difference in gender.  Because if you're sitting up in repulsion or pity on this scale, it's probably best not to be working with clients until you've managed to move yourself through your own education, your own exposure, your own experience into the red and pink zone where you are able to celebrate the young person, where you are able to acknowledge the difference and the benefit to society of the fact that there is difference, and you are able to nurture.

And, also, this is quite useful, this scale, to get an idea about where parents sit with regard to the young person and also the young person themselves.  Because sometimes there can be repulsion towards self because that is what a young person has grown up with and, in that case, it can be very, very difficult to self-express indeed.  So, this scale is very useful.  Now, let's get back to the work.  And this is the scope of working with a child or young person, working with that young person, the parents, the siblings.  The couple, the parents, if the parents are in a couple relationship, if there are parents that are separated, divorced or absent, all parents need to be included in this.  There may be incredibly positive influences from parents that are unexpected.

Again, we come back to, don't make any assumptions about this, that the absent parent may be dismissed by the young person and by the parent with whom they live, if they do live with a parent, but, in fact, this parent could be a key to helping that young person self-express and work through some of the difficulties that they're having.  And, again, if parents are not present at all, if you're working with a child that presents without parents, it's still really important to try and give parents the opportunity to be part of this journey.  The extended family is also important if they want to be part of this, that the service is willing to include them as well as family, friends, and, of course, the broader community, schools, social groups, whatever that might mean to the young person.

So, we're talking about working with the whole of the family and, of course, this depathologises the child.  Many times I've seen families present with a young trans or gender diverse child who is actually quite happy and doing really well at school.  And the issues that they may be experiencing are actually nothing to do with their gender.  There may be problems in the parent relationship, there may be financial hardship, there may be a history of abuse that's affecting this family, there can be all sorts of reasons why this family presents.  And it's too easy for parents to pathologise their child because of their gender.  And it can also be easy for a practitioner, I think, to become focused on the gender of the child, the young person, rather than looking at the whole picture.

So, it's really important to look at the whole picture and the whole family and what's happening.  And often, family members have to experience their own coming out, their own emergence.  Because as a family member, you are the person that needs to stand by the young person and also needs to advocate for them on many occasions.  So, this role that the whole family takes needs to be acknowledged and worked with.  Often, the young person doesn't want family members involved, they don't think that they're on board, they don’t think that they're helpful.  But I guess the job of a worker is to encourage and assist, support the family members so that they can be on board.

And I've seen some beautiful moments between families when the discussion between the young person and their parents suddenly takes a completely different turn and it starts to be much more about appreciation of each other rather than a resistance to listening to the young person's journey, and the realisation of this from the young person that … you know, they never ever thought that their parent was going to be supporting them.  They've kind of dismissed that as a possibility.  But there are some incredible things that happen working in this field.  

So, these are the stories that you will hear about a young child growing up, you'll hear about a child dressing in clothes of non-assigned gender or doing things that the parent wouldn't expect them to do, given the gender they've been assigned at birth.

And also of young people actually expressing their gender vocally, saying, "I am a boy," "I am a girl" or of not understanding the distinction between boys and girls, of being completely puzzled by the fact that when they go to school, for instance, the boys go one side and the girls go another side of the room in order to play certain games, for instance.  It can be puzzling.  As puberty comes along, there are different things that the young person has to deal with.  The discomfort with secondary sex characteristics appearing, and this can be often a time that the young person really becomes much more aware of their difference and it can become distressing.  There's also change as there is with any young person, awareness of their own sexuality and awareness of how they are interacting and relating to other people.

So, “gender dysphoria” is the term that remains in the DSM-5 in relation to gender; the feeling that your gender does not match your assigned gender.  And this may or may not be distressing, it doesn't necessarily mean that if you have gender dysphoria that this is a distressing experience … it can be highly distressing, but not necessarily so.  So, again, no assumptions.  And how a gender diverse child or young person presents is going to differ very much dependent on their own family, social and cultural context because of the level of stigma associated with being trans or gender diverse.  Hopefully this [stigma] will diminish in some areas, certainly in Queerspace it's not there.  But this is the reason why we need to work not just with the individual but also with the family and the social context.  Ari, you want to say something?

Dunphy

I was just going to add that, in terms of gender dysphoria, I think what we talked about before about where someone is with their own self, whether or not they have internalised transphobia, essentially, can really impact the level that gender dysphoria can be distressing or not.  Not to say that it is entirely about that but, certainly, if you have a level of repulsion with your own transgender identity, then your relationship to your body will be really complicated by that.

Cooper

And what we're talking about here in terms of internalised transphobia is the impact that the messages about a person’s identity from the cultural context, from the family, from the social context has had on a young person.  Yeah?

Dunphy

Absolutely.

Cooper

So, these are the stages of emergence.  Again, a very useful thing to use to be able to understand what is going on for parents and young people as to where they are in terms of their awareness, where they are in terms of their emergence, whether they are telling people about who they are, whether they feel able to do that, whether they're exploring this and then whether they have reached a point of wanting some sort of modification to their body so that they can affirm their gender.  And there's no definite order to this, this is kind of what we see but needn't necessarily be the case and some of these stages may be skipped in someone's emergence but it's a very useful tool.

And on the right-hand side here you'll see what the task is, if you want, of the practitioner at these different stages.  So, the kinds of things that young people present, concerns over their safety, whether it's their own safety in terms of self-harm, of not feeling safe with themselves, whether they're concerned about their safety within the family or at school.  And it can be any of these things.  Young people will talk about their friends, their social network or the absence of it.  And the term "ally" we use to describe a person that is on their side, they’re on board.  Not only will they be friends, they will also stick up for someone and they will advocate.  And often very young people become very good allies.

Younger siblings often are very good allies and are way ahead of their parents on being able to stick up and look after their sibling if that's what's required.  “Passing” we talked about before, young people are very concerned about whether they are actually able to be seen as the gender that they are or whether they are stuck with their assigned gender.  So, Ari, we talked about this earlier.

Dunphy

Yeah.  I would add that, for someone who is non-binary in some way, that's really complicated because it's about how you're read by society.  And, at this point in time, it's unlikely that someone is read as non-binary by society, so yeah, passing is very complicated. 

Cooper

What you're saying there is that most people are not going to say that you are non-binary, they are looking to see whether you are boy or girl.

Dunphy

Yeah, they're trying to figure it out as best they can and they'll pick whichever one they reckon might be true.

Cooper

So, this can be distressing, difficult, hard for the young person to constantly have to explain.  Other concerns that young people may bring into the room …  It's important to remember, as I've mentioned before, that what they bring into the room may be actually nothing to do with their gender.  It may be to do with their parents' relationship, their social world or their school or their performance at school.  So, working with young people.

I'd like to establish this aim that what you really want when you're working with a young person, any young person, really, is to make it so that that the young person can get on with the business of being a young person and have good relationships, feel supported, feel safe in their family, social and educational environment.  So, the first thing to do as a practitioner is, as with any client, to build a therapeutic relationship.  And this can help to build a sense of self within the young person, that the person who's there is being validated and can have a relationship with their therapist or worker.  This isn't about an assessment of identity, the person isn't there to be told what their identity should be or is.  It's not about that.

You're not there as a practitioner supporting someone that's trans or gender diverse to come out with an answer, "Yes, this person is definitely going to transition medically" or, "Yes, this person is – I always thought they were a boy from the moment they walked in" or, "I always thought they were a girl."  It's not about that at all, it's about an exploration to allow the person to be able to explore themselves in a safe environment.  It's a very different approach.  Safety is important.  Safety in the room, safety in the service, physical and emotional safety at home, at school and how to navigate all of this, how to make the changes that the young person needs in order to feel safe in these places.  And, of course, this is something that most of you will be doing with all of your clients, it's exactly the same.

Attention to mental health.  If you're avoiding going places, it's likely that you're experiencing high levels of anxiety.  So, attention to sleep, attention to some anxiety management techniques, attention to mood and difficulties that someone is having with mood.  This is what you will see in a lot of the people that are presenting and needs to be given attention, not missed in the complexity of the presentation.  And talking about allies, rather than talking about coming out it's kind of nice to be talking about welcoming people in, to talk with the young person about who they want to be along this journey, who they feel that they can talk to, who they can bring in as supports in order to build a really strong, supportive, social network of connections.

And knowledge, be open to the questions that the young person asks because they may be looking to you once they've built a relationship with you to be able to answer some of the questions that they have about where they can find support, where they can find the things that they think would be helpful for them.  And in their exploration, you mentioned this before, be affirming of this person.  Don't talk about, "When did you become."  Because the person always has been.  No assumptions around sexuality.  And if you do get something wrong, just apologise and move on.  It can be awful, really feel bad to mis-gender someone.  But if you apologise and move on, most trans and gender diverse people understand as long as you're making an effort.  

And working with the parents, it's important to understand why – what the parent is thinking, what they're wanting from this meeting with you.  They're from a different generation, they may not have much information, they may be working off stereotypical images that they have of trans people.  They're probably grieving, they had expectations for their child and they believe that those expectations are not going to be met.  They might be wrong on that, but wherever they are, it's important to meet them in that grief and allow space for it, not expect them to just get over it and get on with it, they need to be given space.

They'll be feeling anxiety about the safety of their young person as they grow older, they will have read things in the newspapers, they will fear for their safety, for their future.  They will be fearful about the judgment that they might receive as a parent, they may be fearful about having to actually advocate for their child, having to explain to their friends and family what is happening.  And they may be anxious about making the right decisions for, or with, their child or young person.  They may feel guilt, they may feel that they are responsible in some way for the difficulties that they see their young person having to face.  They may be  looking for a reason.

But this is very much coming from a place of what we call cis-sexism, that to be cis, to not be trans, to not be gender diverse, is in some way better and normal, that is usually where the guilt is coming from, it’s important to explore.  They may feel angry that they are having to constantly deal with people's questions and negative attitudes towards their child.  And this may be affecting the relationship of the couple if parents are together or it may be affecting how parents relate to each other because they have different attitudes, each parent has a different attitude, and that can be the same if parents are separated.  They need to learn how to advocate at the school for their young person, with family, friends, in the world, generally, advocate for their child.  And they need to have referrals so they know where to go to find social connection and where to find medical treatment if that is the path that the young person is going to take.  

Siblings often feel missed, they're missing out, they're not getting as much attention, they're having to stand up for their sibling that is trans or gender diverse.  Their roles may be changing within the family.  These are all the sorts of issues that siblings can face, but as I mentioned before, often they are the best allies.

So, the whole of family can be involved in choosing names, in the coming out or the inviting in process of talking to extended family members, of accessing support.  The whole family can be involved in this and need to be invited in if they're willing to be there.  

So, there's a lot of information we've just presented.  The take homes, it's difficult to pick for that, but here are the things that I think are useful to focus on.  The work environment of the service, the importance of checking your own attitudes and self-educating, working with the whole family and the community.

Encouraging social networks, working with the parents, not overlooking the grief and anxiety in your eagerness to advocate for the young person, to assume nothing and to raise awareness through your work so that the environment becomes friendlier and less hostile to trans and gender diverse people.  And here are some resources if you're looking for somewhere to go now to find out more.  There's a little bit of reading.  The Royal Children's Hospital Gender Service in Melbourne and Transcend, the website for parents and families I would suggest are particularly good in giving you a lot more resources than we've put here.  And, of course, you can contact us at Drummond Street.

RECORDING CONCLUDED

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Slide outline: Working with gender diverse young people and their families

Slide outline

1. Working with gender diverse young people and their families

Please note:
The views expressed in this webinar are those of the presenters, and may not reflect those of the Australian Institute of Family Studies, or the Australian Government

2. Overview:

Who is Queerspace

  • Definitions
  • Facts and stats about clients
  • Safety and sensitive practice – language, awareness & attitudes
  • Whole of family and community approach
  • Resources

[Poster: Gender is between your ears, not between your legs]

3. Queerspace

  • Health and wellbeing service for lesbian, gay, bisexual, trans, intersex, questioning and queer (LGBTIQ+) people and families
  • Safe space for counselling and support and for meetings of various groups and orgs
  • Service delivered by specialist queer and queer-friendly mental health practitioners
  • Mental Health Psychological Services via Access to Psychological Support (ATAPS) and Better Access

4. Drummond Street

  • Psychologists
  • Social workers
  • Counsellors
  • Youth development workers
  • Health promotion officers
  • Community development workers
  • Stepfamilies experts
  • Family violence trainers
  • Royal Commission clinicians
  • Parenting coaches

Whole of family

5. Why this webinar

  • Time Magazine March 2017
    “Beyond he or she: How a new generation is redefining the meaning of gender”
  • Glaad (LGBTI advocacy organisation in USA) - Harris poll
  • 12% of Millennials identify as transgender or gender nonconforming
  • That is to say, they do not identify with the sex they were assigned at birth or their gender expression is different from conventional expectations of masculinity and femininity 

6. Definitions:

  • Sex: A person’s sex includes genetic, hormonal and physical characteristics.
  • Gender identity: Gender identity is distinct from sexual orientation. Gender is different from physical sex. It is a very personal sense of who we are, and how we see ourselves.
  • Queer: An umbrella term to refer to LGBTIQA+ people. It is also used as a political statement which advocates breaking binary thinking, and seeing both sexual orientation and gender identity as fluid and diverse.
  • Gender diversity: An umbrella term that includes all the different ways gender can be experienced and perceived. It can include people questioning their gender, those who identify as trans/transgender, genderqueer, non-binary, and many more.
  • Transgender: An umbrella term covering a range of identities that transgress socially defined gender norms. It may mean someone who mentally and emotionally identifies as a different gender to the one they have been assigned by society, often living their lives as that gender, and who may or may not choose to undergo any form of medical transition (hormones, surgery etc). Or it could be a person who’s gender is outside of, or between, the binary gender system altogether.
  • Non-binary: A person whose gender sits outside of the binary of man or woman. They may identify as neither, both, or something else entirely.

7. More Definitions:

  • Transman:  a transgender person who was assigned female at birth, but who is a man (uses he/him pronouns).
  • Transwoman: a transgender person who was assigned male at birth, but who is a woman (uses she/her pronouns).
  • Brotherboy: some Aboriginal/Torres Straight Islander people who were assigned female at birth but who are a boy/man in spirit.
  • Sistergirl: some Aboriginal/Torres Straight Islander people who were assigned male at birth but who are a girl/woman in spirit.
  • Sexuality: who a person is attracted to, who they have sex or not have sex with, and who they wish to be in a relationship with.
  • Gender expression: how a person presents their femininity and/or masculinity using socially recognised markers. e.g. clothes, make-up, jewelry, hair.
  • Cis (cis-gender): A person whose gender identity is aligned with that which they were assigned at birth.
  • Cissexism: A belief or attitude that being cis-gender is more natural, healthy or superior to transgender or non-binary ways of being.

8. Poster

  • The Genderbread Person v2.0
  • It includes sliding scales for gender identity, gender expression, biological sex and attracted to.

9. Our Clients

  • 2015/16
    • 144 cases sexuality and gender diverse children and young people (under 25) and their families
    • 50% increase in gender presentations 2016/17
      • Clients present for counselling, not medical treatment

10. From blues to rainbows book 1

  • Produced by
    • La Trobe University and University of New England, funded by Beyondblue (2014)
    • Participants
      • 189 gender diverse and transgender young people aged 14-25.  40% identify with a gender that is not man or woman

11. From blues to rainbows book 2

  • 65% experienced verbal abuse because of their gender identity or expression
  • 21% experienced physical abuse because of their gender identity
  • 90% of those who had experienced physical abuse had thought about suicide

12. From blues to rainbows book 3

Table of the places participants avoided due to not conforming to gender stereotypes by percentage. 

13. Suicide Attempts among Transgender & Gender Non-confirming Adults
American Foundation for Suicide Prevention Report (2014)

  • 41% attempted suicide
  • 57% rejected by families
  • 78% sexual or physical harassment at school 

14. Cultural safety

  • Young person needs to know that their way of being is respected, or at least not harmed or challenged
  • Young person needs to feel that their gender is real and valid, and that they do not need to proscribe to traditional gender stereotypes to be accepted as their gender (or that they can if they wish to without judgment).
  • Young person needs to be able to enact control over their own body/presentation/journey

15. Queer sensitive practice

  • Provide a VISIBLY queer friendly and safe welcome
  • reception (inclusivity on posters/flyers)
  • documentation (male/female/other options)
  • website (gender diverse images)
  • toilets (non-gendered)
  • Ask and use the correct pronouns & language – show respect
  • Assume nothing and be open to disclosure
  • Talk about privacy
  • Make sure your questions are relevant – seek knowledge
  • Check in on safety and wellbeing
  • Have awareness of your own attitudes

16. Language

  • Be curious - ASK
    • How do you identify?
    • What pronouns do you use?
  • Use person’s own language -  creative words can celebrate authorship of own self
    • transboi, a-gender, beautisome, femme, broster, etc
    • Use current name (and pronoun) even when referring to a previous time.
  • Avoid phrases such as:
    • “born a girl” / “turned into a girl now”
    • Use instead:
    • “assigned female at birth” and/or “affirmed their gender identity”
  • From parents:
    • “it doesn’t matter that you are [trans/gay/lesbian/bi]”
    • Use instead:
    • “that is wonderful that you feel like you are getting to know yourself – I love you and thanks for sharing with me”

17. Attitudes

  • Beliefs influence attitudes
  • Attitudes influence behaviour
  • Our behaviour impacts on clients

18. Attitude towards difference: The Riddle Scale

Negative levels  of attitudes

Feeling Attitude
Repulsion People who are different are strange, sick, crazy, and aversive. Anything which will change them to be more normal or a part of the mainstream is justifiable.

 

Pity

 People who are different are somehow born that way and that is  pitiful. Being different is definitely immature and less preferred. To help those poor individuals, one should reinforce normal behaviors.

Tolerance

 Being different is just a phase of development that people go through and most

  people “grow out of.” Thus they should be protected and tolerated as one does a child who is still learning.
Acceptance Implies that one needs to make accommodations for another’s differences and does not acknowledge that another’s identity may be of the same value as their own.

 

Positive levels of attitudes

Feeling Attitude
Support Works to safeguard the rights of those who are different. Such people may be uncomfortable themselves but they are aware of the climate and the irrational unfairness in our society. 
Admiration  Acknowledges that being different in our society takes strength. Such people are willing to truly look at themselves and work on their own personal biases. 
Appreciation Values the diversity of the people and is willing to confront insensitive attitudes.
Nurturance Assumes the differences in people are indispensable in society. They view differences with genuine affection and delight and are willing to be advocates for that difference. 

19. Scope of the work:

  • Young person
  • Parenting
  • Siblings
  • Parent couple
  • Extended family
  • Family friends
  • Broader community

20. Working with the whole family

  • working with WOF de-pathologises the child
  • family supports sense of self
  • families of queer young people often require their own coming out process
  • family members don’t always see the need to attend, or for others to attend e.g. non-resident parent
  • young person doesn’t want family members involved

21. Gender diverse children and young people: what you’ll hear

In Childhood (often)

  • Dressing in clothes of non-assigned gender
  • Activities of non-assigned gender
  • Urinate as non-assigned gender
  • Vocalising not being assigned gender

Onset of puberty (often)

  • Discomfort with secondary sex characteristics
  • Growing awareness of self in social and sexual relationship
  • Gender dysphoria: feeling that your gender does not match your assigned gender – may or may not cause significant distress – any age
  • How a gender diverse child or young person presents depends greatly on their family, social and cultural context - their experience of stigma.

Gender dysphoria: feeling that your gender does not match your assigned gender – may or may not cause significant distress – any age

How a gender diverse child or young person presents depends greatly on their family, social and cultural context - their experience of stigma.

22. Stages of gender diverse emergence
Transgender Emergence, Arlene Istene Lev (2004)

Stage Therapeutic task
Awareness: often great distress Normalise the experience
Seeking information/reaching out for support Encourage links and support seeking
Disclosure to significant others Support integration into family system
Exploration: identity and self-labelling Support articulation and comfort with identity
Exploration: Transition issues/possible body modification Resolution of decisions and advocacy towards manifestation
Integration: acceptance and post-transition issues   Support adaptation to transition-related issues

23. Young person concerns

Safety – self, family, school,

  • self-harm
  • parents and siblings
  • school toilets
  • change rooms
  • sport and camp
  • documentation
  • social environment - transphobia

Allies (social supports)

Passing as affirmed gender (dependent on age)

All other concerns that any young person may have (avoid focusing solely on gender)

  • Intra and interpersonal experience
  • Integrated identity e.g. ethnicity

24. Working with the young person

AIM: the child or young person can get on with the business of being a young person in a safe, supportive and affirming family, social and educational environment.

  • Therapeutic relationship:  builds sense of self in relationship – safe place
  • Exploration: Not an assessment of identity – rather an exploration of self and relationships (age appropriate) – when are where do they feel their best self?
  • Safety (physical and emotional) – self/home/school/social environment – how to navigate changes
  • Mental health: anxiety/depression/self harm
  • Allies – who has been welcomed in?  How to tell people.  Encourage supportive social connection
  • Knowledge: be open to questions and be equipped to provide information or refer

In exploration:

  • Affirming – accept person has always been this way unless otherwise stated (do not ask “when did you become …”)
  • Sexuality - cannot be assumed
  • If you get it wrong apologise and move on

25. Working with the parents

  • Intention: they have brought young person – for what reason?
  • Education: – different generation, they may have misinformation built on stereotypes
  • Grief: previous expectations
  • Anxiety: safety, future, stigma/judgment, advocacy, making right decisions
  • Guilt: ‘what did I do’ – seeking a reason – cis-sexism
  • Anger: having to deal with transphobia
  • Couple relationship: not on same page – exacerbation of this with separated couple
  • Advocacy: family, friends, school
  • Referrals – social and medical

26. Working with siblings and whole of family

Siblings

  • sibling transphobia
  • being ‘missed’
  • change of role and relationships

Whole family

  • how to make social transition – where and when
  • Names
  • coming out or inviting in
  • extended family members
  • access to support and other services
  • Making a plan for transition

27. Take homes:

  • Sensitive practice environment
  • Self-educate and check attitudes
  • Work with whole of family, school and social environment – safety concerns
  • Encourage social network
  • Individual work with parents – grief & anxiety
  • Assume nothing
  • Raise awareness

29. Resources:

Reading:

  • The Transgender Child: A Handbook for Families and Professionals. Pepper, R. & Brill, A. (2008)
  • The Transgender Teen. Pepper, R. & Brill, S. (2016)
  • Treating Transgender Children and Adolescents: An Interdisciplinary Discussion.  Drescher, J, & Byne, W. (2014)
  • Gender Born, Gender Made: Raising Healthy Gender Non-Conforming Children.  Ehrensaft, D. (2011)
  • The Gender Quest Workbook: A Guide for Teens & Young Adults Exploring Gender Identity. Testa, R.J. et al (2015)

Services:

  • The Royal Children’s Hospital Gender Service, Melbourne
  • Gender Clinic, Westmead Children’s Hospital, Sydney

Peer support:

Further resources:

http://www.rainbownetwork.com.au/

https://qlife.org.au/

Contact Drummond Street:

Website: http://http://ds.org.au/

Email: enquiries@ds.org.au

Ph: 03 9663 6733

29. Questions?

Join the conversation & access key resources

Continue the conversation started here today and access related resources on the CFCA website: 

www.aifs.gov.au/cfca/news-discussion

 

This webinar was held on 26 April 2017.

Increasing numbers of children and young people are identifying as gender questioning, gender diverse or transgender, and presenting for support from professionals in mental health, family services, and child and youth services. Queerspace at Drummond Street Services has responded to many families presenting for assistance for themselves, their child, siblings and other family members or caregivers in dealing with the questions and challenges that arise from the experience of being gender diverse.

This webinar introduced ideas of gender and identity formation and discussed the struggles that individuals, families and services face in responding to the changing landscape in this area. Adapted case studies from Queerspace’s own work were used to discuss ways of working with and supporting these young people and their family members. This webinar provided an opportunity to explore some of the essential information and skills needed for practitioners to deepen their understanding of gender, and work in an inclusive and affirmative manner.

Related resources

  • Drummond Street Services: queerspace
    queerspace provides a safe and supportive space to obtain information and support services aimed at improving mental health and wellbeing by specialist queer and queer affirmative mental health practitioners.
  • Rainbow Network
    The Rainbow Network aims to empowering service providers to provide safer, more inclusive services for young same sex attracted, intersex, trans* and gender diverse Victorians
  • QLife
    QLife provides nation-wide, early intervention, peer supported telephone and web based services to people of all ages across the full breadth of people’s bodies, genders, relationships, sexualities, and lived experiences.
  • Transcend: support for transgender children and their families
    Transcend is a parent-led peer support network and information hub for transgender children and their families in Australia.
  • Transfamily
    TransFamily is a peer support group for parents, siblings, extended family and friends of a trans person.
  • Ygender
    Ygender is a peer led social support and advocacy group for trans/gender diverse young people.
  • Gender Service, The Royal Children’s Hospital, Melbourne
    The Royal Children's Hospital Gender Service aims to improve the physical and mental wellbeing outcomes of children and adolescents who experience gender dysphoria.

Further reading

  • Drescher, J, & Byne, W. (2014). Treating Transgender Children and Adolescents: An Interdisciplinary Discussion.
  • Ehrensaft, D. (2011). Gender Born, Gender Made: Raising Healthy Gender Non-Conforming Children.
  • Pepper, R. & Brill, A. (2008). The Transgender Child: A Handbook for Families and Professionals.
  • Pepper, R. & Brill, S. (2016). The Transgender Teen.
  • Testa, R.J. et al (2015). The Gender Quest Workbook: A Guide for Teens & Young Adults Exploring Gender Identity.

The feature image was supplied Drummond Street Services' Queerspace team.

About the presenters

Louise Cooper

Dr Louise Cooper is a Counselling Psychologist and Child and Family Practitioner in Drummond Street Services’ Queerspace team. Queerspace provides affirmative counselling services delivered by LGBTIQ and queer friendly mental health practitioners. Louise specialises in counselling and supporting transgender and gender diverse adults and young people and their families. Louise has been actively involved in establishing several projects promoting the wellbeing of gender diverse youth through Transgender Victoria and YGender. She regularly supports the QProgram, a LGBTIQ youth group based in the western suburbs of Melbourne.

Ari Dunphy

Ari Dunphy is an intern practitioner in Drummond Street Services’ Queerspace team, working with individuals and families. Ari is currently completing a Masters in Counselling and Psychotherapy at Cairnmillar Institute, with a research thesis on frameworks for conceptualising LGBTIQ intimate partner violence. Ari is passionate about the health and wellbeing of transgender people, and seeks to contribute to the collective understanding of gender.

Comments

Thank you so much for this informative webinar. It has inspired me to do more in my work to ensure we are actively being supportive of gender diverse young people.
Meagan