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Mental Health in the LGBTQIA+ Community

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Join Justyn Smith, MS, LPC, Casey Tanner, LCPC, CST, and Moe A. Brown, LMFT as they discuss best practices for offering mental health care to individuals within the LGBTQIA+ community. 

This group of mental health experts, moderated by Dr. Ben Caldwell, discuss how clinicians can be mindful during the initial intake process, and ways you can appropriately market your business to the LGBTQIA+ community. They also offer advice on how to work with parents who may be struggling with accepting their kids’ gender identity, names, or pronouns. 

If you’ve ever been interested in this line of work, this panelist of experts has the knowledge and insight you need on how to get started, and what to expect when working with the LGBTQIA+ community.

  1. Introductions
  2. How can we as clinicians be mindful in the intake process making sure we are providing affirmation?
  3. How can we best market ourselves to the community and show that we are an ally?
  4. How do you view the role or appropriateness of self-disclosure with LGBTQ+ clients regarding the client’s own identity or experience?
  5. Are there any good trainings or certifications that you would recommend for mental health therapists on the topic?
  6. Are there obvious blind spots when it comes to biases in clinicians who are straight or not part of the community?
  7. How do we best include or support parents of teen LGBTQ+ clients who are struggling with acceptance of their teenager’s identity, name and pronouns?
  8. How can we support relationships, more specifically queer couples?
  9. Anything that we didn’t ask about you wanted to make sure to add, or any place that you would draw folks’ attention to before we call it a day here?

1. Introductions

Ben Caldwell: Good afternoon, everyone. I want to welcome you to today’s Ask the Experts webinar on Mental Health in the LGBTQIA+ community. My name is Ben Caldwell. I’m the Education Director here at SimplePractice Learning. None of you are here for me. You’re here for our fantastic panel.

We’ll start with Justyn Smith. Justyn is in Houston, Texas, an LPC teaching as well as working in private practice. Justyn, do you want talk a little bit about who you are and what you do?

Justyn Smith: Yes. I am in Houston, Texas. I’ve been a therapist for eight years. I work in all sorts of settings. Originally from Ohio, but had to escape the snow. So, I’m loving the heat down here in Texas. It’s just been a developing specialty of mine, being my thing as a gay black man, kind of merging the two with my clinical work, with my identity and my passion. Now I’m not only doing full-time work at university, but also my private practice where the bulk of my clients are gay men.

Ben Caldwell: Great. Thank you very much, Justyn. I will tell you, loving the heat in Houston is not something I hear that often. It’s good to have you with us today.

Justyn Smith: Well I mean, I love it from the indoors. I like to see it outside.

Ben Caldwell: Our next panelist is Casey Tanner. Casey’s a certified sex therapist. You’re practicing in Chicago. Casey, do you want to talk a little bit more about you and your work?

Casey Tanner: Sure, absolutely. My specialty is in the intersection of gender expansiveness and sexual expansiveness. I run a group private practice called The Expansive Group, and I also do a lot of free sex education via my Instagram, @queersextherapy. As Ben mentioned, I am an AASECT certified sex therapist, so I do work with a number of queer relationships and couples that want to expand what it looks like to have pleasurable sexual experiences.

Ben Caldwell: Wonderful. Thank you very much. It’s great to have you with us. Then Moe Brown. Moe Brown is a licensed MFT in Illinois and Georgia. Moe has a new course for us on SimplePractice Learning on writing clinical referral letters for gender affirming medical care. Moe, do you want to talk a little bit more about you and your work?

Moe Brown: Yeah, totally. I’m actually originally from Chicago, so I’m excited to hear anything about Chicago. Shout out to Casey. I am currently living in Georgia. I run a private practice called Transcendent Therapy. My goal at Transcendent is to serve as many transgender, gender nonconforming, non-binary individuals as possible. I write a lot of referrals for surgeries, medical referrals. And I run some gender groups.

I’ve done a good bit of consulting work in organizations that want me to do safe space training, or any kind of gender affirming training. I work a lot with people in relationships with people who are transitioning. I’d say the spectrum of my practice is broad, but I do work a lot with gender identity. I’m just excited to be here today.

Ben Caldwell: We’re really grateful to have each of you here with us. I know you have a tremendous amount of expertise. It’s going to be a pretty packed hour. We’ve got a bunch of I think very good questions from clinicians asking about how they can improve their knowledge and their ability to be affirmative throughout their practice. Let’s just dive right in.

Our first question comes from MaryAnne, who’s asking, “How can we as clinicians be mindful in the intake process making sure we are providing affirmation?” Casey, why don’t we start with you on this one, and then Moe I’ll come to you, and then Justyn.

2. How can we as clinicians be mindful in the intake process making sure we are providing affirmation?

Casey Tanner: Awesome. I love this question because I find that folks in the LGBTQIA+ community are often encountering their healthcare providers starting at a place of mistrust and looking for signs that they can begin to trust the person that they’re working with. Intake is that first opportunity to show them right from the get-go that you are an affirming clinician.

One of the places that clients encounter first are your forms. They’ll encounter either a form that holds space for the different identities that they have, or they’ll encounter a form that doesn’t include the identities that they have. One really simple suggestion I have for your forms is instead of presenting a form with different check boxes that people can choose for their identities, having forms that have open-ended questions so that people can choose to describe their sexual orientation under gender identity any way that they want. I think that’s a really clear way to say “Hey, we’re here for you, however you describe yourself, whatever language works for you.”

I think a mistake that people make in the intake process is that they as therapists will have done the training to be really affirming, but perhaps folks on their intake team haven’t had the opportunity to get that same training. Being aware that folks on your intake team are going to be interacting with people’s pronouns, people’s names, wanting everyone to know the importance of using affirming pronouns, and of not just getting people’s legal names for the forms you have to fill out for insurance, but also getting the names that people use on a daily basis that are the most affirming for them.

Ben Caldwell: Yeah, that’s a great point, and it’s kind of a nice transition. I know that, Moe, in your course you talk about in the letter writing process, and especially how that applies with insurance, that you have to kind of balance what’s required on a form or required for an insurance record with making sure that you are using affirmative language and the client’s name. Can you talk a little bit more about that, and how it applies in the intake?

Moe Brown: Absolutely. On your forms, if you are collecting someone’s legal name, I like to also collect whatever name it is that they want to be called, and make sure I only call my clients by the name they want to be called. I give a little bit of a caveat. I will say something like, “You’ll only see me use your legal name if I’m sending a form to insurance.” That’s so intentional, but it’s very, very important to the work.

I also like to start first sessions, first intake sessions, from the very beginning with that kind of question, “What would you like to be called?” I like to offer my pronouns. I broke my first rule here today. I didn’t start with “Hey, I’m Moe Brown. My pronouns are they/them or he/him.” So, I’m doing it now and I see everybody going like, “Yes.”

Casey Tanner: Yeah.

Moe Brown: Totally, that’s so right then. I would start from the very beginning with those kinds of mentionings of “This is what I have to share with insurance. This is what my policy is here. I’m open to calling you whatever you’d like to be called, and I’ll use whatever pronouns you want to be called. For insurance purposes, and only for insurance purposes…” So, if you have a private pay client, you get to collect whatever gender identity sex they identify as, and it’s not as important. For insurance purposes, legal sex and legal name are what the insurance wants to see.

Ben Caldwell: Justyn, I’m curious if there are other elements of the intake process that you’d like to speak to here. I guess one that I’m curious about, you don’t need to take it in this direction if you’ve got something else in mind, but one thing I’m curious about is the waiting room. In some of the earliest training that I got on affirmative care/affirmative communications, there was a lot of discussion about making sure that your waiting room is welcoming, and that there are clear indicators there.

Now that we’re all telehealth, how do you show from the very beginning of the intake process that clients are in a safe and affirming environment?

Justyn Smith: I do miss the waiting rooms, what that looks like. I remember having different magazines, and different posters and things like that, things to be mindful of, and then going around that same bank, we can do it now virtually though. So your website is your kind of waiting room now, because that’s their first introduction to you. I always say, a pride flag can be two inches on your website. I’ll find it. Someone else will see it. Even just those images of the flags that are on your page, the people, the images of who are on your page, that can be very important.

The resources that you post, the blogs that you post, that can all be telling to you being welcoming to this community. Then going back to the intake process, I would say really the social way. Don’t reinvent the wheel. These forms are all things that we want to give for the services we provide. So, reach out to other therapists in your community and do some consultation. I know we all do supervision, and then sometimes private practice can get lonely.

So, do some connecting to other clinicians and get some feedback on your forms, because it may be something that you have just haven’t thought about before.

Ben Caldwell: Yeah, that’s a great point. The discussion of the website stuff I think leads us really nicely into question two here. Taylor’s asking, “How can we best market ourselves to the community and show that we are an ally?” It seems like this is a question that we hear a lot from folks who are wanting to be supportive and affirming. Also, wanting to communicate that in ways that are meaningful, because it’s one thing to say that you are affirming, and it’s another thing to sort of walk the talk.

3. How can we best market ourselves to the community and show that we are an ally?

Ben Caldwell: How can you, in your marketing, in a way that needs to be sort of efficient in messaging, make clear that it is something that is meaningfully important to you and not just “Oh sure, of course I treat members of the community.” Justyn, I’ll start here with you, and then Moe and Casey.

Justyn Smith: Going back to the website, I think that’s the most important because I think now we’re so virtual, so originally your website. Also, social media. I think using that as a platform, you get to talk directly to your potential clients and people who access your services. So, not only doing videos, doing written posts, but visually showing your allyship to that community can be so important. As I’m looking for referrals, I’m looking at those things too to see what has been posted, what is visually on there for me to see, for potential clients to see.

So, using those visual things are so important just to start: a website and social media.

Ben Caldwell: That’s interesting. I hadn’t thought about that. That’s a really useful way of kind of showing allyship over time, showing support for the community over time, showing that this again something where it’s meaningful and not just a statement on the website, but really a key component of the practice that you have. Moe, what would you add here?

Moe Brown: Yeah, absolutely. I would say ditto. That’s amazing. I think those are amazing first steps. The thing I’d add too I think in my practice, I try to keep… This is a little different from marketing, but it’s to keep some type of sliding scale open, especially when I wasn’t seeing predominantly transgender or gender queer people. But, I wanted that population to know that I was committed to work with them.

I offer a sliding scale, because I was aware of the challenges that people in that community faced to getting to therapy. That was one thing that I was marketing, my accessibility. I think that it shows allyship when you offer things like that. I think that’s the one way I’d offer.

Ben Caldwell: Yeah, that makes sense. Casey?

Casey Tanner: Yeah, I love all of these ideas. I think the queer community is conscientious though about rainbow capitalism, which is this idea of companies sort of capitalizing off of queerness, specifically right now in June, in Pride Month. If you do have an Instagram, make sure you’re not just posting stuff about the LGBTQIA during June. Make sure that it’s consistent throughout the year, because guess what, queer people have to be queer for the entire year rather than get to be queer for the entire year. So, so does your marketing.

I think one barrier people face in making this jump to marketing that they’re affirming in a really explicit way, is they worry about what clients they might detract or lose by being really explicit about this work. I do think it’s so important that you demonstrate your willingness to take that risk without community, and to not just… I’m thinking psychology today where you can check “Yes, I work with lesbians and bisexual people.” Don’t just check those boxes. Put the words in the actual text of your profile. That’s what I look for when I’m referring out.

By doing so, I know that you’ve been willing to take the risk of maybe losing some homophobic clients in that process. That makes me trust you more with my people.

Ben Caldwell: Yeah, that’s a great point. Thank you. Our next question comes from Lindsay, who asks “How do you view the role or appropriateness of self-disclosure with LGBTQ+ clients regarding the client’s own identity or experience?” Justyn, I’ll start again with you here.

4. How do you view the role or appropriateness of self-disclosure with LGBTQ+ clients regarding the client’s own identity or experience?

Justyn Smith: I lead with my identity, something that I found that clients really appreciate and look for. It makes my day when I get those emails and they’re like, “Oh my God, I was looking for a gay black therapist, and I found you.” I think I lead with my identity. I know finding a balance of self-disclosure of the clients takes some time and practice. Luckily, I’m eight years in the game, so I think I’ve found my balance of it.

I know for people who are just getting into counseling roles, it can be kind of nerveracking of “How much self-disclosure do I give? If I don’t say it at the beginning, when do I say it? Am I not being honest with them?” I think you have find your balance in self-disclosure with that, and what you’re comfortable giving with your clients. I think it can be so beneficial with your clients as well.

Ben Caldwell: You’re saying you’ve kind of found the balance that works well for you over time. Casey, what about you?

Casey Tanner: I think that when it comes to sexual orientation, willingness to disclose your identity is actually an act of social justice, because people who are white, straight and says… Have a pretty easy job finding therapists that match those identities, especially with sexual orientation, which is an invisible identity. Oftentimes, the only way to find that out is if a counselor is willing to be explicit about that identity.

I think depending on your theoretical orientation, you can really work with this disclosure in different ways, because when a client is asking “Are you gay or are you queer?” What they’re really asking is, “Can I trust you? Am I going to have to teach you about me? Or do you already know some of the things that matter to me?” When a client does ask this question, instead out of maybe your own insecurity because you don’t share an identity, instead of avoiding it, answering it and then making space for okay, how did that answer feel? What was it that you were trying to understand about me by asking?

I think that even if your answer is “Actually, not I’m not in the community. I’m straight,” it doesn’t mean that that can’t be a connective moment that builds rapport with a client.

Ben Caldwell: It seems like the idea of leading with your identity, being transparent with your identity, that seems to be pretty common, of course with some appropriate caveats around it in terms of safety and understanding. There are differences with different clients and that kind of thing. I’m curious, especially here about the experience part of this. I would imagine that each of you have had clients who asked at some point about your relationship experience, your experiences with homophobia, discrimination, and that kind of thing. How do you feel about that sort of level of self-disclosure? Casey, I’ll stay with you here for a second, and then Moe I’ll go to you.

Casey Tanner: It depends. It definitely depends. When I am working with a client in the community who doesn’t have a lot of other community that identifies in a similar way, I am more likely to use myself and my experiences because I understand that there is a developmental value of being relatable in terms of those experiences. If there are many other LGBTQIA people in my client’s life who I know are already doing a lot of that mirroring, I might hold a little bit more and encourage the client to take up a little bit more space. I’m certainly willing to disclose if I think that developmentally it’s going to be a positive mirroring experience.

Ben Caldwell: Yeah, okay. Thank you. Moe?

Moe Brown: Yeah, right on. I really believe that the work of therapy happens in the relationship with the therapist and the client. For a lot of queer people, I realize across this spectrum of identity and experience, community becomes so important. When you’re investing your time, energy, resources, money in meeting with someone every single week, a lot of the time I notice that what becomes important to people is that we’re building a relationship, but it’s a professional one, but they want to know that I’m not a robot.

Sometimes, especially the further I get in my transition, sometimes I have to end up disclosing to people that I’m transgender. I’ve certainly had people who read on my website that I’m an expert in working with transgender identity, and the reason why they were coming to me was because they had a lot of transphobia that they were working through. They didn’t know that I was transgender, and I had to disclose that to them because they were fully in a real transphobic moment. I decided to disclose that then instead of waiting until we got further in the work, and then there would be a harm that was created.

It was like, “Hey, I’m an expert because this is my lived experience.” So we’re starting from a place of “Okay, now you know this about me and you’re working through transphobia. How do we do this work together?” Sometimes I think that disclosure is important. Most of the time, the clients that come to us will be a part of the community and will be curious about our identities. I think from my experience, people are curious about my identity because they want to know… For instance, they might ask “Are you married?”

They want to know if love is possible for a transgender person. I love that Casey’s talking about getting to those questions, like what is behind the question, because really it’s something that’s really a value to the client. I’m totally in agreement with that.

Ben Caldwell: Justyn, I saw you nodding along. Was there anything you wanted to add here?

Justyn Smith: I was just loving all the answers that they were giving, because I think especially me being a professor and people who are early on, it’s really kind of shy to wait from a little bit from self-disclosure, because being so new to counseling. I think as you get more seasoned, you see the value in it and try to find, like I said, that balance in it, and getting behind the question of why this is important. Even you as a counselor getting insight on why this might be important to them to know.

Casey Tanner: Mm-hmm (affirmative).

Ben Caldwell: Yeah. Our next question comes from Mona, who’s asking “Are there any good trainings or certifications that you would recommend for mental health therapists on the topic?” This is for anyone, but I guess Casey let’s start with you, and then Justyn, and then Moe.

5. Are there any good trainings or certifications that you would recommend for mental health therapists on the topic?

Casey Tanner: I definitely want to re-uplift Moe’s training because I can only imagine how beneficial that would be. I myself, offer a number of trainings on this topic. I actually have one coming up specifically on gender neutral language and using pronouns. I’m really excited about that. For me personally, my AASECT certification as a sex therapist was really instrumental in helping me, because I think many of the trainings on this topic actually missed the sex part of this topic.

I guess my recommendation would be its great to have sort of the knowledge of what’s it like to be out in the world as an LGBTQIA person, but also know what goes on behind the scenes. Know what goes on in the bedroom for LGBTQIA people. It’s just as important.

Justyn Smith: I would add, the value I got from trainings or going to conferences. I miss conferences, like in person, but also the value now. I think being virtual, you can attend so many sessions. I’ve found that you get a large variety of topics that you can get for bang for your buck, like the ACA, the national conferences, you get to hear from people from across the nation. What I love about those presentations is usually they will have a lot of resources and research, and things that you can dig into deeper, that you can kind of learn from not only the presentation, but the materials to build the presentation.

That’s usually what I recommend to people. I know sometimes the implication is full ones can be expensive and a lot to a commitment of time, but to start out, just going to those conferences and those topics that you want to start building some competency in.

Ben Caldwell: Yeah, absolutely. Moe, what about you?

Moe Brown: I totally agree. I think in every single city, I’m hoping in this day and age, that might be true in Chicago and in places across California and things, but in every city if you can find a LGBT center, like in Chicago we’ve got the Howard Brown center. You’ve got a number of places here in Atlanta. I’m thinking, wherever you are, if you can find a center. Often, there are training resources at those centers, or figure out what large practices that are devoted to doing this work, what they’re doing, and getting tapped into those communities.

That’s a great way to stay up-to-date on trainings. And, being of course, another shameless plug for my course, because I do get to cover a lot of what goes into creating an affirming space, and then writing letters for transgender people in therapy. So, if you’re interested in learning more about that subject specifically, then definitely that’s a great place to start. Certainly, getting plugged into communities that are already doing the work, that’s also a great tool too.

Ben Caldwell: I can certainly say firsthand, Moe, your course is fantastic. It’s amazing.

I’ll keep saying that as we go here too. Question five, “Are there obvious blind spots when it comes to biases in clinicians who are straight or not part of the community? The thing that a lot of clinicians miss when it comes to being affirmative. Why don’t we start, Casey, with you and then Justyn.

6. Are there obvious blind spots when it comes to biases in clinicians who are straight or not part of the community?

Casey Tanner: When I was thinking about this question, a quote that I heard recently came to mind. The quote was, “In order to know me, you must forget that I’m gay, but you must also never forget that I’m gay.” I think that really speaks to the line that we have to walk as affirming therapists, which is to always allow the clients’ identities to impact the types of questions we ask, and how we respond, and how we do their development, but to never silo our clients too much into those identities such that we make it too much about those identities and not actually about the thing that they walked into therapy with.

I think that one thing people often say when they come and work with me is, “I don’t actually want to work on my trans-ness. I just want to be in a place where people aren’t going to just constantly ask me about my trans-ness.” So, not assuming that just because somebody is queer/trans/non-binary, but that has anything to do if they’re presenting problems, while simultaneously using their knowledge of those identities to help you conceptualize.

Ben Caldwell: That’s a really important point. Justyn, what would you add?

Justyn Smith: I recommend using media to your advantage, that way you don’t have to depend on your clients to educate you so much about these blind spots. So, watching movies and TV shows sometimes can really give you some historical context about what the community has gone through, even around rights and privileges, struggles of coming out. People think of coming out as just a one time thing. It could happen over and over and over. So even little stress errors that you may not have thought of, you can kind of see in visual form and film.

Then I also think it really helps sometimes with clients. Clients bring up media so much in session, even like the show Poles. I was just talking Poles’ finale with a client, and relate to it. Then that brings up that their own feelings and experiences. I think that activity for you can really help get you some insight into the community, and help you with those blind spots that you’re like, “Oh, I didn’t even think that was a thing that they had to deal with.”

Ben Caldwell: When it comes to those kinds of media depictions, I would imagine there’s a balance, because on the one hand they can be tremendously informative. On the other hand, they’re not always informative in a useful direction. How would you encourage folks to balance that out, or to maybe watch with… I’m not even sure what word to put to it, like a grain of skepticism, but also understanding that a lot of the media depictions really have a lot of validity to them?

Justyn Smith: I’d say talk about it. Talk about it with your other counseling friends. Talk about it with other people in the community, and what is extended, not is not representative of the community, and what is right on the money, and what’s like “Oh this is direct.” No, a lot of people struggle with this. I keep saying it, make friends. I think as private practice people and clinicians, you’ve got to talk to people, have consultations. I think finding that balance of what you see in the media, because not only are you seeing it, they’re seeing it as well, and what that could be doing to them.

Ben Caldwell: Yeah, very true. Moe, do you want to add anything here?

Moe Brown: I just think if you don’t share the same identity as your client, then likely you have a blind spot. It’s nothing to be ashamed of. You didn’t do anything wrong. You’re just being you. We all have blind spots because we can’t live every single identity underneath the sun. It’s just being aware of those blind spots, owning them even if you can’t be always aware of what each one is. Just honoring that they exist, and that the potential can happen, so that when they do happen then you respond in a “Thank you so much for showing me that,” kind of way that’s very gracious and affirming, and celebratory.

I think that that’s my biggest piece of advice to give, be aware of all of the blind spots. When they are brought to your awareness, handling them with grace and gratitude for the person sharing that with you. That’s the biggest thing for me.

Ben Caldwell: Yeah, that makes a lot of sense. I’m having a little camera issue here. I’ll get that corrected while we’re working on the next question. The next question on the slide is, “How do we best include or support parents of teen LGBTQ+ clients who are struggling with acceptance of their teenager’s identity, name and pronouns?” I just saw a thread about this in a social media group for therapists this morning, where it was a real struggle for the clinician about how to best do this.

Moe, how would you advise a clinician here?

7. How do we best include or support parents of teen LGBTQ+ clients who are struggling with acceptance of their teenager’s identity, name and pronouns?

Moe Brown: This is a great question. I’ve had parents with kids as young as four years old in session with me. It’s a question that certainly comes up a lot, and I would say we’re going to be asking this question a lot over the next 10 years because we’ll have more and more kids being more aware of who they are earlier. I think the best support is that seeing the child as an equal client, that’s the first starting place. The child is likely the client. They’re either the identified patient usually. When they come in, the parent is like, “I want to help my child with their identity.”

So then we want to really get a lot of information from that child about who they know that they are. When that child says, “Hey, I know who I am,” or even “I’m questioning who I am,” you want to hold a really open space for them to build their narrative. We don’t want to repeat any harms that we have often seen played out in our society where parents kind of tell kids who they are. While that child figuring it out, or if they come to you knowing who they are, we want the child to really be creating a narrative about themselves.

That’s the first place that I start, is asking all of my children to have individual sessions, if possible, so that I get a good sense of who they say they are when their parents aren’t around. Then having the parents, depending on the age of the kid… So, if they’re really young, they don’t really get to keep a lot of information from their parents, so the parents kind of need to know what the child is saying at all times. As they get older, having some type of separation between the child and the parent is still really important so that child knows that they can have their own individual relationship with you, and you’ll talk to the parents when if necessary.

Then if you’re there for family therapy, and everybody’s in the room, I think that’s a pretty good time to do some work with the parents around their own celebratory and affirming way of being at home. So, maybe the parents are struggling with pronouns. I want to get to the bottom of that, because ultimately when they leave your office they’re going to meet other transgender people. I put it in the context of “What if this wasn’t their kid?” We’d be doing work around trying to figure out what’s preventing them from being affirming and celebratory.

In the context of their child, identity, name, pronouns… I’d want them to put in the context of “Okay, what about when my child goes to school? Will they need support? Will they need me to advocate for them?” I’m often working with them to be like “The world is going to be a little challenging for your kid. Can you be the place that’s a safe base? Can we shift the lens and the narrative a little bit?” Then I’ll say one little thing too about hormones and surgeries, because that does come up especially when you have teenagers.

In some states, teenagers with their parent’s consent, can get… I know this question isn’t just about gender, but I’m speaking specifically to gender, in certain states some kids, depending on their age, can have hormones or surgery depending on their parent’s consent. Sometimes those conversations come up, and I like to navigate them with a lot of care. If you don’t feel like you know a lot about that subject, I get very, very educated. I would get a lot of resources, and try to navigate that situation with the parents, not just from the parents telling you what they want to do, moreso like having it be an inclusive dialogue, an affirming dialogue about those things.

I just answered the question around gender, and I’ll leave it open for anybody else.

Ben Caldwell: Justyn and Casey, I saw you nodding along there. I would imagine that one of the things that you all see clinically is when an adolescent starts the coming out process, and tells their parents about where they are. Parents have their own fears, hesitancies, biases. How do you include parents in that process in a way that might recognize that they do have those fears, biases et cetera, but that also makes room for them to develop when it comes to those, and maintain a good positive relationship with their kid?

Justyn Smith: I like what Moe said about the parent being a safe base. Even as a parent you do have a lot of pause, a lot of feelings and fears, it’s going to be important for that parent to have their own space with that therapist or a different therapist so that they can process that stuff. That way, they can get it out, and look it, unpack it. That way, they can be in a space to be supportive to their teenager moving forward, or just having some understanding to work with their teenager and not like basically having that word vomit with them, and having that regret of “Oh, I didn’t mean that. I don’t know why I even said that,” because they want to get in a place of fear and high emotion.

I think it’s important to support the parent, and having them a safe space to process things separate from their child. That way, they can be a safe space for the child when they’re together.

Ben Caldwell: Yeah. Casey?

Casey Tanner: Mm-hmm (affirmative), yeah I completely agree. I think when we ask a parent to be a safe space around gender and sexuality, we more often than not asking them to be the type of secure base that they never had themselves. That’s the opportunity for us, for the parent’s therapist, to be that secure base for them around gender and sexuality. I think one of the first things that I do in this context is, understand my client, the parent’s, own journey around their sexuality and gender, and different messages they received when they were very young because we know that without intervention, we’re often just repeating what was taught to us.

So, making space for any trauma around this, or mis-education that the parents themselves might have, and being modeling that secure base, and modeling what it’s like to hold space for those conversations.

Ben Caldwell: Yeah, that’s fantastic. Our next question I think is a bit of a softball here for Moe. Moe, “What is the best place to start? Where is the best to start regarding letter writing for gender affirming surgeries?”

Moe Brown: You’re starting with my course, and if you’re asking about the process in terms of writing letters, I would always start with exploring what requirements the client’s insurance panel… What requirements that panel has for that particular surgery, or if there’s a medical procedure like hormone therapy. In certain states, certain states have different requirements. In Chicago, I didn’t need any letters for hormones. In Georgia, I needed that.

It just really is a tossup. I’d say that you’d want to start by exploring what your state laws are, what kinds of discrimination is happening in your state regarding transgender people, because all of that is impacting the kind of care you’re going to be able to provide. If you are a Medicaid or Medicare provider, you want to know those kinds of laws. I’d start with policy. I’d want to know if the Humans Rights Campaign, or any other organizations that help with transgender equality if they have any notices that they’ve put out recently that would be helpful.

So, I’d start with policy. I’d start with the state laws, and get training on this particular subject just because you want to make sure that you’re providing quality letters for clients, because in my personal experience and in my professional experience, I’ve seen clients have letters returned. I’ve had letters returned and therapists have to write me other letters. And, it’s a long, long process. We’re talking about people on wait lists for surgeries for a year or two. We don’t a letter to be returned, and then prolong that process even more.

I’d start with training, but then to also know your state policies. There are states that don’t have protections in place to help transgender people to not be discriminated against. We want to know what we can do on our end to avoid any kind of discrimination that’s already in place on the state level.

Ben Caldwell: That’s great. Thank you very much. Our next question comes from Sara who asks, “How should intersectionality affect how we practice and work with our clients?” I know this is a big topic. It’s one we could spend hours on by itself. So, we can sort of talk briefly in broad terms here. How should intersectionality affect this kind of work? Justyn, I’ll start with you.

Justyn Smith: I would say that it just helps you see the person as a whole, so having an understanding and insight around the many different identities that a person can be holding in the different spaces that they have to be in with these identities, and what that means for them in the world, and structure that they can be going through and trying to cope with. I think it helps gives you greater insight into your clients who have an understanding of the many different things that could be going on with them.

Going back to your insight forms, so those questions that you’re talking about, that insight form can give you a lot of the possible intersectionality that’s going on with your current client. It really kind of ties back into the beginning.

Casey Tanner: I just wanted to add onto that, I think that often we think about the lesbian community being a really small community, and the gay community being small, et cetera, et cetera. But within those communities, there are an infinite number of other communities, and I’ve found that the experience of white lesbians is very different from the experience of many black lesbians, and knowing that the more marginalized identities too that are intersecting, the more important it is to be conscientious about this, because there’s a reason why lesbians who are women still make a lot less money than gay people who are men.

Noting those intersections, and the different experiences especially when they’re multiple marginalized identities, is essential because the range of experience is so wide, and then you add on socioeconomic status, geographical location, whether or not the person is experiencing a disability. There’s just sort of an infinite number of combinations. Just being aware of that.

Ben Caldwell: Yeah, absolutely. Moe, did you want to add anything here?

Moe Brown: No, I think they answered it perfectly. Yeah.

Ben Caldwell: All right, then our last question. Casey, I’ll start with you here. This comes from Tracy who asks, “How can we support relationships, more specifically queer couples?”

8. How can we support relationships, more specifically queer couples?

Casey Tanner: Definitely. I think one place to start is non-monogamy is not the same thing as queerness, however people in the LGBTQIA community are more likely to be nonmonogamous. So, on intake forms and the assessments, instead of talking about couples or marriages, talking about partners and relationships because that makes more space for there to be more than two people in a relationship, and it states really explicitly that marriage is not how we validate whether or not a relationship is real.

That’s especially important in this community, where we weren’t allowed to get married until just a few years ago. As I was saying earlier, not shying away from researching and understanding LGBTQIA sex. It’s different for every single one of those letters. I think oftentimes, even folks in the community who feel insecure about sex shy away from those questions. If cis straight people didn’t even get great sex ed, you better bet that queer and trans people got pretty much no sex education. You might be the only person in their life and only space they have to talk about that.

So, do the work to sort of notice the different biases and insecurities you have about that, so that you really can regulate yourself in those sessions through those conversations. Also, in terms of being trans affirming, and those conversations, well actually just affirming in general, expanding what your definition of sex is. It is not just penis/vagina sex. It is not just penetrative sex. Sex can happen for some people without even touching, and that’s really important to acknowledge.

Also, know that the biological terms we’re given for people’s body parts aren’t the only options we have. There are often more affirming ways that we can talk about people’s bodies, especially for trans and gender expansive folks. So, if you are going to be talking about a client’s body, and I think this is true for any client, asking how they like to refer to that part of themselves rather than assuming that they like to use what we traditionally refer to as anatomically correct parts.

Ben Caldwell: That’s a great point. Thank you so much, Casey. Justyn and Moe, I saw you both nodding along. Justyn, did you want to add anything?

Justyn Smith: I’m just clapping for Casey.

I love what she’s saying, and just holding that space for people. So many times, I think counselors shy away from sex, and exploring that area with clients. I really like just encouraging clinicians to do some work around that, to process their own stuff about shying away from that topic with their clients so they can hold that space for their clients.

Ben Caldwell: Moe, anything to add?

Moe Brown: Yeah, just one quick thing. I think encouraging everyone here to not… I guess I want to say just to never underestimate your clients. What I really mean by that is, just because you see a couple or a triad, or however many people in your office, does not mean that they have… They’re just out in the crowd. I guess never miss the conversation about their coming out process. I think I’ve found a lot in therapy that coming out still really impacts people’s relationships, whether or not mom or dad, or sister is comfortable with my relationship, can seep into my relationship.

It’s something that really still should be talked about. Don’t assume just because you see people in this really loving partnership that they’re not being impacted by the stuff that traditionally impacts queer people. I think this happens a lot for nonmonogamous folks, that people will forget that they’re also dealing with these kinds of structures that are oppressive and can really miss how those basic things like parents not agreeing with their partnership can really impact their larger relationship identity.

Ben Caldwell: That’s a great point. I was recently working on a course on measurement tools for romantic relationships, and one of the things that’s coming up in the more recent research there is this notion that social support is actually a pretty strong predictor of whether somebody’s relationship is going to be satisfying and lasting. There has been I think renewed attention to that as a variable, precisely for the reasons that you’re talking about, that it’s not just a question of whether family is approving, that’s certainly part of it, but it also is a question of out-ness. It’s a question of the degree of oppression that you’re going to experience as a result of being in the relationship.

Thank you, that’s a fantastic point, and it’s a good way to move us into final thoughts here in just one second. I want to mention again, again the course that you have Moe, for SimplePractice Learning on Writing Clinical Letters of Referral for Gender Affirming Medical Care. It’s a fantastic course. I’ve been a licensed MFT for a long time. I learned a ton from that course, so I’m really grateful for it.

We also have up on SimplePractice Learning, General Minority Stress in Trans and Non-binary Clients. Cadyn Cathers is based here in Southern California, fantastic trainer, is involved with an organization called The Affirmative Couch, that does a fair amount of good specific teaching and training on the topic. Cadyn is fantastic and that course is certainly worthwhile as well.

I wanted to give each of you a moment here for kind of final thoughts. Anything that we didn’t ask about you wanted to make sure to add, or any place that you would draw folks’ attention to before we call it a day here? Casey, I’ll start with you, and then Moe, and then Justyn.

9. Anything that we didn’t ask about you wanted to make sure to add, or any place that you would draw folks’ attention to before we call it a day here?

Casey Tanner: I think I would just add that every single person, even if you are straight and cisgender, has a journey around this stuff. Don’t disqualify yourself as a therapist for deserving and needing a therapist and a space where you get to talk about and process this. I think that’s probably the best thing that you can do for your clients in this community.

Another thing I just wanted to mention is via my Instagram, @queersextherapy, I post every single day about different ways that we can be more affirming to this community. It’s sort of like a very simple five minute check in daily that you can do to just consistently increase your awareness around that community. I just wanted to offer that resource as well.

Ben Caldwell: Just one more time, for anybody who is writing it down, that’s @queersextherapy on Instagram?

Casey Tanner: Yes.

Ben Caldwell: Excellent. Thank you, Casey. Moe?

Moe Brown: Awesome. I just want to say that if you are on the fence about your ability to work with this community, or specifically the transgender community, to not be on the fence anymore. Go ahead and take a deep dive into the work. You’re ready. What I think I’ve learned so much during my journey, my personal transition, but also my work as a therapist for the community is that we are all in transition every day. We are always evolving. We’re always changing. We’re always growing.

You don’t have to feel like you have to be a perfect mirror in order to sit with someone in transition. You can relate to loss, so loss of identity after you lose a job or some other way you identified yourself, and then having to rebuild. We can all relate to that. You can relate to just being a human with intersectional identities, because you might be sitting with a transgender person who is not working on their transition. Just feel ready today.

I’d like to add if you’d like to follow me on Instagram, I’m on Instagram @loveoutproud. I also share a lot about my personal journey, but also my work with transgender people there. So, follow me on Instagram @loveoutproud.

Ben Caldwell: @loveoutproud. Thank you very much, Moe. Justyn?

Justyn Smith: I would like to share being grateful for everybody attending today, showing interest in this community, because our community, the community I’m a part of, we need therapists. We need the support. Research already shows a higher stress level with our community. So, you have that clinical training. Competency is a journey. It’s always evolving. Thankfully, I feel like information is so accessible at this time, whether it be simple practice or conferences, or different webinars. So, taking that time to get that information to really show up and be present for this community that really needs the support.

Anybody can follow me on @JustynSmithCounseling on Instagram. I like to be social, so any questions or consultations, I’m open to that type of work as well.

Ben Caldwell: Excellent, thank you. Once again, that’s @JustynSmithCounseling on Instagram. Thank each of you so much. Really, really appreciate your time, your expertise, all of your contributions here today. For those folks who are in attendance, please know that we have been recording this as well. You’ll get an email that’s got some links and things, as well as a recording of this webinar. That usually comes out within about a day of our webinar being concluded.

Once again, I’m Ben Caldwell. On behalf of all of us at SimplePractice, thank you so much for the fantastic work that you do. We’ll see you again soon. Take care.

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