Counselors are familiar with the meaning of the word oppression. We take a multicultural counseling course that covers the definition during the early developmental stages of our counseling career. Many of us feel the weight of a biased system that puts immense pressure on us, both systemically and individually. We may even advocate for ourselves and others who are underprivileged and overburdened.
Still, we may unknowingly perpetuate oppression through a lack of awareness of our privilege. Whereas sources of oppression such as racism, sexism and heterosexism are familiar, we infrequently consider privileges granted by gender identity status. Transgender individuals — those
who do not identify with their assigned gender at birth or whose expression of gender differs from societal expectations — are perhaps one of the most oppressed and least supported populations that counselors must acknowledge.
According to the 2012 report by the National Coalition of Anti-Violence Programs (NCAVP), 41 percent of transgender individuals have attempted suicide, which is more than 25 times the attempted suicide rate of the general population (1.6 percent). Fifty-three percent of all anti-LGBT homicide victims were women who were transgender. Youth populations are not excluded from transgender oppression. In grades K-12, more than 75 percent of transgender students experience harassment, more than 33 percent are physically assaulted and 12 percent experience sexual violence. Also according to the NCAVP report, 29 percent of respondents on a housing survey who identified as transgender or gender nonconforming said they had been denied access to shelter because of that identity. An overwhelming 41 percent of black transgender individuals reported being incarcerated “due only to gender identity/expression.” Unfortunately, these glaring statistics represent only the tip of the iceberg regarding transgender oppression and transphobia in society.
Clearly, a massive gap exists between counselor competency and the lived experiences of transgender people. Our helping profession must make a conscious shift in its understanding of gender as it relates to the human body. As part of multicultural competency, it is imperative that we fully understand that cissexism is oppressive and begin to advocate for a more inclusive paradigm. We must understand diversity and identity beyond lesbian, gay and bisexual (LGB) and develop a comprehensive knowledge of transgender identities to truly practice nonmaleficence. This shift must occur in our textbooks, our curriculum, our intake processes, our communities and, perhaps most importantly, our interactions with transgender clients.
Glossary of terms
The following list of words and phrases is intended to explain only the basics of the language surrounding transgender issues today.
Male: Someone who identifies as male. There are no other requirements.
Female: Someone who identifies as female. There are no other requirements
Cisgender: Someone who identifies with the gender they were assigned at birth (not transgender).
Transgender: Someone who does not identify with the gender they were assigned at birth or whose expression of gender differs from societal expectations.
Gender binary: Social structure that says there are only two genders: male and female.
Nonbinary: Those who identify themselves other than male or female.
Gender identity: The gender with which a person identifies (e.g., male, female, agender, genderfluid).
Agender: Not identifying with any gender or having no gender.
Genderfluid: Identifying with different genders at different times, which change from one to another in a fluid manner (e.g., “Today I feel like a boy, but last week I didn’t have a gender at all”).
Sexual orientation: Clarifies what gender(s) an individual is attracted to (e.g., gay, straight, bisexual).
Cissexism: An axis of oppression that privileges cisgender (not transgender) people.
Heterosexism: An axis of oppression that privileges heterosexual people.
Intersectionality: The study of the interactions of multiple systems of oppression (e.g., transgender status and race/ethnicity).
Genital essentialism: The belief that bodies are gendered based on their genitals or “biological” sex (e.g., male bodies or female bodies).
Cisnormative: The assumption that a person’s gender identity is the same as their sex assigned at birth (i.e., cisgender).
Transsexual: Made by heterosexual cisgender men, this word describes a person with a disordered and unnatural disease for which the only cure is physical transition. Alternatively, transgender is a word created by and for transgender people and doesn’t carry the stigma that transsexual does, nor does it imply physical transition. However, some transgender people still choose to identify with or reclaim this word.
Doing our homework
Many people feel overwhelmed the first time they encounter these words and phrases, and counselors should remember that being an ally means doing their homework. It is important for counselors to understand that heterosexism and cissexism are two very related but still separate axes of oppression. An individual can be any sexual orientation while still identifying as cisgender and being cissexist. Straight transgender people can be heterosexist as well. In fact, the LGB population that is cisgender does not experience cissexism and is often oppressive to transgender people. Cissexism is a massive institutionalized structure that takes work for the privileged to understand, just like more familiar forms of oppression such as racism or sexism. In addition, most media is made by cisgender people and is therefore decades behind in portraying the experiences of transgender people.
To be competent and respectful in working with transgender people, it is helpful to identify their preferred words. This can primarily be done through social media, where transgender people speak loudly and unstifled by the threat of violence that is sometimes posed in face-to-face conversations. Engaging with sites such as blackgirldangerous.org, Twitter and Tumblr, reading blogs, watching YouTube, learning from transgender people themselves, referring to self-identification and being open to listen are all strategies for expanding one’s understanding of transgender issues.
It is imperative that counselors do not make assumptions that dismiss a transgender client’s independence by asking that client to act in accordance with the counselor’s values rather than the client’s own values. Counselors who place their cisnormative value system on transgender clients are committing both invalidation and harm. Likewise, counselors who are aware and understanding of differences without treating the individual as “less than” provide a safe space for the client.
In the spirit of nonmaleficence, the “do no harm” principle, counselors must avoid acting in any way that could potentially inflict harm on a client. If we are to serve and protect such a vulnerable population, we must put an emphasis on understanding the needs of transgender clients. Counselors have a unique opportunity to provide a corrective experience for these clients by giving them an interpersonal exchange with someone who is willing to learn, listen and empathize without insult.
Beyond doing no harm, it is crucial that we act as allies and advocates when working with transgender clients, being proactive in our attempts to provide optimal services. Many transgender clients feel unsafe with “LGBT-friendly” counselors because these practitioners may have competence related only to sexual orientation. Indicating a specific competency with transgender issues and your status as a cisgender individual (if applicable) can be much more welcoming.
How can you make a difference?
It is important for counselors to have familiarity with privilege and oppression as social constructs that create power dynamics within our work. Microaggressions, which are subtle and often unintentional forms of discrimination, remain commonplace even in counseling spaces. Such invalidations, although less obvious or harshly intended as an overtly cissexist or anti-trans remark, still must be understood as assaults that dismiss and denigrate transgender clients. Even the most empathic counselor can make the mistake of misgendering or committing a microaggression toward a transgender client that sends the message, “This is not a safe space.”
Although knowledge of current transgender issues and how to work with this population may be limited, counselors should consider the following suggestions.
1) Always refer to self-identification
“What language do you prefer when referring to your body?”
How do you know when a transgender client walks through your door? You don’t. Many transgender people do not “look transgender.” According to the National Transgender Discrimination Survey, 71 percent of respondents said they hide their gender identity, and this figure only encompasses those who were willing to respond to a survey about being transgender. It is quite possible that many others did not feel comfortable responding because of their “closeted” status.
To facilitate healing in this population, it is important never to assume a person’s gender or pronoun preference. Instead, gender can be thought of as something you learn as you get to know someone, just like their name or hometown. Before you learn someone’s gender or pronoun, use neutral language such as they/their/them pronouns and “that person” to refer to them. In this way, always refer to self-identification and use the language that reflects what your client chooses. Furthermore, counselors must be clear on the fact that a transgender woman is a woman and a transgender man is a man. A transgender woman is not a man who thinks he is a woman, and vice versa.
2) Offer your pronouns
“My name is Stephen. I prefer he/him/his pronouns.”
Especially in the intimate setting of a counseling session, one of the best ways counselors can indicate a safe space to clients is by offering their pronoun preference first. Offer your pronouns by simply sharing them when introducing yourself. Ask the client’s preference and then respect that preference. This sort of initiative is not only an invitation to the client but also a recognition of privilege. It communicates to the client, “I know it is frustrating and exhausting to constantly correct and inform strangers, so I will take the burden for you.”
Furthermore, correcting oneself when misgendering a transgender client is a sign of commitment to inclusivity. Additionally, introductory paperwork that reflects the respect of one’s counseling staff can go a long way toward provision of safety and comfort. By offering your pronouns, you begin to build a safe environment and establish the therapeutic relationship.
3) Recognize more than two genders
“How do you describe your gender identity?”
Some transgender clients, mostly those who are nonbinary, will prefer to use they/them/their pronouns, which take the place of he/him/his or she/her/hers in sentences referring to them. (That’s why we use they/them/their pronouns throughout this article). Others may use pronouns you may never have heard of. Even Facebook, the popular social media outlet, has updated its website to be inclusive of gender diversity by allowing for more choices than the male-female binary and by asking for an individual’s preferred pronouns.
Although some counselors may at first find the use of this language a feat of grammatical acrobatics, it is important to keep in mind that your client’s sense of safety is predicated on you respecting their gender identity. In addition, keep in mind how your language excludes those who are not male or female: saying “he or she” when attempting to describe everyone is a very common microaggression in communication that excludes nonbinary individuals.
4) Start de-gendering strangers
“Your body is your own, and you can define it how you like.”
The easiest way to avoid misgendering strangers is simply to not gender strangers. We need to eliminate the coercive attribution of gender based on physical characteristics such as breasts, wide hips or facial hair. If a transgender person identifies as female, then they have a female body. Instead of viewing transgender women as “trapped in male bodies,” we must broaden our definition of “female body” to make room for the bodies of women with wide shoulders, facial hair and external genitalia.
In working with transgender clients, it is important to recognize that there is no such thing as a “biological” gender. Rather, bodies only have a gender when designated by the owner. Another way of describing this phenomenon is to describe sex as a social construct just as much as gender. For example, if most people with type “A” bodies are female, but some are not, we can assume that type “A” bodies are not inherently female or do not inherently cause female-ness.
5) Practice seeing and hearing gendered language
“Women’s rights should include more than individuals with a uterus.”
The role of an ally is not simply to know how to avoid misgendering and committing other microaggressions. An advocate for transgender clients has the responsibility of correcting others who misgender, stereotype, tell inappropriate jokes or oppress transgender communities in any other way, whether overt or subtle. Your courage as an individual of privilege and power can save or, at minimum, improve the life of someone who is all too familiar with being “other.” Systemic changes can eventually happen when they start at the individual level.
Conclusion
This article is meant to serve only as a brief introduction to working with transgender clients. There is no step-by-step formula to providing guidance for any individual of the transgender community. However, the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC) Competencies for Counseling With Transgender Clients (approved by the American Counseling Association Governing Council in November 2009) provides practitioners with a baseline position from which to begin one’s education.
Counselors, and not only those of cisgender privilege, must be pursuing continuing education and self-awareness to provide optimal services to transgender clients. This includes lesbian, gay, bisexual and other nonheterosexual individuals who don’t identify as transgender. Counselors must also remember that the language of oppressed communities is always changing and growing. Therefore, continued education is necessary. Addressing these action steps to change your language is not a simple task. However, your efforts will be catalysts for the healing process and may represent the first time that a client has had a health professional show empathy for their identity.
Continued opportunities for awareness and advocacy may include reading the World Professional Association for Transgender Health Standards of Care and obtaining membership in ALGBTIC, a division of ACA.
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Stephen P. Hebard (he/him) is a licensed professional counselor associate in North Carolina, a national certified counselor and a doctoral candidate of the Counselor Education Department at the University of North Carolina at Greensboro. Contact him at sphebard@gmail.com.
AJ Hebard (they/them) is a transgender counselor education master’s student at North Carolina State University. They are currently the social advocacy chair of the Nu Sigma Chi chapter of the Chi Sigma Iota honor society and are passionate in their advocacy for transgender communities. Contact them at ajhebard@ncsu.edu.
Letters to the editor: ct@counseling.org