A Clinician’s Guide to Gender-Affirming Care: Working with Transgender and Gender Nonconforming Clients

314 Pages·2018·4.208 MB·English

by  Sand C. Chang, Anneliese A. Singh, lore m. dickey

“Packed with a wealth of case studies, historical facts, and actionable recommendations,
A Clinician’s Guide to Gender-Affirming Care is a powerful actualization of the authors’
commitments to creating trans justice. Chang, Singh, and dickey go beyond simply com-
piling information to create a compelling, deeply empathetic, and effective resource that
bridges the gap between helping professionals and the trans communities they serve. A
must-read for all aspiring trans allies and coconspirators!”
—Lily Zheng, diversity consultant, and coauthor of
Gender Ambiguity in the Workplace
“Chang, Singh, and dickey have created the essential guide for clinicians who want to
dive deeper into developing and expanding their skills for affirmative gender-related care.
It is practical, comprehensive, and reminds providers that competent gender-related work
begins with the clinician’s personal examination of their gender socialization. Experiential
activities guide clinicians to dive deeper into their own socialization as they develop their
clinical knowledge of gender-related and transition care. A Clinician’s Guide to Gender-
Affirming Care is a necessary reference for all mental health providers.”
—julie graham, MFT, nationally recognized specialist in gender
health care; consultant on gender-related healthcare and trauma
issues for gender and sexual minorities; director of Gender Health SF
“As healers, we are taking on a major responsibility when we devote ourselves to helping
others. It can be such an enormous gift, but it’s profoundly important that we fill our
souls with the best tools to meet our clients’ needs. It’s time for a paradigm shift, and this
book provides a path to freedom from the shackles of transphobia that will revolutionize
your healing practice.”
—Danielle Castro, MA, MFT, research director at the
Center of Excellence for Transgender Health, and the Division of
Prevention Science at University of California, San Francisco
“One of the biggest challenges to offering competent care and support to trans and other
gender-diverse people is society’s tendency to assume that a singular gender narrative
exists. Academic research, professional association guidelines, media stories, and stan-
dards of care have too often been crafted from the individual experiences of too few. How
deeply refreshing it is to find a resource that gently, persistently encourages the clinician
to consider an individual’s gender pathway within an ever-widening context of individu-
ality, family, culture, and systems. A Clinician’s Guide to Gender-Affirming Care supports
the clinician in not only considering the intersecting identities of their patient—their
age, sexuality, race, faith, and more—but factoring themselves into the equation. This
guide provides many illustrative examples of complex people in an easy-to-read format
that will surely make this text a dog-eared must-have in any clinician’s practice.”
—Aidan Key, K-12 gender education specialist, author,
national speaker, and director of the parent support organization
Gender Diversity
“This unprecedented resource for clinicians and service providers seeking to deepen
their analysis of gender and capacity to provide care to trans people is accessible, reflec-
tive, complex, thorough, and practical. A Clinician’s Guide to Gender-Affirming Care situ-
ates trans mental health care in a sociopolitical context requiring practitioners to contend
with the medical and mental health systems’ ability to perniciously perpetuate structural
violence. Finally, a comprehensive resource that gives clinicians a road map to be in deep
solidarity with trans, nonbinary, and gender nonconforming people who deserve access
to care rooted in dignity and justice.”
—Erica Woodland, MSW, LCSW, healing justice practitioner,
psychotherapist, consultant, and founding director of the
National Queer and Trans Therapists of Color Network
A CLINICIAN’S
GUIDE to
GENDER-AFFIRMING
CARE
WORKING TRANSGENDER
with &
GENDER NONCONFORMING CLIENTS
Sand C. Chang, PhD
Anneliese Singh, PhD, LPC
lore m. dickey, PhD
C P
ontext ress
An Imprint of New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the
subject matter covered. It is sold with the understanding that the publisher is not engaged in render-
ing psychological, financial, legal, or other professional services. If expert assistance or counseling is
needed, the services of a competent professional should be sought.
In consideration of evolving American English usage standards, and reflecting a commitment to
equity for all genders, “they/them” is used in this book to denote singular persons.
Distributed in Canada by Raincoast Books
Copyright © 2018 by Sand C. Chang, Anneliese A. Singh, and lore m. dickey
New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Cover design by Amy Shoup
Acquired by Elizabeth Hollis Hansen
Edited by Rona Bernstein
Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data on file
Sand dedicates this book to all those who work toward collective liberation,
those who are not afraid to ask the hard questions, and the many people and
furry creatures who have inspired their creative, emotional, spiritual, and
professional growth. A special thank you to Theo Chang for reminding me
to breathe, and to Zelda Sesame for reminding me to play.
Anneliese dedicates this book to her beloved partner, Lauren Lukkarila, and
to the trans, nonbinary, and cisgender freedom fighters and angelic
troublemakers who have demanded—and continue to demand—justice in
mental health care. The journey has been longer than our lives, and may we
remember the ancient roots of trans liberation.
lore dedicates this book to his trans ancestors and those whose shoulders
help him to stand tall as an out, queer, trans person. His mentors have held
his feet to the fire and he is a better person as a result. Whether traveling by
himself or with others on the path of life, he never walks alone. We need to
see and hold one another. I see and hold you.

Contents
Foreword vii
Preface ix
Introduction 1
Part 1: Trans Communities and Health in Context
1 Challenge Your Gender Training 9
2 Respect Client Self-Determination 19
3 Understand Cultural Landscapes of Gender Diversity 35
4 Know the History of Trans Health Care in the U.S. 45
5 Consider Diverse Genders and Sexualities 57
Part 2: Foundations for Affirming Mental Health Care
6 Understand Your Role as a Mental Health Provider 69
7 Develop Trans-Affirming Mental Health Diagnostic Skills 81
8 Identify Barriers and Challenges 89
9 Cultivate Resilience 99
10 Assess Mental Health Needs 109
Part 3: Transition-Related Care
11 Know Options for Social, Medical, and Legal Transition 125
12 Assess and Refer for Gender-Affirming Medical Care 141
13 Collaborate with Interdisciplinary Providers and Trans Communities 169
Part 4: Counseling and Psychotherapy
14 Practice Affirming Individual Counseling 181
15 Support Trans Clients in Relationship and Family Counseling 195
16 Connect Clients to Group Support 205
17 Affirm Trans Clients Across the Lifespan 211
18 Support Gender Expansive Youth 223
vi A Clinician’s Guide to Gender-Affirming Care
Part 5: Special Topics and Concerns
19 Create Trans-Affirming Practice Environments 239
20 Be a Strong Trans Advocate 249
21 Empower Trans Counselors 257
Final Remarks 269
Acknowledgments 270
Appendices
A Trans-Affirming Glossary—A Quick Reference Guide 273
B Trans-Affirming Counseling Resources 279
References 281
Index 291
Foreword
I am excited to write this foreword for A Clinician’s Guide to Gender-Affirming Care:
Working with Transgender and Gender Nonconforming Clients! As an Indian American, as
a woman, as a trans person, and as a psychologist who advocates for trans-affirming
mental health practice, I find this book especially meaningful. Like a growing number of
the most “fortunate” trans people, I live with a level of freedom, respect, and celebration
for my whole self that I had never dreamed possible. For example, I reviewed this manu-
script while flying to Jacksonville, FL, to take my fiancé, Teri, a trans man, to see my
parents, who have been wonderfully affirming of my trans identity, my womanhood, and
our engagement. I am reminded of the song “What a Wonderful World.”
However, not everyone in my community has the opportunity to live their lives so
freely or fully. We have experienced decades of mistreatment, including at the hands of
mental health professionals and other health care providers. Rates of suicidality, depres-
sion, anxiety, housing insecurity, and other challenges in our community are still at very
high levels, while trans visibility is still nascent in our society, and all too often, trans
people are still caricatured. Despite all these challenges, as trans people, we are reemerg-
ing from hiding, silence, and invisibility, and taking our rightful place in society. As we
do so, disentangling ourselves from oppression, we redefine our personal narratives and
our collective story. We do so speaking on the authority of our own individual, lived
experience, reaching consensus where possible, and creating space for plurality where
consensus is neither possible nor desirable.
What role do you have in this? We need mental health clinicians who have the
awareness, knowledge, and skills to work with our community in affirming ways. But
even more importantly, we need mental health clinicians who are well-versed in the com-
munity’s advocacy needs to develop a more trans-affirming society and world. Whether
you are trans or cisgender, this book provides you with the opportunity to engage in
introspective work to deepen your understanding of not only the needs of your trans
clients, but also of yourself as a clinician working with and advocating alongside them.
We are living at a time in trans mental health when we can move beyond “basic skills”
of affirming practice to more advanced and nuanced topics. These topics are, of course,
not “advanced” to the trans people who live with them. Rather, what is being advanced
is your understanding, and in turn your ability to deepen your affirmative clinical work.
This will allow you to support redimensionalizing and recontextualizing trans identities
within complex, holistic human identities, which I believe is crucial to trans happiness.
If the topics covered here are “advanced,” the goal is basic. Being fully embraced and