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In Depth Work with Transgender Patients
with Anna Kramarsky PhD and Gary Jacobson LCSW
with Luc-Olivier Charlap PhD and SJ Langer LCSW
This workshop delved into working with trans and gender non-conforming clients through two unique lenses. In the morning portion of this workshop, Luc-Olivier Charlap PhD discussed uses of mentalization, self-states and shame; what they are and how they manifest in the subject. Dr Charlap then explored how the use of mentalization is essential in working through the experience of shame and gender related trauma. He also expanded on how dissociation is the matrix of shame and trauma in addition to how the former contributes to the elaboration of self-states. Dr Charlap utilized works from different analysts, such as Bromberg, Fonagy and Orange.
In the afternoon, SJ Langer LCSW discussed the theory and practice of accompanying patients in exploring their gender identity and expression. Langer described his theory on how trans people feel their gender differently than cisgender people by utilizing the free energy principle. This workshop then explored interventions for use within and outside of session, giving tools to explore with patients such as Langer’s gender algorithm and gender experimentation. Time was provided to discuss specific clinical issues.
Essential Analytic Training
with Anna Kramarsky PhD and Gary Jacobson LCSW
This is an introductory module designed for therapists without previous analytic training. Over the course of four weeks, the instructors introduced key concepts and techniques in analytic theory to help mental health clinicians think “analytically” and work more deeply with their patients. This module was presented from the point of view that mental health clinicians might be hesitant to engage in analytic work with their LGBTQ+ clients due to the history and perceptions of psychoanalysis.
This module explored key analytic ideas and concepts in the context of working with and as LGBTQ+ people. The instructors addressed crucial issues through the lens of a queer therapist and/or patient; issues such as disclosure, transference and countertransference, and boundaries.
Questions asked and answered in this course:
It is the goal of the instructors to address questions such as:
What is the purpose of therapy?
What is the frame? Why does it matter and how do we use it?
How do we think about self-disclosure and boundaries?
What are unconscious processes? How are they expressed/evoked and understood in the room?
What are transference and counter-transference and what do we do with them?
How is analytic listening different from other listening?
Why is it so hard for people to change?
Panel: Supporting Sexuality Across the Gender Spectrum
with Mister Cris, Gail Knudson, MD, Med, Ronica Mukerjee, FNP, and SJ Langer LCSW
This panel was a redux from our 2016 Trans+Sexuality Symposium plenary. It featured an international, interdisciplinary, panel of mental and physical health clinicians, as well as policy experts and activists from within the TGNC community, brought together to explore and discuss sexuality in trans communities. Topics covered in this panel included the clinical implications of sex after trauma, bodies post-surgery, reclaiming bodies, sexuality changes, and much more. Each panelist gave a brief description followed by a moderated discussion lead by SJ Langer, LCSW.
In Depth Clinical Work with Transgender Patients, Part 2
with SJ Langer LCSW
In this workshop, S.J. Langer explored the theory and practice of accompanying patients in exploring their gender identity and expression. He explained his theory on how trans people feel their gender differently than cisgender people based on the free energy principle. The workshop then explored interventions for use within session and outside of session to explore with patients such as his gender algorithm and gender experimentation.
In Depth Clinical Work with Transgender Patients, Part 1
with Ronica Mukerjee FNP and Ali Belen MSW
This two-part course took place over a full day; during the morning, Ali Belen explored an overview of transgender care issues and build skills to work more effectively with trans-communities, including assessing engagement barriers, current issues impacting the trans community and hot topics such as language and pronouns, how transphobia impacts healthcare access, recognizing internal gender bias and how it effects the treatment of clients. In the afternoon, Ronica Mukerjee brought examples from her research and her personal practice as a care provider to explore gender-affirming surgeries currently available to trans patients. The course then delved into a conversation about sexual enjoyment for trans patients who do not have surgery as well as sexual enjoyment after surgery.
Polyamory - Intro + Advanced
with Kristin Keefe LMHC
Session 1: September 9th, 10:00am – 12:00pm
The first session of this two-part course will introduce polyamory and explain the basics of how consensual non-monogamy is often practiced. We will introduce vocabulary and theory from current popular reference books that many clients use as a starting point for their relationships. Clients in my practice have encountered troubles that relate to issues of political or societal stigma, and thus we will use newspaper articles and academic references to illustrate what those can be. I will provide a case example of a couple opening up their relationship where one person identifies as monogamous, and the other as polyamorous (mono-poly) to illustrate key issues and techniques for helping them.
Session One is recommended for clinicians who are new to the topic of polyamory and non-monogamy.
Session 2: September 16th, 10:00am – 1:00pm
In the second session of this course, I will show two techniques I use with clients; one is relationship mapping, or drawing “polycules,” and seeing how dynamics change over time. Making things visual often lowers distress and helps clients untangle complex feelings. The second technique we will tackle is creating visuals about emotion regulation. In polyamory, people generally take more conscious responsibility for their own emotional well-being as compared to. Diagrams remind people of their self-soothing tools and how to ask for what they would like from others. I will provide case examples and I strongly encourage participants to bring cases from their own practices to try these techniques.
Session Two is intended as a follow-up to session one. It is also appropriate for clinicians who have already taken a course on polyamorous/non-monogamous relationship structures or have a strong practice with non-monogamous clients.
About the Presenter:
Kristin Keefe is a Licensed Mental Health Counselor. She did her graduate work at The City College of New York, and her post-graduate training at the Psychotherapy Center for Gender and Sexuality (PCGS), receiving their certification in LGBTQ-Affirmative Psychotherapy. She has a private practice in Greenwich, New York. Two areas of focus are working with clients who identify as Trans* or gender non-conforming, and helping individuals and partners to navigate consensual non-monogamy. As a volunteer she has taught the Our Whole Lives (OWL) sexuality education to 4th graders for the past two years. She is committed to supporting compassionate and open conversation about people’s right to sexual education and expression.
Queer Theory for Clinicians
with Ann Pellegrini PhD
Queer theory and psychoanalysis: it’s complicated.
On the one hand, queer theory shares with psychoanalysis an interest in the limits of identity: the way lived experience so often exceeds our capacity to name—let alone classify—desires, pleasures, relations, embodiments. On the other, queer theory, as influenced by French critical theorist and historian Michel Foucault, has shown us how psychoanalysis has historically functioned to control and “normalize” individuals. From its earliest moments, and especially in light of Freud’s “scientific” aspirations for it, psychoanalysis was a practice of knowledge whereby individuals (in order to be legible subjects in the world) were incited to identify sexuality as the deep truth of themselves. The issue here is not whether psychoanalysis has historically been homophobic or LGBTQ-affirming, though this surely matters to individual patients and to the wider culture, too. The point is rather that, however we identify sexually, we are called by culture to “be” a sex and “have” a sexuality.
This workshop asks what queer theory might have to contribute to: (1) psychoanalytic understandings of gender, sexuality, and embodiment in general (as if there is any such thing as embodiment “in general”) and (2) psychoanalytic ways of talking, listening, being, and becoming in the consulting room and out.
The workshop will be structured around an opening presentation by the workshop leader, close engagement with excerpts from key texts in queer theory (including but not limited to: Foucault, Judith Butler, José Muñoz, and Eve Kosofsky Sedgwick), and interactive discussion with and among the workshop participants. Readings will be made available in advance, and participants are encouraged to bring in clinical materials for group discussion.
About the Presenter:
Ann Pellegrini, Ph.D., is Professor of Performance Studies and Social and Cultural Analysis at New York University, where she also directs the Center for the Study of Gender and Sexuality. Her books include Performance Anxieties: Staging Psychoanalysis, Staging Race; Love the Sin: Sexual Regulation and the Limits of Religious Tolerance (coauthored with Janet R. Jakobsen); and Queer Theory and the Jewish Question (coedited with Daniel Boyarin and Daniel Itzkovitz). She coedits the “Sexual Cultures” series at New York University Press and is a contributing editor to the journal Studies in Gender and Sexuality. In 2007, she was the Freud-Fulbright Visiting Scholar of Psychoanalysis at the Freud Museum in Vienna and the University of Vienna. She’s currently a candidate in the 4-year analytic training program at the Institute for Contemporary Psychotherapy in New York City.
Intersectionality: Race, Immigration and Size within the LGBTQ Community
with Joanne Clark LCSW
This four week module provided an exploration of the intersections of race, class and size within the LGBTQ population. Special attention was paid to to countertransferential issues in therapy with clients who are ‘other’ e.g. of a different race, ethnicity, culture, class or size than the therapist. Racism, xenophobia as it relates to immigrants (legal or undocumented), sizeism are oppressive subjects that are rarely acknowledged or discussed in our work with LGBTQ clients.
Our clients do not want to talk about these subjects either because they are shameful, taboo and shame inducing. The clinician has to be prepared to be uncomfortable in these spaces and aware of the levels of privilege that they embody as they encounter their clients’ differences and intersectionality.
Offering a mix of theory and experiential exercises, clinicians were guided in a safe space to explore issues of race, size and immigration.
Summer Sexuality Series: Transforming Sexual Narratives: Guiding Couples from Sexual Disconnection to Sexual Discovery
with Suzanne Iasenza PhD
When couples come to therapy with sexual problems patients and therapists often fall into the trap of thinking of them as somehow broken and in need of fixing. Integrating psychodynamic, systems, and cognitive behavioral approaches this series will demonstrate how to shift couples from a state of sexual disconnection to a process of sexual discovery. Emphasis will be on how to conduct a therapeutic sexual/relational history to identify sexual scripts and attachment wounds, develop a balanced treatment plan, and construct behavioral interventions that help couples transform sexual narratives and find a path toward sexual pleasure and connection. A live role-play of sexual history-taking will be included as well as case examples and explicit video to examine countertransference in working with sexuality issues.
with Joanne Mackie
Kink can be confusing and overwhelming for therapists when confronted with it in conversation with clients. Therapists’ prejudices are common when first confronted with a client’s kinky fantasies and behavior, and they can become a serious problem in therapy. Knowledge about s/m and kink can make the therapist more comfortable and better able to respond to the client’s particular needs. Joanne Mackie is a psychology student and Dominant with 18 years in the lifestyle. In this workshop, she discussed terminology, different kinds of play, safety and risks, and the very important matter of consent.
Reaching and Servicing those Involved in the Sex Industry; Choice, Circumstance, and Trafficking
with Crystal DeBoise, LCSW
This workshop explored what it means to provide excellent clinical and social services to individuals who have been involved in the sex industry. Issues discussed included defining what sex work is and the complex and nuanced realities of sex workers’ lives. This course also explored coercion into the sex work industry (human trafficking) and how clinicians can assess for and best serve clients with those experiences. Best practices for sex workers and survivors of human trafficking were taught in an interactive and lively format.
with Margie Nichols PhD and Suzanne Iasenza PhD
Being a ‘gay affirmative’ psychotherapist in the 21st century means being knowledgeable about a lot more than same sex relationships. Increasingly the gay community has expanded and become home to bisexual people, transgender people, people who practice BDSM, people who identify as polyamorous/nonmonogamous- in short, all those whose sexual or gender expression is nonstandard. Moreover, these populations overlap and intersect – in other words, it is not uncommon to find someone who is bi, trans, poly, and kinky. Intersectionality in turns fosters new identities – pansexual, genderqueer- that call into question our late 20th century category systems. This lecture challenged definitions of sexual orientation and gender identity and outlined some assumptions of a new theory of sex and gender variance. Implications for clinical work were discussed. At the conclusion of this lecture, participants were able to: explain the importance of the age cohort effect in understanding LGBTQ identities and behaviors, explain and understand the breakdown of both the gender binary and the sexual orientation triparte systems, describe the ways nonmonogamy and BDSM have become integrated in queer culture, and understand the ways these cultural-contextual changes impact process, goals and technique of clinical work. This included considering countertransferential issues raised by clients’ unfamiliar sexual practices; learning to explore clients’ statements about sex and gender identity in depth; distinguishing between clients’ unconventional sexual practices and harmful ones; working with patients to better understand and deal with intimate relationships that include three or more people.
Summer Sexuality Series: When Three (or More) Is No Longer a Crowd: Clinical Encounters with Polyamory
with Suzanne Iasenza PhD
Whether presenting with an open relationship or desiring our help to construct one, couples increasingly are using psychotherapy to explore and manage polyamory. Given the silence on the topic in graduate and postgraduate training, psychotherapists often feel unsure how to proceed. Countertransference can be a challenge for therapist and patient alike. Using case material, this course offered theoretical frames and clinical techniques in working with polyamory in couple treatment. It illustrated the integration of psychodynamic, systems, and cognitive behavioral approaches. This module payed special attention to the therapist’s use of self, including how to learn from and utilize countertransference.
Countertransference Discomfort with Trans Clients; A Workshop for Non-Trans Clinicians
with Julie Mencher, MSW
While uncomfortable feelings – confusion, sadness, fear, inadequacy, protectiveness, envy, disgust, sexual attraction, anger, impatience, frustration, identification — may feel challenging in non-clinical relationships, in therapy we often welcome them for the crucial data they contribute to understanding our clients’ inner worlds. However, well-meaning cisgender clinicians, even those fortunate enough to be well-trained in trans*-affirmative therapy, may suffer unusual discomfort with the more ‘negative’ countertransference reactions we have to our gender-nonconforming clients. This workshop established a safe, open climate for dialogue about the many countertransference challenges faced by non-trans clinicians in working with this population. A didactic presentation was followed by case conferencing, in which participants brought their most difficult moments to the light of day to brainstorm together how to recognize, work through, and utilize so-called negative countertransference reactions in work with these clients.
Sex Therapy with LGBTQ Patients
with Ian Kerner PhD, LMFT
This workshop surveyed the history of sex therapy through an LGBTQ lens and delineated models of human sexual response; it addressed therapist self-location when dealing with LGBTQ sexual issues and covered assessment of sexual concerns and case formulation: how to take a sexual history, conduct a sex-script analysis and use validated scales and measures to diagnose sex issues. Therapeutic interventions were covered, including cognitive-behavioral, psychodynamic, psychoeducational, and pharmacological approaches. This module addressed common sex problems, including desire, arousal and orgasm issues, in addition to problematic sexual behaviors including excessive porn use, hyper-sexuality and distress-causing paraphilias, Other topics related to LGBTQ patients were covered, including the effects of internalized shame and trauma, sex “under the influence,” sex script rigidity, safer sex, non-complementary sexual response between partners, trans sexual function and relational issues such as non-monogamy and polyamory.
with Daniel Chiarilli PhD
This workshop reviewed the persistence of disproportionately high rates of HIV infection among men who have sex with men (MSM) and encouraged participants to think about ways to address risk taking and risk reduction with clients. Although the fear of HIV looms large for MSM, many do not take effective preventive measures. The workshop surveyed relevant data about condom use and shared information about attitudes toward condoms that participants had gleaned from their work and their own lives. This course also discussed the use of Truvada as pre-exposure prophylaxis, or PrEP, a potentially game-changing HIV prevention tool that has stirred up controversy and about which individual men who have sex with men are sometimes ambivalent.
Topics covered along the way included HIV 101 info on transmission and prevention, including the risks associated with specific sexual behaviors, and getting a relevant sexual risk history without jumping through hoops. Information on access to testing and PrEP for un- and under-insured clients were also shared.
LGBTQ 101: Cultural Competency within the LGBTQ Community
with Amelia Pope LCSW and Kyle Suchomel LMSW
This course gave a historical overview of the LGBT experience in contemporary times, owning the progress of what has come to pass, while exploring what continues to be a challenge to different generations of LGBT identified individuals. While the AIDS epidemic shaped the experience of LGBT identified baby boomers, how is Pre-exposure Prophylaxis (PrEP) impacting millennial youth who are coming out now? Has there been a generational loss of information now that the Zeitgeist is greater acceptance and rights for the LGBT community, and if so, how does it and will it impact future generations? These questions and more were addressed over the course of 6 weeks, through a combination of readings and discussions. Presenters and participants addreseds issues such as identity formation, shame, micro-aggressions, coming out, and internalized homophobia across different generations and their clinical implications in the consulting room.