How Gender and Sexuality May Shift for Non-Transitioning, Cisgender, Female Partners

Presenter: D. M. Maynard, M.S., M.A.

Once a partner learns the person they have been in a relationship with needs to transition, a  vast array of feelings often arises. Many of these initial thoughts tend to center around possible  grief and loss, social and medical transition options, sex and intimacy, relationship structures,  questions of trust, and the role therapists can play in helping a partner navigate their loved  one’s transition. A critical unknown that countless partners wrestle with is if they will be able to  remain in the relationship as the transition moves forward. The conflicts and emotional unrest  in arriving at this decision are usually based on a multitude of factors. After conducting  interviews with partners who decided to stay with their partner in transition, they shared  specific shifts and unexpected outcomes that they needed to explore for themselves. This  workshop will examine how non-transitioning, cisgender, female partners began to examine  their newly experienced identities in relation to their own gender, particularly in respect to  exhibiting their gender expression, as well as the questioning of their sexual orientation. In  addition, time will be dedicated to discuss the misconceptions involving inaccurate labeling of  partners by others. Moreover, feedback from the interviews will further investigate how these  imposed perceptions thrust upon non-transitioning partners regularly triggered their earlier  concerns in connection to grief and loss, social and medical transition options, sex and intimacy,  relationship structures, questions of trust, and the role therapists can play in helping a partner  navigate their loved one’s transition. An abundance of partners became self-conscious of the  manner in which they dressed, styled their hair, used or did not use makeup, and gestured,  whereas several felt obligated and compelled to defend their sexual preferences and/or  willingness to discover various levels of fluidity they may not have considered in the past. This  presentation will enable psychotherapists and those who intend to work with the partners of  folx in transition to understand these struggles through the unique lens of the partners who  generously offered their written and verbal answers in response to extremely personal subject  matters. These non-transitioning partners selflessly provided access to this information via a  variety of interviewing methods in hopes of assisting clinicians to best serve partners and those  in transition, in order to obtain the most optimal and affirming comprehensive individual and  couple’s therapy experiences in the future. 

Transgender and gender non-conforming identity process treatment model (TGNC-IPTM): psychoeducation for their support system

Presenters: Marty A. Cooper, PhD, Seojung Jung, PhD, and Jamie Gordon, MS

At the 2019 TransFormations Symposium, Cooper and Jung presented an alternative to the existing developmental frameworks for transgender and gender non-conforming individuals (TGNC). The existing frameworks focus on stages clients may go through concerning gender identity development. While the existing frameworks provide a counseling student or an early career clinician valuable insight into some of the stages their clients may experience along with clinical recommendations, they may not address the real-time impact that interaction with the environment can have on identity across time. Our previous presentation introduced an alternative model, which was grounded in Whitbourne’s (1996) Identity Process Perspective, a model that addresses an individual’s ability to remain stable and change across the aging process. We provided an in-depth explanation of assimilation, accommodation, and balance. as mechanisms for TGNC identity development.

In the present presentation, we will first review concepts from our Identity Process Therapy Model for TGNC clients. Then, we intend to extend the model by discussing psychoeducation of primary individuals in the client’s life with a focus on adolescent clients. Singh and Dickey (2017) remind us that as clinicians we sometimes work closely with families of our TGNC clients. We are further reminded by Singh and Burnes (2010) that we often have a role of advocacy with TGNC clients. Our adolescent clients exist within numerous contexts. These include residential (family home, extended family, group home, foster home, etc.), academic (school, after school services, educational camps, etc.), as well as several other contexts.

While a robust understanding of the Whitbourne (1996) model can provide therapists a framework to help clients develop a keen understanding of how clients use assimilation and accommodation across their life and how this intersects with their transgender identity, providing psychoeducation to the primary individuals, such as parental figures and teachers, in our client’s lives may be important. The concepts may be complex for our younger clients and having adult figures that are educated in the concepts and can help the youth navigate the ebb and flow of how their identity may be impacted by their interaction with the world around them may be important and contribute to successful navigation of identity development. The proposed model becomes an incredibly flexible model that can layer over the top of the existing stage models or function as a stand-alone model that remains grounded in the lived experiences of TGNC clients. This discussion will review the model and discuss the psychoeducation of primary figures, including parental figures and teachers. Participants will be invited to discuss their clinical work and assisted in the psychoeducation of the model.

Not so straight, whatever. Contemporary virtual Trans/FaM/Porn(1) Faszination

Presenter: Dr. phil. Martin J. Goessl

It is never just consuming porn; there are always impacts, a spirit of the time, hidden desires,  culture. Like Jeffrey Escoffier in his groundbreaking book ‘Bigger than Life’ mentioned „(…) gay  men (are) more comfortable with viewing hardcore movies at home without risk of either  police harassment or arrest.“(2) Therefore I would like add, that besides comfort, today there  are other and in some ways quite similar reasons to consume porn: A virtual world creates  pornographic possibilities, which have been so far invisible for many and for others absolutely  unthinkable. These possibilities reach far beyond ‘conventional understanding’ of gender  normativity or some ‘accepted’ queerness.

Moreover and of course, porn is an essential part of art scenes.(3)

Virtual Trans/FaM/Porn, as an upcoming porn segment, is not just more popular than ever,  additionally it is more requested than ever.(4)

What are the impacts of Trans/FaM/Porn in terms of gender normativity? What can be read out  of the pictures of Trans/FaM/Porn and are there any differences to other pornographic  standards? And finally I am looking forward to answer a central question: Is Trans/FaM/Porn  queering anything? Is it a form of sexual modernism? Or just freed sexual desires?

To answer this questions I relate Trans/FaM/Porn pictures to Queer theory and concepts of  modernism to unveil this so far unexplainable masculine fascination about this porn segment. I  am not analysing the process of gender transitions or porn industry standards (both would be  very interesting too), it is an analyse about the aesthetic framework and the queer impacts of Trans/FaM/Porn.

(1) FaM: Female and Male. It refers to visible physical objectification of sexual organs without  telling a story of medical history. That is an effort to avoid diagnosing porn worker without  explicit visible sexual organs or without classifying them a inter- or transsexual. (2) Cf.: Jeffrey Escoffier, Bigger than Life, The History of Gay Porn Cinema from Beefcake to  Hardcore (Philadelphia London 2009).

(3) Warhol´s Sex Factory (Cf.: Escoffier, Bigger than Life, p. 20).

(4) Cf.: Luke Hudson.

Gender is a basic human need. 

Presenter: S.J. Langer, LCSW

Why are gender-affirming medical and social interventions so vital for an individual’s survival?  My proposal is that gender is a basic regulatory need. Whereas biological sex can be necessary  for reproductive survival (less so in the 21st century), gender is a physical, emotional and social  

inevitability. In opposition to gender essentialism which ties gender to natal sex; I insist that  gender is essential in its own right for human mental and physical survival. Aligned gender  expression is a psychophysical necessity on par with breathing, eating and temperature  regulation. This model will be supported by interdisciplinary theories which when synthesized  can claim that living in ones affirmed gender is a self & social regulatory process. We know that  there are higher rates of suicidality and non-suicidal self-injury in TGNB communities, in clinical  and non-clinical samples. These are existential and physical threats to the individual. The sense  of body ownership can be weak or distorted in some TGNB people, which can lead some to be  at war with or in denial of their body. 

Utilizing this theory, the workshop will explore how this relates to clinical presentation and psychotherapeutic practice. This will include how best to explore gender identity and  expression in treatment. We will explore how to manage suicidality in TGNB patients and how  to differentiate between suicidality connected to gender dysregulation and clinical depression.  The connection between gender dyshomeostasis, body ownership and non-suicidal self-injury  will be parsed out. There will also be discussion on how to aid cispartners, families, educators  and other health professionals in understanding the necessity of medical and social transition.  There will be examples from my clinical practice and time for participants to discuss cases of  their own.

Accessing Trans-Affirmative Care for TGNC Youth in Foster Care

Presenter: Julian Wolfe, LMHC

The session will explore what it is like for TGNC youth Of Color to transition and embody their gender identity while living in congregate care in the NYC foster care system.  We will also explore how the mission and culture of the agency informs the work. Best practices and approaches for social service workers and clinicians will be explored.

Part of the presentation will focus on how youth and young adults internalize the messages on social media and in advertising that portray a nearly impossible and rarified beauty standard.  How do our young trans women develop a healthy sense of self-worth that avoids falling into that beauty myth trap?

And finally, youth presenting with complex clinical profiles and how it can influence gatekeeping will be discussed

Depathologizing trans: human rights responses to current challenges.

Keynote address by: Mauro Cabral Grinspan

The World Health Organization affirmed that being trans is no longer a disorder. Making that affirmation a reality requires facing the challenges posed by complex forces, including those of normative frameworks, persistent socio-economic injustice, and anti-gender opposition. Human rights frameworks provide key responses to all of them.

The Paradoxical and Bittersweet Trans Phantom Penis: A Conduit for Dysphoria and Euphoria

Presenters: Chris Straayer, Ph.D. and Kit Rachlin, Ph.D.

From November 18, 2019, to January 22, 2020, the authors received 1,239 responses from an on-line call for trans masculine and nonbinary AFAB participants for interviews about the experience of having a phantom penis. To date the presenters have conducted lengthy and detailed interviews with a subset of the original respondents who were eager to share their stories: 37 were interviewed over Skype, and 75 answered the same interview questions in writing via Qualtrics. Participants were asked multiple-choice and open-ended questions regarding demographics, gender identity, gender-affirming care, experience of the phantom in everyday life, sexuality pertaining to the phantom, and the phantom in relationships. This study is being conducted under NYU IRB-FY2019-3565.

This presentation focuses upon one aspect of trans phantom experience: the paradoxical nature of a phantom penis. Some interviewees described joy in their phantoms, others sadness or frustration. Often they described a bittersweet experience of both. Evolving language can reflect these different perspectives. For example, some hear a connotation of loss, pain, or pathology in the term “phantom” and prefer “psychic dick,” while others find that “phantom penis” describes their body accurately. When a phantom penis is experienced as affirming of gender, it often produces gender euphoria; simultaneously, in some of the same participants, the phantom penis can be a reminder of limitations that produces dysphoria. Phantom experience contains a paradoxical blend; a simultaneous consciousness of presence and absence. The presentation will include excerpts from interviews to bring in the voices of the people who participated in the study and described the joy, sorrow, frustration, and enthusiasm inspired by their phantoms.

As the topic of transgender phantom penis becomes a commonly recognized aspect of trans embodiment, research points to clinical implications for providers who are dedicated to supporting TGD people.

Demographics for 112 people interviewed: Participants ranged in age from 18 to 70. Individuals were allowed to indicate multiple identity terms. 82.1% (n=92) of the sample identified as transgender man, transsexual man, cis man, man, male, and/or transmasculine. 35.7% (n=42) identified as nonbinary, gender nonconforming, gender fluid, gender queer and/or agender. 2.7% (n=3) also identified as intersexed. (We recognize that affirming language has changed in the two years since the survey was designed). The racial and ethnic composition of the interviewees was White/Caucasian 72.3% (n=81), Black & African American 11.6% (n=13), Asian or Pacific Islander 3.6% (n=4), American Indian or Native American 0.9% (n=1), Other race or Prefer not to say 11.6% (13), and Hispanic or Latina/o/x 12.5% (n=14). Thirty-one US district/states and one Canadian province are represented.

Addressing Medical Trauma with Trans & Nonbinary Patients in the Context of the COVID-19 Pandemic

Presenters: Karalyn Violeta, LCSW and Elana Lancaster

Medical trauma is often underrecognized by mental health providers and underreported by trans and nonbinary patients. The emotional distress resulting from a medical crisis can be profound and all-encompassing. And yet, many individuals who report intrusive thoughts, flashbacks, nightmares, avoidance, and distress as a result of past medical care (both planned and emergent) do not conceptualize their prior experiences as traumatic, instead taking it as a given that medical care is unpleasant and must be borne without complaint. This can be true even when such care has been deliberately sought out and has a net positive outcome, as is often true for our trans and nonbinary clients pursuing transition-related medical care. For therapists, the task of addressing medical trauma with our clients is further complicated by our parallel experiences of fear, loss, anger, and grief, which may at times–particularly so during the COVID-19 pandemic- -be inextricable from our clinical work. For trans patients who develop chronic post-traumatic stress in the wake of distressing medical experiences, the locus of trauma may encompass both physical pain or fear of death and the negative interpersonal aspects of the crisis. Trans and nonbinary patients disproportionately experience discrimination, adverse childhood experiences, interpersonal abuse, and mistreatment by medical or mental health systems compared to their cisgender peers; researchers believe this may predispose them to develop chronic post-traumatic stress. As a result, a discrete medical crisis, prior adverse experiences, and the negative relational/interpersonal qualities of those experiences combine and catalyze into symptoms of post-traumatic stress that go on to impact an individual’s present and future relationships, as well as their worldview and overall sense of safety and wellbeing.

In this talk, healthcare educator Elana Lancaster will outline a client-centered response to address past medical trauma and consider its impact on trust, autonomy, and personal agency for our trans and nonbinary patients. Through case examples based on trans and nonbinary participants in healthcare navigation and medical self-advocacy workshops from throughout the U.S., Lancaster will identify common areas of concern warranting both individual and systems level interventions. Psychotherapist Karalyn Violeta will provide relevant case examples and clinical vignettes drawn from their interviews with transgender and nonbinary psychotherapy patients who display symptoms of medical-related chronic post-traumatic stress. Our ability to recognize, assess and treat medical trauma, especially within the context of the global COVID19 pandemic, is essential if we are to support clients in moving towards healing, growth, and full embodiment.

The Child as Panic Room: Transgender Youth and a Wish for Anomaly

Presenter: Tobias Wiggins, PhD

The “panic room” is a miniature safe house, constructed within the walls of the affluent private Western residence. Its mythos stages the neoliberal fantasy of privatized success, where those with wealth have the capacity to care the self, far above and beyond what’s available in the public sector. The panic room therefore mirrors interdependent concerns for domestic safety and national security, acting to reproduce the fear that it proposes to ameliorate. In this way, it serves a double function: this safe room provides a sanctuary to keep panic out, while also acting as a container for the panic to exist freely within. This paper considers how the panic room can be pedagogical, helping to better comprehend the influx of mainstream alarm surrounding the visibility of transgender children and youth. In particular, I analyze Bell v Tavistock, and the High Court of Justice of England and Wales’s ruling on Dec 1, 2020, which stipulates that it is “highly unlikely” that a child under 13 could consent to puberty blockers, and that it is “very doubtful” that children aged 14 and 15 could give similar consent. This decision, and the upcoming appeal from Tavistock and Protman NHS Trust, carries severe global ramifications for the health and well-being of transgender youth, setting precedent for the restriction of young people’s bodily autonomy. I argue that in this case, the figure of the transgender Child becomes akin to a panic room, a legitimized container for otherwise restricted cisgender affects. Ultimately, Bell v Tavistock illustrates the wish for gender variance to remain an anomaly – or a rare occurrence – while simultaneously denying the anomalous nature of gender itself. 

How Can Contemporary Transgender Theory Adapt Cisgender Culture?

Presenter: Heidi Breaux, LCSW-BACS

Transgender theory as coined by Roen, was developed to explain the existence of transgender and gender diverse people. This model has evolved to center gender fluidity over biology and steer away from pathology. Both Queer Theory and Feminist Theory consist of gaping holes where transgender exclusion exists. Understanding the history and evolution of Transgender Theory into Contemporary Transgender Theory is essential. Contemporary Transgender Theory as published by the presenter (who is trans) asserts all transgender and non binary identities are valid, and moves toward adapting a cisgender dominant culture to be more inclusive and safer for all transgender and non binary people. Simply acknowledging that transgender and gender diverse people exist, is no longer enough. Contemporary Transgender Theory places a strong emphasis on Intersectionality and Minority Stress Theory to advocate for gender justice. Understanding the history of two-spirit people includes acknowledgment that severe and violent forms of transgender prejudice are as old as American history. Hateful acts of transgender prejudice, transphobia, and non acceptance is not new, they are in fact rooted in Colonialism and White Supremacy. One way that therapists and counselors adapt cisgender culture is by providing transgender affirming therapy. This session will also open a discussion on how to engage allies of the transgender and non binary community and motivate them to move from compassion to action. Contemporary Transgender Theory looks at ways cisgender culture has been adapted already and visualizes an inclusive society where transgender and non binary people can thrive. This will take collective action. What makes professionals write their name and pronouns on zoom, but not stand up at during their child’s school board meeting when learning about transgender identities in the classroom is brought up to an audience with 1 vocal support, a few voicing staunch opposition, and many silent parents who are compassionate towards transgender and non binary people but do not act in the moment? How do we go from a few hundred people every year for Trans Day of Action at the Christopher Street Pier to over 10,000 to protect the safety and joy of trans youth at the Brooklyn Liberation March, and keep this momentum going? Safety is sometimes needed for our allies to be able to take a more vocal and public stance. Without understanding these needs we may continue to yearn towards adapting cisgender dominant culture but remain at a dangerously slow pace, losing many lives to violence and injustice in between measures of progress.

Transference & Countertransference dynamics during the Therapist’s Transition

Presenter: Cadyn Cathers, PsyD

Unlike coming out as lesbian, gay, bisexual or queer (LGBQ), social and medical transition is a public process for the transgender or gender nonbinary (TGNB) therapist. Whereas a LGBQ therapist may choose not to disclose his/her/zir/their sexuality, a TGNB therapist may not have that privilege of choice regarding self-disclosure due to the physical process of transition. In this way, there is a closer similarity of transference to a therapist who is either pregnant or dealing with illness, but neither of these encapsulate the unique situation that occurs when the therapist is physically transitioning through hormones or surgery. This presentation will discuss transference dynamics in a transgender male psychoanalytic psychotherapist with TGNB patients with a special emphasis during the therapist’s transition with the gender confirming surgeries (GCS) of male chest reconstruction and phalloplasty. Dynamics that the surgeries elicited, such as envy, loss of the maternal object, and presence of the paternal object will be explored. Suggestions about how to handle medical transition for TGNB therapists will be provided with emphasis on timing and nature of self-disclosure.

From Pink Bunny to Rainbow Butt Plug: Sex Toys, LGBTQ+ Identity, and Queer Capitalism…

Presenter: Avery Heimann, MA, MEd, MSW

Within the context of isolation during the pandemic, opportunities for queer community forging based in bodily autonomy and access to pleasure-focused sex positive education has become stifled by financial strain and siloed disciplines. Physical spaces of support, Pride celebrations, and advocacy organizations have struggled to reach LGBTQ+ individuals in impactful ways in order to reduce stressors related to the compounded trauma of COVID-19 and adverse experiences around discrimination. The dialogue around sex toys can be a powerful vector for LGBTQ+ individuals to reconnect with their selfhood, whether through the neurochemical production of oxytocin and dopamine during orgasm, engaging in courageous conversations about body-safe materials, or reducing gender dysphoria with affirming products. Sex toys, despite their taboo nature in hegemonic academic narratives, has an intersectional application of subversion in its demystification, particularly around the ethics of their generation and circulation. Questions in this proposal aim to expose thematic underpinnings behind the systemic and systematic cisheteronormative narratives around sex toys and pleasure, the intentionally accessible aesthetic and design around sex toys, how marketing strategies can lift up or exploit queer communities, and how pleasure is a human right.