Tailoring Therapy for Transgender and Gender Diverse Clients: Effective Strategies for Better Outcomes

Chloe Corcoran, a  former collegiate football player and star of BEING: Trans, the first audio reality show focused on transgender experiences, brings her powerful story to this 1-hour training. Chloe will join Dr. Angela Krumm in helping you learn how to support transgender and gender diverse clients. 

Discover effective strategies for working with transgender and gender-diverse clients

In this video, Chloe Corcoran and Angela Krumm provide effective strategies for working with transgender and gender-diverse clients. Angela encourages mental health professionals to improve their skills in working with such clients. She discusses how discrimination remains a significant issue for them. It is also important not to assume that their visit is related to gender-related reasons only.

It is crucial to truly hear them and validate their experiences of discrimination or trauma. In cognitive therapy, care must be taken not to dismiss their experiences as distorted thoughts. Tools like a daily mood log, combined with skills like positive reframing and radical acceptance, help. This encourages clients to acknowledge their reality while managing their difficult thoughts. Further, using gender neutral language and sharing your own pronouns signals a welcoming space to them. In case of misgendering, simple apologies work the best.

Chloe Corcoran shares her journey, highlighting how her therapist played a vital role in her life, helping her survive and navigate challenges, including workplace discrimination. Therapists can also help clients connect with community resources. Having lived experience is not crucial for being a good therapist. However, assessing one's readiness to work with this population is essential. Personal work and referring to other therapists when not prepared are also important.

Angela also discusses the WPATH Standards of Care, Version 8, as a key resource to support clients' informed consent regarding medical decisions.

This session discusses important strategies for working with transgender and gender-diverse clients. Watch the full webinar today for valuable insights.

IN THIS VIDEO:

Jill Levitt: So welcome everyone to our Wednesday webinar tailoring therapy for transgender and gender diverse clients effective strategies for better outcomes with Chloe Corcoran and Angela Krumm. And I'm going to have Angela forward the slides. We're going to start by, I think we're in for really a very special an amazing webinar today. I'm super excited about it. I'm going to introduce you to today's presenters and say a few things and then I will pass the presentation on to Angela and Chloe. So Angela Krumm is a licensed counseling psychologist and The Clinical Director at the Feeling Good Institute. Dr. Krumm has almost 20 years of experience conducting cognitive behavioral therapy with a special focus on anxiety disorders and social skills. She's served as a professional ally working to support members of the LGBTQ community. She was the co-founder of a long running peer mentor program for LGBTQ students at San Jose State University. She's conducted research and published a paper on discrimination based on sexual identity and she's provided numerous therapist trainings on how to provide affirming care to members of the LGBTQ community and Angela uses pronouns she/her. And Chloe Corcoran is director of alumni relations at Palo Alto University and has worked in higher education for over 10 years in fundraising and engagement. A former Collegiate football player for four years she was cast in Being Trans, the first audio trans related reality show which has had articles about it appear in the New York Times. Chloe appeared on a billboard in Time Square along with being honored by the LA Dodgers for her activism. Chloe earned her master's degree and is currently studying part-time toward a PhD in higher education leadership where her work focuses on equity and inclusion and Chloe uses pronouns she/her. I'm super excited to have this presentation by Angela and Chloe.

I'm just going to take a quick moment to share a few things with you about who we are at Feeling Good Institute, give you a little snapshot and share with you about our mission. So our mission is to make a difference in people's lives through elevating the practice of therapy and our story started with the goal of really trying to make therapy better and help people who are going through tough times. And we achieve this by training and certifying therapists in effective therapy techniques. We have a comprehensive 5 level Team-CBT certification system that provides a path to mastery in TEAM-CBT. We're really proud of what we do especially all our therapists who practice TEAM-CBT. We have treatment available in over 35 States across the US and Canada and we offer therapy both online and in person. We have an intensive one-on-one therapy program which speeds up recovery with extended and more frequent sessions and we also have a program to offer lower fee options supervised by advanced clinicians so that people have more access to high quality care. And just to let you know how you're going to get your CE credit today. So you do need to stay for the whole presentation and at the end about 5 minutes before the hour I will drop the link to fill out the CE survey in the chat box. So you just need to fill out that link on time today just at the end of the webinar and then you'll receive your certificate of completion via email within one week. So again that will not come immediately but we will email you that certificate of completion within a week of today's webinar. And now I'm going to turn it over to Angela.

Dr. Angela Krumm: Got to unmute. It's first time on Zoom, apologies. So okay, what's our plan for today? So thank you for those nice introductions, Jill. So we're going to talk a little bit first about some mental health topics including mental health disparities and reasons to seek treatment. Then you're going to get the real reason you're here today which is to hear more from Chloe. It's why I came back again today because I love hearing Chloe talk about her story and share her wisdom. Finally, we're going to spend a chunk of our time, an important chunk of the time talking about how we can work as mental health professionals or medical professionals for those of you in the group who fall into that group to create more affirming experiences. And within that topic we'll talk about what we can do as therapists or providers, whether lived experience is important to have as a provider as well as talk just briefly about the World Professional Association for Transgender Health, WPATH standards of care.

So if those are new to you we'll talk about what that means and some of the complexities that come along with that. And we will do everything within our power to save some time for Q&A which as Jill mentioned you'll chat your questions to Jill. Chloe and I are way too distractible to manage those in the middle of a presentation so please those who go to Jill she'll be like the facilitator at the end. Okay? So if you're chatting to Chloe or I prepare to be ignored lovingly during the presentation. So let's talk a little bit background. Why are we offering this presentation? Well the truth is that discrimination and marginalization of folks who identify as gender diverse or transgender continues to exist right? And so folks are at greater risk for struggles because of these added inequities in their life. The journey of exploring gender and considering or acting on transition is not without hardship, it's a complex process for many people. And so we do become aware that even within medical and mental health services negative experiences are unfortunately still prolific right? Very common and can deter folks from seeking treatment for whatever their mental health concerns are and deter them from seeking support around gender identity right? So there's also ample research evidence that when providers have received additional education and knowledge to better understand gender identity or transgender experiences that they are eventually rated as more affirming in their care. So it's good you're here and it's good we're all here and continuing to learn. At Feeling Good Institute we're continued to we continue to try to prioritize this journey of making our approach to treatment, TEAM-CBT, more affirming whenever possible and as inclusive as possible. And it is true that CBT can be delivered like any modality can be delivered in a way that is hurtful and harmful to people or a way that's really affirming and helpful and positive. And so we hope today to help folks see some of those paths towards affirming approaches. How will we do that? Well we have a couple just two simple learning objectives because it's a short time together. We hope that you can leave naming at least three things you could do even starting today to make therapy more affirming and we hope that you can better describe a therapist role in working with gender diverse clients and trans clients. And you know today we we really do hope it's an opportunity to grow and learn together. I come to you very humbly realizing that I'm not the expert, I don't have lived experience and I will even today potentially make mistakes in my phrasing or how I approach things. And so there's this awesome opportunity at the end to fill this survey and just give us your honest raw feedback right? I think Chloe's open to that feedback as well and we want to hear from you because there are likely people in the audience who have more knowledge than I do who have different lived experiences and you'll very quickly see what maybe we missed or what you feel we misrepresented and we want to hear from you in those cases. Okay? Okay, so let's start with what is my favorite favorite slide of all which is why do folks who identify as trans or gender diverse seek treatment?

And I joke that my favorite slide because the simple first bullet point is the most important thing you can take away from today, any reason. What does that mean? Does that seem too obvious? Let's think about it a little bit together. Well the reality is that folks come to treatment for all kinds of reasons and sometimes it has nothing to do with their gender identity or any of their identity variables and it can not only be inaccurate but even harmful to assume that people are there for that reason. And I this was brought to life with me with a trans man I worked with years ago who came into therapy the first session and the first thing he said upon sitting down in the chair is he said I'm a trans man, let's just get that out of the way. You know that's part of who I am, I've worked through that, I'm good, can we talk about my relationship with my dad? And I just chuckled and felt this tremendous appreciation for what he must have been through in so many therapy experiences to need to lead that way right? To help me understand that like yes this is part of who he is and I might be curious about that as his therapist and want to know more about it but he's not here today to tell me his story or to talk about that part of his identity at least today. What he needs is help with this other problem. So folks of course come in with all kinds of problems just like cisgender folks do and that's what we want to treat. Now of course they also can come in for gender related reasons and I'll talk about a couple of these and then pass to Chloe to talk more about it. So exploring gender of course, people may be at any stage of understanding their gender identity. They may be coming to counseling to look at their own view of gender. They might be exploring where their views of gender came from whether it was their culture, their family and wanting to better understand those things. What does it mean to us? How do people react to gender? They may also be coming in because of experiences of discrimination or trauma based on their gender identity right? And the important point to remember in those moments is that their gender identity is not the identified problem that's bringing them to therapy but people's reactions to them right? The discrimination, the societal reaction to their gender identity that leads them into your therapy room. And of course in those opportunities as therapists we have the gift of supporting them as we would other folks who've been treated unfairly or had trauma or discrimination and work with them from that from that lens. Chloe why don't you jump in here and talk about this this next part.

Chloe Corcoran: Absolutely, thank you and thank you all for being here today. I think it says really good things about you. I'm going to assume it's because you care and you want to get better especially in this area so I'm very thankful that you're here. For me my therapist was instrumental in my ability to get to a place where honestly I could survive. I truly believe that the therapist I had during my transition helped to save my life. Now as we get going here I'm going to give you a little bit of background and a little color about my story but I do want to start this out by saying it is one story. There are some things that will be similar across trans experiences, some parts of mine are probably fairly unique and I hope that you'll be able to take those in and say okay well this makes sense for this person I can be aware of but it may be different with some of the clients that you work with. I also want to make sure that I cover a quick terminology lesson, cisgender and transgender. You may hear in some circles that cisgender is a slur, I promise you it is not. Cis meaning same meaning your gender identity correlates with your sex assigned at birth, trans meaning different, your gender identity is different than what your sex was assigned at birth. So I was assigned male at birth and I learned early on in my life that expressions of femininity were not going to go over well in my traditionally Irish Catholic household so I buried all of that away and I got very into sports. I accomplished what every young girl wants to do, I became homecoming king and captain of the high school football team before going on to play college football. A little unique in some regards there but it was a way for me to make friends, it was a way for me to fit in, it was something that I was good at because all I had to do was work really hard at it and I could at least be okay. So you know high school sophomore year was homecoming king, was riding high, playing varsity football and then my first depression was really big and it hit my junior year of high school and I really think that's when being trans really started to come back to the forefront of my mind. And I was just deeply unhappy but my grades went from literal 4.0 straight A's to A-minus, A, B-plus. I was doing what I call being loud enough to be quiet. So don't take that because that is going to be the title of my first book. I was making enough noise that people would notice me and think that I was okay but they wouldn't ask questions. I was struggling in certain ways but not in ways that were very noticeable. You could talk up the grades to during year being more difficult. My athletic performance however slipped and that was noticed fairly quickly and I got a lot of advice and counseling and anger about how we need to improve and many of many things along those areas but I still played well enough.

I got recruited by a dozen universities and I ended up attending the University of Rochester and I played football all four years while I was there. I lived in a dorm with a lot of other athletes, mostly football players, got up to shenanigans like tennis ball wars almost cost my friend Ike his eye he said all I could see was yellow fuzz. We had some stereotypically considered male times in there but I was also friends with a lot of girls on the soccer team, the field hockey team and some others. And at one point they we had a talk and they said look we don't know what's going on with you, we don't know what's wrong but something is wrong and you absolutely need to see a therapist. And they weren't wrong. You I was I was still really struggling and wasn't being as quiet as I had hoped to be about it so I started going to therapy and at the time not many people knew about gender diversity or being trans so I got shuffled around a lot and shuffled around very quickly in that regard. It didn't take many sessions to be moved on. So finally they they put me with the director of the counseling center at my university and she did a great job to be honest with you and we had a point. I had never said that I was trans. I said I'm worried that I might be trans. I'm worried because I kind of feel this way and we eventually got to a point where we came to an agreement that I am trans and my first reaction was okay cool how do I unknow this? Like can we put that back because now it's real and now I have to deal with it and and I am absolutely not ready for that. So I went on, I graduated, I got into law school. I decided not to go because my my depression was was too much. I knew I couldn't show up in the ways that I needed in order to be successful in such a demanding program and field so I got a job at a law firm, worked as a paralegal and then I started seeking the geographic cure. I moved a few places down in the Baltimore DC area, shipped up to Boston for a while where I worked a full-time job and a couple part-time jobs one as a bouncer in Chestnut Hill if anybody knows Boston well. It was it was quite the experience. The one rule I had with the people was look I know you you come in every weekend and you get in a fight just have another job, don't hit me in the face. And to their credit they never did. So I got through that, moved back to Rochester and started a career in fundraising and was still trying to get through, get by it. It kind of settled into my life of trying to out dude out bro. Being trans doesn't work. I don't know anybody who that's worked for and eventually I hit a point where I was so depressed I wasn't gonna make it. And I say I had to transition and it was a little bit different than that. You know I will be honest with this group because I feel like it's important. The reason I transitioned had something to do with my upbringing in the in the church and that I was terrified to I'll call it not be here anymore because of what I thought would happen after that. And I said you know I don't want to do anything without knowing I've tried every possible thing I could to get better and the only thing I hadn't tried was transitioning. So I thought well I'll give this a month, maybe two, possibly three and then I can say I tried, I gave it my full effort and then I can I can make decisions from there. In my mind I had already made a decision. So I went through transition.

Came out, my my coming out day at work was the day the federal election results were announced in 2016. I've always had a knack for timing. So that was an interesting moment in my life and that of many other folks and people even now will say oh when when you transitioned your your life got better right? And I have to be honest no, my life got objectively worse in so many ways but I wanted to be here. I want to, I hit month two and I was like all right we'll see, well give another month. Hit month three, I was like I guess we can give it another three and all of a sudden it'll be eight years this November and I'm still here and I'm very happy to be. And I want to touch on some things that Angela mentioned before about some of the issues not really being about gender identity but being about what happens to us in those spaces. And this is where my counselor at the time became incredibly important to me. Speaking of workplace discrimination I had a supervisor at the time use a a slur for the LGBTQ plus community against me and the the response was to functionally demote me and then bounce me around until they put me with a supervisor who is well known to not be a fan of mine. And my counselor throughout all this, I was the first trans person she had ever seen. I started seeing her probably a year and a half before I actually publicly transitioned and she helped me that and she was a cisgender heterosexual woman and I was her first trans client. I she had not met I don't know if she had met other trans people but I was her first client and it was really important to me that I didn't know that by her reaction. I didn't know that at the time. She said okay and she went out and she didn't try to refer me away immediately. She went out and she did the work. She learned about community resources, she read the literature, she talked to other professionals and she did that by within her own community as opposed to having me try to process her reaction to me with her. And that was incredibly important for me because it felt like okay she's still here, she didn't leave me. I had a had a little abandonment thing going on at the time and she just stuck out. My gosh, you know even think about it now I send her an email once a year just let her know I'm doing well. So she stuck with me and some of the things that she did were so important. And you know I hit a point where I was like I got this, I got this figured out. So I had my first moment going out and by going out I mean presenting in public as myself. I went down to New York City and I was so prepared for this to be awesome in my own head and it was anything but. It was a disaster. I went with the wrong person, I stayed at the wrong place, I went to a a bar/club where six men surrounded me to assault me and then I was saved by a girl whom I had never seen in my life. She came over and she grabbed my arm and she said oh come on our friends are over here and brought me to another space where the bouncer found me and then kicked me out. And the reason I'm illustrating this story is because these are some of the realities of what we face. This isn't an anomaly unfortunately. So my therapist at the time let me process that for for a session and a half, so about an hour and a half.

Was able to sit with my feelings. I was able to be upset and then she started moving me towards a different process and we started a lesson that I've taken with me through my entire life is Flo did you set yourself up for success in this instance? And we went over my decision-making process at the time and why did I choose this place to stay, why did I choose this person to go with, why did I choose these outings? And they were all based on what I wanted the reality to be as opposed to what I kind of knew the reality was especially you know for my first time out. And we said that's something I do today when I look at a situation is am I setting myself up for success? So I moved on, I left. I lived in Sacramento for a bit before moving to Los Angeles and my life is quite different now. I live in Hollywood and I asked myself during the pandemic do I really live in Hollywood if I've never auditioned for anything? So I auditioned for an audio reality show and somehow I was cast. They followed me and three other trans people around for me it was five months, 15 to 20 hours a week, it was pretty intense. The last person I saw before going into one of my surgeries was my producer who was awesome. Now I didn't find out until after the recording was done that my producers were the original producers for the Kardashians and I hadn't heard what they had done with the editing yet. So my thought process was oh no what have I gotten into. But I think they really did a really great job with our story. It's me, there's another trans man, and a trans man and a non-binary person all from different areas and walks of life. Jeffrey was from Texas, Sai was from Louisiana, Mariana I believe was from Venezuela. So a lot of different experiences rolled into that. We were all very different. It's called Being Trans, you can check it out on Spotify if you'd like. But that really opened me up to some more things. I started you know thinking about maybe I can act, so I started acting. What I really ended up getting into very strongly was public speaking and one of the reasons was because when I came out I wrote an article to an author whose name is Jennifer Finney Boylan and one of the books she wrote is called She's Not There and when I read that book I thought okay, it's okay for other people to be trans, it's okay I get it as a concept other people not me but other people can be trans.

And I went I sent her an email on my coming out day and let her know what her book meant to me because it started me on a trans and a path towards accepting myself. And she wrote me back within an hour which was quite unexpected and she said a lot of nice things and one of the things she said to me was Chloe part of your job now is to do for others whatever it is you feel that I've done for you. And I really think that as therapists and counselors that's something that you really have an opportunity and I and I'm pretty sure you probably entered the profession because you give back because you want to help other people. Maybe somebody helped you along the way and that's why I'm really glad to be able to come here and share parts of my story with you today. And I'm going to leave you with one more small piece that kind of illustrates the importance of visibility and working through and honestly staying around. Just sticking around is the first public talk I ever gave was outside the Federal Reserve building in my hometown of Rochester New York and it was very hot which is relevant later and I was very nervous and I was everything about me was shaking except for my voice. I hadn't really done this before. I got down from you know where I was speaking in the Bullhorn and I was quite relieved to be done. And this woman comes up to me and she says Chloe I just want to I want to thank you. You're inspiration to me and my family. And obviously you love to hear that because you know I feel like I made an impact and part of me is also like well who's your like I didn't ask of course but who's your family? I don't see anybody else here. All of a sudden this little girl she's she's probably seven or eight years old, she got these blonde curls, she comes running up to me with this huge smile on her face and she looks at me and she just goes I'm transgender too. And the reason I'm glad it was hot was because the sweat could blend in with the tears that almost immediately came when I turned away. And that's when I knew that I was the representation in some light in her life that I didn't necessarily have when I was growing up. So I just want to impart on you that even if you don't know if that session made a difference, it probably did. And I appreciate all the work you do and thank you for letting me share part of my story with you today.

Dr. Angela Krumm: Thank you Chloe. So happy to have you sharing it. It feels like you're doing exactly what the mentor suggested of bringing forward what's been done when you're sharing with us and helping us think about how we can can be more affirming. Thank you. So let's let's just pause and have folks think about that for a moment. What have you heard in Chloe's story that you can take from today to challenge yourself to create more affirming experiences? There are some hints of things that her therapist did for her that other folks in her life did for her and I imagine your brain is already starting to see some of that. We're going to talk about some specific fixes in a moment but I definitely heard Chloe talk about this therapist who was willing to learn and do their own work and make space for feelings right? And before moving towards helping her look for what she could how she could set herself up for success. So we're going to spend quite a bit of time on this slide. I'll do the first handful, Chloe will talk to you about the final bullet points here. So again this is our list where we want you to be looking today for some of these that you could take with you and maybe implement right away right? So the first one we'll talk about is this idea of not rushing to do things but to simply remind yourself to sit with the gravity of the sharing that has been generously given to you by the client sitting in front of you. In some cases you may be the first person to hear someone's questions around their identity or their realizations around their identity right? And you might literally be the first person they've spoken this to. And wow what a gift, what an honor. And we've heard from plenty of folks within the gender diverse community that the rushing past that is is really painful. And I I think actually the more you've worked within the community the easier it is to make that mistake because you are not maybe you know sitting with the gravity or you're kind of see this as part of a counseling process and you might move too quickly. So we just want to encourage you to slow down, honor this amazing sharing that someone has taken this risk to share with you. Not rush to doing, can come and come later. And then of course we want to really focus on this idea of affirming the the real experiences of discrimination, trauma or othering that have occurred for folks. I think that sometimes as humans when we hear about other people's pains it's so much to process that we kind of want it to be be less than what's being described to us right? We kind of hope it's not as bad as they're describing because it hurts so much to sit with it and to feel that right? And so we can subtly or directly kind of negate or minimize folks's experience through our reactions or our rushing past them. And so we just want to acknowledge how very real experiences are for the gender diverse and trans community and make sure that we've slowed down to really affirm that reality and not engage in ways that kind of minimize the impact. And the third point, we'll talk about this one in a little bit more depth. So cognitive therapy specifically there's there's a little bit of a danger zone and when we think about what we call distorted thoughts. So for those of you who aren't as familiar with CBT, I know we have a lot of experts here in this in this group who are. But one of the hallmarks of the cognitive part of CBT is this idea that our feelings are largely created by our thoughts right? So how we talk to ourself, our self talk creates our feelings and that a lot of our our negative feelings are fed by errors in our thinking or distortions right? That's kind of a hallmark of of cognitive therapy. I want you to pause and think with me for a minute about how that could be harmful or painful to clients if done sloppily right? It also can create huge healing for folks when they realize that they've been talking to themselves in unhelpful, untruthful ways and they remedy those errors. There can be tremendous relief and joy and healing that happens but is anything that's powerful can be used to help or to harm. So in this case the most often time we see where distorted thoughts are used to create harm is when we take people's examples of harmful experiences and allow them to assume that we're interpreting it as just an error in their thinking. I'm going to bring this to life with a case example because this might feel a little confusing or complex.

So I'll use the name Dany. Dany is a transwoman who I worked with when she was enrolled in a college nursing program. And Dany was someone who did not pass by standard societal views and actually was not interested in some binary version of passing to begin with. And folks around her often reacted to her with confusion around her gender, often asking questions that felt inappropriate, sometimes even hostile and kind of expressing their own discomfort with the fact that she wasn't buying into a binary that maybe others feel more comfortable with. And in her nursing program what was playing out for her is that she was really just rocking it academically on the coursework right? Doing really well. But she was at the phase of her training where she needed to be in and out of hospitals and like her practicum type setting where she's actually doing patient care and receiving feedback on her skills. And patients were reacting to her with some regularity in negative, confused ways right? And as she encountered more experiences of negative reaction her anxiety went up. And you can imagine how this becomes this snowball effect where she has negative reactions from people, she gets more anxious, her bedside manner skills drop, she gets more anxious, she gets more negative reactions right? And it's becoming the snowball to the point she was starting to get really negative feedback from the you know the nurses who were filling out the evaluations and such. And she came to me in this conundrum and in cognitive therapy we very quickly after empathy and support we move towards daily mood logs or some cognitive therapists called them thought records. And so some of the thoughts she was having were things like these patients are reacting poorly to me, I'll never be able to be a nurse, I won't get the mentorship I need and the program is not supporting me right? So common mistake in cognitive therapy if we're moving too quickly and we're too focused on this idea of thoughts that create pain must be distorted and is that we might ask the person to quickly identify the distortions here and then imply that the thoughts are not accurate. So let's look at that first thought, the patients are reacting poorly to me. If we're quickly asking her to look for the distortions she might hear from us a negating of the reality of this situation. So luckily in TEAM-CBT we have some skills that help us avoid that and couple that are you know front of mind for me are what we call positive reframing and then also something called radical acceptance. So in positive reframing we have this really important step where we let a client slow down and look at the wisdom, the truth, the the good parts of a thought that may be on the thought record right? And see how this thought might be serving her in some way or even reflect her values. We also this concept of radical acceptance encourages clients to look for what parts of the thought are really true and that we have to accept right? And so by the combo of these two skills it allowed Dany to find the truth in the fact that people were reacting negatively to her and also having done that figure out which parts may also have been errors in her thinking. So again it seemed like Dany was being discriminated against in her program but as we parsed out the difference in the thoughts she also was be able to begin this journey where she could talk back to the parts that did have like I'll never be a nurse which actually turned out not to be true. She actually sent me an update found me on LinkedIn just recently and told me she's working at a nurse in an LGBT clinic and really loving it. The parts that were true we were able to shift towards things like planning for how to set our up for success. Also something Chloe had talked about. Practicing how to engage with patients who react negatively, for her self advocating with her mentors, finding allies within the the nursing program and even finding a team of folks to work for like systematic change for some problems that were present in that program that we're leading to not get support. So we want to move slowly with distortions right? That's a lot to say about that. And remember that again, something is powerful as identifying distortions that can really be used for healing if misapplied or rushed through too quickly could also be used to dismiss and cause pain.

Okay. I'll talk briefly about gender neutral language and then you'll get to hear from Chloe again. So paying attention to gender neutral language I think is really important in creating affirming experiences. Clients who are gender diverse or trans or even questioning gender will look at your written materials to find out if you are likely to be affirming or not. So if your website, your directory profiles, your consent forms imply things like the gender binary or use other commonly gendered terms like fireman right? I doubt you're talking about firemen in your in intake paperwork but the point is if you're using these gendered languages it's subtle hints that they're going to pick up on because folks have had so many negative experiences they're looking for any indication of affirmation. So your choice to use gender neutral language is respectful and sends a message that you are affirming and open. We so I'd encourage you to look at your marketing materials, look at written intake forms, profiles you have on things like Psychology Today or other directories. And then we want you to think about what whether you'd like to start disclosing your pronouns to people right? And why do we do that? I'm sure you see it often, some of you do it already naturally. It also sends an important message that you don't assume you know people's gender just based on looking at them right? So if I don't disclose my pronouns to you I'm kind of buying into a rhetoric that you should be able to know what my gender is and I shouldn't have to disclose. And so it's respectful and caring even if you think it's not that important to you to it to others. So you can think about on your online medium profiles including it. You can think about email signatures. Now we also want to be thoughtful that it won't be the right choice for everyone because the act of disclosing your pronouns is an act of coming out to some degree right? Of sharing something about yourself. And you may be someone who is not comfortable sharing that publicly and we sure have respect for that as well but we want you to think about it and make that decision with that knowledge. Chloe why don't you jump in and talk about the others or add anything you think I missed there?

Chloe Corcoran: Yeah, I will second that we talk we have a little bit of a whisper network in the trans community and we we have ideas of of who may be affirming and who might not but when we don't those are some of the things that that we do rely on is taking a look. And I've seen you know and I actually did this myself at the beginning was like gender and you may put two or three in but the easiest way to other someone is by saying other and then having them list it. And even doing something different by saying unlist it could be another way to go so people so it's not literally othering. And it was funny listening to Dr. Krumm talk or Angela talk about some of the CBT things there because I'm like oh that's what you oh that was me that was me okay. So I started to understand a little bit better. And really you know the my calling card was black and white thinking for a long time so that was helpful for me. The gender neutral language is really important but also using client's pronouns is really important too. And there were times when I switched back you know I tried on that pronoun in therapy the she her and it got really scary for me really quick and I went back and I said no I don't think that's right even though I knew for me that it was. So we may do that and you know we're we're hoping that you'll be able to kind of come along with us on that journey but also understand that mistakes are gonna happen. Everybody's human, these things happen. If you could have seen me back then I was very, very far on the gender binary into male presenting and mistakes were made. And the best way to work with having misgendered sorry I meant you know she or you know the proper name and you move on from there because if you don't make it a big deal we generally won't make it a big deal. What happens sometimes is it becomes so awkward that we end up kind of taking care of the other people in our lives and this isn't just with with therapists. I mean I've had it happen at professional conferences and things along those line and the intent is good and the intent is understood but it's a lot easier for everybody if you acknowledge the mistake and moving on from there. And one of the best things that happened to me was community and that's continued to be important in my life and something I continuously search out. But when I was coming out I was not ready to go find my own community. I didn't want to know that existed because I was exceptional right? I was the only one who had the situation exactly like me so nobody could possibly understand. Sure some of the CBT therapist could work with me on that in the past but so what my therapist did was she let me know like hey this exists, hey this is a safe coffee shop, this is another place that these are some things that are happening in the community. Do what you want with it but you can know that they exist. And I could start to inch towards those and inching towards it for me might be driving sitting in the parking lot and never getting out of my car but that is a move towards it. Community is going to be really important for a lot of different reasons. So that kind of leads me to is lived experience needed to be a good therapist? It depends which is the answer to most things I have learned since therapy. Can it be helpful? Sure. Can it be limiting? Sure. Because then you could start to view your clients through your own personal experience having you know a a gender diverse experience or transitioning and there is no one right way to transition. There are guidelines but there's no one right way to do it. So it can be helpful but it as in my experience it it wasn't necessary. I think people can do a great job without as well. And it comes back to even if you don't have that experience maybe you can connect us with somebody who does. And I will turn it back over to Angela.

Dr. Angela Krumm: Yeah, I'm excited to talk about this given my work as an ally and assist gendered woman working with folks in the gender diverse and trans communities. You know I think one thing that's important to think about is that if you don't have lived experience like I don't, if we all said oh then I can't work with folks or are gender diverse or trans, we simply would be denying treatment to a huge number of people because there simply aren't enough providers with lived experience for us to get off the hook that way right? To back away from working with populations that we're not a part of. And so I would argue that it is our job to do our own work and to assess our readiness for how to be ready if or not. And I have some ideas for you of how you can join folks who want to just keep learning and get better. I will say you know to Chloe's experience when you don't have lived experience it's just that much more important to help people finding community so that they do have mentors within the community as well and that's true across populations you might be working with that you're not a part of. So how can we do our own work? I have a couple simple resources also listed in the resource list for you. One is a book called You and Your Gender Identity: A Guide to Discovery. This is by Dara Hoffman and actually was newer to me. I mean there's so many good resources out there. This was one was introduced fairly newly to me. It's a book I love. Clients can use it, you can do it, you can use it to just really start by exploring your own gender identity and then understand how you can help others explore it as well. And then there's this interesting tool out by a person named Adam which actually help lets you self assess your readiness and your view of of gender of working with gender diverse folks. And so you can actually just Google this right now if you're a multitasker. It's called Approaches to Working with Gender Diversity, put in Adam's name. And what it essentially does is it lists these like stages of learning and development and you can do this very quick just by reading them self assessment of where do you fall. There's there's a couple initial ones called unaffirmed or neutral and I would challenge you that if you feel you fit into those then you're probably not ready to take on folks who identify as trans or gender diverse because I would worry that actually there could be harm done in those cases and I'd encourage you to refer out right? Now if you fall into the other categories there's categories called novice, friendly, affirming and then competent or specialist right? And these are the ones that show just this increasing level of learning that you've you've come through and progress you've made in understanding gender and how to work with others in an affirming way. So those are some simple tools you can do and then get support, find others who you can consult with and connect with. I'm going to move us through the last the intro of the standards of care kind of quickly so that we have time for our Q&A. So I might be a bit briefer here than I would otherwise prefer. So the World Professional Association for Transgender Health puts out something called the Standards of Care. They're currently on version eight which means they've been around a while if we're up to version eight right? I'm going to read to you just a brief quote about the purpose of it. I think it summarizes it quite well. The overall goal of the Standards of Care version 8 is to provide healthcare professionals with clinical guidance to assist trans and gender diverse folks in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being and self-fulfillment. And one thing I love about that quote is like it's talking about the idea that we want to focus on the whole health of the person.

And the reason as mental health professionals or the few medical professionals in the audience that I'd want you to be familiar with it is because it really teaches you about the range of medical interventions available to folks and emphasizes what Chloe has said multiple times which is that there's not one path to treatment or one aim for all folks right? But it shows you options. And so you know as we've talked about not everyone even wants to buy into the gender binary to pass right? So it's not like everyone's trying to move through certain steps to get to a certain way of appearing in the world. It might not be their goal or it might not be attainable or realistic for them or it might not be within their resources to do it right? So clients choose what they want and this is the key because in the history of the standards of care, if you if you have a client come into your office who's nervous about the standards of care they may even bristle if it comes up. I don't usually talk with I don't usually name the standards of care for folks anyway but it'd be fair if there's bristling and nervousness because in the history of the standards of care mental health professionals were given a very strong gatekeeper role and actually the history of that has kept a lot of mental health professionals away from working with gender diverse clients because they're nervous, they don't know how to feel about the gatekeeper role or they don't like it or it feels like power they didn't ask for and they don't feel like they have enough expertise. So luckily version 8 is really removing much of the gatekeeping and is talking about informed consent. So mental health professionals now have the goal of helping clients make their own decisions and respectfully trusting that the vast majority of humans should be making their own decisions right? That that seems really wise. So we get to support them in that process. It used to be counseling was required even before hormone therapy could be granted by a medical professional. It's no longer required. There are still some medical clinics or doctors who will ask for a letter of support for certain surgical procedures. Almost always the request in that letter is can you as the mental health professional confirm for us that this person is in a good place to make a decision right? Are they ready to give informed consent? And so in that case you might be ruling like an acute psychosis that might prevent them from making a good long-term decision about their own body and healthcare right? So it's really a beautiful shift that has happened that allows us as professionals to get back to what we do really well which is not gatekeeping but is supporting and helping people make decisions that are right for them. As you see on the slide here there's chapters for specific populations and specific topics. It's a ton of detail a lot of it for the medical specifics. And so you can flip through it, you can read the chapter that are appealing or interesting to you and hopefully gain some knowledge from it. So before we turn to Q&A, I will highlight one resource here for you and I think Chloe will probably highlight one of her favorites but Chloe did you want to add anything about the standards of care? Do you feel like I covered?

Chloe Corcoran: I think I think we're good and I'm going to throw out a quick pitch if you can stay around to the end of Q&A I will give you the easiest thing you can possibly do to make anybody in your life have a better day.

Dr. Angela Krumm: Oh that sounds like a really good good story for you to tell us. So let's talk briefly about the resources and then we'll do it. So you'll see two slides of resources, you can download these these handouts. One I'll highlight for you is that we at FGI we've collaborated with a number of people in the larger TEAM-CBT community over the past years with our diversity committee to develop a course that is helping CBT therapists be more effective in serving a broad range of diverse populations. The next we're running right now the next one available you'd be attending in March and doing a bunch of asynchronous stuff before that. So I'll put a plugin for that if you're interested in learning more about these things. Chloe did you want to talk about there's one of these I think you have a lot cool stuff on the next slide.

Chloe Corcoran: I would ask that you check out the US Trans Survey of 2022. It's really going to inform you about the realities of what our community is facing right now and I'm sad to say that in a lot of places it is getting worse. The biggest thing I took away from this was that over 80% of people said that when they started transitioning their life got harder and well over 90% said their life got better at the exact same time. So you can understand some of the work that you're doing there. And I just realized if you look up Erin in the morning, if you Google that E R I N in the M O R N I N G, she has a Trans Safety Map so you can have an idea of what the legislative picture right now is for Trans people in your state.

Angela Krumm: Okay, so Jill I think we should do Q&A.

Q&A Session