what a young transgender client needs from their therapist(s)

Emily Marie Williams, 2019-03-16
© 2019 Whole-Systems Enterprises, Inc.

Who I am: Credentials or Something?

I’m not a psychologist, not a social worker, not a medical doctor. In fact, I’m not a doctor of any kind. Just a highly intelligent and introspective citizen scientist. (Yes, I hold a baccalaureate).

Oh, and I happen to be transgender: Thirty-nine years living publicly as a man, approaching four years living publicly as a woman.

And I’ve studied the science of gender identity in exhaustive detail; I happen to be a scientist by trade.

And I’ve seen more therapists than I care to count.

First Define Therapeutic Goals

All Ages

Let’s first define therapeutic goals, appropriate for transgender clients of any age:

  • Client learns they are responsible for their own learning
  • Client learns suicide prevention and distress tolerance skills
  • Client learns how to respond emotionally and socially to harassment and bullying
  • Client learns how to respond emotionally and strategically to discrimination
  • Clients learn the correct language and choose what applies to them
    • “Transgender” vs. “transsexual” vs. “intersex” vs. “transvestite” vs. “cross-dresser” vs. “genderqueer” vs. “drag queen” vs. etc.
    • Gender identity vs. sexual orientation
    • “Trans” vs. “cis”
    • “Transwoman” vs. “transman”
      • E.g., a man who becomes a woman is a “transgender woman”, not a “transgender man”!
    • Why the “T” is included in “LGBT”
  • Existential health:
    • Client will not need a theologian or a philosopher to tell them they are right with the divine and/or the universe
      • Although I admit it helps emotionally!
    • Client will not need an evolutionary psychologist or an anthropologist to tell them they are right with society
      • Although I admit it helps emotionally!
    • Client experiences daily joy
  • Client understands that a gender transition (of any kind or degree) will not cure all their ills
    • We all still have death and taxes
  • Client knows their legal rights in their jurisdiction
  • Clients are appropriately guided toward biomedical interventions, where desired
  • Clients become aware that the transgender community exists and is networked
    • We have a history and mythology, e.g.,
      • The Stonewall Rebellion
        • This was just as much about gender variance as it was about non-heterosexuality, a fact that the “mainstream” queer movement swept under the rug until recently
      • Joan of Arc
      • The Rebecca Riots
      • Tiresias
    • We have a music community (e.g., G.L.O.S.S., Trap Girl, Axis Evil featuring Napalm Fatale, Against Me, and QTPi Xpress).
      • Disclosure: I am “Axis Evil featuring Napalm Fatale”.
    • We have legal advocacy groups and work closely with the ACLU

Youth and Their Parents

All of the above-stated goals apply to youth, but parents play a greater role in their success:

  • Parents learn they are responsible for their own learning
  • Parents learn how to affirm and validate their children
    • Including respect for desired names and pronouns
  • Parents learn suicide prevention and distress tolerance skills
    • For both themselves and all their children
  • Parents learn the correct language, and let their children choose what applies to them
    • “Transgender” vs. “transsexual” vs. “intersex” vs. “transvestite” vs. “cross-dresser” vs. “genderqueer” vs. “drag queen” vs. etc.
    • “Gender identity” vs. “sexual orientation”
    • “Trans” vs. “cis”
    • “Transwoman” vs. “transman”
      • E.g., a man who becomes a woman is a “transgender woman”, not a “transgender man”!
    • Why the “T” is included in “LGBT”
  • Parents learn how to work with schools to attenuate bullying
  • Parents learn about discrimination and systemic oppression. They must be “woken up”
  • If parents are spiritual and or religious, find a faith community that proves supportive
  • Parents must learn and model joy
  • Parents understand that gender-related care for their family will not cure all their ills
    • Again, we all still have death and taxes
  • Parents know their children’s legal rights in their jurisdiction
  • Parents understand the array of biomedical interventions available
    • And the time dependencies of these interventions with respect to the onset of puberty
  • Parents need to understand that the body of research regarding transgender youth is slim
    • Parents need to understand that an active effort within the research community regarding transgender youth is identifying the difference between “is it a phase?” and “is it clinical gender dysphoria?”

As Long as I Can Remember

For perspective:  As soon as I realized there was a difference between boys and girls, I wanted to be a girl. Maybe two or three years old?

The feeling didn’t stop with puberty. Didn’t stop when I registered for Selective Service. Didn’t ever stop.

Where Seeing More than One Therapists is Appropriate

Having a client see more than one therapist at the same time is controversial, but I do it. Here is why it is practical:

Therapists who specialize in transgender issues are scarce and generally clustered around major cities. Therefore, it is totally reasonable for a client to see a “regular” therapist on say a weekly basis and see a specialist on a monthly (or longer) basis. Seeing a specialist at least occasionally is vital, as they have access to the latest clinical practice information and are one of the key gatekeepers for obtaining biomedical interventions such as hormone replacement therapy.

The “regular” therapist I referred to in the above paragraph can work on matters like distress tolerance, suicide prevention, family dynamics, etc.

Suicide Prevention and Distress Tolerance

The suicide rate is extremely high in the transgender population. (I don’t know how this breaks out between youth and adults—a later edition of this text will provide those details if they exist). Therefore, it is imperative that transgender youth, their parents, and transgender adults learn suicide prevention skills. “Skills” is the correct word here; we are talking about a set of learnable behaviors that save lives.

Distress tolerance skills are also vital; saying that living transgender proves distressing is an understatement! I’ve found Dialectical Behavioral Therapy (DBT) the best approach for myself and would recommend it to anybody. DBT is all about skills development.

Family Therapy

Family therapy proves vital as well, as poor family dynamics and abuse (if it is present) will not help anybody.

Also, parents may carry undue guilt that their child expresses gender identity issues—as if they were bad parents or something. While my research shows a possible heritable element of gender dysphoria, the same research supports a hypothesis of biological origin of the condition.

Murder Prevention

The murder rate among transgender individuals is high, especially for transgender women of color. A therapist and a transgender child’s parents must ensure the client knows how to protect themselves.

I carry a hunting knife in my purse and know how to disable an attacker by hand.

Affirmation and Validation

Through various channels (social, parental, religious, etc.), transgender children can get the message that their feelings are either “not real” or “bad”. This needs to be countered by therapists, and parents must be taught by therapists how to counter these ideas as well.

What a Therapist Should Watch For

While it is perfectly possible for a client to be both schizophrenic and transgender, the schizophrenia must be treated first, as it might be a source of gender confusion. For example, and forgive my shallow understanding of schizophrenia, a schizophrenic individual might have one or more feminine-identified “insides” and one or more masculine-identified “insides”.

Additionally, there are some homosexuals who are so homophobic that they would rather change their sex than accept their sexual orientation. Here the problem is acceptance, not gender dysphoria, and gender transition is not a clinically appropriate treatment. I can see this scenario playing out in a teenager raised in a fundamentalist environment. Interestingly, Iran forces homosexual men to become woman, as it is okay with transsexuality but not homosexuality. This probably does a lot of damage to these individuals’ psyches.

Adolescent Sexuality

All adolescents struggle with sexuality, but I think it is worse for transgender individuals. Therapists must be understanding of this.

One of the most confusing issues I faced in my youth was that for me as a teenager, I became sexually aroused when I wore women’s clothing. So, I couldn’t tell if I was expressing a fetish or something more fundamental to my core identity. Now that I am an adult and wear women’s clothing full time, this arousal no longer happens. In other words, my desired to cross gender lines cannot be explained by fetish alone.

A minor psychological theory that some practitioners still refer to, though it has largely been discredited, is “auto-gynephilia”. This model defines men who express transgender thinking as simply being sexually attracted to the idea of themselves as a woman (and female)—basically a “meta-fetish”. The idea has been used by hostile parents in court cases to prevent children from receiving appropriate transgender care. The major proponent of this idea—I forget who—is still alive and working for a major research hospital (I think; I’ll check on this detail later and update this document accordingly).

The problem is not with auto-gynophilic sexual fantasies, which I’ll admit even I have from time to time, but with the idea that that model alone fully explains male-to-female transgenderism. To put it in personal terms, when sexual arousal and activity is the farthest thing from my mind, I still want to be called “Emily” and “she”, and I still want to interact socially as a woman.

Feminism and Young Adults

Most feminists support us, but there is a small and vocal subset that severely opposes transgender individuals and their demand for rights. A young woman thinking of transitioning to manhood can easily be dissuaded by these ideas. This is okay if the individual decides so; but most members of this small, vocal subset of feminism are bullies and need to be taken through that lens. (We call them TERFs, for “trans-exclusive radical feminists”). TERFs often refer to female-to-male transitioning as “testosterone poisoning”, among other things. I won’t even begin to tell you what they say about women like me, because it is out of scope for this document.

A good therapist needs to be aware of TERF thinking and influence, especially when working with young adults attending a university.

I’ll Add More Later…

I’m sure I’ll think of more to add to this document as time passes.

Axis Evil featuring Napalm Fatale @ the Che Café – 24 January 2019

My performance with special guest Queen Mab playing the Kaossilator Pro. I’m using a seven-string guitar and trying new embellishments in the guitar parts, especially in the song “Voice in the Distance”:

new song: “3Jane”

Lyrics

Growing a new philosophy
is it grand design, or subtle folly?
The serpent was anything but…
…but this was an engineered forest,
its fruit a postmodern delight

Recording

Explanation

Wrote this sometime in the late 1990’s while working through my gender dysphoria (and identity and bipolar disorder in general) as a young adult. It is about humanity’s ability to hack everything, including our bodies. Changing one’s sex is a postmodern experience from a certain point of view, and it might be complete folly (but I don’t think so).

Artifact is nature.

I think starting my life as a man and becoming a woman at 39 was by God’s design. Don’t think any serpents are whispering in my ear.

Live Performance

declaring myself an arbiter of proper ladylike behavior

Today I officially declared myself an arbiter of proper ladylike behavior. Issued the announcement via Twitter and Facebook:

Obviously I’m not a perfect lady myself, having immediately mocked the whole concept by using foul language in the second sentence of the announcement tweet.

But this speaks to a fundamental issue: A proper lady will not take herself too seriously! A proper lady knows that “ladylike behavior” is an abstraction and a ruse, yet chooses to employ it anyway. It’s a means to an end, and, for those that wish to participate, one of many pathways an individual may take toward creating a more civil and empowered society (if taken within proper context).

For a transgender lady such as myself, and perhaps for all ladies, ladylike behavior exercises empowerment. It provides an assertion of identity against a world that devalues the feminine. Deep in my transgender femme brain (and I’m only speaking for myself here), becoming a woman is never enough. I need to blossom into a lady. A “proper” lady. This liberates, not oppresses!

The best thing about this process is that I get to define “proper” and define “lady”. I’m creating something that works for me within the current time and place. Certainly I draw on a multitude of others’ etiquette manuals, blog posts, and how-to videos. I tap the Kama Sutra and the Bible for ideas. But the tiara stops with me—I’m the ultimate arbiter of my intent.

However, I plan to actively influence culture with my process and conclusions. Therefore I will add my voice to the growing worldwide call for promotion of civil, polite, feminine, demure (when appropriate), and of course, “ladylike” behavior by (interested) women of all ages. Will never treat my contribution as mandate, as many fabulous women will find no interest in it. This is perfectly fine.

My perspective proves unique in that no one taught me proper ladylike behavior growing up. The result is that I still “man-spread” and chug my beer when I lose mindfulness. As a work in progress recreating my own social construction from the ground up, I assimilate ladylike behavior as a foreigner learning a new language from scratch. This is beautiful and absurd. And it means all assumptions fell off the table.

So in my derivation of ladylike behavior for this social reconstruction I’m learning a lot about it, and intend to share my findings from a position only a transgender lady can offer.

Let’s get started!

Ladylike behavior involves many “musts”. I now issue my first:

“A proper lady never wears flip-flops in public, except at the beach, the pool, or the public shower.”

Proudly developed this “rule” myself; read it in no style guide or etiquette post.

The world is ours, ladies!

Update 27 April 2018

Received the following perspective-enhancing reply to my Facebook announcement:

Just reminds me to follow what I first admonished above:  “A proper lady will not take herself too seriously!”. Also illustrates how “expertise” lies in the eye of the beholder.

my spinning moral compass

I’ve discovered a complete willingness to manipulate men into one-night stands purely to stroke my ego. (The trick is to let men feel like their own ego is in charge).

However, I experience complete moral repulsion at the idea of treating women this way.

I think my reason comes from evolutionary psychology: Women may become pregnant and therefore require support during their “down time”, the period when hunting and gathering would be difficult due to carrying a child—consequently they learned to highly value relationship stability across an evolutionary timeframe.

However, men can deliver sperm without such risk to their livelihood. Therefore they experienced less evolutionary pressure to value relationships than women. Given that I don’t want to hurt anyone, I provide far more ongoing commitment to my romantic relationships with women than men, due to the difference in evolutionary psychology between the sexes illuminated above.

Men do love, and greatly. I certainly did when I identified as one.

Moreover, I’ve realized that the manner in which I love IS very masculine (culturally), and that that is extremely unlikely to change. For example, I carry a strong “hero instinct”–want to solve problems for my beloved. I delight in the role of “pursuer”: Will combine culturally masculine flirtation technique to make my intention clear no matter how impeccably feminine I appear. I would feel shame if I couldn’t economically provide for a partner, despite the fact that times have supposedly evolved beyond that. Most significantly, I want to provide a constant beacon of (inner) strength.

Certainly, I have love-traits we could label as culturally feminine (commitment to radical kindness and collaboration). But the sum total of how I love leans strongly masculine.

And that is where things get interesting. Evokes my moral crisis:

I am a complete predator when I pursue women. Calculating. Shrewd. Persistent. Experimental. Adaptive. Creative. Subtle. Patient.

My motives prove decent but never pure. I operate by gaining the trust of women through my innate femininity (even did so back when I was “Dan”), and then later strike at opportune moment. My metaphor for this activity is “moving through the back door” when most suiters only show the wit to try the front. I suppose the redeeming feature of this maneuver is that the trust I establish is 100% genuine—as my intent always is to create a successful long term relationship (which relies firmly on trust).

So I demonstrate capacity for commitment during my pursuit. I only act this way when I’m prepared to deliver.

The other redeeming feature in this approach is that I only practice it when I’m completely besotted. Therefore the woman involved holds all the power!

The moral crisis lies in the fact that I do not like the idea of being a “predator”. But that is the correct word, so I’ve accepted it. More to the point, I’ve accepted the duality of being simultaneously predatory and noble in my pursuit, of delivering both genuine trust and absolute danger.

spinning masculinity into a seduction tool

Last night at my favorite bar I found myself flirting with two stunning women. Delivered bold masculine technique punctuated by proud feminine presence. I stood out hot and I knew it. Through my maneuvering I made it extremely clear which side of the tracks I walked on that night.

A man in their party saw this behavior and quickly complimented me on my dress. I thanked him genuinely, smiled, and then immediately returned my attention to the ladies that enraptured me.

Later I started thinking about what motivated the man’s compliment. While I really don’t know, here I’ll brainstorm through a feminist lens:

  • He could have genuinely liked the dress. Nothing to deconstruct there.
  • He could have genuinely wanted to flirt with me. Again, nothing to deconstruct there.
  • He wanted to remind the women whom I was so obviously putting the moves on that I was a woman.
    • And this is where things get interesting…
      • Was he jealous—afraid they’d take interest in me over him?
      • Was he jealous—wanted my attention but wasn’t getting it?
      • Some combination of the last two?
      • Or was it more fundamental?
        • He subconsciously intended to assert the heterocentric social order?
        • He subconsciously intended to assert the patriarchal social order?

I’m certain my use of masculine flirtation technique combined with my confident feminine poise knocked everyone involved off guard. I planned this juxtaposition while arranging my tactic prior to engaging.

From the point of view of my transgender journey, this experience demonstrates how I completely operate from a feminine foundation now. I started as, and remained, feminine throughout the whole encounter, only employing masculinity as a tool for seduction.

power and sexual technique

Competence proves extremely sexy.

My firm desire (pun intended) is that all women, particularly transgender women, take complete ownership over their presence and their bodies. Presence emits power. Ownership delivers power. Here I refer to “power” in a feminine network sense, enabling women full constructive influence within the relationships they build and expand. These relationships may include friendships, business connections, or romantic partnerships.

In the case of romantic connections, whether short or longterm, sexual competency wins constructive leverage. I therefore encourage all women, and again, particularly transgender women, to study sexual technique. To set an example, I’ve embarked on the reading list given below.

Why do I focus on transgender women in particular? Because we often regard ourselves as “inferior” women and I wish that to cease immediately. Furthermore, we are often sexualized for being transgender rather than treated like human partners. That probably won’t cease but can be manipulated. My opinion is that developing skill in bed resists the former mindset, and shifts control toward transwomen in the latter situation.

Regarding the latter: Instead of thinking of myself as objectified for being trans, I think of myself as having cornered a market. This economic viewpoint empowers. I can set my base price (expectation of a partner) based on scarcity. I can then increase my price (expectation of a partner) by enhancing my sexual technique.

Become a world-class lover. Own yourself. Own your power.

My reading list:

Here is the most famous one, but you should know that sexual technique is only a small part of it. Wikipedia explains this well:

Contrary to western popular perception, the Kama Sutra is not exclusively a sex manual; it presents itself as a guide to a virtuous and gracious living that discusses the nature of love, family life, and other aspects pertaining to pleasure-oriented faculties of human life.

Finally, we must learn to seduce, a skill separate from competency in bed:

tracking my gender transition through computational linguistics and machine learning

I wrote 299 blog posts in the last decade, roughly half on badassdatascience.com and half on genderpunk360.com. Produced most of the Badass Data Science content while publicly expressing as a man, and most of the Gender Punk 360 content as a woman. Some articles appear on both blogs—for example this one—and in the analysis described below I account for such duplication.

My speech therapist observed that I successfully employ feminine language in my recent video “radical forgiveness”. This led me to thinking: Has the language I use in my prose evolved as I blossomed into femininity? I detail my attempt to answer this question using mathematical analysis below.

Two Caveats

I make two major assumptions in this analysis, assumptions I will address in future work:

First, I assume my writing skill remained constant throughout the last ten years. Not a great assumption in the long haul but necessary to simplify the math for this “back of the envelope” analysis.

Second, the two blogs cover different subjects, and the first one even contains source code on occasion. This may distort the clustering process described below. Again, ignoring this concern proves acceptable for this “quick-and-dirty” calculation to enable exploration of the problem domain.



Method

I download each of my blog posts and then calculated the part of speech (POS) for each word in the post. After that I computed the frequency distribution of the POSs. I then performed hierarchical clustering using a similarity matrix defined by the dot product of each pair of posts’ POS use frequency distribution vectors. The resulting dendrogram looks like:

I recommend downloading the image to view it at full size.

Each vertical line represents a blog post, and the trees linking the vertical lines indicate the degree of similarity between any two blog posts. For example, in the above image, the cyan and magenta colored posts prove similar but the green and black posts diverge significantly in terms of their POS use frequency distributions. The asterisks indicate posts created after I started expressing publicly as a woman full-time. The colors divide the tree into sections that group similar blog posts. Please note that I chose the grouping threshold manually (but rationally).

Results

By visually inspecting the density of these asterisks for the different color groups we derive an indication of how “feminine” or how “masculine” we might regard each group of blog posts. For example, we see sparse femininity in the green, yellow, and black groups; while we see enriched femininity in the cyan and purple group. The algorithm clearly found little distinction between the posts within the large red group, but even there we visually recognize sections of diminished femininity and sections of enhanced femininity.

So a linguistical difference between my pre- and post-transition writing appears to exist. But is it real? Can we conclude that my prose grew more feminine after my public transition? Not so fast! We must build a model that includes time as a variable to cancel out possible influence of improvement in my writing skill, and then test that model for significance. I’ll save this work for a later date.

Grrl on Grrl Podcast interviewed me!

Today my interview with Grrl on Grrl Podcast came out!  We discuss, among other things,

  • The science of gender identity
  • The music of Axis Evil
  • “Ladylike” behavior as a source of personal empowerment
  • Cultural appropriation
  • Psychosexuality
  • Model minorities

Big thanks to June Owatari of Grrl on Grrl Podcast for working so hard to put this together! The music presented during the interviews may be downloaded here.

 

numb penis

To prepare for gender affirmation surgery, I’m having hair removed from my testes and penile shaft through electrolysis. To manage pain, I numb the area prior to each session using tetracaine.

I like having a numb penis. Then I can’t feel a part of my body that I don’t particularly want, don’t feel particularly attached to.

at a wedding in Delhi

One of the most amazing experiences of my journey into womanhood occurred when I attended a wedding in Delhi.

The bride knew me before I transitioned, but immediately embraced my identity as Emily when I announced it. We quickly became extremely good friends, and I therefore eagerly attended her wedding when the time came. I was so happy for her that I even wrote a string quartet for the couple to celebrate their union:

The wedding rituals we performed during the two-day ceremony appeared more gendered to me than those of the American weddings I’ve attended. The women did many activities together with the bride, such as application of henna (see my hands on the photo below) and the anointing of saffron, while (presumably—I wasn’t there so I can’t confirm) the groom participated in activities with the men.

What stands out for me is that the women fully embraced me as one of their own, allowing me full participation in their rituals, knowing full well that I was biologically male. Result: An extremely happy moment in my life. Core validation!



After the anointing of saffron, still among women only, we danced to Bollywood songs for about half an hour. Felt very spontaneous.

Today I watched Kaouthar Darmoni’s TEDx talk “Dare to be feminine for guts sake!” (below). She begins by telling a story about growing up in Tunisia where women would gather together, away from men, and simply dance. She then describes how this practice traces back to Mesopotamia 4,000 years ago. Perhaps the dance ritual I participated at the Delhi wedding described above traces back that far; perhaps it inspired the Mesopotamians, or perhaps the Mesopotamians inspired it.

But I realized immediately upon starting this video that I participated in something ancient and profound.

transgender people love

Lost in the ongoing ecclesiastical debate about whether transgender identities hold validity in the eyes of God [1] are interactions between (cisgender) Christian thinkers and transgender individuals themselves, particularly those of faith.

Many faith-leaders and Christian scholars intellectualize us into sub-humanity:  Their idea is that God made humans male and female strictly in God’s own image and that to be fully human therefore requires full embrace of one or the other polarity, the polarity matching one’s genitals. (We are ignoring the intersex population in this argument for convenience–however the body of Christ will have to come to terms with intersex individuals’ existence too). Because transgender individuals cannot live healthy lives under the constraint of this particular sex/gender model—a model believed quintessential to the construction of a human by many Christian thinkers, we are regarded as having rejected God’s gift of humanity.



However, one knows a tree by its fruit [2]:

God gave humans the ability to love. And transgender people love. We love deeply. We love just as much as as cisgender people.

The fruit therefore is the love produced, and only a human can produce it.

It follows then that we fully received the gift of humanity.

References

  1. https://www.ncronline.org/news/people/transgender-issues-next-battle-culture-wars
  2. Matthew 12:33 (NIV)

the real reason I live in an RV

Not paranoid, just a student of history.

Even CNN and President Obama are concerned about the development of authoritarianism in this country [1]. That is saying something.

I don’t just live in an RV to save money or live portably. (Both good things in my ethos).

I live in an RV primarily so I can flee to Canada or Mexico if things get bad for transgender people in the United States.

Berlin in the 1920’s welcomed transgender individuals to some extent. The city served as a hotbed of transgender medical research. By the 1930’s the Nazis started arresting LGBT people.

I do not trust the “religious” right. They do not understand Christianity. They do not know Christ. Pharisees, the lot of them. Given power they would lock me up or execute me.

I do not trust current trends to protect my liberty. While I 100% trust and expect California to intervene on my behalf, a U.S. state can only do so much.

Going to stash money in the Royal Bank of Canada soon, in case my U.S. assets are frozen.

I’ve memorized the highways to Canada so I can turn off my smart phone if I flee. (To prevent tracking). Already know how to drive to Mexico from where I live.

Keep my RV in good repair for sudden travel, with my propane tanks and battery array full. Keep the fuel tank in my truck at least half full.

See Also

RV chic

References

  1. http://www.cnn.com/2017/12/09/opinions/obama-hitler-germany-democracy-warning-ben-ghiat-opinion/index.html