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.

constant self-reinvention: my profound habit for creating success

Video of speech I gave at a Toastmasters meeting about my primary method for obtaining success:

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.

weekly transwoman-friendly fashion roundup (#2 – body shape)

Welcome back ladies!

Last week I introduced this series and proposed some garments that I believe address the specific needs of many transgender women’s bodies. But then I realized we need to step back to basics; that I need to educate readers a bit.

So before we continue with fashion and style recommendations, I thought it best to discuss body shape. Your body shape influences whether an article will look great or blah (or even absurd) on you, so it’s best to know your body shape as you develop your personal style and wardrobe. So today I make no clothing referrals; we’ll only discuss how to derive your body shape, and what to do with the information.

In the last week, I wrote the following web-based Body Shape Calculator. I highly encourage you to use it to determine your body shape, and to share it with your friends. Not only will it serve the needs of transwomen, but cisgender woman will benefit from its use as well.

Once the app returns your body shape based on the measurements you enter, it provides a link to guidance on how best to dress for that body type. I will enrich this guidance toward the needs of taller women in the future.

A picture of the web-app follows. Click on the image to use the app. Instructions follow this picture:

Here I provide brief instructions on how to use the app:

Other Editions of Weekly Transwoman-Friendly Fashion Roundup

Click here for other editions of this series!

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.

 

corset hazard

I wear corsets regularly, such as the one pictured below:

For reasons explained in my post “corset training”, I’m going nearly full-time with these. What makes the one above suitable for daily waist training is that it is heavy duty—steel boned. Particular to the needs of transwomen, it’s made for long torsos and comes from Amazon in sizes up to 6XL.

But There’s a Hazard

Consider the following close-up:

I sliced my hand badly on the blade of a clip when pushing hard to unclip the corset.

Don’t do this!

go to a damn tailor!

Let’s face it, transgender women often experience a difficult time finding clothes that fit perfectly. (But then, doesn’t every woman?!?). For example, my particular problems are:

  • I usually need plus-sized blouses to enable fit around my chest and shoulders, but then the blouses generally appear unflatteringly wide around my waist.
  • While I usually buy dresses that flair to diminish my lack of hips, I’ve at least one dress with too much “definition” in the fabric such that actual hips need to fill the space for it to look right.
  • At least one of my dresses expected a larger breast size than I possess.

 

To solve all three cases I’ll regularly hire a tailor rather than waste my time looking for perfection at the item’s point of initial sale.



This of course requires some experience (and common sense) to know what can be altered to suit your needs. I can’t tell you how to gain this experience except through taking risks and making mistakes (I generally buy at Goodwill so I’m only out a few bucks if the item can’t be altered to meet my requirements). Your tailor will describe to you why a request will or will not be achievable and you will learn from those discussions.

You may not even know what needs to be accomplished to improve a (mostly fitting) outfit. But your tailor will employ their experience to gain the best result for your body.

Here is the most important thing a transwoman must look for when seeking a tailor:

Are they trans-friendly? If you have a penile bulge under your panties it might show while they are working with you to specify the correct fit. They must be cool with that possibility!

But money talks—and therefore I’ve experienced no problems.

I also recommend tipping your tailor. Not sure if that’s customary, but I do it anyway.

The most important thing I want to impress upon you:  A good tailor will make a mediocre outfit stunning on you! Found this vital in my business life.

I interviewed my tailor, Karla Vega of Vista, California, for tips on how to find a good one. Here is what she told me:

Know the difference between a “seamstress” and “tailor”. Seamstresses make dresses from scratch, tailors alter and repair clothes.

Tailoring works successfully when you begin with clothes that are too big rather than too small, for obvious reasons. So buy one size up if you anticipate the need for tailoring of an item. I asked if certain parts of an item, such as a dress, proved more challenging then others to alter, and she said no. My experience confirms this as she has successfully altered the bust areas, hips, or the waist of the items I bring her as required.

Learn your body type, e.g. “pear”, so you increase your shopping prowess.

Understand that knowing how to sew does not make you a tailor. The warned of clothing swap meets where an amateur sets up an alteration table for the event and sells “tailoring” services. Her advice is too look for someone who makes tailoring their business. I asked about places like Nordstrom that offer tailoring services and she said they are just fine.

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.

weekly transwoman-friendly fashion roundup (#1 – introduction)

Today I initiate a new series, a weekly roundup of fashions I’ve become enamored with during the week.

I particularly focus on the needs of transwomen in my survey, as transwomen generally stand taller than the average woman, generally fill more space, carry diminished hips, and sport broader shoulders.

With each recommendation I’ll state why it proves a good pick for many transgender woman, so that readers can improve their own eye for successful shopping.

This is a blatant effort to make money, as most of what I show you can click on and buy, resulting in my getting a cut. But think of it this way: The resulting cash flow supports this blog!

Without further ado:

A-Line Dress Skirt Vintage Floral Fit and Flare

This goes up to XXXL, and maximizes the image of having hips. The shoulders will appear neither too broad nor diminished:

Sleeveless Casual Flared Tank Dress

The lack of a waistline helps tall women look natural in this sort of dress–I’ve experienced much success wearing beltless flared dresses. This one goes up to XXL and offers many options for color and pattern:

Sleeveless Elegant Cocktail Dress

Two things really work for me with this type of dress:  First, the folds in the front help diminish the visual presence of by beer gut. Second, the cute bow in the shoulder distracts from my broad shoulders. I rock dresses like this all the time!  (See my Twitter profile picture for an example). This dress goes up to XXL and comes in three colors:

You can pull this off, girl!

Wedge Sandals

For transwomen just getting started wearing heals, I recommend beginning with wedges (see my post “the trick to walking in heals…” for helpful How-To videos).

Once you get the hang of it, I guarantee you’ll wear heels far more often than your cisgender peers!

Here are two wedge sandals I like, one modest, one flamboyant, from quality brands that go up to large sizes. Never fear expressiveness!

HINT TO NEW WOMEN:  Don’t wear white shoes on rainy days! They just get dirty and look terrible.

Other Editions of Weekly Transwoman-Friendly Fashion Roundup

Click here for other editions of this series!