Gender Affirming Therapy: A Guide to What Transgender and Non-Binary Clients Can Teach Us

Laura Scarrone Bonhomme (she/her), is a Consultant Clinical Psychologist who specialises in Gender, Sexual, and Relationship Diversity. She provides assessment, psychotherapy, and training to other professionals through www.affirm.lgbt.
https://www.linkedin.com/in/laura-scarrone-bonhomme-3749087a
laurascarrone.com
 
Skye Davies (she/they) is a Peer Support Worker at TransPlus, a gender dysphoria service. They also work as a Volunteer Counsellor at Metro, helping LGBTQ+ people.

Dr Michael Beattie (he/him) is a Counselling Psychologist in private practice with research interests in the psychology of men and masculinities. In addition to psychotherapy, Michael provides training in Gender, Sexual, and Relationship Diversity through www.affirm.lgbt.

Purchase the book at bookshop.org.
Social: https://www.linkedin.com/company/affirm-lgbt/ 

Transcript

Alex Iantaffi: 0:36

Hello, and welcome to another episode of gender stories. As usual, I always say that I'm excited by it because I am truly excited every time and today I'm very excited to be with Laura Scarrone and Michael Beattie, who, alongside Skye Davis have authored this wonderful book, gender affirming therapy that has been published by the Open University Press, and Skye's now with us today. But I have the privilege to talk to Laura and Michael today. And I'm just going to let you know about their wonderful work. Laura Scarrone Bonhomme is a console clinical psychologist who specializes in gender sexual and relationship diversity. She provides assessments, psychotherapy and training to other professionals through a firm LGBT. And we'll talk about that wonderful online training platform that both you and Michael are involved in as we go today. And then Dr. Michael Beattie, is a counseling psychologist in private practice with research interests in the psychology of men and masculinities. In addition to psychotherapy, Michael provides training in gender sexual and relationship diversity through the same platform, a fair majority, thank you so much for making time to be with us today.

Laura: 1:44

Thank you, Alex is lovely to you know, after so many emails exchange, to be able to see you and to talk to you directly. And I think that the the first thing would like to start really, is to think of you because you wrote the foreword, for our book, and it was very, very important for us to, first of all, to get such a heartfelt piece of writing from you and such validation from you. But also, you know, thank you because both Michael and myself and I know as well Skye have been following your career and your writing career. And it's been really inspirational to us to see how you use vulnerability as a superpower in your work. And I think that's very difficult for us sometimes, as a psychologist who have been taught not to self disclose anything about ourselves. But also, in such a politically heated environment, to be able to be vulnerable is very, very difficult. So you are doing a excellent modeling for for the rest of us. Thank you.

Alex Iantaffi: 2:52

I'm gonna just take that in, practicing to take it in, when people give you a compliment, you know, to say, thank you, you don't have to, like you know, deflect or anything. So, just let that soak in? Well, I did really enjoy writing the foreword for your book, and I felt very grateful that you've asked me, you know, and I definitely want to talk about the current political climate. But let's start from the book, first of all, and why did you feel this book was needed? Let's just start, you know, people decide to write books for sorts of reasons. And I'm always fascinated, like, what made you go into writing this book, because writing a book is the project, right? A lot of people think about it, a lot of people might even start it, but it is a project to go from start to finish to publication. So yeah, what inspired you to write the book?

Laura: 3:42

So Michael had already written an excellent clinical guide on supporting trans and non binary people counseling skills. For Michael, do you know the title of

Michael: 3:53

the title, it's counseling skills for working with gender, gender identity and gender diversity, I think or the other way around, It's carried at all good bookstores. (laughs)

Alex Iantaffi: 4:11

I remember, it's been a minute.

Laura: 4:17

But I hadn't had the chance to write a book, I had done some research and some exploratory material on the relationship that transcend memory fog form with a mirror. And I felt from my end what it was lacking is to find something that was a bit more personal. I think that there was a lot more clinical and dry content out there. But I wanted to find the sort of the, the Esther Perel, or the , or the Kerouac of gender therapy, you know, and this is not to me, you know, bringing my ego up. But this is like the modeling of the things that I wanted to be able to find as a clinician, both Michael and myself, worked at the gender identity clinic in London, and that's how we met. And, you know, thinking about the sort of support that was available at the time, it was religious, sit with this clinician and learn what you can. But many times people ask what kind of books can I read tonight? I felt like that there weren't that many that could encompass these elements. So after we delivered a training session for the British Psychological Society, I was approached and I was like, Yeah, I know the book. I would like us to write And knowing in Michael's experience and excellent ability with words, particularly as a non native English speaker, I was like, I need him by my side. And so that's how we started putting the book together. And it was very, very important as well for us that it wasn't all it was, as a, you know, not bias in a way that it wasn't just clinicians talking about the life of trans people, but rather than it was the other way around, right, we are informed by what we learned from our clients by what they told us. And it's almost taking those snippets of repeated narratives that you hear time and time again, is that oh, well, this is really resonating with this other person and this other person. So we invited our clients, we invited families together London, which is an organization, supporting parents of trans people. And we wanted to make it as alive and truthful as possible.

Alex Iantaffi: 6:32

Yeah, and one of the things I really appreciate about your book is that you do have lived experiences of folks and I love the subtitle is a guide to what transgender non binary clients can teach us. You know, often things like trans and a queer lens can be so supportive to clients of all genders and sexualities, actually, especially as a family therapist, and a couple therapists, sometimes I really see out that cisgenderism or cis normativity really impacts people, even like cis straight people are impacted right by those things, which is at the heart of gender trauma, of course, which is, you know, my like, that's how I approach the whole topic. And so I really appreciated that subtitle to, again, to our trans non binary clients can teach us, and to put it distill it in a book so that clinicians don't have to learn from their clients directly, right, that they have, like, Oh, we've already done the work for you. We have learned from our clients and our training, and now you can maybe be a little bit more culturally attuned to your clients. Michael, I'm really interested in how I mean, I do think that the first book Euro, and this book are different. But I'm really interested in to hear like, what is different between those two books, right? Because like you said, louder. Often books for clinicians are very much this is how you treat other people. Right? Like, this is how you, you know, there is this kind of underlying assumption, you know, that the people we treat are others from us. And there is this distance, right. And this book is not written in that way. So yeah, my God just would love to, to hear more about how you feel the difference between those two?

MIchael: 8:15

Yeah, really interesting question, I probably could probably answer it in a whole bunch of different ways. I think. Certainly, I would agree with what Laura said in terms of positionality that that certainly, the way I was trained was very much like, don't self disclose anything about yourself. And I particularly found that challenging. I mean, I didn't train that long ago, in the UK, and gender and sexuality were very much out there in the clinical population. So I wrote my thesis on gay male therapists experience of working with men. And it was quite challenging to kind of get that work done, in part because there was never this sort of sense that that the gay and trans and so on, people were were therapists, you know, and, and, and I raised the question of like, why wasn't I given training on how to work with straight, cis het people. Because, you know, when I first started working as a therapist I was working with to set people I'm like, I don't really understand how these people do their relationships. And you know, the first person I worked with was a straight woman who was divorcing her husband. And I find that really challenging because it wasn't in in my kind of wheelhouse, but I'm kind of slightly going into that, that sort of side topic. But the the core sort of idea was to say, well, actually, this is this is in here. And that one of the things about this particular book, compared to the previous one was that Laura very much gave us all permission to very much be in the book and write about ourselves and to and challenge it was a real challenge for me to write in my chapter that I wrote something about my childhood and about my experience of having my masculinity policed. And this sort of idea that actually we all have a gender identity. And that gender is something that we share, it's very much your sort of point about gender trauma. So I sort of felt that that that permission then allow the kind of conversation to be about Okay, so what is masculinity and how do I do I even define myself as as male and and What does maleness mean? And I think both of us realized in that that it's not a topic really that was ever discussed the gender clinic, we might have been given training on HRT, and gonadotropin releasing hormone analogue and all of this kind of technical stuff. But like, what is a man? What is a woman? What is masculinity? What is femininity? How is it performed? What is gender even mean? Was never, never looked at or discussed. And so we wanted to bring that into the book a lot as well.

Alex Iantaffi: 11:08

Absolutely. And I love how you did that. And you're really speaking tomorrow, Michael, because I remember even when I did my therapy, my psychotherapy training in the UK over 20 years ago, now wow, I'm getting real old. Because my, my first licensure was actually in the UK with the UK CPE back all the way back in 2006. At the end of my training, and it's easy for me to track because I have my, my oldest was born, but rarely, I think my second year of political trading. So it's an easy remember, I was like, Well, how old is she? Oh, yeah, she's gonna be 21. So over 20 years ago, there was really so little, you know, yes, there was something about LGBTQ populations out there. But it wasn't really integrated, you know, and I remember we had to do this paper and like, observe a family, you know, because I did systemic psychotherapy training, observe a family that's different from yours in terms of like culture and so on. And I went to observe, like, English Christian family and their mealtime, you know, as a ritual and the paper and I remember the tutor going, Oh, that's not what I had in mind. And I was like, well, they're different from me. I was like, I'm not a Christian. You know, I'm a practicing pagan. I'm queer. They're straight. I wasn't out as trans yet, at the beginning of my clinical training. To myself, even I was just figuring it out still. Just about, you know, I'm, like, genderqueer by it, like, they are different from me, you know? And they're like, oh, and I'm like, yep, that says a lot. So it's this other egg of anybody who is, you know, when often when we think about diversity in our field, we're thinking about people who are not says people are not straight people are not white, right? We never think that for some of us, actually. I was like, English culture, endlessly fascinating to me, right. But I have people in my cohort that were like, You're so lucky that you have culture? We don't have any I was like, Well, you do. Let me tell you all about your contracts. And these are all the fascinating things about English culture, you know what I mean? And so I feel that. Yeah, well, and you know, I love that you're going through this process, also, like, putting yourself in the book. But and I wonder, you know, you said it was challenging. What was it like also to write this book? I mean, you're in partnership with Skye as well as an author. But in terms of assist folks, and you know, us as people, as therapists, what was it like to engage in that process of like, really putting your positionality in there and putting yourself out there? In this way? Does that make sense? That question?

Laura: 13:56

I think, yeah, it was conflicting at times, you know, there was a element of thinking, Am I going to put too much of myself out there? Is this going to hinder my work? How am I going to feel when someone approaches me and say, Hey, I read your book, and I know that your family is South American, and or I know that you know, these things about yourself. So I think there was a lot of active questioning as to how much was I comfortable to share, but also involve a little bit of a leap of faith, you know, in terms of being able to share it and hope that it would be received in the way it needed to be received. For me, the leap is even greater, because not only am I cis but I'm also straight, and I was also raised, very Catholic. And so you know, it's the whole, the very, the very core of the ideology that we're trying to shape and challenge and this is why for me, it's been so amazing, because even though I've had lots of, you know, a LGB friends in my life, I had never met a trans person until I got the job at the clinic. And it was a matter as well as challenging as well. What was I going to do there? For a moment, I thought I needed to, I don't know, gay trans women on their expression of femininity, because as a syst person, I had that too, you know, validation and I know how to do it, you know, I had that perhaps the idea of, you know, a certain arrogance that is personal rise to a Transfield with you know, or thinking that certain things might be odd? And certainly it's like, well, why your sis mobile in the mind, you know, why your experience. So this being a whole world opening to me and as much as MCs head, you know, when I learned that queer was also an ideology, I was like, Okay, I'm queer to have and I want to insert myself into into this one into this way of seeing things more flexibly and to fit people's experiences, you know, not just the mold.

MIchael: 16:04

was gonna say I find the process very effective in terms of thinking about intersectionality. And the fact that as a middle aged white man, who has been privately educated, I grew up in a very colonial kind of setup, I was born in what was then Rhodesia, and then Bush became Zimbabwe, and I lived in, in a kind of very white colonial upbringing with a reasonable degree of privilege. I also, like Laura, I have a very Catholic background, I in fact, even trained to be a priest for a while, as a way of kind of avoiding having a sexuality and the shame of being gay and within the context of culture that I lived in. But the process of writing I think, just made me more and more aware of different kinds of intersectional privilege, and kind of oppression in different kinds of ways or dis privilege. I don't know, I wouldn't want to say particularly that was oppressed and such. But, you know, my experience of having my, my gender policed, or my experience of being shamed for my sexuality, etc, then also intersects with people listening to me, because I'm six foot two middle aged, privately educated white man with a doctrine. And people just sort of like, automatically assume that what I say is right. And all of these things, and really kind of having that, pull it holding that kind of mirror up to yourself and going well, okay, I really do need to think about my own positionality in my work in the way in which I write and the way in which I speak, and the way in which I think about the work that I do with, with all of my clients, and particularly with the trans non binary ones who I support.

Laura: 17:59

I liked Michael that you say that I gave you permission to write from your experience. Michael to go there.

Alex Iantaffi: 18:06

very, very gentle British reframe.

Laura: 18:18

Know, we're going back? And I think I think as well, I don't want to speak for Skye, but I think also for Skye was a big element, you know, to think about their own identity and how, you know, what is the impact in terms of putting yourself out there. And I think for a lot of people that who are trans or non binary, and the repeated experience that I'm hearing is, you know, like, on the one hand, I want to represent my community, and I want to show people that you can be trans and a therapist, trans and a teacher, trans and a person who has difficulties or not, you know, whatever it is, but also want to just not be anything of the things, you know, don't want to be holding these labels constantly in front of my face. And saying that, yeah, it's it's about striking that balance with being authentic. This is what we needed to model for, for everyone.

Michael: 19:08

And I am also sorry, to kind of interrupt. But I think that that really, that really kind of speaks to the title of the book. So the reason we call it gender affirming therapy, and what that sort of meant. And I think that for both Laura and I, we've kind of went on a bit of a journey, if you like, but also, you know, it was where we've started with the title, but then we started to really try and bring that to life. And what does it What does affirmative practice mean? What does it mean, to do this kind of this kind of work in this way? And I suppose for both of us, there are the two things one is knowledge that you it's incumbent on you to increase your knowledge in the area. So the example we always give is if if you're working with eating disorders, for example, it's incumbent on you to read some books about eating disorders, to learn about the subject area. But secondly, and most importantly, to practice reflexivity in relation to that subject area. So to think about what's my relationship with food, how do I feel about my body? What has been my experience of kind of dieting, of not liking the way that I look of having the way that I look policed or commented on by other people or feeling shame about different body parts and things? And so that I have this shared experience with the client, they're, they're struggling with something that I also struggle with or have struggled with, or have an experience of and So for us, this kind of the, the part of us as, as long as I say, gave me the give me permission, but also politely pushed me into it. But it's partly about kind of like showing your, your vulnerable bits in terms of this is my experience. And when I reflect on, on my identity, this is what happens for me and for us. Those are the two things. That's what we mean by it. And that sort of thing. should kind of be the basis of it. Oh,

Alex Iantaffi: 21:01

absolutely. I couldn't agree more. I feel like there are like 20 tangents I could go off. On right now. I was like, Oh, I love that we were all brought up Catholic. I feel like I could do episodes. Gender in the Catholic Church. Yeah, almost became a nun. I really wanted to be a priest. But that wasn't a thing, right. And then I was like,

Michael: 21:25

I used to have a T shirt that said, recovering Catholic. Oh,

Alex Iantaffi: 21:29

I love that. Oh, my God, that's so good. And yeah, I did two years at the Gregorian University, I was pretty serious about becoming a nun. When I was big, you know, brought up in Rome, kind of, so I feel that. So there was all times in there that made me want to type in that was, you know, another podcast episode. Exactly. It can be gender and Catholicism. But I love a lot of what you said in terms of that the reflexivity right from both of you, because one of my pet peeves is always, often clients have seen a therapist for a long time, and then all of a sudden, you know, they're exploring their gender in it, like, oh, you need to go see somebody else. Right. And I know that in some, you know, in the UK, though, different system, but for example, here on Turtle Island, and the so called us where I live, right, it's like, that is not necessary. You know, it's like, if we all have a gender identity, we should all be able, you know, there are things like gender, sexuality, like we all have gender and sexuality in some way, shape, or form. It's part of the human experience. So I don't see it as a specialist right subject. And I think that any gender or sexuality that falls outside of cis heterosexual ality is seen as a specialist population or as the reserve of like, specialists, right? And I was like, Why, like, we shouldn't refer people because of their gender and sexual I end up seeing the harm of that too. Right? Right, the harm of like, clients feeling like rejected or feeling like, I'm such a freak, that now I need to go see a specialist because of my gender, right? And it is painful, right. And I've also seen the impact even on like, you know, clinicians were 2030 years older than I am, in terms of sexuality, having internalized that sense of like, having a criminalized sexuality, right. And then not my that is trauma, actually, when our gender is policed, no matter what our identity is, right, we are being put in a box and squished and like, a part of us that's being told it's unacceptable, regardless, right, of our gender identity. And so I love how you approach it, because it really highlights we all need to like, do our gender and sexuality work to work with clients, it should be an essential part, does that make sense? Or training, but it's not? Still, I don't think it is not a part of our trading. So I love everything you just said about that. And I am curious about when you ask trans folks to like, share, you know, maybe like, I'm gonna use some of your experiences in the book or a conversation with some of your colleagues or clients. How did that go? How was that received? You know, because it can go I think a number of different ways. And I think sometimes people are like, scared of asking, you know, I don't want you to feel talking eyes. I don't want you to feel others, like, you know, that I'm doing ballroom dance. And my studio was like, we want to ask you and your partner, have you been photos, but like the studio owner would didn't want to offend you. And I was fine. You know, I was like, Absolutely, by and stuff like that show. I was like, this studio is very Trans and Queer affirming. And of course, if you only have people photos of people look this hat like people are not going to know that. But that helped me that nervousness right in approaching people share different identities. And so I was wondering what that experience was like for you.

Laura: 25:01

So there are some of the some of the stories that I share in the different chapters, which is a bit of an amalgamation and also the clients that I haven't seen, perhaps in years, so I didn't have the opportunity to ask them directly. I simply ensured that you know, their, their, their identity remain confidential. But the couple that I did ask particularly one of them, he loved it, he loved it so much. I sent him the fragment and then he came back because I gave him a pseudonym. And it he is Mediterannean But he is not Italian. And he loved the idea of seeing himself as Italian. And so in then he was signing the email back to me with a pseudonym I had given him so he was reading into it. Very, very funny guy. And then the other the rest of the interview was actually that was fully Skye's work, who was amazing at, you know, seeking people online and communicating with them and setting up the meetings. And I think perhaps the one interview or sets of interview that I was a little bit more anxious about was the interview with the parents of trans folk. Because within that group, and within any group of parents, you will find a variety of attitudes, right? So it was interesting for us to see who would come out and also, how does it feel to communicate perhaps if you struggle with ideas around what it means to be trans to a person who is themselves a, you know, trans or non binary. But what sky relate to the study was a lovely meeting, and they were all very keen. And we really wanted to ensure that everyone was comfortable with what had been published. So they received copies, they didn't they came back, even, you know, there was so hopefully, when I go here, there's at least some type of make sure that is correct itself, you know, this properly collaboration with them.

Michael: 26:57

Yeah, and I think, certainly, that, although we haven't kind of particularly addressed it quite yet, but we wanted to carry that same thought on to the training platform that we've developed her firm. Because I think that, you know, we've talked a lot about positionality Laura and I are both very aware of our sickness. And this kind of idea of cis plaining transmits to people and to trans people, it's like, it's apparent, and we don't want to do it. And but at the same time, we also recognize, you know, I first started working in the field 14 years ago. So, and I've worked on and off in it, but, you know, that, that we both have significant clinical hours, you know, we reckon probably together we've maybe worked with or supported, like, 1000 trans people, it's like, it's just, like, it's lots lots of clinical experience. But we're not, we don't have those those lived experiences. And so we want to, we want to kind of bring that in. And we certainly do that on the training platform, as well. And that's where I have been involved in interviewing different folks, and then taking their their stories and breaking them up into little clips, little snippets and clips that go into the training. So that that, you know, people who who are watching or or engaging with the training, kind of have these voices.

Alex Iantaffi: 28:23

Absolutely, I do want to talk about the training platform. And I also want to hold on to, like, one of the threads that was following is loud, I want you said something about and I'm gonna I'm gonna paraphrase, because I don't remember your exact words. But you know, when you start, you're working in the clinic, like you never met a trans person, right? And you really were like, What is my role? Right? Am I just, for example, guiding trans women to understand what femininity is, right? What, what is it that I'm doing? And I think that is a really, I love the way you put that right? And so like honest and authentic, because, you know, for myself, even as a trans person, I know what to unlearn a lot of internalized cisgender ism, right, the words we use to use, like when I started writing, you know, we used to use needles, sex, you know, we used to say male bodied, female bodied, you know, in like, it was really other folks in the community, you know, pull me aside, and when like, when you say, male bodied or female body, you're like, reinforcing this idea, right, that our gender is not real or authentic and awesome. Oh, that's a really good point. And I think, you know, that there is a real process of unlearning, right? And really, and capitalism, we would say in somatic experiencing, right? Those things like, Oh, if I see somebody with a beard, it means they're a man, for example, right? And I know lots of lovely trans feminine folks who don't have dysphoria about their beautiful beards. And so that has been a process, right? Just because I'm trans myself doesn't mean that magically cisgender ism disappears from my mind. I mean, I wish but in my experience, that's not how it works. Right. And I've had really interesting encounters with clients even, you know, because we have different ideas of gender, you know, and often I'm like, Well, I say to clients, my job is not to impose my ideas of gender and your with my job is just to ask you questions to help you think critically about the choices you want to make, so that you make the best choices for yourself. Right? And it's just like, in so I'm really curious about what did you find maybe, I mean, within the realm of what you Feel comfortable disclosing public? What did you find the most challenging concept to unlearn around gender? If that makes sense? What was one of the things that really was like, wow, this is a hard one for me. I know what like I had my my share, as somebody was brought up as a second wave feminist in terms of shedding, you know, all that cisgender ism. But yeah, I'm curious about for you both.

Laura: 31:00

I think that, well, I'm not sure if it's unlearning. But yeah, the things that have been most interesting to me, and this is actually something I was talking with my husband about. And he put it even more beautifully than I could ever. And it's this idea of the assumption of sameness, right? Just because we share a human body. That doesn't mean anything, right? I don't know what you know. And you can see it, for example, on the perception of color, you put a green and a blue, and some people say no, this is blue, this is green, right? And they say, gray area in between, metaphorically, not literally, where you cannot really tell the difference, right? Or pain? How do we evaluate pain? How do we evaluate this very intrinsic human and phenomenological experiences of our bodies and who we are in our environment. And I think that when it comes to gender diversity, that is the beauty of it, the you will be confronted with things that you don't quite understand, yet you have to rely on on the other person, you know, that actually, you know, it sounds like they're saying, and they know what they're talking about. And there's nothing really psychotic about their experience is just as different from my own. So who am I really to make a judgement, now you are invalid. And then when we mix this with neuro diversity, you know, and feeling your body differently with interoception extra perception, all of these sensations that vary so greatly for people who are neurodiverse, from people who are neurotypical, then it's even more, I think that now starting as well, I sort of when looking back at the time that I've been in the field, how at the start, when there were some non binary folk who wanted to access top surgery without their nipples. This was like rare study, right? You really need to think about it, there must be something wrong. All people have nipples, why would you refuse this, and what I'm finding most recently is that there are a lot of neurodiverse people who have a hypersensitivity to their nipples. And that is making my life difficult. I walk around, like this pulling my shirt so that I don't feel this. So it's just inconvenient. You know? So again, it's about it's about helping people feel comfortable in their own bodies. And it's about challenging, whatever we feel normal is, right, because we might be abnormal in another society in another culture.

Michael: 33:32

Yeah, I mean, I absolutely endorse what what Laura said, I suppose I was kind of thinking after you asked Alex of, of what, what the challenge has been for me, and I suppose, something that I've noticed, you know, that when I first started working in the field, you talked about different language that was used, and so on. So in 2010, you know, non binary was not available, there's not really a an idea. And I realized that that basically my position in the clinic, and I wasn't assessing clients, I was doing psychotherapy, with trans non binary folk to help them kind of either make sense of their decisions and their gender identity and explore it with them, or deal with challenges in living as a result of their gender identity, either how it affected their relationships with families and those kinds of things. But one thing I've become perhaps aware of is, even though theoretically, we talked about it a lot in my training, which is how to sit with uncertainty. And be okay with it. You know, we're kind of like, we're modeling uncertainty, we're okay with sitting with, but in fact, when you think about it, gender wise the temptation to try and kind of move into a certainty into a binary and just go, Okay, well, you're completely and utterly clear that you are you have a female gender identity, or you are kind of feminine, or, or masculine or whatever. And that's clear, it never changes. And it's like, okay, everyone can kind of relax and we can go into our boxes. I think one of the the, one of the things that continues to be challenging for me is is to be okay with and to allow uncertainty and not knowing. And yeah, and even, you know, that the end point of therapy might be a comfortability with uncertainty rather than a certainty that kind of indicates that there He's done now because we're all certain. And everything. So I suppose there's all sorts of tangents I could go off in in that, but I suppose, yes, there's this kind of real pull towards gender norms and fitting in a box and being a Oh, you're one of those. Okay, so there we go. You want that to be to be more relaxed or more okay with the stuff that we don't know.

Alex Iantaffi: 36:02

Absolutely. And there's so much more in line with what we know even about how our brain works in terms of neuroplasticity. And so why would our gender identity necessarily safe, like fixed in one place? You know? And, and yeah, we have come a long way. I got my top surgery back in 2010. And it just was not a thing. I mean, yes. You know, my surgeon talked about you. We can do a nipple grafting, but we don't have to, you can do surgical tattooing, right. But even a handful of years ago, it was, you know, and I wasn't taking hormones. So we had to put that in the letter, and why and we didn't have non binary language, right. And it was, it was definitely an interesting experience. And I was lucky to get approved by insurance here, I get it. But it was like, if you don't take the classroom before you have top surgery, that's not our plan. Right? Now, that's not even a thing that I need to put in letters. By and large, if somebody is not on hormones and want to pursue other body modification for surgical intervention, it's not not even a consideration pretty much anymore, in most cases, at least in kind of my geographical context, so the things have changed so much. And I love what you said about uncertainty. I often talk with clients about like, yeah, you can, you can be 90% Sure, it's okay. Like, and also you're probably gonna have lots of different feelings. You know, and I think that folks feel like I have to be certain and otherwise, I'm a bad trans person. And then, you know, then that, you know, conservative folks are going to use me as an example of like, See, people make choices, and then they regret them. I was like, humans make choices they regret all the time. And most of the choices I've regretted have nothing to do with gender. Personally. You know, I also work with a lot of cis people will regret all sorts of things, right. But there is this pressure that we put on gender to be like us to be absolutely sure. And that really is just now human nature. Right? We were assures can be, but there is that piece, sometimes I even talk to clients like oh, you know, like there is this concept of embodied cognition, right. Merleau Ponty? Like it's okay, if you're not sure, if you're not gonna know exactly how you feel, or Norman's until your normals, that's the reality of it, you can make the best guess you can, you know, you can feel like, I think more or less, this is what I want. But you're not going to know how it feels in your body, right until you've made that change. And so I love everything you're saying, because I think it really, we need to change the way we approach transports because there's so much pressure. And then you have this very cookie cutter stories, right? I remember when I started, especially in the gender identity clinic, when I started working with trans people, I was like, Okay, you're giving me the spiel, right? I always felt like it was just really boring. Sometimes I would have to say to people, I'm like, That's great. I'm glad that's the official story. I'm not withholding the letter from you. I actually would like to have an authentic conversation to understand, right, because, and I don't know if that was ever your experience. But definitely, you know, even 15 years ago, you would get this very like, this is what I need to do. To go through the hoops I need to perform my gender in a very normative way. Exactly.

Unknown: 39:27

I mean, I think one of the things that shocked me, I mean, the clinic that both Laura and I met in some years back, I think has or certainly positions itself as the oldest or one of the oldest gender clinics in the world. Charing Cross Hospital used to be. But I was stunned to find out that until reasonably recently, I'm going to say probably the 90s. The idea was that conditions would only well, they ostensibly saw far more trans women than they saw transplant. And ostensibly, they would only allow them to go forward for treatment if they believe they had a substantial chance of passing. And so the whole idea was that you had to kind of convince the doctor that you could pass for a specific person or assist person. And that's just, I mean, it's speechless with that. It's just like, it's horrific. And that attitude, certainly I think, I don't know, virus speak to that. herself, but I think it was still kind of around in it, it was not obviously policy in any way at all. But that sort of that the center of it kind of lingered on a bit, I think people would present for assessment a little bit in the kind of like, I'm, I've got to do the best job I can to convince you.

Laura: 40:57

I absolutely see that. And I can almost almost not fully on to feeling that because I guess it is a lot easier to validate and believe someone who matches your expectations, right? If you are a trans woman who is tremendously feminine, who has a very high pitch boys who loves to wear high heels and makeup, you're absolutely you are a woman. However, if you happen to be a person who used to be a bodybuilder, who is very typically very masculine in the body characteristics, then suddenly you, you show Are you sure, and this is something that every time I need to stop myself from having that automatic reaction. And I think that this is a lot as well, part of what Michael and I are really wanting to work on when it comes to the librium this trainings through a firm, you know, is that reflexivity of the clinicians and the same way that there is this whole beautiful and amazing movement around you know, challenging your own racism, and not being blamed for about it simply you have grown up with these ideas about people who are different from you. This is the same basics that we need to apply to gender and to translate well, you know, I'm always I feel it's okay. But there's a little bit of me that feels sad. Every time a patient says, Can I talk to you about my sexuality? Like, is it okay? Are you going to think that, like the underlying speech says is are you going to think I'm a sexual deviant because I have sexual feelings and I'm trans you know, in a see it time and time again, how B is medicalization of trans identities and of gender diversity leads to sexual repression for transport, particularly for trans feminine people. And I really enjoy the part of the psychotherapeutic work that is about liberating, you know, helping people to liberate themselves to enjoy themselves and to say, you have the right to enjoy is your body is for you to take into on and to use them in whichever way you feel is best. And I think that, that said, like, there's a part of me that so looks forward to 30 years from now, looking back and saying was in that fact that sorry, I'm just gonna sweat within that tab, about how, how help we lead the lives of trans and non binary people? Well, because at the end of the day, there's, there's an element about what your core beliefs as an individual, about the human rights of people, do you think people have an ability to choose whether they can wear whatever clothes they want? Or any hair they want? Can they get fillers? Can they get Botox? Is that okay? Why when we transgress that invisible line of feminizing, masculinizing, someone suddenly becomes a political issue, I cannot understand, you know, and in the variety of, of models from the consent model to, you know, the more guided military or police or, you know, in the UK, it really shapes the way in which we interact with the people that we are aiming to serve, you know,

Michael: 44:28

and I think sorry, that the the point that just kind of like bubbles up and I need to talk about that is is the connection with your own workaholics with gender trauma. And I suppose, to some extent, they're the chapter in iron, but which parallels that in terms of identity based trauma, but this idea that we are all traumatized by gender or socialization, and so much of what Laura's has been talking about in terms of like our automatic thinking and thoughts about like, what's an appropriate trans feminine person, what's an inappropriate trans feminine presence? All of it is all of these stereotypes are kind of policed into us. And I think that's, that's why I got into gender in the first place, because I had my masculinity policed as a gay man, and certainly in the era in which I grew up, and I suppose particularly maybe now as well. You can't really be a real man if you're gay, because gayness or homosexuality, whatever kind of language label you want to use, is a is the opposite of of masculinity because part of masculinity is defined by heterosexuality so you can't really be a real man, you can sort of be a bit. And we see it within the communication communities of masculinity, that there are effeminate men, or we see it within, for example, even gay culture, you know, kind of like, gym bunnies are kind of like the ones with like, we're certainly in my youth of dating with like, straight acting. So if you are straight acting or could pass for straight, you had more social capital women, the kind of gay community and this, this this pernicious constant trauma that we all kind of like playing out on each other. For like, how to be a real boy or real girl, whatever it is just

Alex Iantaffi: 46:21

it's definitely, it's so ubiquitous and kind of yeah, lingers, right, even in the early 2000s. I remember presenting at the conference in Norway, and people are like, well, but you know, if a trans man really enjoys kind of penetrative sex, because they're gay, are they really a trans man? Or are they just like, you know, some sort of confused woman. And as a very, you know, I'm by been very gay leaning, so to speak, transmit trans masculine person, that was a lot to hear, right. And even in terms of gender identity expression, right, the way I need to explain my gender, expression, like, if I'd been born a cis boy, I would have been a very effeminate queer cis Boy, you know, for my mom to understand that I was like, I would not have been the quarterback of the football team in Glee. You know, I think I've used that example before on the on the episode, but just how that kind of people confusing gender, for sexuality, you know, the pathologize ation of like, trans women are attracted to women even, you know, in our field, I don't even want to give that concept, the favor of naming it actually right now. But like, even the fact that the concept persists some people buy into it, and also the same young people then find it right often about young trans feminine people are like, that's the first concept I came across, you know, and so how do I then feel like, um, you know, it's, it's the concept of pathology, right, and so like that, that lingering, is still very much like seeping in the field, you know, and it wasn't that long ago, like, you know, even, you know, in my own lifetime, the the university based gender identity clinic, I used to work, I used to have panels, you know, before my time, but in the 80s, I think, still were like, members of the public deciding if somebody was masculine or feminine enough, that they could get access to more money in surgery, or, you know, front office staff giving makeup lessons to trans feminine folks, you know, we're talking within my life, you know, and even within my own professional identity lifetime, I went from having to diagnose gender identity disorder, you know, to now we have the ICD 11, with gender incongruence. And that that isn't irrelevant, that's two decades. It's a very, like, things have changed very quickly in some ways. But things are also swinging back. And there's the oldest transatlantic, and I'm doing a talk about that. But I do want to talk about your platform. Tell me about the training platform that you put together. You know, I think it's affirm.lgbt. And of course, we'll put that in the episode description. But yes, tell, tell us about the, the training platform and what motivated you to put that together.

Laura: 49:06

I think that as you can see, Michael and I can speak for hours. So we needed a platform. Maybe we have a whole other episode about that, wejust have to get scheduled. (all laugh) But yeah, I think that, you know, it's I was always very frustrated with my teachers at university. And with lectures being boring, with me saying, if you're going to tell it to me that way, I'm going to read it at home, you know, on my slippers, and, you know, my pajamas, there's no point in me going in there. And I guess, I think you learn more when people speak to you, truthfully, and from the heart and authentically and and I think that's what we wanted to do. So Michael and I sat down and might will use his amazing background in as a marketing consultant to sort of help us decide what is it that we are and what we want to be so Michael was the term we chose. They're

Michael: 50:16

the kind hearted rebel was was our we were doing archetype work. So my background is in marketing and communication. So we're kind of doing brand development and so on. And so we want to just be we wanted to kind of like work from and speak from the heart and we wanted to also be a bit rebellious, because, but within the context of counseling psychology, or maybe clinical psychology where we have to color between the lines and you know, absolutely be very unscientific, it's like, it's not that we didn't want to be scientific. But we also wanted to kind of like, speak in a less dry tone, perhaps, and to be as warm, engaging, reflexive, all of the things that we've talked about in relation to the book, but kind of turn that into training. And as Laura says, you know, both she and I have worked together on trainings, before we started this, we did deliver trainings together, we work together, we just kind of vibe with each other, and we like and spark off each other. And we've got kind of good complementary skills. And, yeah, as she said, we know we, we like the sound of our own voice a bit. And so the idea of doing some training together kind of was was fun for us. And we've, we've had a lot of fun over the last, I guess, must be 18 months now, building a lot of content.

Laura: 51:37

Via Michael has been traveling to Tel Aviv, there's been a lot of filming in my living room. My husband has been behind the scenes doing all the tech parts for it. And now we've come to the point where we're very, very proud to present a five hours comprehensive training for clinicians and clinicians who might say, You know what, first of all, I might know enough about gender, but I've actually never been thinking much about my own gender identity, or this is the first trans client I have, or actually, I don't have any trans client, but I find this very fascinating. So for anyone who would like to learn, and not only hear us, but hear trans people speak in themselves, but what is like and what they struggle, and what are the joys as well, you know, then this is the sort of training we feel people should complete that we wish we had when we started in the field.

Alex Iantaffi: 52:28

That is really wonderful. I mean, I wish there was a needed, right, because it was integrated in everybody's training. But given that it's not like we said, you know, it's really wonderful to have that kind of platform. And he sounds like very much, you know, just like in the book, it's not just folks talking from a clinical perspective, but it's also those lived experiences that I think it can be, you know, so hard for folks to access, you know, often say to supervisees or trainees like read books, listen to podcasts, right? If you're in training and the pure, you want to learn more about, you know, trans folks or non monogamous folks, or, or queer folks, like, read the stories, listen to the stories, don't be your client, be the first person to hear those stories that because, you know, find that or avenues, but I love that there is an avenue that is more like, and here is something that merges kind of best scientific knowledge, like you said, Michael, with also lived experiences. Because yeah, otherwise you can just read a paper in your pjs like. And I think there is something to be said for kind of hitting people with their more and more that like we're humans, right, we need to connect. Otherwise, it's kind of almost dehumanizing, learning about other people just in numbers, right? You know, people are 10 times more likely to like, you know, engage, have suicidal ideation. Okay, but then you listen to a poem or like somebody who shares living with chronic suicidality. That's very different, right.

Unknown: 54:05

And I think also how we use statistics, you're, you're kind of stuck there, Alex just reminded me of a wonderful one that that Laura shared, which is about relating to D transition, that you're more likely to become pregnant while using contraception than you are to D transition. And all of these kinds of, you know, sometimes using stats, but in a way that that kind of disrupts a bit or, but yeah, I mean, we want to be storytellers.

Laura: 54:32

Yeah, I did. I sent you. I think I sent you the screenshot. Michael, there was also like a recent article, I think it was in the gay times, saying that more people regret having children that that regret the transition? Yes.

Alex Iantaffi: 54:45

I can, I can believe that, being parents is like really hard. You know, and it's really interesting, also, best thing I've ever done and also hardest thing I've ever done to parent children. And that's one thing, you know, like, I've worked with clients who are trying to decide if they want children, that is a theory, actually, like almost more heart wrenching process for me, than people are exploring their gender or sexuality because it's like, you know, it just brings up a lot. And again, there's societal expectations as internalized expectation, but there's a lot to but we don't see that as like necessarily like, this is very specialist and satisfied, right. So it's really interesting, who gets to be viewed as like a human and as therapists we should be able to deal with those tissues. And you'll get to be viewed as like, this is a special case that right needs to go over there. I feel like we could talk about all those things for a long time. So you've got this wonderful online training program, you've got the book, and you're also, you know, cis, folks who are very passionate about this access to health care. What's it like to do this work? Or what do you feel like it's your role as cisgender therapists at the moment, with the increasing level of like, backlash of like trans panic? transphobia? You know, I would say, almost everywhere, definitely, you know, nationally, here on Turtle Island in the support us, I know that Australia has got its own version, the UK has got its own version. So yeah, how do you see your role as this therapist, authors trainers in this moment, in this political moment?

Laura: 56:31

Michael. (laughs)

Michael: 56:35

Just a light question. I mean, it's, it's a very, very light question, I think for both of us. You know, we, I think from a from a val speak, first of all, from a personal perspective, I definitely am a kind of a voice within an overwhelmingly, kind of cis het group of friends say, you know, I'll go to a dinner party with people who feel perfectly entitled, often, cis het white men to have opinions about things they know nothing about. And I will just say, Well, how many trans people have you ever met? Or how many books have you written on this subject? Or how many papers have you read? Or how many conferences have you been to about this? And yet, you sit here with me at the dinner party, telling me what what the answer is, it's like, you know, sit down, and, and, and listen, you know, don't kind of so I feel kind of quite activist ish. And certainly I advocate for, for my clients and for the communities and so on. That being said, it is a very difficult space to stick your head above the parapet and be an affirmative practitioner in a political environment, certainly in the UK, which is very transphobic, I would say the government is transphobic. And it is, you know, there's more legislation, which is apparently announced this week, where they're like, going to make it a sort of a statutory requirement for all new buildings to have gender specific toilets, not gender neutral toilets. And this whole kind of like, I mean, the bathroom panic thing is just nuts. And of course, it's a way of distracting in my view, from the failure of the government to address all kinds of other things and is part of obviously the kind of a culture wars but to to stand up for clients is and and for you to use my privileges as a salesperson. I suppose I see that definitely as as something that's part of being an ally. But it is also difficult, for example, to do that, really publicly, I've been invited onto different news shows and things like that often very right wing news shows and I've refused to go because I just don't want to be kind of like red meat to a transphobic. News Anchor to kind of like stir up things, and I suppose. Yeah, it's hard. I don't know. Maybe not answering this as clearly maybe yes, but I feel very conflicted about it. I, I worry about being attacked. I mean, not physically attacked at all. But we know that that within our discipline. I mean, I'm a counseling psychologist Lauer's a clinical psychologist, you know, tomato tomahto, but we're both within the British Psychological Society, and that there are gender critical practitioners and voices within that. Sorry, Laura, let you speak a bit to this.

Laura: 59:40

Yeah, it's, it's challenging. It's challenging to know what you want to do. You know, whether, whether you want to, you know, really fight, whether it is a fight that is worth fighting, or whether you're just fueling the fire with your words, you know, so it's, it's really a matter of my show, I think, for me, what's most difficult is having to bring the political reality into my clinical work. And so for example, as part of the assessments that I do for people who want to access hormones or surgery, we ask about fertility preservation, right. Would you like to have biological children one day? Is this something you think and in most people because there's so much looking forward to starting hormones? They're like, No, no, no, I'll adopt adopt. And I have to say I'll stop there. Do you think you might have the opportunity to adopt in future? Or is this right going to be revoked? You know, we haven't I think currently in I believe is Hungary, there's been a regression of gay rights in terms of marriage. You know, so it can happen, and we're not in the best trajectory in the UK. And so to think that you have to think ahead, because your rights are going to be revoked. It's really, really sad. And it feels paralyzing. And as someone who like I said, Being cis het who has the privilege and rage on behalf of my clients, and on behalf of the communities because I cannot because it's absurd, I simply absurd. But it's, it's, it's challenging as well, because of this whole ideology that the gender critical movement is a valid one, when racism isn't considered valid when other forms of homophobia isn't considered valid. Yet, when we're talking about trans folk, it's kind of okay, you know,

Michael: 1:01:47

It reminds me a bit of two things that occurred to me what Laura saying is one is absolutely say that solidarity becomes more and more important. And Laura and I kind of have worked with and connected with a bunch of organizations, we recently worked with Transgender Europe to, to deliver some training for mental health people and psychiatrists, psychologists in Slovakia where there are no gender services. And we know that conditions there are being targeted by individuals who say that their work is sinful and wrong, and so on, and how we can have solidarity for and with one another to sort of like so we don't feel like we're, we're on our own. And I guess, I can't remember what my second point was, it was... I've kind of lost my thread in that. In that kind of question around around solidarity, but also, yeah, that kind of recognition that rights can what has been given come can be taken away.

Alex Iantaffi: 1:02:52

Yeah, absolutely. And I love where you both said, and I know we're kind of coming up to time, but I think it's so important to an orphan it's like yes to start maybe with trans people but then it's like well, which queer people are acceptable in the no queer people are acceptable like and actually then we see that oh, actually like this old this is racism even a thing you know, critical race theory that we're seeing on Turtle Island we know that it's never just about one group of people when we're trying to police folks right and so and it's tricky like you said, Michael, and Laura as well. It's like how do you discern which sides to step up about which fights to like you know, amplify which which fights are just not even worth it because it's just kind of fodder for right wing media right and or conservative media. It's, it's, it's not easy to do the work you do in this current political climate for sure.

Michael: 1:03:52

Struggle so far, you're just reminds me of the very kind foreword that you wrote to our book, which was written in the, in the aftermath of the Pulse nightclub shooting in the States. But also, my own kind of experience of growing up as a gay man in what was then Rhodesia, then Zimbabwe, the very kind of heteronormative macho masculinity, where gay men was seen as a threat to children and that very much you you can't have gay men being around kids, because they are ultimately going to recruit them, or sexually assault them and the same tropes are being rolled up particularly for trans women. Trans masculinity is less problematized. And we can have a whole thing around the patriarchy and masculinity and all those kinds of stuff. But but, you know, it seems that trans women are being particularly or trans femininity has been particularly attacked in the same way or similar ways to, to the way that men have been, maybe perhaps continue to be in different ways, attacked some kind of threat. Absolutely.

Alex Iantaffi: 1:05:09

It's all part of that biological determinism, right? If you have a penis in some way or ever had one, you're a threat. But oh, you have a vulva. You couldn't possibly be afraid we'll just infantilize you and just not pay any attention to you basically, which because you couldn't possibly be a frat right. It's just always goes back to that biological determinism, which ultimately then invalidates transcripts at that To the but yeah, the the tactics are the same and most of us were old enough were like, hang on a minute does we've seen this discourse around grooming, right? This is not our first kind of rodeo. And it's yes, absolutely. You know, and as a parent, you know, I've had people, when my oldest was little like, trying to stop me from going into the bathroom with her, even though she wanted me to go to support as a neurodivergent. Kid, and like, you know, depending, you know, if my gender is read ambiguously, like, right, what's happening? Is that your child what's going on? Right? So it's also it's like, yes, if you're a trans man who passes you might be if you're like, a gay trans man, who's a parent, then it's all different ballgame. Because then you're falling more into that, like, what happens to queer masculinity around kids? Right? I remember when she was a young teen, like, please don't look like if you connect you. This is why, you know, conversations and queer parents have to have with their kids know, queer parents. Right? This is complicated enough with all of us have different last names. And we looking like this was like, let's not make it harder and talk to some social workers. You know, like trafficking you, um, your parents with a very cantankerous teenager at the, you know, of course, we gotta love but it's like, it's like, I shouldn't have had to have this conversation with my kid. But it's all it's all the same route. Right? Who's the danger? and who's not? And how do we maintain this like, colonial cis heteronormative state of we could go on. So we'll have to do another episode to talk about all the things because I also know it's like afternoon for you. And we're going over a little bit. I'm located time. So the question I always ask at the end of interviews is, is there anything that we haven't talked about that you were really hoping that we would talk about? And if there isn't, that's okay. But I always ask that question just to make sure.

Laura: 1:07:43

Psychotherapeutic approach to this (laughs) nothing else from my end. Thank you for the question.

Michael: 1:07:54

No, absolutely. I mean, there's so many things as you say that then tangents and different places we could go your your sharing of your story about parenting reminds me of that. I think it's a YouTube channel or certainly a meme, but like driving while black. I sort of think parenting wild queer is a whole other. You know, it's a whole kind of other thing. But yeah, I mean, nothing, nothing. Nothing big has been has been left out from my side. But I've had an absolute blast. I've really enjoyed the conversation.

Alex Iantaffi: 1:08:28

Yeah, likewise, I'm like, Yeah, I'm looking forward to that Catholicism and gender episode that maybe we'll do at some point. And if people I mean, all of those links will also be in the episode description. But if people wanted to get ahold of your lovely book, which if you're watching us on YouTube, you can see what the pretty cover is

Gender Affirming Therapy: 1:08:47

A Guide to what Trans Gender and Non Binary Clients Can Teach Us. Where can they find your book where they can find you and your learning platform? All the links share them away?

Laura: 1:09:03

The only other thing as well is that it is a beautiful cover because Fox Fisher draw the cover. Yeah, so we're very very happy that collaborated.

Alex Iantaffi: 1:09:15

Oh, I love it I love beautiful Yeah, so you can find the book I think wherever you get books, so ordinary asked your library to carry it. And then the platform is affirm.lgbt right? And is there anywhere else that people should follow you any social media that people should follow or anything else that you want to share?

Laura: 1:09:42

So I'm the Social Media Manager here we have a we have a LinkedIn account to the name of a firm dot LGBT, but also I have my own profile so you can follow me at laurascarrone.com if you can spell that

Alex Iantaffi: 1:10:02

it will be in that. Okay. You any additional social media platforms?

Michael: 1:10:11

I'm a little bit of a kind of social media phobe? I know that we shouldn't be and that we should be more more present. But when I spoke earlier about complementary skills, this is one of them where Laura, Laura is able to kind of hold that it's an area and a thing that I feel quite anxious about, perhaps betraying my age, but yes, Laura's. Laura kind of holds that for both of us.

Laura: 1:10:40

(laughs) If you want to send messages for Michael I can pass them on.

Alex Iantaffi: 1:10:50

I feel your social media, is getting intense. I'm in my 50s. And even as a early adopter of technology, and as a social media enthusiast, that's a lot to keep up with. Don't ask me about TikTok. I'm like, I kind of get it but you know, in Tumblr just passed me by you know, I'm still on Live Journal. So it's Well, this has been an absolute delight. Thank you both so much for making time for this. And thank you for creating this beautiful book and the training platform really looking forward to checking it out and recommending it to folks and wonderful gender stories listeners. Thank you as ever for listening. I hope that this episode kind of give you some inspiration to explore. What is it that I need to unlearn about gender to make my life and maybe my loved ones life more expansive, and more easeful? And until next time, take care.