Don’t Poke the Dysphoria Monster

dont-poke-the-a4ghnn

There may be a monster in your child’s closet. All of the reassuring you may have done when your child was little that there was “no such thing as monsters”, checking under beds and in closets to alleviate anxiety, may not have been exactly true. For transgender kids and adolescents, and even adults, a Dysphoria Monster may be lurking nearby.

When I worked in a residential treatment facility for children, I used the “Addiction Monster” metaphor to explain addiction to children. Many children who resided there had parents who were addicted to substances, and this resulted in inconsistent visits, broken promises, and time away in jail. I would explain that when someone is struggling with addiction, they have an addiction monster that is sometimes small and manageable, sometimes huge and overpowering, but never nonexistent. When it’s huge, it has them in their grip, throwing them around, banging them up, holding them hostage. When the addiction becomes more under control, the individual may have more power over the monster, like walking it on a leash. After some time of sobriety when urges have decreased dramatically and the individual is in recovery, the monster may get small enough to tuck away in their pocket. But remember: it’s always there, and they would need to take care to keep it small.

Now that I work with transgender individuals, I have met the Dysphoria Monster. For those of you who don’t know, dysphoria is the discomfort and depression that can come with having a body that does not line up with one’s gender identity, or come from not being read as/treated as the gender one is in their brain. Dysphoria can range from unpleasant to life-threatening; it’s a force to be reckoned with.

Most transgender people experience and relate to dysphoria differently. Some have very little (tiny dysphoria monster tucked in their pocket), some have debilitating dysphoria (picture the gender dysphoria equivalent of Godzilla). Dysphoria can fluctuate on an hourly, daily, weekly basis. How much dysphoria is present on a day-to-day basis can be dependent on temperament, life experience, support, stage of transition, relationship status, triggers, and much more.

Here is an example of how the Dysphoria Monster can work: picture a female-to-male individual walking down the street with a female friend. He’s feeling good; confident, content, enjoying the day. His monster is quiet; he doesn’t really notice it. Suddenly he and his friend enter a restaurant and they are greeted with, “Hello, Ladies!”. His monster is awakened! Growling, breathing down his neck. The monster sits with them at the table for the rest of the meal as he agonizes over being misgendered.

Ever heard of the expression “don’t poke the bear”? It’s important as the loved one of a transgender person that you don’t “poke the Dysphoria Monster”. Be aware of the fact that this monster is lurking nearby and that it is in your loved one’s best interest that the monster stays docile. Unfortunately, parents and partners (and other loved ones) can fairly easily poke the monster because they are usually the ones who are around the individual the most. This can happen in any number of ways: misgendering (using wrong pronouns), using birth name, commenting on body parts, commenting on appearance, giving tips on how to be masculine/feminine, the list goes on.

Do you want to know how big and unruly your loved one’s Dysphoria Monster currently is, and how to avoid inadvertently awakening it? Here are some tips:

  • Educate yourself on dysphoria. Don’t expect your loved one to do it all for you. Understand what can be the most distressing parts of being transgender. Use compassion to fill in the blanks you don’t understand.
  • Check in. Don’t be afraid to ask, “How’s your dysphoria?” (or whatever word they would like you to use). Usually they will know exactly what you mean, and you will get the most direct answer that way.
  • Ask them what triggers their dysphoria the most. This will help you not only learn to avoid causing these triggers yourself, but will be alerted to check in after you witness one of these triggers happening.
  • Ask what helps lower their dysphoria. Ask when they feel the least dysphoric, and then try to increase or replicate these experiences/situations.

How big is your or your loved one’s Dysphoria Monster? Would you describe it differently?

Advertisements

CONSISTENT! PERSISTENT. INSISTENT?

One of the cornerstone phrases for recognizing a transgender child is whether or not they have been “persistent and consistent” in their cross-gender identification. This means the child has shown a consistent (“of a person, behavior, or process unchanging in achievement or effect over a period of time”) identification with the brain gender of that of the “opposite” gender than which they were assigned at birth, and that this has persisted “continued to exist or endure over a prolonged period”. This is in regards to not just gender expression and interests, but in how they relate to themselves or identify in terms of gender. More recently, I have heard “insistent” added on to further qualify how a transgender child will likely present. I have to say, I don’t agree with this one being one of the characteristics a parent or professional might look for in terms of clarification. I think if one is looking for all three of these characteristics, they might miss something. I think the level of insistence displayed by the child is largely dependent upon the child’s temperament. Not all transgender children will be insistent about their “true” gender identities. Really, if taking all different temperaments into consideration, we may want to also reconsider our thinking about the use of the word “persistent” when it comes to transgender children as well. Another definition for persistent is “continuing firmly or obstinately in a course of action in spite of difficulty or opposition”. Will all transgender children be persistent in this way or insistent in the face of opposition or re-direction from parents or other significant figures in their lives? Likely not. Just like everything, one’s personality and desire to please guardians are on a spectrum. MANY children are not insistent about anything, so they sure as heck aren’t going to be about their gender identity or desire to be recognized as a different gender than their assigned gender at birth. Some children eat their vegetables simply because they are told to. Others refuse to take even a bite despite any tactics used by those in charge of feeding them. Such is the same with gender identity: if a child is consciously aware of identifying with a gender other than that assigned to them at birth (i.e. a natal female feels like a boy or a natal male feels like a girl), how much they express this will depend upon the level of distress it brings to them as well as their temperament. Some children will scream, “I am a _______!” and insist upon wearing what they want, being referred to as they want, etc. until everyone around them is quite clear of who they really are. Others, if told the way they feel or how they perform gender is wrong or unexpected, will quickly make modifications to please those around them. When considering persistency and consistency, this is typically in regards to cross-gender identification and gender expression. This may include way of dress, interests, how the child seems to categorize themselves (in play, roles, or how they relate to others), gender of friends, bathroom behavior, etc. If these things seem to be an expression of “cross-gender” identification, that may be a sign of having a gender identity that does not match one’s birth sex. However, the individual (a child, teen, or adult) may not be consciously aware of being transgender until much later. Transgender people become consciously aware of being so at various ages and stages; some seem to know since birth, others as children, others as soon as puberty hits, still others only in late teens or adulthood. I think this largely depends on how much the individual has been exposed to knowledge of variations of gender, family environment, how freely one is allowed to express self in regards to gender, defenses, suppression, the list goes on and on. Only once the individual is consciously aware of being transgender does transition become a factor.   From the child who insists on his or her true gender since the time they could speak to the adult who does not become consciously aware until much later, both are equally transgender; the age of conscious awareness was simply different. If the child is yet to be consciously aware that they have the brain gender identity of something other than their assigned birth sex, there is nothing to be insistent about. The point of my post? Don’t wait for your child to insist that he or she is transgender or needs to transition in order to open up the lines of communication. Ask a lot of questions about how your child is feeling. If you sense gender is a source of internal conflict or stress, make it known it is a topic that is welcomed in your home. Ask creative questions to find out how your child experiences his or her gender. Be honest about options that are available in regards to transitioning. (Doing so will not make your child transgender or “plant” ideas in their head. Transition is not an appealing option for non-transgender child.) If you still sense distress but they are not being open about their feelings, seek a consultation with a gender therapist trained in interviewing children. The benefits of early intervention (and transition if right for the child), are many. If you are transgender, looking back to yourself as a child: How consistently did you express a cross-gender identification? How long did this persist before you transitioned? Were you insistent about it?

Viral Video: Ryland’s Story

A very important video has gone viral with over 4.5 million hits in one week. It’s the story of young Ryland, a transgender boy who was allowed to socially transition at the age of 5. To see the video, click here. As a gender therapist, and a gender therapist who also works with transgender children, I’m thrilled to see this video in mainstream media: Huffington Post, People.com, Upworthy.com. It’s bringing awareness to an extremely important issue: not just that transgender children can transition, but it drives home the point that transgender people are born transgender. The age that one is consciously aware of being transgender or transitions can vary widely, but an individual does not become transgender over the course of their lifetime.

I had the honor of speaking about this issue on Good Morning America. To see the clip, click here. I said a lot more than what was aired, but there’s only so much they could fit into a 4-minute news segment. I’d like to take this opportunity to address some of those things now. These points are in direct response to the questions I was asked by Good Morning America about the video. Regular readers of this blog are probably well-versed in the answers below, but in case this post is read by someone seeking more education or to understand young transgender children, I wanted to be thorough.

Many people were surprised to read that 41% of transgender individuals have attempted suicide, while the rate of the general population is 4.6%. That staggering statistic, I believe, applies to transgender individuals who transition later in life and meet with familial/societal resistance, rejection, or shame. “New analysis of responses to the National Transgender Discrimination Survey (NTDS) shows that transgender respondents who experienced rejection by family and friends, discrimination, victimization, or violence have a higher risk of attempting suicide.” I strongly believe that number will plummet in the coming years with increased awareness, education, and accepting, responsive families like Ryland’s. To read the full report from the Williams Institute, click here.

I was asked questions about what interventions are recommended for transgender children. For a transgender child as young as 5 or 6, the first step is social transition. This means changing pronouns, sometimes name, and some societal markers of gender such as haircut or dress. No medical interventions happen at this stage, contrary to some sensationalistic beliefs. The first medical interventions would be just before the onset of puberty, at which time hormone blockers would be introduced to prevent the body from going through the “wrong” puberty. As the teen ages, cross-sex hormones would be administered to initiate puberty of the preferred sex, which would produce some much-desired “gender markers”.

When a child has been clear about their gender identity and not transitioning causes distress, transitioning young can be incredibly beneficial to the individual. While not all transgender people are focused on “passing”, it is hugely important to many. “Passing” means being read in society as the gender with which you identify in your brain. Going to the grocery store and having the cashier address them with the correct gender pronouns… that is “passing”. Transitioning early and intervening before puberty takes over will allow that individual to pass as his or her “true” gender without question.

One thing I want to say is that I know many people worry that a very young child is too young to make such a big “decision”. I want to remind you that gender identity is not a decision. We all know very early on what gender we are. A transgender child of Ryland’s age is not making a “huge decision” to be a boy. He IS a boy. His parents were faced with a huge decision about allowing him to transition, and they made it based on Ryland’s asserted gender identity.

I thought Good Morning America did a good job of covering this video. I was pleased about the input from ABC’s Chief Health and Medical Editor, Dr. Richard Besser. “The more we’re learning about gender, the more we’re learning that this is really hard-wired. It’s hard-wired in the brain. And from very early, from the first couple years of life, children will recognize gender and then start to identify with gender.” My only feedback would be that he should have used male pronouns when referring to a transgender boy.

One thing that didn’t sit right with me was the way they worded the “teaser” for the upcoming segment on the video. “True Identity: The incredible story being shared coast to coast of one little girl who just wanted to be a boy. Why her parents encouraged her to change gender.”

This statement is misleading at best. First of all, this child is not a little girl. This child did not “want to be a boy”, this child has the brain gender identity of a boy. As the video said, this child did not say “I want to be a boy”, he said “I AM a boy”. Now, I understand those snippets are meant to be short and can’t cover it all, and they are geared to having people tune in to watch the segment. The part that got me the most was the last sentence: “Why her parents encouraged her to change gender.” If you are the parent of a transgender child, you probably understand why that sounds a little silly. Do these parents have some sort of ulterior motive to have a transgender child? Doubt it. Was this in their master plan? Likely not. Many of the parents of young transgender children I work with struggle extensively during the process of understanding their child’s true gender identity. It takes time to accept their child is transgender, and naturally, parents tend to agonize over allowing their child to transition. Supporting and responding appropriately to their child’s gender identity is not encouraging something that wasn’t there; you can’t make a child transgender. However, supporting and encouraging the child to live life as their true selves, that is selfless, unconditional love. For more reflections on how difficult and intense this journey can be for parents, see my blog post “Feelin’ The Love: Watching the Journey of Parents”.

In the video, the song fades from “Hallelujah” by Jeff Buckley to “Good Life” by One Republic as it shows Ryland transitioning. I think it was the perfect song choice. So many parents worry whether or not their transgender child can have a good life. The answer is: ABSOLUTELY. Thank you to Ryland and his family for being selfless and strong enough to share your story so that many more transgender children can have good lives, just like you.

Simply Put: Worksheets for children about gender identity and transition

When I was asked to help a child understand the gender transition their loved one was about to go through, I created a one-page overview of the process in simple terms. I also created a little “worksheet” that would encourage the child to think about how this change was going to affect them, and their loved one, specifically. The worksheet facilitates conversations between the child and adults; fill-in-the-blanks are a great way to find out what is on a child’s mind. While I was at it, I created a one-page summary for gender nonconforming children, complete with a brief fill-in-the-blank portion at the bottom.

These summaries/worksheets have come in very handy when working with transgender youth and the young loved ones of my transgender adult clients. I thought others may benefit from using them as well, so they are attached below. Please feel free to use, copy, and distribute as needed to assist children on their journey to understanding. (Who knows, sometimes concepts stated in simple terms can help adults, too. ;)).

For those of you not in the field of mental health or well-trained in interviewing children, here are a few tips for completing this worksheet:

  • Don’t make a big deal of the sheet. Just say you’re going to do a little something and do it. Act like it’s no big deal and you’re not nervous, even if you are.
  • Don’t look at the child being interviewed. Look at the worksheet.
  • Poise your pen or pencil over the blanks and begin asking the questions. Write the answer in the blank as soon as they are stated, without a reaction (facial expression, question, anything!) Children are incredibly in tune with others’ responses to what they are saying, particularly if the “other” is a parent.
  • When the worksheet is completed, go back and ask questions for clarification.

If you have any trouble with the way they are opening on your computer or printing out, please email me at tandotherapy@me.com and I will email you copies.

Kidworksheet

kidinfotrans

transitionworksheet

Feelin’ The Love: Watching the journey of parents

My work with my transgender clients often includes not only the transgender individual, but the family as well. As important as it is to be an advocate for my clients, it’s also essential I understand the process that is being undertaken by the loved ones of the individual. (See “It’s Hard for Moms”.) Many parents of my adult clients are very resistant to the idea of their “child” being transgender or transitioning, and are initially quite wary of me for supporting this venture. Typically with my adult clients I only hear of the resistance expressed by the parents without witnessing it directly. In session, I am privy to the intense longing of the individual for support and acceptance by their parents, no matter how old they may be.  This is yet another reminder that unconditional love from parents is crucial at every stage in one’s life.

When I work with parents of transgender youth, it’s a little different story. These parents are willingly seeking gender therapy for their children, searching for answers and a roadmap for this unforeseen journey. Fear and resistance are often still a part of the work, but there’s so much more than that.

I have seen parents evolve in the journey with their transgender/gender nonconforming child from tearful and terrified to peaceful and resolute. I’ve seen parents give their child space to express themselves in a way that allows the child to be honored and embraced, even if the parents are scared by the possible ramifications. Some parents accept very quickly while others fight to hang onto what feels safer and more familiar. Some become advocates, others are willing to share their stories, still others remain very private; all of them intensely love their child. To see a parent accept something they never wanted or saw coming is a source of true inspiration for me, and a very touching part of the work I do. I respect and admire these parents more than they know.

The passion I sense from these parents for their child can be expressed in all sorts of ways: fear, anger, pride, doubt, guilt, sadness, grief, bravery; the list goes on and on. I’ve always loved children, but it wasn’t until I became a parent that I could truly understand the passionate love a parent has for their child. The kind of love that makes you willing to do anything for another’s happiness, willing to sacrifice, fight, and conquer all for the sake of your little person even in the face of your own anxiety or trepidation.

Sometimes I feel hot tears spring to my eyes* in the middle of one of these sessions with parents, especially with those early in the journey. What brings on these tears? Is it sadness? No. It’s not quite something I can explain. It feels like a mixture of compassion, inspiration, and awe at the intense love I’m witnessing, along with honor that I get to be a part of such a life-changing journey.  I’m definitely feeling the love, and in the end, I know the child will too.

*Not a robot.