Why Gender Affirming Care is Critical

This blog post was written by JKP authors Kelly Darke and Shannon Scott-Miller

Gender affirming therapy is part of all therapeutic care. Every human has a gender identity. Every human has a sexuality. Gender affirming care recognizes that exploring gender and sexuality are healthy parts of the journey in learning about ourselves. There has been a lot of discussion lately in politics about Gender Affirming care with misinformation that confuses our ability to provide ethical and, at times, life saving care. Put simply:

  • Affirming therapy is an interpersonal process that recognizes and supports an individual’s unique sexual orientation, gender identity and expression. 
  • Affirming therapy moves beyond the binary of male and female to support an individual’s personal growth as they explore their personal and social identity. 
  • Affirming therapy does not categorize any form of gender expression or sexual orientation as a mental illness.
  • Affirming therapy happens when a person is supported without any prior belief that any particular sexual orientation, gender identity or expression is the optimal outcome.

All of us have a gender identity. When our gender identity is aligned with the cultural norms that we experience on a daily basis, we don’t give it much thought. However, we are expressing and experiencing the world through the lens of our gender identity everyday. This includes our way of expressing it in the roles we take on at home, the workplace, and in the world around us, how we interact with others, and how we are perceived by others.

Learning to live comfortably within our own gender identity can be challenging when cultural expectations of gender do not connect with our internal sense of being.

This is particularly true for people who are transgender. (For the sake of ease, we will use transgender as an umbrella term to include any gender that exists outside of the restrictive male/female binary including gender fluid, nonbinary, demi, etc.). The stricter the outside expectations are, the more intense the internal struggle can become.

This struggle increases mental health risks including anxiety, depression, self harming behaviors, eating disorders, substance abuse and suicidal ideations. Without support from family, friends, and community the risks only increase. As a society we need to protect our most vulnerable citizens; as therapists we must learn what we can about our clients’ experiences and help them navigate through the difficulties.

As therapists supporting our clients, we look to our therapist tool kit to see what resources we have that we can share with our clients to help alleviate the struggle. We seek to keep clients safe from external and internal harm, build coping skills, gain insight, and build on strengths that already exist within our clients. These goals exist outside of the binary and apply to every human being we serve.

Adapting this to our transgender clients simply means recognizing that their lived experience within their own gender and sexuality are a valid part of who they are. Again: Affirming therapy happens when a person is supported without any prior belief that any particular sexual orientation, gender identity or expression is the optimal outcome.

Gender identity is built on cultural norms. Recognizing how we interpret these norms is important before we enter the therapy session. It is not our client’s responsibility to educate us, the therapist, about what it means to be transgender. It is not the clients job to explain how gender identity and gender expression affect everyday life. It is our job to explore our own experience and history of gender and sexuality and understand how our lived experience has shaped our personal understanding. This allows us to open ourselves to how the client understands and lives in their own gender identity without bias or judgment.

Being open and accepting is a crucial part of building a therapeutic relationship. If someone doesn’t feel safe within a therapy setting it will be difficult to help them develop coping skills. Oftentimes our transgender clients have increased anxiety surrounding their gender identity and expression due to the cultural norms that are placed upon them. We need to do this work ourselves so that we can provide affirming care for our client, and we can do that through art.

Art offers a way to express internal feelings on the outside.

Creating art in an art therapy session does not require formal training. As humans, we are all creative and expressing ourselves is a natural and necessary experience. For many of our clients, this is the first time they have had to express themselves without the confinement of words. This may be the first time they are able to see and understand their emotions that words alone could never explain. Lines, shapes, and images can construct a story that reflects our own experiences and emotions without words, without the need to define the feeling, without the need to justify our experience.

Expressing  yourself with no restrictions or consequences for coloring outside of the lines can be incredibly empowering. For transgender clients who face criticism and negative consequences for living outside of the lines, we can offer a safe space to be creative, explore their identity, and build the internal and external resources needed to not only survive but thrive.

Our book, Art Therapy with Transgender and Gender-Expansive Children and Teenagers, includes information for therapists and caregivers that will help you provide supportive care to the youth in your life. Each of these topics is explored more fully to assist therapists in providing effective gender affirming care.

Art Therapy with Transgender and Gender-Expansive Children and Teenagers by Kelly Darke and Shannon Scott-Miller is out now!

Kelly Darke, ATR, M.Ed., BFAis an art therapist based in Michigan, USA. She has experience working with gender-expansive children and young people.

Shannon Scott-Miller, MA, ATR-BC has over 20 years’ experience in medical art therapy, including working with gender-expansive youth.

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