7 Things Therapists Working with Non-Binary Individuals Should Know

By: Laura Kacere, MA, LPC

When non-binary clients seek out therapy, it may be that they’re seeking out a safe space to explore their gender identity and expression. They may already understand their gender identity and seek support in coming out to friends and family, or they may be seeking therapy for something else entirely, like for anxiety and depression. Regardless of what is bringing them to your office, it is imperative that therapists create a space that feels safe and affirming, and this requires a level of knowledge and comfort on the part the therapist.  

While we often think of clients as teachers, and it’s important to trust that clients know their own experiences better than clinicians do, we also have to take responsibility for educating ourselves on the common experiences, and common mistakes, that clinicians and others often make when working with non-binary clients. Although there is more research and training in the mental health field today than in previous years around working with transgender clients, it is still very limited, and there is far less understanding in the mental health field around non-binary and other gender non-conforming identities.

When we have a better sense of the issues affecting our clients, we are more effective in helping individuals further explore their sense of self to build greater authenticity and congruency in their lives. Through my own work with non-binary clients, as well as with all clients (gender experiences and expressions pertain to all of us!) I’ve found the following 5 principles to be useful considerations.

 

Educate yourself: terms and experiences

The term non-binary usually refers to people who identify their gender outside of the binary, as neither man nor woman, or both, or somewhere in between. While I use the term non-binary here, the term genderqueer is often used in the same way – generally as a catch-all category to refer to individuals identifying outside of the gender binary. Under the “non-binary umbrella,” there are many more terms that may more accurately describe a person’s gender, such as bigender, gender fluid, gender neutral, agender, and more. Use this list to explore other terms and definitions. Learning about pronouns (and asking every client what their pronouns is!) can also help you feel more comfortable using language that creates a safer, more affirmative environment.

It’s also important to learn about experiences of marginalization that your non-binary client may experience, both through interpersonal interactions – including street harassment, microaggressions, and bullying, as well as on a systemic level – including higher incarceration rates, discrimination in housing and employment, and a general lack of protections for gender non-conforming individuals.  As with any marginalized community, we cannot consider mental health concerns as separate from the environmental context of distress and systemic oppression.  

 

Be open to seeing gender as a spectrum, not a binary

Our understanding of gender has continued to expand over recent decades, thanks to gender theorists like Judith Butler, who have questioned the limitations and innateness of gender. It’s worth digging a little deeper into feminist and queer theory to explore these ideas further, but I think the most important thing to acknowledge is that limiting gender to a compulsive binary categorization can be inaccurate, and even harmful.  Gender, both in identity and expression, exists on a spectrum, from masculine to feminine, and framing it this way allows all of us more room for self-inquiry and exploration.

You can use this Gender Unicorn activity to help clients explore their gender on a spectrum that also differentiates gender identities from presentation/expression, as well as from their sexual and emotional desires. By making space for clients to explore their gender in their broad and open way, you make space for clients to explore their gender based on their own needs and desires, within the context of their environment, relationships, and history, rather than on your own.  If these concepts seem confusing to you, there are plenty of resources out there to learn more about it – here are two that I find helpful:

Gender Spectrum: Understanding Gender

Nat’l Geographic, How Science is Helping Us Understand Gender

 

Explore your own experiences of and views on gender

Regardless of your views on gender, as well as your personal gender identity, it will be extremely useful for you to do your own work exploring your internalization of societal expectations and norms when it comes to gender. Be careful about how you bring your assumptions around gender into the room, and acknowledge and unpack your own biases before seeing non-binary clients, so as not to further stigmatize or invalidate their experiences. Understanding your own ideas about gender will help make sure your therapy room is supportive and validating for gender exploration.

For more support in exploring your gender, check out therapist Dara Hoffman-Fox’s book You and Your Gender Identity: A Guide To Discovery


 

Don’t pathologize: Gender exploration/fluidity does not equal dysphoria

This is pretty simple, but a necessary rule to make clear for working with any gender non-conforming client. Don’t assume that because a client does not always feel like they fit into categories of “woman” or “man”, that this is symptomatic of a pathological nature within them, and that their distress will be relieved when they “choose a category.” This only further stigmatizes your client, and will likely set up a dynamic in which they don’t feel there is space to truly explore who they are with you.

Despite the fact that gender dysphoria exists as a diagnosis in the DSM-V, we have to be incredibly careful about using this as a general framework for understanding clients who seek therapy due to questioning their gender. There may certainly be moments of dysphoria or distress as clients uncover parts of themselves and shift toward more authentic expressions, changing aspects of their presentation/bodies, and coming out to friends and family, but in this process, it is often the environment within which a client exists that causes the stress, and less reflective of intrapsychic conflict or pathology. We live in the world that often feels unsafe for gender non-conforming individuals because it is unsafe, and there is a lot of vulnerability involved in coming out as/presenting as non-binary.

Feeling overwhelmed, confused, anxious, or sad can accompany this gender exploration for a variety of reasons; but this doesn’t mean that exploring gender is a problem, or that it is the cause of the hurt. In fact, it is often through the process of gender exploration and change that these symptoms of distress decrease.  

 

Uncertainty is okay

Make space in your sessions for doubt, for uncertainty and insecurity, for the discomfort that comes with this often scary inner exploration alongside a pushing of societal categories. In “What’s My Gender,” author Micah writes about “certain uncertainty,” saying:

You are not only diving deep into what it means to be you, but having a non-binary gender (or just considering the possibility) means coloring way outside the lines of what exists in society, sometimes even coloring off the page entirely! So of course it can be both a very scary, though exhilarating, experience.

Help your client to be okay in that uncertainty by normalizing it, and allowing yourself to sit in that uncomfortable uncertainty as well.  Remind them that it’s okay to not know right away, and even for your identity to change over time. Helping a client let go of the expectations or urgency of “needing to know” can open up a whole new space for clients to try out new things, access more inner creativity and playfulness, and pay more attention to what they notice inside around what they like and don’t like.

 

Don’t push for linear transition or an “end” goal

When we talk about gender non-conformity, we often talk about a transition with an end goal, as if there is one final true expression of one’s gender. This is more likely to be the framework of therapy with a transgender client, but often, with clients who identify as non-binary or gender fluid, the changes may be more subtle, sometimes only internal, or may constantly be in shift. Be careful about asserting that a linear process must take place before they can consider themselves to be the gender identity they associate with. Being non-binary does not require any particular expression or presentation, it simply requires a person to find it authentic and true to who they are.

 

Trust your client

Lastly, but most importantly, as with any client, it is so important to trust our clients’ own understanding of themselves over your ideas about who they should be. Respect their choices – they may ask that you use different pronouns from one session to the next, or they may express their gender in ways you don’t understand, and that’s okay. You don’t need to always understand why, and maybe they don’t need to either. Just be respectful, honor their choices, and make it clear that you recognize them as the expert on their gender identity. Validate your client, every step of the way. This can be a scary process, and your client may be faced with a lot of external pressure to conform to gender expectations. Make your therapy room at least one space where your client can safely express themselves.

To learn more about what non-binary clients may experience, or if you think you may want to explore your own gender, consider these resources, or contact me at laura@catharticspacecounseling.com.

 

Help! I Think I Might Be Non-Binary, But How Can I Know?

The Gender Playbook: A Guide to Figuring Out Your Non-Binary Gender Identity

This Is What Gender Non-Binary People Look Like

Gender Unicorn (I truly love this – print these off and color in where you feel you are at any given moment)

GenderSpectrum.org

Spring - A Time of Renewal

By:  Peggy Burns, MA, LPC

Spring is a time when the flowers bloom, grass is growing again, and trees are beginning to fill in. It seems made to be  a time for the renewal of one’s spirit…...at least it is supposed to be that way. How is it for those of us who are still grieving the loss of a loved one? How do we celebrate Spring and the new season?

I am coming up on the anniversary of my daughter’s passing and my feelings are conflicted and complicated because I want to feel the Spring air and all the passion it brings  after a long Winter. Yet, I am reminded of a loss that is still very fresh and am feeling apprehensive about the next few months.

I have been thinking about this for awhile now and below are a few thoughts I think will help me, and hopefully you too:

  1. Live each day for itself, separately from yesterday or tomorrow

  2. Do something for yourself that you enjoy

  3. It’s ok to take a break from grief

Spring Renewal

I know it has been said a lot to take each day one at a time, but it is still the best advice I can give anyone who is grieving. Today is a good day and I am enjoying it, but perhaps tomorrow the sadness will return. I can only take one day at a time and feel what I am feeling. Thinking about how I may feel tomorrow puts pressure on the future and no one knows what the future holds.

When you are having a good day, rejoice in it and breathe it in. Try not to think about it too much and just enjoy the day.

When we have anniversaries, birthdays, celebrations on the horizon, it is hard not to think of our loved ones who are no longer with us. There are no magic words to say that will make it better and the feelings still run deep, but I can say with certainty that taking it day by day is the best way to get through it.

Doing something you enjoy is very important to renewing your spirit. It feeds your body and mind with a refreshed sense of purpose. It could be anything from sitting in a coffee shop and enjoying a latte, getting a pedicure, or going for a walk in a garden blooming with Spring flowers. It doesn’t have to be an entire day of indulgence but if it is possible, why not? We must take care of ourselves first so that we can be present for our loved ones who need us. Our spirits deplete and our tanks get empty. Don’t let it run you into the ground. We all deserve a break to take time for ourselves.

I also think taking time by yourself is just as important as doing something for yourself. Many times, we are so busy with life that we forget to connect with ourselves. We all need alone time to sit back and be with our thoughts. I know that might sound scary to some people, so perhaps just taking a walk or walking your dog by yourself is all the time you need, and that’s ok too.

I recently went on vacation and before I went I really thought about what I wanted this vacation to be for me. I thought about it so much I was beginning to worry it wasn’t going to turn out like I wanted it to. All I wanted was a true vacation. I did not want to feel sad anymore, or at least for the week that I was on vacation. I knew it was a tall order. But then I was thinking… why not? I think it is ok to take a break from grief. It can consume us and overwhelm us and we forget what it is like to enjoy life and not have that cloud following us. I am here to report that it did work. I felt lighter, freer and enjoyed every day I was on vacation.  I will say that when I did think of my grief, it was ok, it wasn’t as heavy and it was momentary.

We cannot carry the heaviness around all the time….it changes us and it weighs us down. A break from grief just may be a glimpse into the future to help us see that it is not always going to be this dark.

I hope these steps can help you with the upcoming Spring renewal and lift your spirits.

Feminism & Mental Health, Part 2: Prevention and Healing

By: Laura Kacere, MA, LPC

Parts of this piece have been reprinted from an earlier piece written by Laura Kacere for Everyday Feminism, entitled “5 Awesome Ways Feminism is Good for Your Mental Health.”

According to a 2016 national survey, 6 in 10 women in America identify as feminists, with 7 in 10 calling the movement empowering. Taken before Trump was elected, it’s possible this number is higher now; the growing number of people who have shown up to protest and challenge our current administration’s sexist and racist policies seems to reflect a growing awareness and willingness to speak out about how they negatively affect us and our communities. If women are finding themselves empowered and connected to the broader struggle for their individual and collective rights, could this also be protective against depression, anxiety, and PTSD? Could feminist awareness and activism be a part of the healing process?

I’ll never forget when I first became a feminist. I was fifteen, a difficult age for many girls, as their bodies start to change and awareness of their bodies as potential sexual objects, their expected roles in society, and the messages about who and what they should be start to crystallize. Depression, low self-esteem, and confusion about identity are common at this age. I remember coming across a book that helped me understand the context and causes of what I was experiencing, that I was not to blame, and that I was not alone. My confidence grew, and I learned how to make my own decisions about how I received and responded to sexist messaging, in fact, I could reject them altogether, and join in with others who did, too. Developing a feminist identity at such a young age in a world that is so hostile to girls can have a radical effect on one’s sense of self. Being able to critique cultural pressures, as we learn to recognize and resist oppressive cultural messages about our bodies, our value, and our roles in relationships and society can create a new sense of personal and collective power in all of us.

Research shows that feminist identification can protect against and be a mode of recovery from depression and low self-esteem. The mental shift that can come with feminist awareness, including understanding and letting go of internalized sexism and self-blame can deeply impact our psychological well-being.

Research also shows that feminist identification and perspective can play a huge role in body image and protecting against body image dissatisfaction, and that women with higher levels of feminist identity tend to have lower levels of disordered eating, despite experiences of sexism.

It’s also been confirmed through research that women who identify with feminist values tend to have better overall wellbeing, particularly when it comes to our sense of purpose, our autonomy, and personal growth.

It’s not surprising that self-efficacy, or one’s belief in their ability to succeed and accomplish goals, is also significantly associated with feminist identity and attitudes. It seems that feminist identity, attitudes, and behaviors are not only good for our communities, but are significantly beneficial to our own well-being, including our psychological wellness, our relationships to our bodies, and our belief in ourselves.

Feminist therapists tend to believe not only in the power of building knowledge, but also in the healing power of building and engaging with community. Collective action has always been a core organizing principle of political movements. And coming together to connect – to see that the “personal is political” – has played a significant role in the feminist movement since women first learned that “it’s not just me.” And research shows that participation in collective action provides needed emotional support and an outlet for the difficult emotions we experience, like anger and stress.

Being a feminist may certainly sometimes feel like it causes more distress, as the burden of staying informed alone can heighten the emotional weight of anger and stress, especially in our present moment. But it also means that we can connect with the larger social justice community to take action to change those very structures. We gain a sense of strength in numbers, as well as support from others as we heal from and sustain our emotional wellbeing amidst these challenges.

It is also important to remember out that mental health is a feminist issue, that the stigma and shame surrounding psychological disorders have a strong force in our culture, and serves only to isolate and further harm those who struggle with these issues. It’s so important for us to do the work of supporting one another as we navigate this difficult world. This might mean encouraging a friend to get help from a mental health professional when they need it, or speaking up about your own struggle with mental health if you feel ready to do so. It might mean placing mental health advocacy at the center of your feminist work.

As a feminist therapist, I can attest to the power of both individual therapy and collective support. It’s important to make space for healing in the very specific ways that you need and desire, and this can often be done in a therapy room, with a trusted therapist. At the same time, I often encourage, where possible, making intentional choices about connecting with other people and ideas through books, online, or in person, around issues that we care about. An understanding of our pain in a broader context – to see the ways that our hurt has been experienced by others like us, to cultivate empathy and connection toward others, and to see the resilience and hope of those around us – can be a big part of managing our distress and healing from trauma.

Seeing the universality or shared human experience of pain and suffering is a building block of self-compassion. In this sense, I believe that not only is feminism good for our mental health, but that our deepening awareness of how oppression impacts our mental health can support our fight for equality. When we do our own work, building insight and awareness into our mental health struggles, we strengthen ourselves, and have the potential to better care for those around us and support movements for justice.

Feminism & Mental Health, Part 1: The Gender Disparity

By: Laura Kacere, MA, LPC

Did you know that women are nearly twice as likely to be affected by depression and anxiety disorders as men? Women who are unemployed, less educated, and have less access to wealth are at even higher risk, as are women of Color and immigrant women. Post-traumatic stress disorder, which affects approximately 7.7 million adults in the U.S., is also more likely to occur in women than men. Why are women more likely to be affected by these largely diagnosed disorders of depression, anxiety, and PTSD? What’s the relationship of gender and mental health? And what role can feminism play in all of this?

It is common to try to understand mental health through the framework of the medical model, the way we tend to view physical ailments, viewing mental health concerns as disorders of the individual, and therefore treating them as such. Psychologists like Alfred Adler have identified the significance of viewing “the individual in context,” noting not just the impact our social and cultural environment has in shaping us, but on the role our connection to community can play in our development and in healing.

Limiting our understanding of disorders to the individual “out of context” disregards the larger systemic and cultural factors that play a role in such a disparity in mental health. Perhaps it can be seen most clearly when it comes to PTSD, for example. According to the National Center for PTSD, women are more than twice as likely to experience PTSD in part because sexual assault is the most common traumatic incident leading to traumatic stress, and women make up 90% of adult victims of sexual assault, with about 1 in 3 women experiencing a sexual assault. These numbers reflect a serious cultural and societal problem around gender and power.

The issue of sexual violence has become a more frequent topic of discussion in media recently, as women are increasingly feeling empowered to speak out about their traumatic experiences. There seems to be a bit more safety at the moment in a culture that otherwise lends itself to victim-blame (though there is certainly still a lot of this happening); we’re seeing that when women speak out in large numbers, a culture of support can be created, which often means survivors are less likely to carry the burden alone, and less likely to blame themselves for the violence they’ve experienced. Receiving social support – from family, friends, and the wider community – is a significant protective mechanism in preventing the development of PTSD. Our cultural response to women about their traumatic experiences can play a huge role in how they view what happened to them, and how they heal.

As with PTSD, we cannot view depression and anxiety as separate from the sexist oppression that women experience in our country, and worldwide. Women’s economic disadvantage, connected to such issues as inequality in wages and the lack of accessible reproductive healthcare, lends itself to higher rates of stress, and fewer resources to manage mental health challenges.

The Gender Disparity

There is much research still needed on the adverse psychosocial experiences of women, but research does show that 3 important protective factors against depression include autonomy/ability to exercise some control in response to events, access to material resources that allow for that autonomy, and social support. When we simply look at the feminization of poverty in the U.S., as well as limitations in bodily autonomy that stem from limited access to reproductive care and the large prevalence of gender-based violence, we can see how these protections do not exist for many women. Along with the violence (or threat of violence) of devastating policies and interpersonal harm that affect our mental health, it is also the daily microaggressions and “benevolent sexism” that can lead to chronic stress, as well as symptoms of anxiety and depression.

According to the World Health Organization, “Depression, anxiety, somatic symptoms and high rates of comorbidity are significantly related to interconnected and co-occurrent risk factors such as gender based roles, stressors and negative life experiences and events. Gender specific risk factors for common mental disorders that disproportionately affect women include gender based violence, socioeconomic disadvantage, low income and income inequality, low or subordinate social status and rank and unremitting responsibility for the care of others." And as one might guess, racism similarly increases adverse mental health reactions, including increased anxiety, depression, and stress.

In short, sexism, like all forms of oppression, is bad for your mental health. So how does feminism fit in with all of this?

Feminism can be understood broadly as the advocacy for women’s political, social, and economic equality. I want to clarify here, that when I speak about women, I am including transgender women, who face painfully high (and rising) rates of both systemic and interpersonal violence and discrimination. The kind of feminism that I believe in will lead us in the direction of progress and support for our mental health centralizes the needs of transgender women, as well as those of women of Color. This is an anti-oppressive or intersectional feminism that challenges a historical legacy of White feminism and understands the fight for gender equality must include fighting the overlapping systems of racism, heterosexism, wealth inequality, and other forms of oppression.

Experiences of trauma on a systemic level, such as poverty and incarceration, and interpersonal/individual, such as sexual abuse and intimate partner violence, as well as the less overtly traumatic yet insidious harm of compulsory gender roles and objectification of women’s bodies are all rooted in these systems of oppression. Feminist therapists have helped radically shift our understanding of these kinds of distress as fundamentally connected to social context, arguing that how we think about healing from trauma and other mental health concerns can be rooted in feminist awareness, and that feminist identification and activism can be healing for trauma survivors, as well as for those struggling with depression and anxiety. But how does feminism actually help us recover and heal?

Check back next month for Part 2 of this piece: Feminism & Mental Health: Prevention and Healing

 

The Promise of a New Year

By: Peggy Burns, MA, LPC

New Year’s Eve comes with resolutions for a new beginning. Whether you call them resolutions, goals or even suggestions, the new year starts with hopes and dreams of a better future. There are many schools of thoughts of whether it does more harm than good to make resolutions for ourselves. I am one that lends towards more good than harm.

I think the key is to not burden yourself with expectations that will lead to disappointment. Be realistic in what you are seeking for yourself. I believe even if it is one goal that you write down and look at each day, that is enough. It is easy to get caught up in the excitement of making new promises to yourself, hefty goals to accomplish, and a clean slate for the new year. It can become overwhelming, especially for those who have anxiety, depression and/or overcoming the loss of a loved one.

The last few blogs I wrote about talked about grief and the grieving process. Many of us who have gone through a painful year of losing a loved one may find it difficult to set goals for the new year. The loss is still with us and sometimes still feels like it was yesterday. I understand.

How do we move forward? I believe by making resolutions, goals, or whatever you want to name them, the act of doing something to move yourself forward will be a goal in itself.  Think of it as more of a lifestyle change.....positive reinforcement from past behaviors that were not so healthy.  Even though a goal is something to attain in the future, it can still be a daily event that you accomplish and feel good about.  

Goals

Here are a few helpful suggestions:

1. Start small: If you made a commitment to join a gym, start slowly with just one day per week; If you are trying to eat healthier, start by cutting out desserts instead of cutting out everything you like all at once. It is easier to stay committed to these changes one small step at a time.

2. Change one behavior at a time: Unhealthy habits or behaviors did not start all of a sudden, so it is going to take some time to make these changes. It is also helpful to start with just one behavior and work on that and then move on to another one.

3. Talk about it: Sharing your thoughts and goals with another person or group helps with your commitment, accountability, and struggles. Consider joining a group if you are losing weight or taking an exercise class with others who have similar goals.

4. Don’t beat yourself up: Remember, perfection is unattainable. Don’t beat yourself up if you ate a brownie or skipped a workout. It’s ok! It is normal; just get back on track the next day.

5. Ask for support: Accepting help from those who care about you and support you in your goals only strengthen your commitment and resilience to stay on track. If you feel overwhelmed by stress with meeting your goals, consider seeking professional help. Psychologists, counselors, and other professionals are trained in the mind/body connection and can help with goal setting and changing unhealthy behaviors.  

I would also like to add that being realistic in your goals eases up on expectations that cannot be met, which in turn makes you feel like you have failed. Remember to be true to yourself; share your thoughts, hopes and dreams with your friends and family so they can rejoice in your successes as well.  

The Holidays are Approaching, and They Aren't Always Merry

Anxiety, Depression, and Grief & Loss

The holidays are approaching, and it’s supposed to be the happiest time of the year. There are family gatherings, office parties, presents, music…...the list goes on. It can be overwhelming, and especially so for those suffering from anxiety, depression, or the loss of a loved one.

The expectation of putting on a happy face when you don’t feel like it can be exhausting. On a daily basis, people who have gone through a loss or are feeling depressed find it hard to attend parties or interact socially. The holidays add to the complexity of our feelings and the anxiety level rises.

You may feel pressured to celebrate, invited to participate in and attend gatherings you do not feel like attending. You may feel your co-workers or friends do not understand that you are not ready to celebrate and are urging you to join in.  Anxiety, depression, and sadness over the loss of a loved one is felt more deeply at this time of year.

What can we do to help ourselves through this season? The first thing to do is give yourself permission to feel what you are feeling. Let the feelings come and let the feelings move on out. Denying them or pretending everything is fine will only delay the feelings, and they will catch up with you. It is ok to feel sad, you are sad, it is ok to feel anxious, it’s an anxious time of year. By acknowledging those feelings, we can take deep breaths and it will help us to feel less sad and less anxious.

The second thing to do is limit your gatherings to a few that you really would like to attend with people you want to spend time with. You do not have to attend each party you’re invited to or each gathering at a neighbor’s house. Perhaps it would be better to invite a few friends and family members over to your place. This way you are surrounded by the people you care about; you are in control and feel more comfortable and secure at home.

The last thing I would like to suggest is to take this season as one for reflection. I know from a personal perspective that I think a lot about the people in my life past and present and what they mean to me. I think about the lessons learned and teachings from my parents.

It is a time of renewal and hope. For those who are religious or spiritual, take the time to reflect on readings and think about the goodness of life. For those who are not religious, it is still a time for renewed strength and promise of a new day. Feeling gratitude is an excellent way to say thank you to your friends and family who have supported you throughout your life or during your sorrow.

Feeling gratitude is not as hard as you may think. When you start to feel sad or have negative feelings, think of the tiny things you are grateful for at that moment. It could be that first cup of coffee in the morning or taking your dog for a walk. Simply saying thank you to the universe for another day may lift your spirits each time you do it.

5 Ways to Support A Loved One Who is Transitioning

By: Laura Kacere, MA, LPC

The process of transitioning one’s gender identity can bring up a whole host of physical and emotional experiences for the person engaging in the transition, as well as for those around them.  Everyone’s experience is different, but often some of the most challenging and rewarding parts of a transition can be the reactions from one’s family, friends, and larger community. Receiving social support is so important when one goes through any big life change, but particularly when someone comes out as transgender, in part because of the many systemic challenges a person can face when attempting to transition. Whether they’re your friend, family member, or partner, here are 5 ways you can support your loved one as they transition. (For the purpose of inclusivity, I will use the pronouns they/them in this article).

LGBT Support

1. Use the language they have asked you to use

When someone is first coming out as transgender, it’s not uncommon for them to request that others begin using a different name and pronoun to refer to them going forward. It can be challenging for some to make this change at first, but do your best to use the pronouns and name they have requested, even when your loved one is not around. This is an important part of validating your loved one’s identity and respecting their experience. It might feel like a small thing, but it can feel incredibly hurtful and invalidating to the person when they hear the wrong pronouns used, especially if this is the first part of their transition. Remember that it may have taken a lot of courage to make this request of you.

At the same time, be mindful of who you talk to about your loved one’s transition; the process of coming out can be an arduous one, and it is ultimately up to them how and with whom to share news of their transition. Do NOT out your loved one without their consent. This significantly disempowers them, and can have severe consequences, like harming a relationship or putting someone’s job in jeopardy. Coming out can be difficult and terrifying enough; support your loved one’s choices in how to do so.

2. Respect their process

There is no “right way” to transition, and everyone transitions at their own speed, and in their own way. Be aware of your own assumptions and expectations you may have of them. For example, your loved may or may not choose to make medical/physical changes, like starting hormones or getting gender re-assignment surgery. Recognize that you don’t always have to understand the process of their transition in order to support them.

While some may have known for years, even decades, what they want and need as they transition, the process may be more exploratory for others. Be patient. Transitioning doesn’t happen overnight; it’s a process, one that can take longer for some, and still others may not even have an endpoint of their transition at all. In fact, a transition doesn’t always have to mean transitioning from one gender to the other; it can also mean exploring different parts of the gender spectrum over time, or staying somewhere in the middle. Allow your loved one to make the transition their own.

3. Offer to help

Many aspects of transitioning can be intimidating - from medical changes, like starting hormones, to legal identity changes, like changing the gender marker and name on a driver’s license, to aspects of gender expression, like picking out new clothes – there is often a lot of that goes into the transition process, and it can be overwhelming. There can also a lot of vulnerability in seeking these services, and finding a doctor who is trans-affirmative, for example, can be challenging. Ask what you can do to help them navigate this process and help your loved one connect with the larger transgender community for more support.

4. Take care of yourself

While it’s necessary to recognize that this transition is theirs, and not yours, it’s also important to acknowledge your own reactions to your loved one’s transition, and to give yourself the space to process your own experience of the transition, ideally with a therapist. It’s not uncommon to experience what can feel like a grieving process, especially if you’ve known this person for a long time. For your loved one, the process of transitioning can feel like they are finally able to express themselves authentically, and they may feel detached and even dislike for their old way of presenting, or their old “self.” At the same time, you may feel that you’re losing someone, and may experience symptoms of sadness, grief; you may feel betrayed or angry or distrustful, and that’s okay. Recognize that what you’re going through is valid, while also recognizing that you’re responsible for those feelings.  Seek support from friends and family, and find a trans-affirmative therapist who can help you take care of yourself throughout this process. Giving yourself the space to process your emotional reactions to your loved one’s transition will also help you be a better support to them, and will ultimately likely strengthen your relationship.

5. Advocate for the transgender community

Transgender people, while thankfully gaining in visibility and political support, also continue to experience immense amounts of systemic and interpersonal violence and oppression. Your loved one may now have less legal protections, and are more likely to experience discrimination, harassment, and barriers to adequate health care, employment, housing, and more. It is immensely important that that we fight for the rights of transgender people. But if you haven’t already been a part of this fight for equality, now is a good time to start. Show your loved one that you care about the systemic inequalities they may now face by educating yourself on policies and other challenges affecting trans people. Show up at rallies, write your legislators, speak out, and stand up in support of the transgender community.

Resources:

Transequality.org: Know Your Rights and Supporting the Transgender People In Your Life

Gender Spectrum, which provides resources and support for transgender children, teens, and their families

Gender Unicorn, the much beloved unicorn that helps us understand the spectrum and fluidity of gender and sexuality


 

Grief Counseling - What Happens in the First Session?

Grief Counseling

By: Peggy Burns, MA, LPC

In my first blog, I wrote about Grief Counseling and when the right time is to make an appointment to see a counselor. Now I would like to write about what happens when you do make that appointment.

The very first thing to do is congratulate yourself. It’s a big step, and it took courage to get here. Grief and loss are universal, but what makes it unique is the person going through the loss of a loved one, the break up of a marriage, or another life changing event.

Your grief is yours alone. If this is your first time seeing a counselor, you may not know what to expect or what is expected of you. Start from the point at which you are right now. Feel the grief that you are holding right now and just talk, let it spill out like a fountain. As a therapist, I want to offer a calm, open, and nurturing place for you to be yourself and talk about whatever brings you in that day.

There are a few things that will happen during your session. You may cry the entire time you are there, or you may not cry at all. It’s the beginning of a new day, a small step that will lead to bigger steps. It may sound cliché, but it’s true.

At first it will feel like everything is all mixed up and out of order, and the words and stories sometimes don’t make a lot of sense......it won’t and that’s ok. There is no right or wrong way to say things in therapy. Just let the pain come out and feel all the power it will give you by releasing your thoughts and feelings.

There is no short cut for grief. I encourage you to be as open as possible in your sessions and go with the pain it brings. I know this sounds a little scary......what does it mean to go with the pain? For me it means when the saddest part of you feels like there’s a hole in your heart and the pain is deep within; just let it come out.  Sit with the pain, not by rushing through the emotions, but by letting yourself feel sad, angry, or whatever it is at that moment.  You can talk about how sad it makes you feel, how it hurts to think of your loved one, or you can cry and let the tears fall. If you don’t, it will keep coming back and creeping into your life unexpectedly; it will not just go away.

In the first couple of sessions, the therapist will most likely mention the stages of grief. It is probably something you are familiar with. Some of the most common ones are the Kubler-Ross' stages, also known as "The Five Stages of Grief," or Worden’s Task-Based Model. Whatever works for you is the best one.   It also helps normalize what you are going through by reading about the stages and knowing that everyone will go through these in their own time.

On a personal note, I did not feel anger in the order it was listed when my sister died, and it showed up much later when my daughter died. I was so mad at my sister for not being here to help me grieve for my daughter, and I was surprised when I felt this emotion. I had to go back and re-read the steps. It helped me see that the stages don’t always have to be in order, as emotions come at their own will.  

I want to congratulate you on reaching out to a grief counselor and letting the healing begin. I hope you will take your time and listen to your heart. You will begin to feel relief with each session.

Yoga for Anxiety, Part 3: The Poses

By: Laura Kacere, MA, LPC

Yoga asana is one of the 8 limbs of yoga, and refers to the physical poses. While most of the other limbs of yoga focus on meditation, it can often be difficult to calm the mind while the body holds anxious or stressed energy. In a yoga practice, the poses are often used with the intention of energizing or calming the body first in order to set the stage for the deep focus of meditation.

Yoga poses are able to have a deep effect on the body’s relationship to the mind and to emotional balance. They have shown to decrease physiological arousal, reduce heart rate and blood pressure, and ease respiration. They also increase heart rate variability, which shows the body’s ability to respond to stress in a healthy way.

Setting time aside to practice yoga can be enormously helpful in reconnecting yourself, tuning into your body’s needs, and decreasing your anxious thoughts and sensations.

The poses that tend to be most effective for reducing anxiety are also the most calming, and can be beneficial to do in the evening, especially if you struggle with racing thoughts and anxious energy as you wind down to go to sleep. You may notice, however, that when you try these slower poses, your anxious mind races. This can be the perfect moment to practice breathing and mindfulness, explored in my previous posts. You may also find that a more active and faster-paced yoga practice works better for you, and that’s okay.  There are many different ways to practice the physical poses of yoga, so explore different yoga styles and see what works for you. Just make sure to continue to practice breathe awareness and mindfulness as you move through the poses.

As with any kind of physical movement, consult your doctor if you’re unsure about doing these poses, or attend a yoga studio in your area to get assistance from a trained instructor. Listen to your body, and if any of these poses cause discomfort or pain, or you feel lightheaded or out of breath, move out of the pose immediately. If you are pregnant, consult your doctor before beginning this practice, and consider taking a pre-natal yoga class in order to know which poses are most beneficial for you.

Seated forward fold in a chair

Do this forward fold in a chair, like at your desk or at a table. Doing the pose seated, as opposed to standing (described in the next section) can be a safer way to practice if you have back problems, or have tight hamstrings, and is accessible to everyone, regardless of your flexibility level. It can also be a great pose to do while at work or school during the day, when you feel stressed or anxious. This pose can be energizing as it reverses the blood flow to your head, yet promotes deep relaxation by allowing your spine to lengthen and your neck and shoulders to relax.

Sit toward the edge of your chair with your legs in front of you, knees bent, and your feet firmly planted on the floor. Start with your hands on your knees, and take a slow, long inhale through the nose. As you exhale, move your hands forward and down your legs, allowing your belly to come forward toward your thighs. Keep your seat in the chair and your feet on the ground as you move your hands to your ankles or the ground, and allow your head to relax and hang over the knees. Relax your neck and shoulders, and breath slowly through the nose, allowing the spine to lengthen, and the head to hang heavy. You might even close your eyes. Stay here for a few breaths, and when you’re ready to come out, rise back up as slowly as you can, staying firmly grounded in the feet, and allowing your head to come up last. Take a few deep breaths once you rise back up to your seat, and notice any changes in the body and mind.

Standing forward fold

For a deeper stretch in the legs, try this pose standing.  Start with your feet firmly rooted on the floor and hips distance apart. Bend your knees slightly, fold forward at your hips and bring your torso slowly down toward your legs. If balance is difficult here, place your hand on a chair or a wall as you come forward into the fold. Make sure to keep the legs slightly bent, at least in beginning, so that you don’t stretch too deeply in the lower back.

Bring a little more weight into the heels, as it is natural to move weight forward into the torso when folding forward. With the feet rooted down, allow the neck and head to relax. If you feel steady, bring your hands to opposite elbows and rock gently from side to side. Allow the spine and chest to lengthen as you inhale and exhale slowly through the nose. If it feels okay, you can start to straighten the legs. Allow the crown of the head to point down toward the ground as you lengthen and soften the spine with each breath.

To come out of the fold, release the arms and root the feet down into the ground, knees slightly bent, as you very slowly rise up. If you move too quickly, you may find yourself with a headache, so rise up as slowly as you can, and take a deep full breath once you’re back to standing.

Legs-Up-The-Wall pose

This is my favorite pose, and is a great one to do at night before bed. It takes very little work or energy, and yet has tremendous benefits; it is said to be good not only for stress and anxiety, but also for insomnia, headaches, lower-back pain, and menstrual cramps. Where the forward folds increase blood circulation to the head and torso, this pose inverts our legs and pelvis, energizing and refreshing those areas of the body.

Start by sitting on the floor next to a sturdy wall. Sit close enough that you’re seated almost right up against the wall, and then with one smooth movement, swing the legs up against the wall as you bring your back to the floor. Your body should make a right angle now, with your seat against the wall, or a few inches away, your legs vertical, and souls of the feet facing the ceiling. Your back, shoulders, and head should be completely supported by the ground so that you can completely relax. There are ways to modify this pose with pillows, blankets, and even a chair if you would like more support. If you start to experience any pain or tingling in your legs or knees, come out of the pose. But if you feel comfortable, you can stay in this pose for 5-8 minutes. Try practicing mindfulness in this pose, allowing the body to relax and the mind to be still.

When you’re ready to get out of the pose, bring your knees into your torso and gently roll to one side. Stay here for a few breaths, and then use both hands to push yourself up to a seat.

Child’s pose

This pose is one that can generate feelings of safety and groundedness, and is one of the most commonly used poses for anxiety. Start by coming to the floor on your hands and knees, with your toes un-tucked and knees slightly apart. Sit back onto your heels. If this is uncomfortable for your knees, you can bring a blanket in between your thighs and shins. You can also place a long pillow under the torso and beneath your seat for even more support in this pose.

Walk your hands forward and bring your forehead down to the ground or to a blanket. You can keep your arms stretched out in front of you, or bring them by your side with the tops of your hands on the ground by your heels. Breathe slowly and deeply through your nose and relax into the pose.  Let your spine stretch with this poses, allowing your back to act like a shell that feels protective and safe. Stay in the pose for a minute or two, as feels comfortable.

Tree pose

Balance requires concentration, focus, and a lot of awareness of your body in space, which can often allow you to let go of any other anxious chatter going on in your head. It can be easy in balancing poses to get frustrated with yourself when it gets hard. Tree pose is one of the most commonly-practiced standing balance poses. See if you can try this pose without judgment; if you fall out of the pose, notice the thoughts that might try to tell you you’re not doing well. See if you can let those thoughts go, and gently move yourself back into the pose.

Start by standing with your feet hip distance apart and pressing firmly into the ground. Before beginning a standing balance pose, I often lift all 10 toes off the ground and stretch them wide before placing them back on the ground, attempting to take as much floor space as possible. Notice the support of the ground beneath your feet, and take a few slow breaths here to establish balance. Then slowly lift your left knee, bringing your left foot off the ground, and turn your left knee out, opening your hip. Rest the soul of your left foot either just below the right knee or on the inner right thigh. Your right thigh can then push back, engaging the strength of right leg by lifting the kneecap if you can.

Bring your hands, palms together, at your heart, and bring your gaze to one thing in front of you that isn’t moving. Keep your visual focus on this one thing, and notice if you’ve stopped breathing. Take a few breaths in this pose. When you’re ready to come down, gently lower your left leg, and bring your foot back to the ground, toes facing forward. Take a long slow breath here before switching to the other leg.


For more poses for anxiety, explore this great list of poses on Yoga Journal.

Yoga for Anxiety, Part 2: The Breath

By: Laura Kacere, MA, LPC

Noticing our breath goes hand-in-hand with mindfulness, which I spoke about it Part 1 of this blog. In fact, intentionally changing the way we breathe is, some would say, at the core of a physical yoga practice. Breathing is also an incredibly effective strategy for managing anxiety.

When you experience anxiety, you may find that your breath moves very quickly, with short and shallow breaths, or you may find yourself holding your breath, particularly during moments of increased tension. The way we breathe, in fact, has significant effects on our emotional and physical wellbeing. Shallow, irregular breathing can increase our heart rate and raise our blood pressure, while causing our mind to speed up. When our breath is full and regulated, our blood pressure and heart rates lower, balancing the nervous system and calming the mind. Long, slow exhales, in particular, stimulates the parasympathetic nervous system, which is the part of the nervous system that prepares our body for rest.  

[A quick disclaimer: when doing breathing techniques, it is important to first consult a doctor if you have any breathing issues, like asthma. Take breath practices slow, especially if you’re new to them, and if you notice yourself becoming short of breath or lightheaded at any time, or you find yourself in any kind of pain, stop immediately and return to your normal breathing pattern.]

When you feel ready to try this practice, find a quiet place where you can sit comfortably or lay on the floor. Start by gently noticing where your breath is at this moment. Bringing some mindfulness toward your breath – keep a gentle awareness on how it feels and sounds, and just be curious about the places where you may be more open, or more tight and tense. Are you taking short, shallow breathes? How relaxed or tense do you feel, and where do you feel it? Is there a tightness in your chest? Are there places where you might be holding tension that are making it difficult for you to breathe smoothly and fully? Again, just notice what it happens in your body, without judgment. Perhaps you notice your body changing as you bring your awareness to it. Often when we bring our awareness to particular parts of the body where we store tension, we begin to automatically relax those spots.  

Breathing in and out through your nose, see if you can now intentionally soften parts of the face that may be holding tension. Now relax your shoulders, your chest, and your abdomen. If you’re having a difficulty time relaxing them on cue, try this: tighten the skin on your forehead before relaxing it, squeeze your eyes shut before softening them and so on for every part of the body as you move from head to toe, intentionally tightening, and then softening every muscle. Continue to breath as you do so, in and out through the nose.

Now that your body is a bit more relaxed, start to count the length of your inhales and exhales, keeping the breath through the nose if you can. Count for a few rounds of breath, and once you have a good idea of the general length of each, see if you slow down your exhales by a count of 1 (so if you typically exhaled to a count of 4, try exhaling to a count of 5). Keep the exhales longer than the inhales, make sure to breath all the way in at the top of your exhale before slowly extending and releasing the breath out on the exhale. Continue to do this over a few more breath cycles, at whatever pace feels right for you. When you’re ready, return to your normal breathing, and see if you notice any differences in your body and your mind. Allow yourself to sit in the effects of this practice before moving to something else.

If you felt comfortable doing this, you can continue to explore other breath practices, like 2-to-1 breathing and alternate nostril breathing when you’re ready. Breath practices like this one can greatly increase your emotional balance, and can be particularly helpful in moments of anxiety and stress to slow down the mind and bring you into your body and the present moment.

To read more about breath practices for anxiety, I recommend Bo Forbes’ book, Yoga for Emotional Balance. And stay tuned for Part 3 of Yoga for Anxiety, where we’ll explore the asana, or poses, of yoga that can be most helpful for managing your anxiety.