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Insight Magazine

Q&A supporting transgender children

While children have long expressed gender in ways that are not consistent with socially prescribed gender roles, the reasons haven’t always been clear. A choice in toys, clothes, friends, sports, activities, and even hair length may all be signs that a child is expressing gender fluid tendencies. Until recently, the spectrum of observable gender identifications in children has been rife with stereotypes, but the American Psychological Association (APA) is working to break down these stereotypes and help psychology professionals and therapists better serve gender fluid or transgender children and their families by creating guidelines and trainings to help unpack gender identification in children.

We spoke with three professionals that are utilizing these guidelines and trainings in their practice to learn more about how their work is positively impacting the children and families in their charge.

 

Braden Berkey, Psy.D. is associate professor at The Chicago School of Professional Psychology’s Chicago Campus, and executive director of Projects Advancing Sexual Diversity, a nonprofit that applies the practice of psychology to further the understanding and acceptance of diverse sexual and gender identities, practices, and cultures.Braden Berkey, Psy.D. is associate professor at The Chicago School of Professional Psychology’s Chicago Campus, and executive director of Projects Advancing Sexual Diversity, a nonprofit that applies the practice of psychology to further the understanding and acceptance of diverse sexual and gender identities, practices, and cultures.


 

Adam F. Yerke, Psy.D., is a faculty member in the Forensic Psychology Department at The Chicago School’s Los Angeles Campus, where he specializes in working with clients dealing with substance abuse and dependence issues, chronic mental illnesses, criminal behaviors, as well as issues related to gender and sexuality.Adam F. Yerke, Psy.D., is a faculty member in the Forensic Psychology Department at The Chicago School’s Los Angeles Campus, where he specializes in working with clients dealing with substance abuse and dependence issues, chronic mental illnesses, criminal behaviors, as well as issues related to gender and sexuality.


 

Kerri Rönne, Ph.D. joined The Chicago School in 1997 as adjunct faculty and joined the full-time clinical program faculty at the Chicago Campus in 2001. She has a private practice specializing in assessment and therapy with adults, and teaches in the areas of psychopathology, neuropsychology, personality assessment, and gender. Kerri Rönne, Ph.D. joined The Chicago School in 1997 as adjunct faculty and joined the full-time clinical program faculty at the Chicago Campus in 2001. She has a private practice specializing in assessment and therapy with adults, and teaches in the areas of psychopathology, neuropsychology, personality assessment, and gender.


 

 

{INSIGHT}: Why are the APA’s guidelines important?

Rönne: Training is essential. Our credibility as psychologists with the transgender community has been damaged over the years because so many transgender people have had negative experiences with therapists who know very little about gender issues. At worst, these treatments were ineffective or actually harmful, like “conversion therapy,” and at best clients spent a lot of time and money teaching their naïve therapist about gender variance. The availability of therapists trained to work with gender variant clients has improved in recent years, but we still have a lot of work to do to regain the trust of the transgender community, and these guidelines go a long way in that work.

{INSIGHT}: What potential psychological issues do children with gender dysphoria confront when expressing their identity?

Yerke: It’s important to understand that not all children who identify as transgender (or as a gender different than what they were assigned at birth) experience gender dysphoria, and it’s necessary to avoid overgeneralizing and pathologizing all these children as such. In reality, discrimination and victimization against this population is what fuels the higher incidence of mental health issues among transgender people. So, while psychology professionals may be helpful to transgender children, even more important is the work they do to educate and guide the families and communities of transgender children. When these people are informed, transgender children can receive the love and support they need.

{INSIGHT}: What may be some key indications for a parent to know if their child is transgender or gender fluid?

Berkey: There is no litmus test for this. Identity formation is a process, and one that has twists and turns that may travel outside traditional narratives without arriving at a transgender designation. Gender needs to be considered in terms of physiological, identity, and enactment components. A child gravitating toward activities or presentations that differ from those associated with their assigned natal gender should not be labeled. Parents and professionals need to carefully listen to children and support their explorations, while at the same time checking the impact of their own assumptions and prejudices. A child’s behavior and assertions need to be thoughtfully considered in developmental, cultural, and clinical contexts without a rush to diagnose. Throughout this process, support and validation is critical— children will guide the adults on where they are going.

Yerke: I agree. Transgender children persistently want to be or believe they are “the other” gender. This differs from a boy who simply shows more feminine attributes or who enjoys dressing as a girl during playtime; these instances could be more related to gender expression or gender roles, rather than identity. Parents should talk about gender with their children and help them explore how they feel and want to express themselves, which is true for all children. We want to affirm what is genuine for children rather than encourage fixed, societal-created gender identities and roles. Having such discussions does not encourage a child to be transgender if they aren’t already; but for children who are transgender, these conversations may be incredibly affirming and allow them to further explore and understand themselves.

Rönne: Sometimes worried parents want to know if there is anything they can do to “encourage the child away from” being transgender or gay. I try to help them understand that if the child is gay or transgender, trying to discourage them will not change their gender identity or their sexual orientation. What it will do is cause their child to stop confiding in them, and lead to a much higher likelihood of depression, anxiety, and behavior problems. They can either discourage the child and have an unhappy transgender child, or support the child and have a happy, well-adjusted transgender child.

{INSIGHT}: How is gender identity different from sexuality? What does society need to understand about that difference, and why?

Berkey: This is a hard point for most people to understand. Gender and sexuality are assumed to be intricately and inextricably coupled. While there are strong interplays between gender and sexual identities, they are separate constructs. An individual may, happily and healthily, hold socially disparate identities—for example, female sex, masculine presentation, heterosexual partnering or male sex, masculine presentation, homosexual partnering. These concepts are entering the popular culture, and while many people remain uncomfortable with them, important discussions are being generated and room is being created for those who live outside of binary paradigms.

Rönne: The confusion also comes about, in part, because many of our terms for sexual orientation, such as gay or lesbian, include a definition of gender. For example, lesbians typically identify as female. But consider what happens when you have a biological male, who identifies, and lives, as female. If this person is attracted to females, does that make them straight? Or are they a lesbian? It is important not to make any assumptions about who someone is attracted to based on their gender presentation.

Yerke: Here’s a good example: Psychologists previously thought that transgender women were shame-ridden gay men who sought to transition to women so that they could remain heterosexual. This simply was not true and has been discredited. It is disrespectful and harmful to suggest that transgender people are attempting to transition because of discomfort with being gay, bisexual, or lesbian.

{INSIGHT}: Thank you for your insight. What can parents of transgender children do to accept their choices, and help their children navigate a world where they may always be perceived as “different?”

Rönne: Parents of transgender children often experience a process similar to grieving. For many parents, it feels as if they are losing a son or daughter. Psychological professionals can surely help support parents who are coming to terms with the grief associated with having a child who is transgender. At the same time, parents have an important role to play to support their child, as we’ve said. Research indicates that transgender children who have supportive parents have higher self-esteem, fewer mental health problems, better physical health, and a greater sense of life satisfaction.

For parents raised in very traditional homes, especially in very religious homes, this can be a huge challenge. Gender is so embedded in our culture that it permeates most, if not all, of our activities and social roles. Parents will have to give up some of their expectations for their children. I’ve had more than one mother crying in my office over giving up the fantasy of seeing their daughter—who now wants to live as a boy—as a bride.

And then, the biggest thing parents can do to help their children navigate the world is to advocate for them. Parents often need to take an active role as advocate and educator with schools, churches, and social and athletic organizations. Schools are required by law to provide a safe environment that is conducive to learning for all children. The vast majority of teachers and school administrators are highly motivated to do this. However, many schools have little or no experience with gender variance, and may not understand what kinds of support are helpful for the transgender child. This means educating teachers, but also office staff, janitors, lunchroom workers, other students, and sometimes the other students’ parents.

{INSIGHT}: That brings us to another important point—what role does the psychology community have in promoting tolerance through education in schools and in community programs such as camps and sports teams? While a few cases of transgender children have gained national attention over the past year, it is still an emerging issue.

Yerke: Like Dr. Rönne said, schools need to be proactive rather than reactive when considering the needs of transgender children. First, policies should be adopted for addressing transgender-specific needs, such as school identification cards, sports teams, bathrooms, etc. Many school districts across the U.S. have already instituted and applied policies for transgender students, and those policies were informed by research conducted by psychological professionals about transgender children. Psychological professionals are best prepared to train staff and conduct parent education workshops.

It is also necessary for schools and community programs to incorporate the topic of gender into curriculum so that all children can be informed. When cisgender children are knowledgeable, they are more likely to have empathy for their transgender peers, resulting in fewer negative experiences for transgender children.

Rönne: I agree with everything Dr. Yerke has said, and have seen how raising gender as an open topic in class can help a lot. I have seen gender variant kids, even in grade school, talk to their peers openly and effectively about their own experience, if given the opportunity. In other cases, a psychologist could be brought in to facilitate a discussion about gender and gender variance. Let kids (respectfully) ask questions. Sometimes, the questions can be unexpected.

In one class I spoke to, there was a lot of murmuring in one corner among a group of 6th grade boys. When I asked if they had a question, one of them finally got up the nerve to ask me, “If they let Jack (formerly Jacqueline) play on our basketball team, what will she wear, and where will she shower and change?” When I explained that Jack would wear the same uniform they all wore and would use the coach’s small (private) shower room, they looked at each other for a minute and then yelled, “Yay! Jack’s on the team!”

Social media training is another big area for improvement. Bullying through social media has become a huge issue affecting the mental health of children in the U.S., and gender variant kids are especially vulnerable. Once a harmful comment is posted, it can’t be retracted, and tends to recirculate endlessly. On the other hand, the internet can be an amazing source of support for transgender children who have little support in their home community. I have seen transgender children in overwhelming situations be pulled through by the outpouring of support and encouragement they received from an online community.

Overall, I think the role for psychologists in promoting tolerance is critical. I was lucky to be mentored by Randi Ettner, a well-known psychologist who was one of the early voices sounding the need for gender advocacy, and for psychologists to be trained to work with gender variant clients. I once asked her why she was so generous with her time in training me, and she said, “Because I need soldiers for my army to fight for gender equality.” That was more than ten years ago. We have made huge strides, but we still need more soldiers for our army. I am glad to see the psychology community responding more and more to the needs of some of our most vulnerable patients.

Find more articles from this issue of Insight here.