How to Meet the Needs of Transgender and Non-binary Therapy Clients

In this recorded webinar, Rae McDaniel and Ani King discuss affirming care and how to meet the needs for transgender and non-binary therapy clients.

Rae McDaniel, MEd, LCPC, CST (They/Them) is a non-binary, Gender and Certified Sex Therapist, Coach, and Educator who works with transgender/non-binary/questioning folks feeling anxious and lost about transitions they’re experiencing in gender identity, gender expression, sexual orientation, and relationships. They are the creator of GenderFck: The Club, a one-of-a-kind, research-based online coaching community of transgender/non-binary/questioning folks who are on a mission to transition with less suffering, more ease, and (dare we even say it!) pleasure. Rae is the founder of Practical Audacity, a Gender & Sex Therapy group practice in Chicago, Illinois. They also provide education & training for medical and mental health professionals and organizations wishing to uplevel their knowledge and expertise in trans-affirming care, supports, and environments. Rae holds a Master of Education in Community Counseling from DePaul University in Chicago and is a Licensed Clinical Professional Counselor in Illinois. Rae graduated from the University of Michigan’s Sexual Health Certificate Program with specializations in Sex Therapy and Sexuality Education and is a Certified Sex Therapist through the American Association of Sexuality Educators, Counselors, and Therapists.

Webinar Transcript

Speakers: Rae McDaniel, Ani King

Ani King 0:06
Right. Hi, folks, this is Ani King with here with another inclusive therapy webinar, everyone, feel free to take a couple of minutes to get situated and comfortable. I will let a few more people come in and we’ll get introductions going. I’m going to drop a couple of quick things in the chat for folks, just so that it’s there. If you have any questions at all, feel free to hit your chat button at the bottom of the screen, or you can hit raise hand. And I’ll check in with you to see what your question is.

Ani King 0:41
Here. Today, we are going to get started in about two minutes.

Ani King 0:50
And it looks like we’ve got some folks coming in.

Ani King 0:57
All right, so today, we’re here to talk about transgender and non binary affirmative care with Rae McDaniel, who is located in Chicago, right, Chicago area.

Ani King 1:09
And Rae, I’m gonna let you tell everybody a little bit about yourself and your background. And just a minute, I will also drop links to your websites in the chat so that folks can go take a look. Because you’re doing some really cool work with non binary and trans folks in terms of expression, and sexuality, and all of those things that can be really complicated. And just so everybody knows, again, my name is Ani King, my pronouns are they them. And I’m super excited to be here with Rae. Rae. While we’ve got folks coming in. Would you mind telling just a little bit about yourself?

Rae McDaniel 1:43
Yeah, absolutely. So my name is Rae McDaniel. I’m a licensed therapist in Illinois. I’m also a certified sex therapist. And I work with mostly trans and non binary folks helping them transition their gender with less suffering and more ease. So my work kind of falls into about three buckets. I own and run a group therapy practice in Chicago with about 17 therapists who are all specialized in this area as well. I also run genderfck the club, which is an online group coaching community, for trans and non binary folks who want to transition with less anxiety and more pleasure and more joy and curiosity. And then I also do a lot of stuff like this. So I do trainings and dei work on trans inclusion and diversity.

Ani King 2:34
Fantastic. So I’m gonna ask a just real quick question. Would you mind covering for folks who might not be aware why we’ve separated transgender and non-binary into their own groups?

Rae McDaniel 2:48
Yeah. So I think that’s a really interesting question. So I often don’t separate them into their own groups. But you know, if we’re talking about dialectics, dialectics here, I also recognize that there are differences between folks who identify as a binary trans person and folks who identify as a non binary trans person. What I’ve seen, however, is that a lot of folks who are non binary, don’t feel like they, quote, unquote, belong under the trans umbrella. And so I often say, transgender slash non binary to just put a bug in people’s ear that non binary folks are a part of the trans community, while also recognizing the lived experience can be the same in some ways, but different and others.

Ani King 3:42
Awesome, thank you so much for that, I think it can bea little bit difficult to you know, even also being non binary, when you’re a part of that, you know, transgender family also understanding that there’s some nuance there, and how, you know, your trans siblings kind of feel about themselves and how they walk in the world. So I appreciate your covering that.

Ani King 4:08
Looks like we’ve got a question I’m going to get to you in just a second. Sostarting with, I guess, a little bit from the beginning, you know,what do you think, is kind of a key thing for folks who may not already work with trans and non binary folks or who are just starting to consider, you know, as counselors, therapists and so on, and being affirming.

Rae McDaniel 4:38
Yeah, another great question. The good news is that the basics go a really, really long way. So if you can get pronouns down, if you can get using someone’s real name, and someone’s real name is always the name that they go by, regardless of whether or not that is their legal name.

Rae McDaniel 5:00
You can get some basic language around trans inclusion and trans affirm formative care, you’re probably 80% of the way there, which is awesome news. So those basics, I would say focus on that first, the next thing would be watching your assumptions. So what we know is that our society is incredibly gendered, even before babies are born. If you tell somebody that a baby in a womb is a girl or a boy, they actually talk to the belly differently.

Rae McDaniel 5:38
So literally, before we are born, we are put in these gendered boxes. So it takes a lot of unlearning, and critically questioning to say, Okay, what are ways that gender has been helpful? And what are ways that gender has been really restrictive? So watching assumptions about what does it mean to be a trans person? What does a trans person look like? Watching assumptions about? If a trans person wants to medically legally and or socially transition? Because not everybody does? It’s questioning our assumptions about what does it mean to be masculine? What does it mean to be feminine?

Rae McDaniel 6:26
I think the core of what I teach is that gender transition is a process of self growth. So if we view it from that frame, then it is a lifelong process of simply becoming more authentically who you are. And that takes so much of the pressure off. So if you as a clinician can go into working with trans folks with that frame in mind versus gender transition is from point A to point B, and point B being medical, legal, and social transition and all the areas of their life, then you open up a lot of freedom and space for your clients to to get more comfortable in their skin, and also acknowledge any limitations that they might have about being able to be out in all areas of their life or even wanting to be out in all areas of their life.

Rae McDaniel 7:26
I think another really important thing here is advocacy. And that’s a pretty obvious one. But when you’re working with trans and non binary folks, and especially if you have folks who need a higher level of care, one really amazing thing that you can do as a clinician is advocate for affirming care in emergency rooms, and hospitalization programs in IO, peas and phps. And also with medical gatekeeping, around surgeries around hormone therapy, a lot of time clinicians play a really key role and helping their clients get the affirmative care that they need.

Ani King 8:11
Thank you so much for for covering that. I think there are also some administrative things too, that I know, folks will notice if if your intake forums Do or do not allow for real name versus legal name, if they allow you the opportunity to identify what your pronouns are. Those can be I think, really key signifiers to people who are honestly just members of the queer community in general of how accepted and affirmed they might be, you know, when you were talking about keeping in mind that transition is different for everyone. And it’s a process. It made me really think about to the importance of, you know, the joy of finding out who you are, versus focusing on the trauma that we read about all of the time that people who are trans and non binary tend to face. Absolutely. So just going from, you know, here’s some, some things to start with. for clinicians who are pretty comfortable saying, Yeah, I, you know, I understand that we’re talking about real names, not preferred names, their pronouns, not preferred pronouns, and are making those steps. What are what do you think are some things that are sort of next steps and growing in their ability to affirm trans and non binary clients?

Rae McDaniel 9:38
That’s a really good question. So the way that I work with folks is, well, let me back up for a second. Sure. You mentioned this earlier, where the trans typical trans narrative that we hear especially in the the media, centers around suffering, it centers around gender transition being This horrible anxiety ridden process that is like slogging through mud. So for folks who are wanting to really up level their game, the key thing that I found is focusing on how amazing it can be to discover your identity like you’re describing, and focusing on a goal orientation versus risk management. And what I mean by that. So I don’t know how many of you have read emelina, Garcia’s book burnout. But she talks about this really great study, where they put two different groups of people into a room, they give each of them a maze, a little paper maze to fill out. And on one group of the participants, they have a little mouse who is running from this big scary owl at the edge of the paper. And then the other group had the same little mouse, same maze, but they were the mouse was running towards this piece of cheese at the end of the maze.

Rae McDaniel 11:07
And they found that the people who had the cheese maze, got through the maze quicker than the people who were running through from the owl. And what that says about this is when we frame gender transition and working with clients as simply risk management, and dealing with all of the negative parts of being transgender in our society, which is real, it doesn’t really set people up for success. What sets them up for success is saying, Why do you want to transition? What are you hoping for at the end of this, and it leads us to gender transition is not the point. What is the point of gender transition is just being able to live your life as authentically as possible. And if we can help our clients develop a vision for what they want for themselves, just being their authentic self in the world, that is a much stronger motivator than running away from really hard things in their life running away from gender dysphoria.

Rae McDaniel 12:17
So that I think is one of the key things that I want to impress on everybody. And along those lines, we talk a lot about gender dysphoria, how do we cope with gender dysphoria? I like to look at how do we move towards gender euphoria? What are the things that make you feel alive, that make you feel the most like yourself? How do we get curious about those things, and take one tiny step in that direction. And if that tiny step feels good, let’s take the next step. Because what I found with clients is that, especially those who have a lot of anxiety, which is kind of a sub specialty of mine, is that they get at step zero, and they’re looking at step 10.

Rae McDaniel 13:10
You know, whatever step 10 means to them. And they say, well, because I cannot predict what step 10 is going to look like. Because I don’t know the outcome of this, I’m going to freeze, and I’m not going to take any steps forward. And one really powerful way of working with trans and non binary folks, is helping them just look at what is right in front of them and get curious about what do you think might help you experience gender euphoria, let’s take one tiny, tiny, easiest step in that direction. And then we stop, we assess. And then we take the next tiny step, instead of worrying about step 10. And for a concrete example of that, so I’ve had clients who were very nervous about starting hormone therapy, because they weren’t sure how they weren’t sure if they were going to like the outcome of it. And they also weren’t sure what the outcome is going to be because everybody’s body is so different. And so what I teach people is instead of fixating on, well, I can’t do anything until I figure out if I will like the results and outcome of being on HRT. I asked people to gather information, if they have questions, book an appointment with the doctor to just ask questions about what hormone replacement therapy might be like.

Rae McDaniel 14:40
And if that is something that feels good to them, they have that little spark of excitement when they have that conversation. Maybe the next step is just getting your blood drawn and making sure that it’s safe. And the next step after that might be getting a prescription for HRT picking up the prescription. putting it on your dresser and just looking at it. And seeing how you feel, when you’re getting closer to that goal. It’s the idea of if you flip a coin in the air, and heads is, you know, outcome a tails is outcome B. And when it’s in the air, you say, Oh, I hope that it’s outcome a, that gives you a lot of information about what you want. And I want another thing about HRT, specifically that I talked about is, sometimes starting, even taking a dose or two of hormone therapy can be the thing that gives you the information you need about whether you want to continue.

Rae McDaniel 15:42
So hormone therapy is not an escalator, you can start and stop at any time. And it doesn’t, the changes don’t happen overnight. So you always have an ability to say, Okay, well, I don’t like this thing that’s happening in my body, you can slow down or stop hormone therapy at any time. And usually, if you’re being mindful about it, if you’re not liking an outcome, you can catch that pretty early, and then make adjustments from there. Now, what we know from the research is that gender expression, and actively exploring your identity, through the way that you want to present yourself can be a really powerful way to explore to explore your identity. So what I mean by that is, if you look at teenagers, they kind of try on all of these different identities, they try on different ways of expressing themselves, they try different hobbies, different interest. And that is how they discover who they are. They don’t sit there and say, well, who am I let’s figure that out completely. And then decide how I want to express that. This is the the same idea.

Ani King 16:59
Though, that makes a ton of sense. Anecdotally, I wanted my children and their friends are a group of very cool, very fun trans kids. And one of the ways that they kind of try on who they are, is I think their names will change. You know, sometimes, sometimes it’s a couple of weeks, sometimes it’s a couple of years. And I really enjoyed that. Because there’s something really profound about choosing your own name. And I think that we all do it even to a lesser extent with nicknames. And, you know, yes, my full name is Michael, but I would prefer to be called Mike and like just that idea of what are the How does the sound and language I’m using best, say who I am in this moment?

Rae McDaniel 17:41
Absolutely. And that’s something that I think is really profound for cisgender. Folks, as well know, everything that we’re talking about, also applies to cisgender, folks, mindfully engaging with their gender. And knowing you don’t have to keep the name that you were given at birth, you don’t have to fit into a box that our society says that you need to, regardless of whether you are cisgender, or trans.

Ani King 18:10
Yeah, and, you know, the idea that gender roles are roles, they’re kind of meant to be examined, and they’re meant to be looked at in a is this serving me? Or is this not serving me? And when answer is no. cisgender or transgender, non binary, taking a step towards Okay, what would that makes a lot of sense? I’m curious too, because I really think that, you know, the, the idea of trans joy gets skipped over a lot and conversations that happen, that are you know, more notable or easier to see, what are some ways you think that clinicians can kind of help, aside from the ones you’ve already mentioned, but help bring out that expression of joy and affirm that expression of joy?

Rae McDaniel 18:56
Yeah, so from the stuff that I’ve already mentioned, I think that’s the key thing, right? That goal orientation versus risk management. One exercise that I do with clients that I stole from Debbie Millman, who is a Human Centered Design person is a 10 year in the future letter. So what we know about marginalized populations is that they often have a sense of that foreshortened future, they have a hard time imagining a positive future for themselves. So one of the things that I do with my clients is exercises to help them imagine more for themselves. And this 10 year in the future letter is one of the most powerful exercises I’ve found.

Rae McDaniel 19:42
So it’s fairly simple. All it is, is you are writing a letter to yourself now from yourself 10 years in the future, and the letter describes from the moment that you wake up to the moment that you go to bed in as much sensory detail as possible, everything that you want for your life. And I tell people to go hog wild right sky’s the limit. It doesn’t have to be realistic. Just your wildest dreams, what would you hope that your life looks like and 10 years? And what do you want to tell yourself now? So part of that is about gender, obviously. But even beyond that, like what do you want your life to look like holistically, which helps people tap into that, why and that goal orientation that I was talking about. So I think that is definitely a key thing.

Rae McDaniel 20:35
The other thing is that pleasure and joy, it’s a muscle, we often think of it as something that we just experienced kind of out of the blue. But the truth is that what we focus on expands. So if folks are focusing more on what feels good, versus what feels bad, and tapping into their, their five senses, literally what feels good on my body, what feels good. If I’m sitting and drinking a cup of tea, those are the things that help people build that pleasure muscle. The other thing that I think is really important, and helping people develop that confidence, and develop that sense of ease and pride is boundaries, which again, seems like a really obvious thing. But what I found is that a lot of the trans and non binary folks I work with, feel like their identity is a burden.

Rae McDaniel 21:41
They feel like simply asking people to respect their name, to respect their pronouns, and to, to validate their identity is harm to them, that they’re taking up too much space that they’re asking for too much. And I like to debunk that myth, right, someone respecting who you are, and your pronouns, and your name is a basic human, right? It’s just real basic, you are not taking up too much space by doing that. So I talk a lot about the fact that discomfort is not harm. So if you are asking someone to respect your name, and pronouns and who you are, and it makes them uncomfortable in some way, that’s not harming them.

Rae McDaniel 22:32
What is harm is having someone not respect your identity. So I like to ground the boundaries and that and ask people to critically think about how do they want to be treated. And if they were confident, if they were feeling a sense of pride in their identity, what decisions would they make about how they wanted to be treated, about how they talk to themselves, about how they treat their body. And that is something that I believe, really helps folks develop a sense of agency and confidence, like nothing else.

Ani King 23:16
That’s, that’s such a huge thing I was thinking about, you know, before the pandemic, I worked in an office with a lot of people and I would spend a lot of time with folks trying to, honestly to move the company forward in some affirming ways. And then, after I left the company, and came out as non binary, I found that even though I was really comfortable standing up for other people that it was a really big step forward to say

Ani King 23:40
Actually, my pronouns are there in them, or actually, I don’t identify in this way, and the first few times where that kind of like, Oh, my gosh, what will this reaction be like, but then over time, it got easier, not only to say it, but to also sort of, you know, not take that little bit of critical damage every time. You have to point it out, because I think there’s that anxiety around, okay, if I say this, how will they react? Not just, am I putting them in a harmful place in some way? But am I putting myself in a harmful place by standing out there because we are constantly absorbing, you know, from the media, all of the trauma and all of this and that So then, you know, your brain always imagines the most in the wrong direction. And it can be really hard to, to get past that. Yeah,

Rae McDaniel 24:27
it really can. And it, it is so nerve wracking to stand up for yourself and that way. And I also want to name like, sometimes it is a legitimate safety issue. Right? Standing up for yourself is not something that everyone can do and all the areas of their life because it might not be safe. So I talk a lot about the fact that authenticity is about being your most authentic self but also keeping yourself safe. So if being authentic means that you don’t stand up for yourself because It would be financially damaging, maybe your job would be in jeopardy, then that’s a legitimate and authentic choice to keep yourself safe. So I think that is definitely an important caveat that my brain had something else, but I lost it. Maybe I’ll think

Ani King 25:20
maybe it’ll come back. I think that that safety piece, you know, is as important as looking at joy and looking at all of these other things. And what are some ways that, you know, you clinicians can help their clients kind of determine what is safe, what is unsafe? Because there is some of that, you know, there have been times where I’ve confronted people who I’m very close to, and felt more anxiety over it than I might necessarily in a place where the danger was actually a little bit higher.

Rae McDaniel 25:51
Yeah, absolutely. And I think that makes sense, right? Because the people that you’re close to, there is more emotional vulnerability. They’re a stranger on the street, maybe it is physically unsafe, but it’s slightly less emotionally vulnerable, I think, often. So accurately assessing for safety. I think the good news here is that most clinicians already have this skill. It’s no different than helping someone who has a history of trauma, accurately assess for safety. So it’s reality testing, it’s helping people walk through what feels safe, what does not feel safe.

Rae McDaniel 26:32
Do what happens if you feel unsafe, the same way that you would with someone who is hyper vigilant around something like sexual trauma, or familial trauma. So that, that’s great news. The other thing is, those tiny steps that I was talking about. So for example, I’ve had clients who were very, very nervous. And I’ll use a trans woman as an example. So very nervous to go out of their house, dressed and more feminine clothing and wearing makeup. They’re very, very afraid of the safety aspects, which is valid. In a lot of cases, however, this person lived in an area that was really affirming, they had social support, and the places that they were going, were affirming.

Rae McDaniel 27:30
So we talk specifically about like going to brunch in their their neighborhood. And we started working up to it, right putting on more kind of gender neutral women’s clothing and walking around the block with a friend. And then we worked up to walking around the block with lipstick with a friend. And then we worked up to Okay, like, let’s go to brunch and wear just a little bit of makeup and something that’s a little bit more neutral. And they did that and nothing bad happened.

Rae McDaniel 28:04
And then the next time they go, they put on lipstick, and they wear something a little bit more feminine, like they want to, and nothing bad happens. So it’s about that zone of proximal development, if we’re talking about education, educational theory, right, it’s a little bit outside of their comfort zone, but not so much that it’s going to flood them. And the more that there’s those are they’re taking those steps, and they nothing bad happens, or something uncomfortable happens or bad happens and they’re able to handle it, the more that they build their confidence that they can accurately assess for safety. They know what to do if something doesn’t feel safe. And that these areas that they were very nervous about are maybe not quite as unsafe as they thought.

Ani King 28:58
Awesome. That’s the idea of the you know, take a small step and it might be uncomfortable, but it’s not. It’s not going to push you over if you feel like it’s just that heart pounding too hard to do. Do you? Do you find that for the folks you work with that doing things like groups, you know, support groups or community can be especially helpful?

Rae McDaniel 29:26
Yes, 100%. It is one of the first things that I talk with people about what we know from research on all marginalized populations, but especially the LGBTQ plus population is that community support is one of the number one resiliency skills. And beyond that we also know that familial support is a huge resiliency skill and not everybody has that. So developing really close intimate relationships, chosen family relationships with people who are affirmed of their identity is going to be the thing that helps people feel resilient and confident in themselves. So it is always a first line of a goal that I go for is, let’s find your community, let’s find the people in your life who do support you. And if you don’t have those people, right now, let’s figure out where they are.

Ani King 30:24
You know, and I think that, you know, one of the small are not small, but one of the significant things that has been good about the last year and a half is that those options have become more accessible to some people and that they are remote, you can do it over zoom, or they’re a hybrid of some sort. I’ve seen folks talking about how, you know, pride itself being online was a lot more accessible for folks who, you know, had specific disabilities and that sort of thing.

Ani King 30:53
And I think one of the conversations I had recently was around how recovery of spaces can be really inaccessible, especially to the trans population, depending on where they live, you know, and to everyone, I think that there is a little bit of that, you know, if you have mobility issues, and the only meeting you can go to is in a church basement with no elevator, that’s a problem. Yeah, if you’re trans, and the only place you can go to a meeting is in a church basement, where they’ve talked openly about being anti trans is also an issue. So do you find that yourself and other clinicians, you know, tend to have some idea of Oh, hey, here are some places that you can start? Do you think it’s important for clinicians who are starting to think about this to start developing? You know, those lists or suggestions for people?

Rae McDaniel 31:46
Yeah, I do. You know, developing a strong referral network of affirming places is a huge service to your clients. And we know, like you said that not everywhere is. So AIA has some LGBTQ specific meetings, there are other recovery programs that are more mindfulness based that, you know, depending on where they are, and the culture of the group might be more affirming. So knowing those resources is really important. One thing I found is that it’s really difficult for folks who are going into recovery programs for alcohol and drug use and abuse to find affirming phps, I LPs, hospitalization programs.

Rae McDaniel 32:33
So having a list of these are the places I know that they are able to handle trans and non binary folks in an affirming way, which means letting them use the bathrooms that they want, being able to put them in the housing that best fits their identity, making sure the environment is not transphobic. And that there is recourse of other members of the recovery program are being transphobic. Knowing those places is really key. There are some LGBTQ specific recovery programs. There’s not that many. So it’s you know, not a requirement that somebody who identifies as trans or non binary goes to one of those, but it if it’s available, it could be a helpful option, because they’re going to be a little bit more well versed in that.

Rae McDaniel 33:33
I’m trying to think what else around us. I think those are the the main things. The other challenging thing, though, that I see with clients who are in recovery or struggling with drug or alcohol use is that a lot, I would say the majority of trans non binary and queer events centered around alcohol, it’s very much a nightlife culture. And it can be really difficult for folks to find events, social spaces that don’t send around alcohol. So if you have ideas around some of those spaces, if you can have some resources for that, that can be incredibly helpful for someone who is trying to stay away from a very alcohol centric environment.

Ani King 34:23
that’s a that’s a huge thing. That’s one thing too, it actually leads into my next question is, there’s such a, you know, being able to go to a gay bar, and it can be such an affirming experience, it can be the first time that you’re like, Oh, my gosh, my people, but also, you know, has that sort of what are the kind of spaces you can be in where you can find the same amount of community without having to worry about it. Either I’m in recovery or I just don’t like to hang out and drink with people or any of those reasons. The other thing is it you know, I know it can be hard for adolescents to find those safe spaces.

Ani King 35:01
The area I live in Michigan, there is one, you know, teen LGBTQ group serving probably call it 25 or greater mile radius, maybe 30. And you know, they have some really specific age stuff, because trying to make sure that it’s not okay, there could be alcohol, or there could be this and so on. And so there was a question we got and registration asking, you know, what are some best practices and working with adolescents who are trans non binary questioning?

Rae McDaniel 35:34
So that is a really good question, I will say, I don’t personally work with anybody under the age of 18. So I’m not going to be the expert on working with trans adolescents, what I will say is that, again, the basics go a really long way, in your space might be the only space where that adolescent is affirmed, because at home, they might be getting constantly misgendered, the parents or guardians might not call them by the right name. So just being able to validate on a very basic level, their name and pronouns goes a really long way.

Rae McDaniel 36:16
Another thing is, honestly, a lot of the work with adolescents is about working with the parents, and figuring out how can you communicate to the parents how they can be supportive. And one of the main things that is an issue is that a lot of parents of trans and non binary youth feel like the their child’s gender transition is a is harming them in some way. Right? They named their child one thing, and they want to go by something else. And it can be really helpful to work with families to say, hey, parents, or guardians, this isn’t about you, nothing is happening to you, this is not a rejection of you. And what you have called this child, your child is simply evolving, and simply becoming more of who they are. Which goes back to that discomfort is not harm.

Rae McDaniel 37:17
So even if if it’s uncomfortable, to call your child by a new name, or a new pronoun, that isn’t actually harming you, but not doing that might harm the child. Now, this doesn’t mean that parents and families are not able to have feelings. Of course they do, right, there’s a change. And that makes sense. And your child does not the one to take out that discomfort and to process those feelings with that as a job for the parent, loved one family member with their own therapist. The other thing goes back to advocacy, especially with adolescents. So this might be advocacy with parents, this might be advocacy with the school, it might be coordinating with medical providers, whatever it may be, you might be the person that is this child’s only advocate. And so that is an incredibly important piece.

Rae McDaniel 38:24
Another piece of just working with a youth who is exploring their gender, is exactly what I talked about earlier, which is this experimentation. And I call it spaghetti wall mode. Right? If you cook a pot of spaghetti, you see if it’s ready by you, like throw it up the wall, and if it sticks, yay, spaghetti. If not, you haven’t failed, you just cook the spaghetti a little bit longer. So it’s just experimenting, there’s no failure involved, helping the adolescent the youth explore their identity without putting pressure on themselves. They don’t have to figure out everything now. They just have to say, Well, if I do this, does that feel good? If yes, cool. I’ll do the next thing. If no, cool, I’ll go back to the drawing board. They don’t have to decide who they are forever.

Rae McDaniel 39:14
The other thing that I think people get hung up on with youth is, oh, they’re they’re going to regret it, they’re going to permanently change their bodies and then not be able to go back. And then my understanding. Again, I’m not an expert on working with adolescents. But the current guidelines are that for anyone under the age of 18, the first thing they’re going to do is put them on hormone blockers that just delays puberty that’s reversible. And it gives that child the ability to grow up a bit to figure out and understand more about their identity before they make a permanent decision about their body.

Rae McDaniel 39:53
Now some youth have a really strong sense of who they are before the age of 18. And it might be 100% the right thing to do to do medical intervention before the age of 18. And that’s where the professionals come in to help that youth work through those decisions, a lot of other people are going to make permanent decisions about their body as an adult. So this isn’t about, you know, kids are going to make really bad decisions, because they’re just exploring their identity, we can take that pressure off, and say, we’re just going to delay things for a bit and help somebody explore their identity. And as they get older, they can make those decisions for themselves.

Ani King 40:41
Yeah, one of the things that a therapist I know is talking about too is with adolescence, it can be really important not to push them towards an end point, specifically for kids who are exploring gender and identify at the time as non binary or gender variant or anything like that, not having an idea for them in mind, or pushing them towards whatever, okay, so if you are assigned female at birth, then your next step is to identify as trans and ask that to under spend some time really allowing for that huge amount of exploration of, you know, what is gender role? What does it even mean, whether you move in one direction or the other, I saw there was a study out saying that Gen Z, about 25% of polled Gen Z kids identify as non binary, which I think also says something about, you know, gender identity and the younger generations as a whole. So, I think that, you know, they’re doing a lot of really cool, really interesting exploration about what the whole thing even means.

Rae McDaniel 41:45
Yeah, absolutely. And that’s such a good point. I think some parents and professionals, they have such good intentions, and they want to be so affirming. So a youth comes in and says, or an adult to, hey, I think I’m trans and like, Okay, let’s do all the things right now. It’s like, let’s, you know, let’s slow down, we don’t have to do all the things right now. And as a personal anecdote, I have a friend who identifies as trans masculine, and pretty early in their life medically transitioned. And we’ve had discussions about the fact that now if they had to do it over again, they might have done some things differently, because they felt like the only option they had was to a to identify as trans masculine, and that maybe they fall more on the non binary side. But they didn’t really know that was an option. So right to your point. We don’t have to go from this extreme to this extreme, there’s a lot of room in between.

Ani King 42:52
Absolutely. And I think it’s also interesting, just the idea, you know, we’re talking about, like therapists and so on. One of the things that I run into, and the community I’m in and I know other folks have talked about, is there can be a really, it can be really difficult to find an affirming therapist, and not have it overlap in you know, whatever part of the queer community you are in. And so it made me think about how that referral network can be so so important, you know, because there there have been times where it’s like, oh, this therapist seems awesome.

Ani King 43:29
And I’m like, oh, okay, so they actually see a former partner of mine or something like that. And so it gets into that kind of area where I know, encouraging people to say, Hey, listen, even if you’re looking for a different therapist, like start out by asking your current therapist if they have a recommendation, as long as it’s safe for you. So you know, there are people where they’re ending that relationship, because it’s problematic. But yeah, your therapist, especially if they work with trans folks, maybe the best place to say, Hey, listen, this isn’t working for me. Do you have another suggestion?

Rae McDaniel 44:04
Yeah, absolutely. The queer and trans community is about this big, like, no matter where you are, even in Chicago, it’s so small. And so it is really challenging as a trans or non binary person to find a trans or non binary therapist that isn’t connected to your social group, which I think speaks a lot to the fact that we do need more people in the field who have this competency, whether or not they identify as trans or queer, because we need more people who are able to work with queer and trans folks. Because Yeah, that is where a lot of people get stuck. Even me looking for a therapist in Chicago, right? It’s so small, so hard.

Ani King 44:56
My own therapist lives an hour and a half away from me or is an hour and a half. For me, because of that, you know, concern at the time, you know, probably a good chunk of the LGBTQ community worked with me at the place I was at, or was associated in some way. And so I just was like, fine an hour in a way, and we’ll see what happens. And now I’m like, you have to maybe be my therapist forever. This is what it is, it is so difficult, you know, and kind of wrapping up the child and adolescent thing, it is even more difficult.

Ani King 45:28
I know even when I took my kids in their last check in, I was like, hey, do you have any new recommendations, we’re looking for a new therapist, and the one person they knew was my kids, former therapist. But I will say to, for clinicians who don’t already do this, if you are Trans and Queer, affirming, you know, reach out to pediatric offices, if you work with adolescents, they will happily send you clients. I know that I get asked if I have any suggestions when I take my kid in for checkups? You know, hey, do you have any folks who do this just because they know, by virtue of the conversations and saying, Hey, this is my kid’s name, this is my kids pronouns. Here are my expectations. I would say for folks who are looking to work with queer and trans adolescents, as a parent, one of the things that I have found helpful is kind of pre interviewing those therapists myself.

Ani King 46:22
So if you offer something like that, to people who are looking ahead of time, I guarantee you a lot of them will take you up on it. Because there is that feeling of Okay, I need to make sure this person is safe, I need to make sure that, you know, like, from paperwork to whatever if they some of the administrative things, one is, you know, in your forums, are they affirming? But also, if you have an alert system that has names in it, where does it pull from? Is it using legal name? Or is it using the real name, because those things can really throw people off? You know, even if you everyone in your office is really good at using people’s real names, if they get mail or anything that doesn’t have to have that legal name on it, you know, that can be a little hiccup or bigger, depending on what the day is like, or what, you know, where somebody is at?

Rae McDaniel 47:14
Yeah, absolutely. And you know, it’s a thing that people, we have to use legal names sometimes, especially if we have insurance. And if you have to do that, and you know, a client is going to see a name that they don’t go by warning the client and saying, like, Hey, I have to do this, because insurance reasons can be really helpful. The other thing, and this relates to the advocacy piece, don’t be afraid to advocate with your electronic medical record provider.

Rae McDaniel 47:44
So I use simple practice. And there have been a couple times where they have done some interesting things that were not cool, related to the trans community. And I, I reached out and both times, they said, Oh, well, there’s nothing we can do, it’s going to take a really long time to make this change. And then I tweeted out a couple times, and in 24 hours, it’s a miracle that it was fixed. So don’t be afraid to call people out on the administrative logistical side. A lot of those companies, if you push them, they will make the changes. And if the first person says, No, we can’t do that. It’s too hard. Keep going up the ladder.

Ani King 48:27
And use the power of the internet. Yes, social media is powerful. Yeah, it’s an especially, you know, when you’re talking about a current moment in time, where so many people are forced to or enjoying having to work more online, work more remotely engage with the internet and the tools available? That means that there’s a lot more power in it, then there may have been before because now you have more people who are looking for, I need a therapist, and I need it to be remote.

Ani King 48:57
Okay, well, if, you know, they honestly, if they if people started tweeting about how BlueCross should be able to do this better, and it gained enough speed then that might make some movement, because the unfortunate thing is that a lot of places are more concerned about their image, but the useful thing is that they are concerned about their image. So if it’s especially right now, you know, I like to do a lot of that stuff in June when people have their rainbow flags up. And it’s so cool. So do you have gender neutral bathrooms?

Rae McDaniel 49:29

Ani King 49:30
And yeah, because I mean, their social media managers job is to scramble through this and then hope that they never have to deal with it again. So strike while the iron is hot.

Rae McDaniel 49:41

Ani King 49:43
And we had a couple of other questions too. One of them was around counseling and coaching specifically so you know, professional type coaching or coaching as it relates to employment, workplace those kind of goals.

Rae McDaniel 50:01
Can you say more about the question?

Ani King 50:04
So it wasn’t super specific. And I’m not sure the person who sent it in is on. So I will I’ll expand from my curiosity there. When you are working with trans and non binary folks, Are there areas that you find are unique or specific in terms of, you know, coaching as it comes to, you know, job or other types of growth?

Rae McDaniel 50:27
Yes, let me think of how to answer that through a lot. Yeah, that’s okay. So I think the the basis of it, and maybe part of what this question was about is that I’m both a therapist and a coach, and what’s the difference? So I like to describe it as an therapy can, in therapy, I can use all of my skills, right, I can do more crisis work, I can go deeper into trauma, I can go deeper into the past, and really dig into that I can deal with things like alcohol abuse, and eating disorders, and suicidality.

Rae McDaniel 51:07
Versus coaching is more of that goal orientation that I was talking about. So it is more about what do you want? And how do we practically get you there? So sometimes it’s pulling from the past, but not a lot. We don’t dwell in, like, let’s talk about your trauma story. Let’s talk about your past. It’s more of Okay, let’s have some understanding of what that was, and what happened. But let’s talk about your symptoms now and where you want to go, and how do we get you there. So that’s kind of the basis of the difference.

Rae McDaniel 51:43
My personal therapeutic style, very much lends itself to coaching. So I tend to be very action oriented, I tend to be a compassionate challenger. I, it’s very collaborative, we talk a lot about people’s goals, I use a lot of modalities like CBT, aact, DBT, that are more skills based. So just naturally, it’s not a stretch for me to move into coaching. More to your question, I have found that coaching around things like career is a huge thing that I do, and helping people develop, like we were talking about those boundaries, that confidence to stand up for themselves at work to figure out what they want out of their life holistically, career wise, and these other ways, and how can I help you practically take steps in that direction? So I don’t know if that completely

Ani King 52:46
does. I, especially in the roles I’ve had, like coaching and mentoring is one of my favorite things to do. And one of the frustrations I often have is finding material that acknowledges the trans or queer experience, right, where they’re often written by people who, you know, the, they’re kind of one size fits all, it all comes down to, you know, if you just do it hard enough, then you’ll make a lot of money, but it doesn’t necessarily acknowledge, you know, there’s a difference in the amount of emotional labor that is done in the workplace. On the whole there are, you know, these different things that stack up that are inevitably challenges that have to be navigated in one way or another. And that is not true for everyone.

Ani King 53:28
So I, I think it’s really cool that you have that focus and emphasis on that coaching. And because especially coming out of tech, there is such an absence of that formal, you know, I’m here to help you grow. I’m here to understand what are your goals or figure out, you know, if you don’t have them yet, how do we develop them? How do we get you in a place where you can do that and sort of partnering with somebody to, to walk them there? Folks, we’ve got about five minutes left. So I just want to remind everyone, if you have any questions want to close out with, feel free to get those in real quick. Right, this has been awesome. I especially want to know, is there anything that we didn’t cover that you want to kind of talk about in closing?

Rae McDaniel 54:13
Yeah. So the main message that I have is that gender transition isn’t the point. You know, I said that earlier. But what I really mean by that is that when we are all walking around as our most authentic self, and mindfully engaging with our gender, we’re not thinking about gender all the time. And that means that the more freedom we have to be our authentic self in the world, the more freedom we have and the more capacity and brain space we have to do all the other amazing things in our lives that we want to it. We have more space for advocacy for showing up for causes that we care about, for being present with Our our family and our loved ones, to read a book and just enjoy it to develop hobbies to really take your career to the next level, if that’s what you want. That is the point of all of this. And that is something that everyone, regardless of whether or not they are trans or non binary, or cisgender can benefit from.

Ani King 55:27
Fantastic. Thank you again, so much. This has been such a terrific conversation. Again, everyone. This has been Rae McDaniel talking about being affirmative with your trans and non binary clients. You can find out more about Rae and the work that they do on and Just pay attention that spelling there, although I’m sure Google will will help you out. So again, thank you so much, everyone. Thank you so much.

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