They are:

1. Validate Your Clients’ Gender
2. Hold Space for Complexity
3. Create Safe Spaces (and Help Clients Find Them)
4. Recognize and Mitigate Non-Binary Erasure
5. Be Trauma-Informed and Acknowledge Intersectionality

These cultural competency tips are great for psychologists, counselors, clinical social workers, and marriage and family therapists. (Other mental health providers, like nurse practitioners and psychiatrists, could benefit as well.) This article lays out 5 great ways to enhance your competency with non-binary and other gender diverse clients. (If you’d like additional info, including 12 best practices and other aspects of non-binary/genderqueer cultural competency, check out the book chapter or poster from the same project.)

These tips aren’t a replacement for your other therapy skills, and you don’t have to totally change what you’re doing. Rather, they will help you make non-binary, genderqueer, and other gender-diverse clients and patients feel at home and comfortable alongside what you’re already doing well. It just takes a little knowledge and practice to serve non-binary clients better.

1. Validate Your Clients’ Gender

To practice with non-binary and genderqueer cultural competency, therapists need to validate clients’ gender in a basic way. That doesn’t mean lecturing people or being the expert on their gender; rather, that means trusting in the client’s gender journey and supporting them in their process of becoming.

Too often, clients have experienced therapists that doubted their gender or treated them as a special case or odd specimen that the therapist didn’t understand. If you don’t understand, that’s okay, but you should be the one to educate yourself about your client’s gender position, generally. (It’s okay to ask your client about things that are specific to them, or what particular words mean for them— but ideally you’ve already looked things up and gotten familiar with the terminology before asking your client about it.)

Take Them Seriously— Don’t Tell Them It’s Just a Phase

Sometimes non-binary and gender-diverse people have gotten the message that their gender is ‘just a fad’ or ‘just a stepping stone’ along the way to a binary gender position. While it’s true that for some people, a non-binary gender identity can be one step along the way, for many people, it isn’t— and some people have assumed a binary gender identity before later shifting more towards a non-binary space. Taking people’s gender identity seriously is a great move at any step of the way, and affirming clients in their gender experience will help them feel that you hear, respect, and understand them.

Read and Lend Out Affirmative Books & Get More Specialty Training

Another great way to signal to clients that you validate their gender is to keep trans- and non-binary affirmative books around your office. This also provides a ready store of bibliotherapy resources that you can loan out to client so they can learn more, too. Attending appropriate trainings, consulting with other professionals who are trans and non-binary, and building relationships with the trans and non-binary communities can also help you learn more ways to validate non-binary people.

Learn What You Can & Don’t Fake Awareness

What about if you don’t know about a client’s gender identity or position? Not a problem— gender is a shifting field, and there will always be something you don’t know about yet. Letting clients know that you don’t know can serve to enhance the therapeutic relationship, because non-binary people can tell when their therapists are faking competency. (That said, if you do tell the client that you don’t understand their gender, it’s a good idea to then say that you want to, and then to go ahead and learn more on your own time.)

There are some big no-nos that get in the way of validating clients’ genders: doubting the validity of a person’s gender, viewing a client’s gender situation as a problem, and feeling uncomfortable about it and therefore ignoring it are a top three of gender invalidation. A lot of non-binary clients will ‘vote with their feet’ if their therapist can’t get up to speed about their gender being a real thing. So learn more, build those relationships, and validate!

2. Hold Space for Complexity

Non-binary and genderqueer people often experience complex thoughts and feelings as they start to figure out who they are and who they want to be in the world. Gender can get tangled up with all kinds of developmental, social, and relational issues, and it’s also connected to the sense of self, who one is as a family member, sexuality, career, etc. (Basically gender is kind of connected to everything!)

But because non-binary and other gender diverse folks have a gender that is outside of the binary, and beyond the typical cultural narratives of how to be a person, they have to chart their own course in terms of becoming who they want to be. At the same time, they face enormous pressure to conform to cisgender and gender binary cultural patterns and stories.

This simultaneous experience of not enough cultural guidance about how to be non-binary, and too much binary and cisgender social norming, makes non-binary transition and non-binary life especially complex. So it can be really helpful to hang in there with a complex situation, and to get comfortable with not knowing what’s going on. (This goes for clients and therapists both!)

As part of that, let clients know that even though the process of becoming who they are is complex and not always straightforward, you are in it for the long haul. Communicate your trust in their ability to find their way— and that you’re here to help.

3. Create Safe Spaces (and Help Clients Find Them)

Ideally, non-binary and genderqueer people should be able to feel safe anywhere that other people do. Unfortunately, due to social norming, cisgenderism, and transphobia, this ideal is far from a reality in many places. So much of what non-binary and gender-diverse people need is to experience social spaces that are safe enough for them to relax and let their guard down. This can really help people build resilience and find belonging.

First of all, therapists can ensure that the contexts they do therapy in are safer— whether that’s online or in person. Forms, processes, intake paperwork, nearby businesses, and gender-neutral bathrooms are all issues to think about to help non-binary and genderqueer clients feel more comfortable. The therapist’s own work also goes a long way in building that kind of safety in therapy. Analyzing and working through one’s own gender socialization is a basic discipline for creating safer spaces for trans and non-binary people, because unconscious and unprocessed gender socialization runs the risk of recreating harmful gender dynamics.

Secondly, clients need to be supported in finding and creating gender-validating spaces outside of therapy. This can include support groups, building trans and non-binary friend groups, and reaching out to supportive family members. Clients can also benefit from guidance in finding support in their institutions, such as queer resource centers in universities, queer-straight alliance clubs in secondary schools, or trans and queer affinity spaces at larger employers. Organizations like PFLAG can also be helpful for finding and building community. In addition to seeking out existing resources, clients can benefit from creating their own activity groups, skillshare workshops, and other social opportunities.

Non-binary and trans-validating media can also be a way to cultivate a safer cultural space. Podcasts such as Gender Reveal offer online social media opportunities, and reading, listening to, and viewing media that offer positive portrayals of gender-diverse people can be a powerful way to counteract damaging cultural messages.

4. Recognize and Mitigate Non-Binary Erasure

A big issue that non-binary and other gender non-conforming people deal with is erasure. Basically, anytime the people, the culture, or the built environment assume there are only two genders, people with other gender identities are being erased. This happens with bathrooms, medical forms, paperwork, forms of address (i.e. ‘ladies and gentlemen’), clothing, toys, team sports, and all sorts of other situations in which people are divided based on gender.

Another type of erasure that non-binary people experience is when strangers (or therapists!) address them in ways that assume they know the person’s gender. Although it’s quite common for people to address each other informally in gendered ways (i.e. ‘hello sir,’ ‘hey man,’ ‘hey girl,’ etc.), it can feel very invalidating and erasing for non-binary people to be addressed in this manner. So practicing non-gender-imposing ways of communicating can help therapists make non-binary and genderqueer clients feel more seen.

Helping clients build resilience against these experiences can be a powerful therapeutic intervention. Resilience-building practices include processing such experiences in therapy, connecting with friends, journaling, and doing practices that promote gender euphoria. Gender invalidation can feel like the world tearing you down; these practices can help a person build back up again.

Mitigating non-binary erasure can also happen at the advocacy level, which can include therapists rallying to get gender-neutral bathrooms at their practice location, influencing their EHR provider to create more gender-inclusive forms, and speaking to other professionsals, legislators, or the public to improve how gender diverse people are treated in social life.

5. Be Trauma-Informed and Acknowledge Intersectionality

Our last tip covers trauma and multiple social identities. First of all, although many non-binary and gender-diverse people have experienced trauma, trauma does not cause gender diversity. The matter is further complicated by the fact that many non-binary people have been targeted because of their gender diversity, such that gender and trauma can seem linked in a significant way. However, many non-binary people do not have clear traumatic experiences— so it’s clear that one doesn’t cause the other.

Nonetheless, the combination of trauma and the ongoing experience of erasure and exclusion due to gender can create significant obstacles in peoples’ lives. Being a trauma-informed therapist includes not doing harm and understanding common trauma triggers. However, it goes beyond that to having competency with trauma treatment.

Ideally, therapists should having a sensitive and finely honed relational capacity with clear boundaries, to address social trauma. Trauma-informed therapists should also pursue training in trauma modalities such as EMDR, somatic experiencing, sensorimotor psychotherapy, attachment therapy, IFS, or other evidence-supported trauma-specific approaches.

An additional component of this tip is for therapists to understand the unique social positionalities of the client and the therapist. We each inhabit multiple social identities, and most people occupy some positions that are marginalized and others that are privileged in mainstream US society. These multiple social identities combine to create unique experiences of privilege and oppression, and understanding clients’ different positionalities can help therapists provide better treatment.

Therapists should have a clear social justice analysis that acknowledges these intersecting identities and their impact on clients’ well-being. This makes it possible for therapists to understand the interplay of power and privilege in the therapeutic encounter. It also enables therapists to help clients recognize when psychological distress and trauma are arising due to systemic forces that maintain privilege and oppression, rather than due to any fault of the client’s. Finally, naming and understanding systemic social ills helps therapists and clients build resilience and skillful resistance to these forces.

Conclusion

Understanding and deepening into these five themes is a great way to cultivate more cultural competency in working with non-binary, genderqueer, gender non-conforming, and gender-diverse clients. Combining these perspectives with your existing training can be a great way to start improving services now, and it’s also important to seek further training if you want to hone your abilities and develop a specialty working with non-binary folks.

Our research group also came up with a list of 12 best practices for working with non-binary and genderqueer people— to be featured in a future blog post. If you’d like more detail, (If you’d like additional details, including the 12 best practices, the book chapter and poster are free to download.) Thanks for learning more about non-binary and genderqueer competency! If you’re ready to take your learning to the next level, and you’d like to book a training or consultation, get in touch!

Folks can have all sorts of gender journeys, and that can involve passing through multiple ideas of gender. Gender is one facet of who we are as people, and having a lifespan view of gender can be very helpful, I think. To talk about a lifespan view of gender, I think it’s helpful to look at the cis hetero models of gender identity, and then tease that apart a bit to display how gender is a fluid thing throughout life. To be clear, I’m not trying to undermine cis hetero people, many of whom have genders that are perfectly nonviolent and congruent for them; that said, I think that pondering and unraveling gender is a helpful exercise for anybody, because it makes life so much more fun.

In the cis het world, to take the example of the normalized male gender, people actually have distinct gender identities and expressions that are compressed and normalized under the rubric of ‘male.’ A baby designated male at birth has a very different gender role and different socialized expectations than a young boy, and that young boy has different expectations than a teenaged boy, who in turn has different expectations and life activities than a young man, a father, a grandfather, etc. These different gender roles are due in part to lifespan changes, in part due to socialization (e.g social conditioning), and in part they are based on individual differences in how people change over time and adapt their responses to themselves and the world based on situations, experience, and prior learning.

So we each get to change over time, and part of what gets to change is our gender, including gender identity, expression, and performance. Even within a binary gender category, there is room to be a certain kind of a man, a certain kind of a woman; to dress certain kinds of ways; to act, move, and speak in certain kinds of ways; to hold particular interests, particular identities, and particular ways of being. Furthermore, these ways of being and doing arise in contexts, so that a man (to continue with our example) has a certain kind of role to perform as a father, colleague, supervisor, friend, lover, etc. Because that can change over time, we also have the potential for endless variety in our individual gender careers, because of how our genders (identity, expression, and performance) change throughout life and in different contexts. In the most radical analysis, we could say that there are at least as many genders as there are people, extended through time and contexts.

I personally feel that having a wide enough view of gender to allow for that kind of playfulness and creativity makes space enough for everyone to do their gender as they see fit. However, just for there to be gender freedom (or, as Kate Bornstein put it, “creative gender anarchy,” in the sense of non-hierarchy) doesn’t address the very real forms of oppression that gender-expansive people face. I take that up in the next post, on gender oppression.

Our society recognizes but a few thresholds of grief: the death of a loved one, the end of a career, the loss of a home or property due to theft or disaster. In the clinical setting, we have insight into a few more sources of grief, some linked to changing roles due to circumstances and life transitions: birth and postpartum depression, children growing into adults and leaving the home, mid-life crisis, retirement, or the accomplishment of a major project. These grief processes are often understood as role changes, or adjustments of a person’s narrative and self-image to a new situation.

In the case of my ongoing nonbinary/genderqueer gender transition, my experience has been of multiple layers of self that bloom into awareness, ripen, wither, and die, only to reveal something new. Possibly this understanding is influenced by my background in Buddhism, which holds that the self is a fluid phenomenon, characterized by constant change— and thus open to possibility and improvisation. My gender transition, which is revealing itself as a journey without specific goal or endpoint, has involved the coming-into-awareness of a variety of feelings, wishes for gender expression/performance, and associated body states.

For example, an emergent transfeminine identity which has clarified over the last six months, feels graceful, vulnerable, gentle, kind, and open. Although I have had these sorts of feelings before in my life, this mode of being dominates my awareness lately. In the realm of outer gender markers associated with this self-state, I have bought more makeup and have begun studying feminine fashion. These gender performance options swim in my awareness like notes or chord progressions I could play in the spontaneous improvisation of life, an expansion of repertoire rather than a monolithic endpoint to be practiced and mastered. In this way of doing gender, it is much more interesting to learn jazz improvisation and mash up genres, rather than practice and perfect a single piano masterpiece with perfect technical skill and zero creativity.

With each reach for greater vocabulary and flexibility in my gender repertoire, I have had to mourn previously conditioned gender moves, many of which (in my case) have been male-socialized impulses to cover up and protect against vulnerability and tenderness. Harsh, barking words, gruff body language, and aggressive urges are the automatic gendered impulses I notice and restrain; then, feeling underneath the aggression, I soften into the tenderness of my open heart. Staying with that gentleness in the moment, the hardness and gruffness dissolve, and a sense of sadness arises. I do this over and over whenever I catch these hardened self-states arising. Practicing these skills of self-compassion and open awareness helps me gain greater neural flexibility (Siegel, 2010) and makes me a therapist who can accommodate my clients in their own vulnerability, tenderness, and growth.

This is like a dying of the self, and a momentary grieving of who I have thought myself to be. In these moments of my internal process, the self that is dying is the self protecting the self that is being born. The struggle between protection and tenderness is my transition between the male socialized self and whatever I am becoming in the world. Understanding this as a transitory process of death and dying, of rebirth and becoming, is a helpful metaphor for me because it frames it as a natural process. In this way of thinking, we are not meant to be an endless constructive process, an edifice or amassing of ideas and experiences. Rather, like a plant, we grow, flower, bear fruit, give seed, and die, to winter over and then be reborn in the spring (Ferrer, Romero, & Albareda, 2005). This process of death and rebirth is mirrored in many cycles of life, and the gender journey is one of them.

References

Bornstein, K. (2013). My new gender workbook: A step-by-step guide to achieving world peace through gender anarchy and sex positivity (2nd ed). New York, NY: Routledge.

Ferrer, J. N., Romero, M. T., & Albareda, R. V. (2005). Integral transformative education: A participatory proposal. Journal of Transformative Education, 3(4), 306–330. https://doi.org/10.1177/1541344605279175

Siegel, D. J. (2010). The mindful therapist: A clinician’s guide to mindsight and neural integration. New York, NY: W. W. Norton.

This article was originally published in 2018 in the Oregon Counseling Association Newsletter, 47(2), pp. 9–10.

Mindfulness and Fear

Fear is a natural response to life situations that functions to keep us safe and alive. In situations that are actually threatening, fear helps mobilize us to run away or freeze, and once the situation passes, fear normally subsides. Because we are human beings with complex brains, we can symbolize experience to ourselves in words and images, and this is a handy ability. However, we can also react to the words and images that we symbolize to ourselves as though they were real, and this can get us caught in fear loops, reactive patterns, and build a cocoon of habit and misplaced belief.

Sitting meditation practice can help us cultivate kindness towards our own fear when it arises, and it can help us evaluate whether our fear is in relation to a real external danger, or towards something we have merely imagined or believed out of habit. When there is a real external danger, fear is an appropriate response, and we should react by leaving the situation or changing it. When there is not a real threat, however, we can work with fear by becoming curious about it, softening our hearts, and getting underneath the storyline to work with the raw experience of fear itself. The life energy thus liberated becomes available to us as the ongoing flow of life itself, and we are able to step into a more intimate relationship with ourselves and the world. When mindfulness practice works in this way, it is good, wholesome, and healthy.

Mindfulness and Trauma

Trauma is a specific response to overwhelming situations of the past, when the organism felt threatened beyond its ability to cope. Traumatic affect remains lodged in the nervous system as unintegrated impulses, sensations, and behavior patterns that are characterized by nervous system hyperarousal (e.g fast breathing, flushed skin tone, sense of fear, desire to run or fight, flinching), experiential constriction (e.g. avoiding situations that resemble the original experience), and intrusion (thoughts, feelings, sensations, and memories from the original experience intrude in present-day life).

Mindfulness practice can help people work with trauma, and it is important to adapt mindfulness practices to present-day needs. For example, sometimes sitting alone in a room focusing on your breath can help you calm down and feel better, and sometimes it can just make you feel more alone, scared, and unstable. For these reasons, it is important to use a mix of self-care skills in working with trauma, and not to overrely on one skill (e.g. meditation practice, distraction, socializing) when building a network of wellness skills is more likely to lead to health and success in trauma healing.

Mindfulness Practices for Trauma

Here are some suggestions for mindfulness practices in working with trauma.

1. Noticing present-moment level of arousal

Notice the signs in the present moment of nervous system arousal (e.g. fast breathing, wanting to run, pain or tightness in chest or stomach, racing thoughts— whatever your signs are that you are starting to feel anxious or frightened). Rate your level of arousal on a scale of 1 to 10, with 1 being the least activated and 10 being the most activated. Optional: Track your level of arousal throughout your day.

2. Noticing arousal level, choosing what to do, and learning your soothing activities

Rate your present-moment level of arousal. Based on how activated you feel, what could you do to lower your arousal by just 1 point? Experiment with different grounding, soothing, resourcing activities, such as slowing down to breathe, feeling your feet, going for a walk in the park, petting a cat or dog, mindfully drinking a glass of water, etc. Learn the different soothing activities that work for you in different states of arousal.

3. Awareness of a present-moment resource

Choose something in your environment that feels soothing, relaxing, and resourcing to you. Pay attention to it. Notice how paying attention to a soothing object feels to you. (This can be particularly helpful if your nervous system is activated [e.g. aroused in a fight-or-flight way] and the external situation is actually safe.) Practice in different situations with different present-moment resources until you understand how to work with a variety of feelings and situations, and until you gain the habit of soothing your nervous system by choosing what to pay attention to. (In many situations that are safe in the present moment, but feel unsafe, you can change your level of activation simply by choosing to pay attention something soothing in the present moment, rather than paying attention to something frightening in your thoughts or memories. Practice cultivating safety until you have made a habit of it and it comes easily for you.)

4. Awareness of the feeling of fear itself

Once you are skilled at calming yourself down and feeling safe, you could experiment with bringing your attention directly on to the feeling of fear and activation. If you are able to observe the fear and pain without being sucked into it, you might be able to understand it better and find ways to see through the painful and fearful experiences. By letting the trapped nervous system activation move through you, you can free yourself from the past and integrate what once felt overwhelmingly scary. By bringing your awareness onto the present-moment experience of fear from within a nervous system that is anchored in safety and abundance, you can befriend and liberate those aspect of you that have been held in thrall to the past. (Note that this is an advanced skill, and often in trauma healing it helps to have trusted, skilled others to accompany you in your journey.)

There are lots of great books, friends, and professionals out there, as well as many wonderful life-affirming practices and activities. I wish you well in your journey, and I hope you find just the right combination of things to work with your fear and trauma, and find liberation from them. Please feel free to get in touch with questions or feedback!

Suggested Reading

Cori, J. L. (2007). Healing from trauma: A survivor’s guide to understanding your symptoms and reclaiming your life. Cambridge, MA: Marlowe & Company.

Herman, J. L. (1997). Trauma and recovery: The aftermath of violence— from domestic violence to political terror (Revised ed.). New York, NY: Basic Books.

Levine, P. A. (1997). Waking the tiger: Healing trauma. Berkeley, CA: North Atlantic Books.

Linehan, M. M. (2015). DBT skills training manual (2nd ed). New York, NY: Guilford Press.

Rothschild, B. (2000). The body remembers: The psychophysiology of trauma and trauma treatment. New York, NY: Norton.

Siegel, D. J. (2010). Mindsight: The new science of personal transformation. New York, NY: Bantam Books.

Trungpa, C. (2010). Smile at fear: Awakening the true heart of bravery. Boston, MA: Shambhala.

Trungpa, C. (1984). Shambhala: The sacred path of the warrior. Boston, MA: Shambhala.