Transgender and gender-nonconforming people are becoming more accepted in mainstream society, but they still remain misunderstood and understudied. In this episode, psychologist Anneliese Singh discusses how she and other researchers are trying to understand resilience within this population. She also talks about new practice guidelines for the mental health professionals who work with them.
About the expert: Anneliese Singh, PhD
Anneliese Singh, PhD, is an associate professor at The University of Georgia and co-founder of the Georgia Safe Schools Coalition and Trans Resilience Project. Singh has worked on several national guidelines projects for transgender people and mental health professionals, including the APA’s Guidelines for Psychological Practice with Transgender and Gender Nonconforming People.
She is author of the upcoming Handbook of Transgender Affirmative Counseling and Psychological Practice. Singh is the past-president of the Southern Association of Counselor Education and Supervision and the past-president of the Association of Lesbian, Gay, Bisexual, and Transgender Issues in Counseling.
Audrey Hamilton interviews Anneliese Singh in Episode 30
Audrey Hamilton: Welcome, Dr. Singh.
Anneliese Singh: Thank you. It’s good to be here.
Audrey Hamilton: You’ve been selected to take part in a National Institutes of Health-funded study with other researchers to examine how transgender people came to accept their gender identity. Can you talk more about this study?
Anneliese Singh: Sure. We’re really excited about this study because it’s the first longitudinal study that is specifically looking at transgender identity development. And the reason that that is important is because most of the federally funded research for transgender people has mostly centered around more pathological issues, such as HIV and AIDS, risk – whereas this longitudinal study is not only looking at risk, that transgender people might face in their identity development over the lifespan, but it’s also looking at resilience, which is a really important part of coping and navigating trans prejudice for trans people. So, we’re very excited to be collaborating with the University of Georgia, San Francisco State University and Columbia. So, it feels like it’s the start of a new day for transgender research.
Audrey Hamilton: Now, as part of the trans resilience project, you have been studying transgender people’s resilience in the face of discrimination, specifically. Why do you think it’s important to explore resilience among the transgender community?
Anneliese Singh: That’s a great question. I think one of the things we know as we look back a transgender resilience and transgender research is that resilience has been an understudied construct. So for instance, we know pretty well in 2015 how many people are getting hurt who are trans. We know that there are multiple stressors. We know that there are discrimination and barriers in housing and employment. We know that trans youth face higher rates of homelessness and suicide attempts. So, we kind of know all the bad stuff that’s happened, but what we don’t know as well what are the multiple sources of resilience that trans people use on an everyday basis to navigate those multiple oppressions.
So, the way I think about resilience is it’s kind of the stuff that drags you down in life. It kind of is hard to bounce back to normal, and so, resilience strategies that I’m interested in studying for transgender people are really what helps them bounce back. Ultimately, I would love to study what helps trans people thrive. But I think right now in my studies with transgender people of color, youth and elders of color, it’s really looking at what are there different strategies of resilience. How do they navigate oppression?
Audrey Hamilton: As I mentioned in the introduction, you were also on the APA task force that developed guidelines for practicing psychologists. They work with transgender or gender-nonconforming people. Can you talk about those guidelines? Why were they needed?
Anneliese Singh: Well, one of the things that we know in psychology and counseling and other helping fields is that there’s not a lot of guidance in what psychologists and helping professionals should do in serving transgender clients. So, a lot of people are maybe trying to do the best that they can. And maybe the best that they can is really harmful to transgender people. And so, when you look at these guidelines, they’re very basic level, foundational pieces of information of how to do psychological practice with transgender people and gender-nonconforming people across the life span. So, we did have lesbian, gay and bisexual guidelines. But again, that’s not really enough. One of the things that was really important in designing the guidelines were to really make sure that we not only talked about trans phobia and anti-trans bias, but that we also talked about how issues such as racism, adultism and other forms of oppression really affect the mental and physical well-being of transgender people.
The other good reason that we had for beginning guidelines system in APA for working with transgender people was really to be very clear about what providing affirmative therapy is to transgender people. We know from the research that the more the psychologists are working from an affirmative approach with transgender people, the better their outcomes are. So, it was an idea that was really important and I’m glad the time has come that these guidelines are now released.
Audrey Hamilton: Can you explain what affirmative means?
Anneliese Singh: Yes, I would love to. Affirmative is not tolerating transgender people. It’s not being inquisitive or objectifying transgender people or making trans people educate psychologists on how to work with them or what their gender identities are or mean. Being affirmative means using the pronouns and the names and the language that really support and empower transgender people. It’s understanding that when you’re working with transgender people it’s not just asking them what’s wrong with their life, but asking them how they are resilient. And being affirmative, a key component is really looking at your own gender. So for psychologists wanting to be affirmative in their psychological practice with transgender and gender-nonconforming people, we have to look at our own gender – what we came to learn about our gender, whether we’re a person of color, we’re raised to think about gender a certain way, whether we’re a person living with a disability and we think about our gender a different way – just the psychologist self-reflection on gender is such a key and foundational part of affirmative practice.
The other piece of foundational practice and the guidelines is really knowing that transgender people were not a recent thing. It’s not a fad. It’s not a trend. Transgender people and gender-nonconforming people have existed across time and culture across the globe.
Audrey Hamilton: What about the mental health and developmental needs of gender-questioning youth? This is something you’ve been hearing a lot about in the news and the media. How are their needs unique?
Anneliese Singh: You know, the interesting thing about transgender adults is life can be really challenging, right? But at the same time, when you’re working with transgender and gender nonconforming young people, what this group of people has to face additionally is adultism. So, adults tend to have power in the lives of young people. We know that. But, when you add a gender identity that may or may not be accepted by society and families, then you’ve got a different situation on your hands.
So, one of the things that we know for transgender youth and gender nonconforming youth is that family acceptance is a priority. So, we know that health outcomes, mental health and physical health outcomes like suicide attempts, depression, substance abuse, homelessness. All of those things can really be moderated by family acceptance. At the same time, it can be really challenging to work with families in school settings and community settings around these issues because there can be a lot of grief that families experience as they try to navigate their child’s gender identity. And schools and community settings may just have no idea about how to support transgender youth.
So one of the things that we really think is important about working with trans youth is assisting them to kind of explore their gender and also making sure to advocate for them. If we know they have little power in their lives and we know that anti-trans prejudice exists, then we’ve got to be strong advocates when we’re dealing with medical settings, school settings, family settings, you name it.
Audrey Hamilton: Now the task force that we talked about did address guidelines for adults working with gender questioning youth. What should parents and school officials know and how can they make sure these children feel safe?
Anneliese Singh: One of the really important things is that unfortunately, conversion therapy is still something that’s out there with transgender young people.
Audrey Hamilton: Can you explain what that is?
Anneliese Singh: Conversion therapy is really an approach where they kind of advocate that the sex assigned at birth that the child should really be kind of guided into playing with toys, dressing and identifying with a gender that aligns with that.
So, for instance a young child that is assigned female sex at birth but identifies as a boy would be more encouraged to play with things or dress in clothes that align with the sex they were assigned at birth. I think that is considered to be a very unethical approach. The World Professional Association of Transgender Health in 2011 came out with a strong statement that those approaches are unethical. And so, if you know that’s unethical – I mean the good news is then you don’t have to do it and shouldn’t do it. Instead, you should work with families to really keep in mind the research on family acceptance. You can’t use a heavy hammer to say, “OK, accept your child’s gender.” But what you can do is share that the more acceptance there is, the better the outcomes are long-term. So, supporting gender exploration, helping families grieve – a lot families believed that their children were perfect, the exact way that they were born. And so what that means is there’s a lot of grief work that you are doing in therapy, but they are also really thirsty for information. A lot of families just don’t know how to support their children the best. Or maybe they learned really stereotyped notions of gender or perform those stereotype notions themselves. So, helping families, helping children, develop coping strategies, really being a strong advocate for the family and the child with their interaction with school settings, with community settings and helping facilitate collaborative medical care, if that’s needed. Those are really important things to help children feel safe.
But the other thing is to really be able to explain that for families of transgender and gender-nonconforming children the families often go through a coming-out stage that’s very similar to transgender young people. So, there are different stages. The children, the adolescents, and the families may be in very different stages. So, it can be really complex, but to really drive home as a psychologist that the best needs of the child are what you keep at the center of therapy and that the more that you support the child in exploring the gender, the better their health outcomes are long term.
Audrey Hamilton: Dr. Singh, thank you so much for joining us. It’s been such a pleasure.
Anneliese Singh: Wonderful. Thanks so much for having me.
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With the American Psychological Association’s “Speaking of Psychology,” I’m Audrey Hamilton
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