The APA has recently pre-published the updated Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. (1) The guidelines stress not only issues involved in direct clinical work with transgendered persons but also the broader social and institutional challenges and barriers faced by the transgender community. Under Guideline 6. “Psychologists strive to recognize the influence of institutional barriers on the lives of TGNC people and to assist in developing TGNC‐affirmative environments,” (2) the following is stated about how psychologists might consider their workplaces in light of expanded understanding of the transgender community:
Psychologists are encouraged to be proactive in considering how overt or subtle cues in their workplaces and other environments may affect the comfort and safety of TGNC people. To increase the comfort of TGNC people, psychologists are encouraged to display TGNC‐affirmative resources in waiting areas and avoid the display of items that reflect anti‐trans attitudes (Lev, 2009). Psychologists are encouraged to examine how their language (e.g., use of incorrect pronouns and names) may reinforce the gender binary in overt or subtle and unintentional ways (Smith, Shin, & Officer, 2012). It may be helpful for psychologists to provide training for support staff on how to respectfully interact with TGNC people. (3)
Over the past year and one-half I have had the opportunity to work with a remarkable transgender person, Erika Thorn, B.A., who has taught me and my staff much about the needs of transgender persons in the workplace. Erika does outreach work with the Maine Transgender Network and was recently asked to be a speaker in a program on transgender issues at Bates College. They generously agreed to co-write an article about being transgender in the workplace based on their experience in my private practice where Erika holds the position of being a neuropsychology psychometrician.
Along with the APA’s recent updating of their Guidelines there has been increasing visibility of the transgender world in the media, perhaps and to some degree unfortunately, culminating in Bruce Jenner’s transitioning to being Caitlyn Jenner with full Vogue Magazine coverage of her new identity. But what was not explained during the media frenzy is the foundational understanding that gender, sexual assignment and sexual orientation are not identical concepts and are not always congruent. Many transgendered individuals do not transition to being the opposite gender by changing their bodies to be that of the opposite sex, and there are a vast array of combinations of sex, sexual orientation and gender identity that form the broader transgender community.
As Erika puts it, “This simplistic understanding of what it means to be transgender is only a fraction of the truth. Yes, there are transgender people who transition in this way (such as Caitlyn Jenner), but this is not the experience of many transgender people. Transgender means that your gender identity is incongruent with the sex you were assigned at birth. The possibilities are endless. A transgender person could be, for example, assigned male at birth but identify as female, or a transgender person could be someone who is assigned female at birth but identifies as both male and female, somewhere in between, or neither. A cisgender person, on the other hand, is someone whose gender identity is congruent with their assigned birth sex. Unfortunately, in our society, cisgender is seen to be “normal” which in turn creates an environment in which transgender people are seen as “other.”
The APA’s Guideline 1 states that “Psychologists understand that gender is a non‐binary construct that allows for a range of gender identities and that a person’s gender identity may not align with sex assigned at birth.” (4) The “Application” section for Guideline 1 indicates that:
A non‐binary understanding of gender is fundamental to the provision of affirmative care for TGNC people. Psychologists are encouraged to adapt or modify their understanding of gender, broadening the range of variation viewed as healthy and normative. By understanding the spectrum of gender identities and gender expressions that exist and that a person’s gender identity may not be in full alignment with sex assigned at birth, psychologists can increase their capacity to assist TGNC people, their families, and their communities (Lev, 2004). Respecting and supporting TGNC people in authentically articulating their gender identity and gender expression, as well as their lived experience, can improve TGNC people’s health, well‐being, and quality of life (Witten, 2003). (5)
One of the most important ways that that we can acknowledge a transgender person’s authentic self in the work setting is to find out and use the pronouns which they have chosen to best fit their gender identity. As Erika writes, “Pronouns are the words we use that often identify (or assume) one’s gender. An adult cisgender male, for example, would probably be referred to using the following pronouns: he, him, and his. These pronouns are chosen for the cisgender male because he is identified as male by his secondary sex characteristics, such as facial hair, low voice, etc. Similarly, an adult cisgender female would be referred to using “she, her, hers” pronouns, because she would be seen as female by her secondary sex characteristics, such as breasts, higher voice, etc. For cisgender people, being “misgendered” (or having the incorrect pronouns or words used to describe your gender) is usually not a problem. For transgender people, however; being misgendered is often a problem because their gender is assumed to be the same as their sex. To be repeatedly identified as the wrong gender can be very distressing. I am almost constantly gendered as female, but I do not identify as a female. It is exhausting.”
As with our culture which assumes congruence between sex and gender, thus creating a binary male/female world, so in our language are we confronted with the same problem. This becomes quite clear when faced with the paucity of vocabulary to identify nonbinary gender states. Erika explains it in this way, “I identify as gender queer, which, to me, means that I do not fit into the gender binary, which is the socially constructed system in which a person is assumed to be either male or female. Instead, I feel that I fall somewhere in the middle. I use gender neutral pronouns: they, them, and theirs.”
APA Guideline 7 states, “Psychologists understand the need to promote social change that reduces the negative effects of stigma on the health and well‐being of TGNC people.” (6) The “Rationale” section for Guideline 7 states:
The lack of public policy that addresses the needs of TGNC people creates significant hardships for them (Taylor, 2007). Although there have been major advances in legal protections for TGNC people in recent years (Buzuvis, 2013; Harvard Law Review Association, 2013), many TGNC people are still not afforded protections from discrimination on the basis of gender identity or expression (National LGBTQ Task Force, 2013; Taylor, 2007). For instance, in many states TGNC people do not have employment or housing protections and may be fired or lose their housing based on their gender identity. Many policies that protect the rights of cisgender people, including LGB people, do not protect the rights of TGNC people (Currah, & Minter, 2000; Spade, 2011a). (7)
Although I was aware that Erika was interested in transgender issues and sent them to a conference on supporting transgendered youth, it was not until after they went to the conference that they made the decision to share their gender identity with me and their co-workers. In my opinion this was an incredibly courageous act. Although my practice is an accepting and liberal group I am sorry to say that we were only on the cusp of understanding transgender issues. Erika writes about their experience of sharing their gender identity with the practice as follows.
“Coming out as gender queer, and therefore transgender (because gender queer falls under the transgender umbrella), in the workplace was a daunting task for me, but not because I feared that I would not be accepted. I am very lucky to work in a space where that was not a concern of mine. For many, choosing to come out to others as transgender is a very difficult decision, especially because it can put one’s safety at risk. Some transgender people may never come out at their workplace because of this safety concern. For me, coming out was a daunting task because I had a lot of explaining and educating to do, just to make the existence of my gender known and understood. Ultimately I decided that it was the best decision for me, because I knew that, while it may be difficult for a while, one day at work I would be correctly gendered more often than I would be misgendered. The thought of being correctly gendered was a very exciting one, and I very much wanted to get to that point, especially because I spend a big chunk of my life in my work environment.
I also thought it was important to come out at work to educate my coworkers about transgender inclusion and support. Coming out at work and being open about my experiences allowed my coworkers to ask questions and learn how to be effective transgender allies. Another important part of coming out at work for me was the visibility that I would be contributing to the transgender community. Recognition that transgender people exist in our culture and that not everyone fits into society’s definition of gender is important.”
While Erika was quickly successful in educating the practice about gender identity and transgender issues, they had to cope with the difficulty we in the practice had in adapting to their pronouns: they, them, theirs. As we had first had a different set of pronouns for them it did take time to adjust. It also took time to get used to using third person pronouns often used for the plural when referring to Erika. I would have to say that Erika is very patient with us. As Erika writes:
“Many (necessary) difficulties have surfaced from teaching work mates about gender and how to be transgender allies. Perhaps the most difficult outcome for me was the (long) adjustment period. Understanding that my pronouns were gender neutral (they, them, theirs), and putting into practice the use of these pronouns are two different undertakings, the latter being the more effortful endeavor. Changing the pronouns you use for a particular person requires a lot of thought and attention. From a young age we are taught how to identify another person’s gender (incorrectly assuming that sex and gender are the same) in order to engage in communication. Over time that identification process becomes an automatic one and pronouns are used without thought, effort, attention, or awareness. Essentially, being (re)-taught gender identification and pronoun usage causes it to become a controlled process, one that requires thought, effort, attention, and/or awareness. It is easy and common to fall into the automatic process of gender identification, hence making errors. It takes time for the errors to decrease in frequency.”
In assessing their experience to date, Erika reflects on the sometimes awkward position they found themselves in as they negotiated the need to remind us to use the correct gender and the need to maintain positive co-worker relationships.
“When I came out to my work mates, I conveyed to them that I knew that errors would occur and that this was okay, that it would take time. However, these errors in turn engendered another difficulty for me: I found it very difficult to correct my coworkers when they unknowingly misgendered me. Here are a few reasons why this was difficult for me: I felt awkward putting my coworkers on the spot; I felt I might be seen unfavorably by pointing out their mistakes or that I might cause them to feel badly; correcting them felt forced and unnatural. I felt that I should be correcting them though, because being misgendered was distressing and because I felt that they would not learn to use my pronouns if I never corrected them. Coming out was freeing yet alienating at the same time. I was being true to myself, but now I really felt different from my coworkers. I had to, and still have to, remind myself that being different is not a negative thing.”
I can say with absolute clarity that for myself and for my practice Erika’s honesty and their willingness to be themselves despite the discomfort and effort involved, has been a very positive thing and has provided the opportunity for all of us in my practice to expand our awareness, challenge our preconceptions, and move toward greater inclusivity in our daily practice.
In addition to the updated APA Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, Erika and I offer some further resources which can be helpful in learning more about transgender people and ways to be more inclusive in both the work setting and in clinical practice:
Maine Transgender Network: http://www.mainetransnet.org
Trans Youth Equality Foundation: General: http://www.transyouthequality.org
For Providers: http://www.transyouthequality.org/health/
Trevor Project: http://www.thetrevorproject.org/section/resources
Erickson-Schroth, Laura (Ed) Trans Bodies, Trans Selves: A Resource for the Transgender Community. Oxford University Press. N.Y., N.Y. 2014
Israel, G. and Tarver, D. Transgender Care: Recommended Guidelines, Practical Information and Personal Accounts. Temple University Press. Philadelphia, Pa. 1997
- American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. Retrieved from http://www.apa.org/practice/guidelines/transgender.pdf; Retrieved 11-14-2015.
- Ibid p. 13
- Ibid p. 14
- Ibid p. 4
- Ibid p. 6
- Ibid p. 14
- Ibid p. 14