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by Wyatt Okeefe

Dec 1, 2023

Empowering Trans Lives: A Therapist’s Approach to Goal-setting, Resilience, and Collaboration in Transition

How do you approach the unique challenges that members of the LGBTQ+ community may face when coming out, and what strategies do you use to create a safe and supportive environment during this process?

Being a lifelong member of the LGBTQ+ community is one of my best tools I have for connecting with and understanding my client’s experiences.  I have the academic credentials but that’s only a part of the equation.  I believe being queer and trans gives me a unique perspective in that I have lived experience that cis/het therapists may not have.  I think it is very difficult for a cis/het person to fully understand what it feels like to be queer or trans or both or all of the above. They’ve never encountered the inner conflict, the discomfort, the unease, or the apprehension of being exposed as different or unacceptable within the context of their religion, culture, or society as a whole. They generally have no idea what it means to be an “outsider” in the same way.  Being queer and trans poses challenges that we can and do overcome to claim our places at the table of life. This is a process we have to go through that those from mainstream society really don’t.  We have to find and claim our places at the table where so many others have always known they have a place ready and waiting for them.  Having the lived experience of being queer and transitioning later in life informs my practice and allows me to have a clearer perspective and understanding of my client’s experiences, strengths and barriers.  I also believe it is important to have a therapist or mentor who more closely represents us, who is more like us to allow for a trusting connection to develop.

Can you share examples of successful outcomes or positive experiences that your clients have had after working with you to come out? How do you measure progress and success in this context?

To me a successful outcome is where my client feels they have gained the necessary tools and removed barriers that limit their happiness and ability to self actualize sufficiently enough to take the next steps in their lives.  In my experience that often looks like my clients developing a healthier sense of self and their value in the world.  They have learned to self advocate and assert themselves to be heard and seen in a world that would often rather they disappear.  Success looks like my clients finding their voice, learning to express their authentic selves, finding the courage to take the next steps in coming out or transitioning or in their career, or relationships.  It looks like the strong, capable, loving, lovable person inside every client is finally getting a chance to shine out in the open.

How do you address potential cultural or religious factors that may impact a client’s decision to come out, and how do you navigate the intersectionality of their identities during therapy?

I think all LGBTQ folx come to the table with cultural and religious factors that affect our coming out experience and process.  Even those of us who come from the dominant culture / religious belief system come with significant baggage around those issues.  That being said, I believe it is important to be sensitive to those from different cultures and religious backgrounds and not simply apply the dominant cultural norms and expect therapy to be helpful.  Because I’m not an expert on all cultures or religions, I ask my clients how their cultural and religious beliefs impact their beliefs about themselves and their ability to safely come out.  To me the first step is understanding the barriers, and then working toward gaining the skills and support needed for clients to be empowered to overcome them.  I also know there are some situations in which there is no safe solution, so what I can offer is a safe place for clients to talk, have their queer self seen and recognized, where they don’t have to hide, where at least for that hour they get to be themselves.

How do you support transgender individuals who are at different stages of their transition? Can you describe your approach to addressing the unique needs and challenges they may face during emotional, social, and physical aspects of transitioning?

Most of my practice consists of trans and non-binary folx who are in various stages of transition from contemplation to actively socially or physically transitioning individuals.  My clients are also from various age groups from adolescents and young adults to older adults who may have started transitioning at a later age.  Each group has its own kinds of issues and developmental factors to consider but all need compassion, a place to explore themselves in a safe, judgment free environment with someone who understands where they are coming from.  I think it is essential to have a therapist who has experienced the trials and delights of being queer/trans and can relate and celebrate with our clients from a place of experience.  I think my clients appreciate having a therapist who has experienced coming out (twice), who has experienced socially transitioning, who has experience navigating surgical interventions and recovery, and who recognizes there are ongoing opportunities for growth as we evolve into our most authentic, empowered selves. I know there are not enough therapists to meet the need right now, so that’s why I’m licensed in 5 states currently, working on getting more so I can provide care in as many areas as possible.   I’m currently licensed in WA, OR, FL, GA, NY

Can you share some examples of the goals you typically set with transgender clients and how you help them achieve those goals during the different stages of their transition?

Goals always start with helping my clients clarify where they are currently and where they want to be.  A lot of times clients come to me not sure where they are or where they want to go or maybe they are questioning and exploring their gender identity or sexual orientation for the first time, so through the therapeutic process we clarify their goals.  Once we know the direction to face, we start making short term goals that can be easily achieved that advance toward the goal.  Sometimes we encounter barriers in terms of personal fears, misinformation, lack of support, unmet interpersonal needs, etc.  So we start working to remove barriers and replace them with skills and resources necessary to achieve their goals.  Sometimes you start with the basics…accurate information and access to resources.  Other times we start with making goals around physical presentation, finding one’s style, self exploration to find out what clothes, style, mode of presentation, etc.feels right to each individual.  Finding the place where we feel right in our own skin  is always the ultimate goal.  One of the things I do is help my clients determine what they can do that gently stretches their comfort zone and set goals around those things until the comfort zone is larger and more comfortable.

How do you address concerns related to potential social stigma, discrimination, or family dynamics that may arise during a transgender individual’s transition process? How do you empower your clients to build resilience in the face of these challenges?

We all know there is social stigma, not everyone accepts  trans people so rather than pretend it’s not a part of our daily lives we talk about it, what it feels like living in the world at this time in history, we talk about it, we develop tools and resources to cope with it proactively to build resilience.  We develop ways to cope with the ignorance of others, ways to nurture ourselves and each other to find community and connection and to never give in to self hatred or internalized transphobia.  Even with social, family, societal stigma and oppression, I nurture hope in my practice.  I help my clients build upon their strengths and develop supports to help them withstand push back or problematic family dynamics and other interpersonal relationship issues that create barriers to forward momentum.  In sessions I may use role play, creative arts or other interactive means to explore client needs values and boundaries and then explore how to set and maintain them...

In what ways do you collaborate with other healthcare professionals, such as medical doctors or endocrinologists, to ensure comprehensive support for transgender clients who may also be pursuing medical aspects of their transition, such as hormone therapy or gender-affirming surgeries?

Upon request and with the appropriate legal releases, I make myself available to my client’s care team via phone, video conferencing or written correspondence.  I also make the care team aware of these services whenever I write a letter of support for surgical procedures.  In general I am available for consultation on my client’s behalf and for the general education on trans specific issues and considerations to providers from various disciplines outside the mental health field.

Intersectionality, Mental Health, Gender Identity

by Wyatt Okeefe

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