trans awareness training - wordpress.com

sam-hope.co.uk© Sam Hope

Trans Awareness Training

Sam Hope

“I’m not trapped in my body.I’m trapped in other people’s

perceptions of my body”Source unknown


Sam Hope

• BACP accredited therapist, supervisor and EDI trainer, MA Trauma Studies

• Disabled, neurodivergent, trans, non-binary, ace & bi (they/them)

• Community organiser/volunteer

• Writer, blogger and author: Person-Centred Counselling for Trans and Gender Diverse People


Housekeeping

Please keep microphone on mute and camera off in the main group – turn on for small group work

Max is in the chat room – they are here to assist

Please use chat to ask questions if you can

10 min Tea break at 12.00, 20 min lunch break at 1.10, finish at 2.20


House rules

• Oppressive or hate speech will be challenged

• Confidentiality for all present

• Slides are copyright – please do not share

• Language handout is open source and may be shared


Introductions

• In the chat, please type:

– Your name

– Your pronouns

– Briefly, what you’d like from the session (optional)

– Any access needs I or Max need to know about

Hi I’m Sam

I use they/them pronouns

I’m here to bamboozle you!


Learning Outcomes

• An understanding of the biopsychosocial underpinning of trans experiences

• Culturally competent language and approaches to working with gender diversity

• Debunking myths and stereotypes• Mental health, trans people and the

minority stress model • What trans clients feed back about helpful

and unhelpful interventions


Content warning

• Mentions of various kinds of abuse, violence, mental health, mistreatment, oppression and other harm

• You will leave knowing less than you knew when you started – this is deliberate!


“Biological Sex”D

r C Fin

e(20

10

) Delu

sion

s of G

end

er: Ho

w O

ur M

ind

s, Society, an

d N

euro

sexismC

reate Differen

ce. D

r C Fin

e(20

17

) Testostero

ne R

ex: Un

makin

g the M

yths o

f Ou

r Gen

dered

Min

ds.

Scientific A

me

rican. Sex R

edefin

ed: Th

e Idea o

f 2 Sexes Is O

verly Simp

listic

https://www.goodreads.com/book/show/8031168-delusions-of-gender

https://www.goodreads.com/book/show/35187176-testosterone-rex

https://www.scientificamerican.com/article/sex-redefined-the-idea-of-2-sexes-is-overly-simplistic1/


This is biology

“Gender”

He MrSirMan

She Ms

Ma’amWoman


• Strong evidence that gender identity has a “durable biological element1”

• Many-layered experience:– Our internal sense of who we are

– How our brains map onto our bodies

– Which genders we do and do not unconsciously learn from

– How others experience our gender and interact with us

– Varies in intensity from person to person

“Gender identity”1

. End

ocrin

e Society P

ositio

n Statem

en

t

https://www.endocrine.org/advocacy/position-statements/transgender-health


“Trans”

Any person who experiences incongruence with the gender they were assigned into at birth


“Gender incongruence”


What’s your model?

MF

F M

F MNon-binary

Non-binary?

Non-binary

a)

b)

c)


M

F

Non-binary


Gender Roles?

Social Orientation?

Embodiment?


Any Questions? (small groups 5 mins)


Tea break! 10 mins


A Little Trans History . . .

• People have lived as the “opposite sex” or in between the sexes throughout the ages and in all cultures – body modification is also seen

• Many cultures have celebrated and supported expressions that today’s global northwest thinks of as “transgender”

• Many countries across the world have legislation recognising non-binary and/or intersex identities


Indigenous American Two-spirit people

Indian Hijras

https://www.youtube.com/watch?v=A4lBibGzUnE

https://www.youtube.com/watch?v=8zFA__VnprU


http

://tgdo

r.org/h

olo

caust.sh

tml

http://tgdor.org/holocaust.shtml


Declassified as a mental illness

Year WHO declassified

Homosexuality 1990

Gender Incongruence

2019


Gender Recognition Act

• Gender Recognition Act 2004– Allows a trans person to change birth

certificate

– Many people don’t have one

– Trans people can use single sex facilities without one

– Complex administrative process

– Ireland, Malta, Argentina introduced a statutory declaration (“self-ID”) process without problems


Equality Act 2010• Gender reassignment is a protected characteristic

– “You can be at any stage in the transition process –from proposing to reassign your gender, to undergoing a process to reassign your gender, or having completed it”

• Includes:– Harrassment – making someone feel humiliated,

offended or degraded (e.g deliberate misgendering)– Direct discrimination (e.g “you have to change jobs now

you’ve come out”)– Indirect discrimination (e.g. “we won’t give you paid

time off for treatment despite giving this for other health conditions)

– Exceptions: “A proportionate means of achieving a legitimate aim”

– Non-binary people are covered by the law


Lancet Study, 2016

"We found distress and dysfunction were very powerfully predicted by the experiences of social rejection or violence that people had," he said. "But they were not actually predicted by gender incongruence itself.”1

1. Lan

cet stud

y

https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(16)30165-1/fulltext


Canadian Study

• A 57% drop in attempted suicides when parents are affirming

• A 44 % drop when trans people can access documents to legally recognise their gender

• A 66% drop for trans people who experienced low levels of anti-trans hate

• Suicide rates get lower as trans people get closer to their transition goals

1. C

anad

ian Stu

dy

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2


Cornell Study• Systematic literature review on the effect of gender

transition on transgender well-being. • 56 studies

– 52 (93%) found that gender transition improves the overall well-being of transgender people

– 4 (7%) report mixed or null findings– no studies concluding that gender transition causes

overall harm.

“This search found a robust international consensus in the peer-reviewed literature that gender transition, including medical treatments such as hormone therapy and surgeries, improves the overall well-being of transgender individuals. The literature also indicates that greater availability of medical and social support for gender transition contributes to better quality of life for those who identify as transgender.”

1. C

orn

ell Stud

y

https://whatweknow.inequality.cornell.edu/topics/lgbt-equality/%20what-does-the-scholarly-research-say-about-the-well-being-of-transgender-people%20/


Regrets and detransition

• Detransition is rare, contrary to myth

• Usually for safety reasons, non-acceptance, change in transition trajectory, conversion therapy/practices

• The Amsterdam Cohort of Gender Dysphoria Study (1972-2015): 5000 surgical patients, regrets expressed by 0.3-0.6%

1. Th

e Am

sterdam

Co

ho

rt of G

end

er Dysp

ho

ria Stud

y

https://pubmed.ncbi.nlm.nih.gov/29463477/


Conversion therapy doubles suicide risk

“The findings suggest that lifetime and childhood exposure to GICE [Gender Identity Conversion Efforts] are associated with adverse mental health outcomes in adulthood. These results support policy statements from several professional organizations that have discouraged this practice.”

1. A

ssociatio

n B

etwee

n . . . G

end

er Iden

tity Co

nversio

n Effo

rts and

Psycho

logical D

istress . . .

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2749479


Children

• Trans identities are as stable as cis1

• Puberty blockers: established treatment, positive outcomes2

• Allowing social transition is beneficial3

• “Rapid Onset Gender Dysphoria”/social contagion: clinical evidence does not support these theories4

• Myth: Trans kids are likely to later “desist”/ non-conforming kids get “diagnosed” as trans5

1.

Gen

der C

ogn

ition

in Tran

sgend

er Ch

ildren

2.

You

ng ad

ult p

sycho

logical o

utco

me after p

ub

erty sup

pressio

n an

d gen

der reassign

men

t3

.M

ental H

ealth o

f Transgen

der C

hild

ren W

ho

Are Su

pp

orted

in Th

eir Iden

tities4

.A

critical com

men

tary on

‘rapid

-on

set gend

er dysp

ho

ria’5

.A

critical com

men

tary on

. . . “desistan

ce” theo

ries

https://journals.sagepub.com/doi/abs/10.1177/0956797614568156

https://pubmed.ncbi.nlm.nih.gov/25201798/

https://pediatrics.aappublications.org/content/137/3/e20153223?ijkey=86d33950655dd8aec35fb715a6ed84196c042834&keytype2=tf_ipsecsha

https://journals.sagepub.com/doi/abs/10.1177/0038026120934693?journalCode=sora

https://www.tandfonline.com/doi/pdf/10.1080/15532739.2018.1456390?needAccess=true


“Trans threat” myths

• Trans women do not pose a greater threat to cis women than other cis women do

• Trans people are not more violent, criminal, or prone to sex offending, nor comparable to cis men’s criminality

• Trans civil rights progresses have not increased risk/ caused problems

1. C

reating a lie: H

ow

trans w

om

en are p

ortrayed

as pred

ators

2. G

end

er Iden

tity No

nd

iscrimin

ation

Laws in

Pu

blic A

ccom

mo

datio

ns: a R

eview o

f Eviden

ce . . .

https://feministchallengingtransphobia.wordpress.com/2019/05/10/creating-a-lie-how-trans-women-are-portrayed-as-predators/

https://link.springer.com/article/10.1007/s13178-018-0335-z


© Sam Hope

Differences (like being trans

and autistic) often cluster

together

– this does not imply

causality

1. H

ow

med

icine m

istreats disab

led tran

s peo

ple

https://spooniehacker.com/features/society/how-medicine-mistreats-disabled-trans-people/


Learning points

• Harm is well evidenced when trans people (including children)– Are denied social transition

– Are subjected to conversion therapy

– Are denied civil rights

– Are denied appropriate, well evidenced healthcare (puberty blockers for <16s)

– Are not respected in their identity

– Are misgendered (wrong name, pronoun, etc)

– Are excluded based on being trans


What can we do differently?

• Update our language – homework!• Note if we’re resisting using correct pronouns,

name etc. **understand this causes harm**• Do some reflective work on what is blocking

us/how we see trans clients• Correct others when they misgender• Make sure our policies are inclusive• Reject attempts to exclude trans people based

on unevidenced “risk”• Support trans people to access the transition

options they need


It's so hard for me to get it

right!

I recognise it's hard on you when I get

it wrong


Affirmative model

• The trans person is the expert on themself • Only they know what is right for them and who

they are• There is nothing less good about being *any

kind* of trans person• There is nothing less good with *any* of the

available transition/non-transition options• No one way to be trans is better than any other• Cis norms, identities and appearances are not

better• More binary or non-binary norms, identities

and appearances are not better


Lunch – back in 20 mins!


Small groups work

• What are the issues affecting trans people?

• How might these impact trans people’s mental health?

• How might these create barriers to accessing our services/client relationships?


Q: What are the issues affecting trans people?

• Social isolation, marginalisation, stigmatisation• Misdiagnosis, pathologisation, gatekeeping• Homelessness/poor housing• Access to services and facilities• Employment issues• Abuse (historical and current)• Poverty• Physical violence including DV and hate crime• Suicide and self harm• Alcohol and substance abuse• Sex work/exploitation• Autism and other co-occurring disability, including

physical disability


Scottish Trans Study

0%10%

20%30%

40%50%

60%70%

80%

1

2

3

4

Percentage of trans people

1. O

ut o

f sight, o

ut o

f min

d? Tran

sgend

er Peop

le’s Experien

ces of D

om

estic Ab

use

http://tgdor.org/holocaust.shtml

https://www.scottishtrans.org/wp-content/uploads/2013/03/trans_domestic_abuse.pdf


Suicide Statistics for Trans People1

48%

59% 59%

35%

0%

10%

20%

30%

40%

50%

60%

70%

trans people

under 26 who have attempted

suicide

trans people

under 26 who have

considered suicide

trans people

under 26 who have

self harmed Overall

number of trans

people who have attempted

suicide

1.

PAC

E The R

aRE

research rep

ort: LG

B&

T men

tal health

2.

No

ttingh

amsh

ire Health

care Men

tal health

survey rep

ort fo

r LGB

T+ p

eop

le

In Nottinghamshire, UK, a 2017 survey showed that 60 per cent of trans respondents had self-harmed and 48 per cent had attempted suicide2

http://www.queerfutures.co.uk/wp-content/uploads/2015/04/RARE_Research_Report_PACE_2015.pdf

https://nottstranshub.files.wordpress.com/2018/07/2017-mental-health-survey-report-for-lgbt-people-in-nottinghamshire.pdf


Just to recap . . .

• Mental health issues correlate to mistreatment and transphobia, not to being trans in itself

• Recognising trans people’s gender legally and socially substantially improves mental health

• Access to medical transition improves mental health

• Conversion therapy is harmful and ineffective

• Suicide rates get lower as trans people get closer to their transition goals


Trans ChildrenStudies show that:

• Allowing children to socially transition is significantly beneficial

• Gender Identity is as stable in trans kids as in cis

• Conversion therapy (trying to help a child align to their birth assignment) is harmful


There is a direct connection between:

Supportive, accepting relationships

And

Good psychological, health and material outcomes


Trans clients feed back

• Out of date and problematic theorising. • Gatekeeping and infantilising• Making unwanted connections• Lack of competence/awareness• Being unaware of the traumatising nature of

transphobia• Problematic attitudes to trans people’s sexuality• Judging whether clients are “trans enough”• Misgendering (esp past self), othering, unskilful

language• Unaware of power imbalance/structural inequality

between cis and trans people


Some ideas . . .• Broaden knowledge by reading/following diverse

trans voices and reflecting on their words, • Update research evidence, unlearn biases• Respect client autonomy, affirm their self-

experience• All experience is multi-determined, one box will

never work• Develop an understanding of minority stress, bear

witness to trans pain/anger, civil rights struggles• Reflect on how society sexualises and objectifies

trans people and overly focuses on their genitals• Reflect on attitudes and biases to sex/sexuality/sex

work• Accept and use the words and definitions of the

client, for their identity, body parts etc.


Above all . . .

• Know when to refer a client on

• Understand the limits of your competence

• This training helps you treat trans clients with respect and dignity. It takes many years to become competent to do deep work around gender identity.


Minority Stress Model, Meyer1

• “LGBs have a higher prevalence of mental disorders than heterosexuals”

• “Stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems [due to]:– prejudice events, – expectations of rejection, – hiding and concealing, – internalized homophobia, – ameliorative coping processes”

1.

Preju

dice, So

cial Stress, and

Men

tal Health

in Lesb

ian, G

ay, and

Bisexu

al Pop

ulatio

ns

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072932/


The web model:A relational approach to minority

stress

sam-hope.co.uk© Sam Hope© Sam Hope

Media demonising

Minority Stress

Health Inequality

PovertyViolence

Discrimination

Services adding to

stress

HarassmentIssues

dismissed as “culture”

Hate Crime

Social Isolation

Poor Housing/

Home-lessness

© Sam Hope

Web

Model

sam-hope.co.uk© Sam Hope© Sam Hope

Media on your side

Hidden Support

Social Support

ResourcesLess

experiences of bullying

and violence

Better Housing,

Schooling, Healthcare

Being Noticed

Feelings ValidatedPositive or

Neutral Assumptions

Well attached

Access to Services

Being Believed

© Sam Hope

Web

Model


Social model of trans distress

A social model situates client’s distress in their social environment, rather than individualising it: It is the structures society created around gender that often harm trans clients. Not just individual change but structural change is needed to make trans people fully safe and well. These harmful structures will be unconsciously woven into the ideas and theories we were taught.


Any Questions?


• Further resources can be found on my website: sam-hope.co.uk

• Email me for the slides to this training – [email protected]

Sources of support:

• Mindline Trans helpline

• Gendered Intelligence

• Mermaids

• TransUnite: list of support groups

sam-hope.co.uk

mailto:[email protected]

https://mindlinetrans.org.uk/

http://genderedintelligence.co.uk/

https://mermaidsuk.org.uk/

https://www.transunite.co.uk/

trans awareness training - wordpress.com

Documents