Guest Article

Navigating Mental Health As A Trans & Non Binary Person

Van Ethan Levy, LMFT, LPCC

In my and my clients’ experience navigating mental health as a trans person, it is unfortunately near impossible to find a mental health professional who creates an affirming environment for therapy.

The tone set as early as the mental health professional’s (MHP’s) publicity and intake paperwork is already one of exclusion.

For instance, rarely do intake forms have spaces for pronouns to be listed, or when they do this is sometimes requested as “preferred pronouns.” Typically a form asks for “Gender” or “Sex,” sometimes with only the binary possibilities of “male” or “female” listed, sometimes with an option of “other” (who wants to be described as “other”?), sometimes with the options “trans male” and “trans female,” as if people who are trans are not “real” males or females.

These examples are all transphobic micro-/macroaggressions. One’s “gender” does not communicate one’s pronouns, and neither does the way a person presents. Instead, MHPs can put a blank for pronouns, and then only use the pronouns listed, not what they decide the client’s pronouns are.

MHPs can also think about why they need to ask the client’s gender. And rather than using “name” to refer to “legally assigned name” and “preferred name” to refer to the name the person uses, if it is necessary for MHPs to know information for insurance purposes, for example, the MHP can ask for “legally assigned name” and “legally assigned gender,” in addition to client’s name.

When people in my community contact MHPs and are met with terms such as “ma’am/sir/Mr./Miss/Ms./Mrs.,” this signals that the MHP’s general awareness is firmly within assumptions about gender and the gender binary and that the space is not safe.

When this is pointed out to them, MPHs may become defensive, due to:

1. Cis fragility: Derived from race fragility, this is when someone is resistant/ defensive when hearing experiences that differ from those of the person’s own gender. Cis refers to when someone’s identity aligns with the gender that the person was assigned at birth. An example would be when a person points out that what the MHP said was harmful and the MHP argues that the person was being too sensitive or that the MHP is an expert because of (insert degree, education, identity, etc.).

2. Internalized transphobia: Thoughts and assumptions we all have inside of which we may not aware. These are due to societal constructs, i.e. beliefs that have been constructed by society (e.g. a societal construct in the US is that skirts are for girls/women, while in Scotland what may look to us like skirts are in fact kilts that are for men). Examples of relevant societal constructs are saying things like, “the person was (insert gender) and is now and/or wants to be (insert gender), and the person appears/presents as (insert gender).”

Such responses are transphobic, and extremely harmful to the trans community (non-binary, non conforming, and many more identities). It is vital for MHPs to address consistently and constantly their internalize transphobia, even if they do not believe they have it and/or will work with someone who is trans. For all MHPs know, they may be working with a client who is not cis, and it may not have been safe enough for the person to come out/ share their identity with the MHP.

As the MHP self-educates through training/articles/blogs by people who are part of the community the MHP is learning about, it is equally vital to remember that a client’s experience is more important than the MHP’s perception and/or what the MHP has learned elsewhere. We are not a copy and paste; just because someone has learned one thing about someone who holds an identity does not mean it applies to everyone who holds the same and/or similar identity. Trans/nonbinary/nonconforming and many more identities that one holds does not make us all the same, just like all womxn/men are not the same. If we ask 100 womxn what it means to be a woman, we will get 100 different responses.

I will close by describing two parts of my identity to shed light on some of these concepts. I am trans and what this means to me is that doctors assigned my identity as female at birth because of their internalized transphobia that women have vaginas and men have penises. Therefore, my identity does not align with the one that was violently forced upon me.

I am also non-binary, and to me, my non-binary identity means that in order to be my authentic self I chose to show up as me and not fall into the societal constructs of what it means to be man/woman but rather who I am.

This can be hard to conceptualize because of our internalized transphobia and learned societal constructs. As a result, the world has not seen and still does not see me for who I am. If you are interested in unlearning internalized harmful messages/behaviors and learning to create supportive and affirming ways of engagement, please consider buying my interactive workbook Exploring My Identity(ies) or contacting me for my training on deconstructing gender.

Van Ethan Levy, MA, LMFT, LPCC, (they) (elle), a trans and non binary therapist, is a queer, non binary, trans, socialized as female, nBPOC (not Black Person of Color), who is autistic, and has dynamic disabilities amongst many more historically excluded identities. Van provides consultations and trainings on trans and non binary identities, is the organizer of the 2022 Virtual International Do Something: Identity(ies) Conference, authored the interactive book, Exploring My Identity(ies), and produced the Documentary, Do Something: Trans & Non Binary Identities, Website: VanEthanLevy.com