Thank you so much to those who gave me input from your own experience. Here is the list of what I cover in this video: 1. Listen and trust that trans people are the experts of their own lived experience. There are infinite trans narratives.
2. Fears and anxiety may not be pathological. They can be normal responses to the constant discrimination trans people face. For example, a trans person may fear that they'll lose the ability to pass if they gain weight. This is not a cognitive distortion – being able to pass as one's gender lowers the risk of experiencing violence and harassment and can reduce the level of discrimination experienced.
3. Body Dysmorphia =/= Gender Dysphoria. With dysphoria, people see their body for what it is and it doesn't match their perception of their gender. Treating dysphoria often requires changing the body, generally through hormones and/or surgery. Try to reframe recovery ideals such as “change your thoughts, not your body” or “learn to embrace your body” with inclusive messages like “all bodies are worthy of care and respect”.
4. Trans people have a long history of invalidation, both historically and as individuals. Many have wrestled for years with accepting their identity. Ensuring that this dynamic is not reinforced in therapy will help build safety with your client.
5. There's an expectation, especially within the trans and queer community, that all trans people have or have had mental health problems. Trans people are expected to have suffered from being oppressed, experiencing rejection because they are trans, and having struggled to come to terms with their identity. Recovering from their eating disorder may be especially frightening if part of its function was to validate the client's trans identity.
6. Even between trans people, similar symptoms can arise from different processes. The reasons trans-masculine people are prone to eating disorders are different from why trans-feminine people are prone to them, but even between trans people who share a gender identity (eg both trans-feminine) there can be different reasons why the same symptoms develop. Take care not to assume that one trans person's eating disorder has the same causes as another's.
7. Being transgender is not a mental illness. Gender Dysphoria is a current DSM diagnosis for a variety of reasons. Some trans people feel like their dysphoria is a disorder. For others, having a diagnosis can simply be a requirement for insurance to cover their transition.
8. Ask for your client's preferred name and pronouns since these aren't always reflected in medical records. Advocating for your client's name, pronouns, gender, etc. with their other providers can be very helpful as well.
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