Trans-Negotiations in Couple and Family Therapy
Beyond the Binary: Trans-Negotiations in Couple and Family Therapy
SHAWN V. GIAMMATTEI*,†
Dualistic notions about gender and sexuality have permeated the field of couple and fam- ily therapy. These binary constructions have been limiting for everyone, especially those who fall outside the male/female dichotomy. This article examines the impact of these bin- ary notions, especially on transgender and gender-creative individuals, couples, and fami- lies. Current theory and research in the field as they relate to gender identity, sexuality, and gender minority stress in couples and families are presented. Case examples are used to illustrate affirmative approaches to treatment issues such as coming out, safety, grief and loss, redefining relationships, and social/medical transitions that may arise for trans- gender or gender nonconforming (TGNC) individuals, couples, and families.
Keywords: Gender Nonconforming; Transgender Aging; Transgender Couples; Transgender Families; Transgender Parents; Transgender Relationships; Transgender Youths
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The field of couple and family therapy, like much of the world, has become trapped indualistic notions of gender. In couples therapy, we talk about same-sex or opposite-sex partners. On rare occasions, we contemplate those who are bisexual and have relationships with both men and women, but where does that leave those relationships where one or more of the partners does not identify as male or female? What labels do we use to describe these relationships? Furthermore, what are we actually describing with regard to gender identity, roles, etc., when we stick to binary constructions? How much do we miss in the nuances of couple dynamics or family processes when trapped in these constructions? How does this impact our children who do not conform to the societal expectations for their birth sex? It is time for us as family therapists to deconstruct these notions, not only for TGNC clients, but also for all of our clients and families who are trapped by gender straitjackets. I am not proposing that we throw out our constructs but rather that we expand our frame- works to include the diversity of identities and experiences that may be possible.
Although a majority of people across cultures and contexts experience something closer to a binary construction of gender, sexuality and gender are not so cut and dried for any- one. In terms of sexuality, it seems that a primary reason for condemning diversity in sex- ual orientation is that anything falling outside of a traditional heterosexual orientation challenges gender norms (Gordon & Meyer, 2007); it is not uncommon to hear anti-gay rhetoric that proclaims that LGB people are not “real” men or women (Giammattei &
*Online Certificate Program in LGBTMental Health & Human Services, San Francisco, CA. †Rockway Institute for LGBT Psychology, California School of Professional Psychology at Alliant International
University, San Francisco, CA. Correspondence concerning this article should be addressed to Shawn V. Giammattei, Ph.D., Rockway
Institute for LGBT Psychology, California School of Professional Psychology at Alliant International University, One Beach Street, Suite 100, San Francisco, CA 94133-1221. E-mail: sgiammattei.rockway@ alliant.edu.
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Green, 2012). These binary notions are simplistic and very limiting for everyone, especially for those who fall outside the gender binary.
To approach work with TGNC people, one must understand the natural diversity of gender and sexuality in human experience as well as what clinicians will invariably encounter in their work with such individuals and their families (Coleman et al., 2011). Across most cultures, the majority has a tendency to fear and discriminate against those who fall outside of the cultural standard. Yet, when one looks at the natural world, diver- sity is actually the norm (Roughgarden, 2004). It appears that what is naturally occurring is much more fluid and expansive than languages represent and most societies accept.
In most cultures, there is limited language or none for describing people who fall outside this binary construction of gender. For example, there is the wordMahu in Polyne- sian culture (Roughgarden, 2004), and some Native American cultures have words for the concept of being Two-Spirit (Williams, 1986), which both describe all who do not identify as their assigned sex at birth, play out gender roles opposite their assigned sex, or are attracted to same-sex partners (Roughgarden, 2004). Yet these terms do not fit for many; nor do they describe the nuances that distinguish one gender identity from another.
Transgender is a similar term and has distinctly different meanings depending on age and context. For adults, transgender is an umbrella term that encompasses a wide range of gender expressions and identities: Female-to-Male (FTM), Male-to-Female (MTF), agender, bigender, cross-dressers, drag kings/queens, genderqueer, etc. (Lev, 2004). Despite this, many therapists confuse the term with the older, more clinical term, trans- sexual. Although transsexuality falls under the transgender umbrella, it certainly does not describe all, or even the majority, of people who actually identify as transgender. In fact, many of those who have physically transitioned from one sex to another may no longer identify as transgender but as their affirmed gender; and they too may also identify with a binary construction of gender (Lev, 2004). For clinicians working with trans chil- dren and adolescents, transgender usually refers to youth that meet the DSM-5 criteria for Gender Dysphoria (GD; American Psychiatric Association, 2013) and have a strong desire to live in a different gender than the one assigned at birth. Children who do not meet the DSM criteria for GD but express their gender in ways that do not conform to society’s expectation for their assigned sex at birth are usually referred to as gender nonconforming (GNC).
Under the transgender label is a complex and ever-changing range of identities, expres- sions, and naming systems that show the fluidity and diversity found in the community (Beemyn & Rankin, 2011). TGNC youth, in particular, tend to use more fluid and spacious terms to refer to themselves, such as gender queer and gender expansive. Many in the community find the term transgender too limiting and have moved toward using the terms Trans* or Trans as an umbrella term when referring to the whole community. This article uses the term trans to be as inclusive as possible, and the term trans couple to describe all couples with one or more partners whose gender identity falls under the trans umbrella.1
Despite outward appearances, trans couples may identify themselves as such or some- thing else.
Obviously as a clinician, one can never know how a client identifies or what language they use to describe themselves unless you ask. If you assume nonbinary constructions of identity, you may offend a trans person who identifies with the binary; and on the other hand if you only hold two options, your client may feel misunderstood or rendered invisible (Malpas, 2006). It is good practice to ask clients their name, pronoun, and gender descrip- tion, as well as honoring their language when interacting with them or discussing their
1Definitions for italicized words can be found in the glossary (Appendix A) following the references section for this article.
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case. It is considered very disrespectful to actively ignore a trans person’s affirmed language and to do so may lose your client’s trust. At the same time, this can become tricky when working with family members who are not yet accepting of their loved ones’ gender identity, especially parents. Therapists may find themselves using different terms depending on who is in the session, especially if they have come in to deal with gender-re- lated issues such as a social or medical transition (Stone Fish & Harvey, 2005).
Despite an increase in understanding of gender issues across the lifespan as a result of recent gender-affirming media coverage of trans youth and their families, the societal support of rigid gender roles and fear of anything outside binary con- structions of gender often throws a family into crisis when it becomes apparent that a family member, partner, or spouse is trans. How these families deal with this cri- sis depends on their own notions of gender, parenting, and the family’s level of social support (Giammattei & Green, 2012).
SEXUALITY
Another area that one must understand when working with gender diverse clients is the difference between gender identity and sexual orientation, and the diversity of sexual orientation identities in the trans community. First and foremost, transgender and transsexual are not sexual orientations. Trans people come in all sexual orientations: heterosexual, gay, lesbian, bisexual, pansexual, omnisexual, asexual, etc. In their study of over 3400 GNC people, Beemyn and Rankin (2011) found that respondents’ sexual orienta- tions were almost as diverse as their gender identities. One third identified as bisexual, 30% as heterosexual, 22% as gay/lesbian, and 16% as other. The younger participants were more likely to identify as other and included terms such as pansexual and queer. These findings are consistent with Savin Williams’ (2005) findings of sexual fluidity in his study of gay youths and a recent study of trans male sexuality (Meier, Sharp, Michonski, Babcock, & Fitzgerald, 2013).
As stated earlier, sexuality can become difficult to define when a person does not fit neatly into the male/female binary. Furthermore, how someone identifies with regard to sexual orientation may shift if the person is transitioning from one gender presentation to another. For some, their…
