I decided to dedicate myself to investigating and writing about the experience of body in transgender people. Though I am by no means an “expert” in working with this population, I have learned significantly from people I have worked with who identified themselves as transgender. I set out to organize my observations and insights by grounding them in current research, to offer something of use to the reader that is legitimized by work in the field. It struck me that in looking at body-appearance satisfaction we could learn a lot from people who experience being born with, and living with, a body that they experience as opposite of what they were suppose to have.

What is the nature of the relationship to the body for transgender people? How do they value their body? How do they take care of it, take pleasure in it? How do they deal with other people’s perceptions versus what they see or what they wish they could see? Does that change if they are able to change their body to look like what they believe they were supposed to have? What I was to discover was a dearth of research and a complete lack of theory or even sufficient conversation on the topic. There was certainly almost nothing scientific or academic of any use to working with clients. So here are my truncated thoughts combined with what I learned in my search for information on a very complicated subject.

For those new to this area, know that for transgender people, the desired body isn’t a thought, or a feeling, or even a drive. History has shown that the experience is relatively unchangeable. I would describe it as an experience of persistent identity messages incongruent with the physical body. There is a “hardwired” nature to this lived experience, though science hasn’t found the neural connections yet. Despite abusive efforts to create aversion in people who feel they are in the wrong body, to force them to stop thinking of it and stop expressing it (society can’t handle ambiguity or non-conformity, apparently), transgender people don’t stop being transgender.

[fat_widget_right]For most documented cases, it has proven to be a life-long struggle between the inner sense of self and the physical, external self. It has also, for most, been a struggle between expressing the true self and repressing it in order to earn or keep acceptance and belonging in relationships and in society in general. The extent that people (often rightfully) fear societal reactions to their true identity is directly related to how much psychological distress they suffer.

Interestingly, to the transgender child, there is no incongruence or distress about the body until they are confronted with the gender that is socially assigned according to the worlds’ image of them. They are often shamed, ridiculed, and otherwise discouraged from expressing what they consider to be their true selves, from an early age. You don’t have to be a therapist to think about the impact of such conditions of worth on the development of self-esteem. Indeed, transgender people have the highest rate of suicide.

There is some published anecdotal evidence that children who are allowed to explore their gender-related interests and self-expressions without external pressure to conform are better adjusted. There is also some research that suggests that trans people who have the resources and support to transition—and who believe they will be able to “pass” as the desired, chosen gender—have better mental and physical health outcomes. Also, while trans people have been shown to be at greater risk for developing eating disorders due to body-image dissatisfaction, depressive symptoms, and low self-esteem—they have also been shown to have reduced risk of these problems after gender-confirmatory surgery.

How do we begin to support these people or even understand their struggle and offer them hope? What is our role as therapists or friends in supporting transgender people? We know that body image issues are a problem for women who feel the pressure to conform to societal ideals and this can result in negative self-perception and negative health outcomes. In clinical studies, trans people have been described as being obsessed with the aesthetics of outward appearance. It makes sense that a trans person, having to live with a body that looks nothing like what they want and one that is often in complete opposition to social ideals for the gender they feel they are, would have even worse self-perception and greater negative health outcomes. So how do we help?

I believe in the fundamental healing value of acceptance and understanding of human experience. In my role as a therapist, I must be a non-judgmental mirror for the people I work with. In asking “what” rather than “why” questions, like at the outset of this article—I can get closer to an understanding that can allow me to mirror a person’s inner view of themselves. In that way I can strengthen the sense of self and self-worth of a person. I work to emphasize the importance of the functions and joys of the body, not just its appearance.

I share the idea that self-esteem comes from dedication to loving self-care and encourage habits that lead to better relationship to the body. This can be life enhancing for a person who has had very little acceptance and hence suffers low self-worth. Indeed most trans people I have met tend to focus on the well-being of everyone other then themselves. However, to truly support trans people in healing their relationship to the body, I must also educate myself on their unique experiences and needs, whether they are in transition or not. I must also be political in joining the struggle for their rights, including educating others. I must be an advocate that supports their rights to dignity and well-being, if that involves gender-confirmatory surgery or other procedures or services. Hopefully this article is a drop in the bucket towards that monumental task.

Most teenagers naturally reach a point where the bounds of sexuality are explored and roles and sexual identity are created. For LGBT teens this natural part of growing up can often be confusing and overwhelming, resulting in a variety of responses. Some individuals experience such intense negative emotions about their sexual feelings that they repress and push those feelings as far away as possible and choose to ignore their sexuality.

By hiding deep in the closet, these teens are setting themselves up for an uphill battle as they get older and inevitably arrive at a point in their adult lives when the reality of their feelings can no longer be ignored. In other cases, this aspect of an individual’s personality does not surface until later in life at which time they may uncover feelings of same sex attraction, for example.

However they arrive there, the challenge of coming out in adulthood is a unique and often mystifying journey for both the person coming out and the people in their lives. As an adult, the fabric of life is often strongly developed with work relationships, long-term friends, and even children and spouses. The complexity of this web of relationships can make the process of coming out quite messy in adulthood, characterized by experiences of deep confusion, guilt, betrayal, rejection, and heartbreak.

When LGBT adults make the difficult but necessary choice to come out, they are often faced with many emotionally fraught questions from people who are shaken by the revelation that their friend or family member is not the person they thought they knew. There can be feelings of shock, anger, and disapproval from those close to the newly identified LGBT person. It is a bewildering experience for everyone involved.

The most basic questions from friends and family address concerns that the newly open LGBT person has been hiding their true nature and their sexuality, and that the trust of the relationship has been broken. Both parties experience feelings of loss and confusion that can severely strain the bonds of the relationship. [fat_widget_left]

For the person coming out, at a time when they most need the support of their friends and family, this layer of confusion can create a perceived lack of safety from the people who would otherwise be that individual’s support network. This lack of support can sometimes lead to an interruption in the coming out process and lead the newly open LGBT individual to regret the decision to come out.

In addressing this issue, it can be important to realize that not only are adults who come out having to redefine themselves and their relationship to their community but also the people they are coming out to have to create a new framework of understanding.

When an adult child comes out to family members, the family story of kids, grandchildren, spouses, and family that has been carried for many years must be re-authored to make the new details meld into the existing family scenario. A time of transition will occur where parents, relatives, and siblings will need to re-establish the family story with fresh details adding a vital new definition to the fabric of the family history. Some family members may become estranged as a result of religious disapproval or an inability to move past feelings of betrayal.

For close friends, there is also a redefinition that must occur in order to assist in building a strong bond between the newly out and open LGBT person and their friends. With both family and friends, questions of lifestyle, safety, and the impact this news will have on future relationships may come to the forefront. Some people who have just come out will feel comfortable answering all of these questions and more, while others may be unsure of their own feelings and may not have all of the answers at that time.

Leaving room to discover this newly developed aspect of the LGBT person’s identity is vital in their ability to define and understand who they are. All of the answers may not be available immediately but the process of coming out is an ongoing experience with new pieces of understanding being continually discovered.

And most important for all people involved in the coming out process—from the LGBT person coming out to family and friends—the qualities of the person coming out are not changing. All of that person’s vital goodness and qualities remain, with the addition of new and exciting aspects being shared openly and honestly for the first time.

The question often comes up among LGBT (lesbian, gay, bisexual, transgender) people: should they see a gay therapist, or would they would be comfortable with a gay-friendly therapist? This is a personal decision people need to make for themselves, but as in choosing any therapist, it is important to find a professional who has the education, the empathy, and the ability to understand your individual needs.

Although there are many gay-affirmative and gay-friendly therapists, sometimes it is important to find a therapist who is a member of the gay community. The process of therapy is a very personal one, and for many people it is vital that their therapist be someone who understands and can directly relate to their life experiences. For many LGBT people, there is an internal process that makes it important for them to work with a therapist who has direct knowledge of what it is like to live as a member of the gay community.

So what should you look for when choosing a therapist who specializes in LGBT issues? First off, if having a gay therapist is important to you as a client, then you should make sure you find a therapist who is open about his or her sexual orientation and is willing to openly discuss yours. A gay therapist who is comfortable with his or her own sexuality will be more open to discussing issues that you may be facing as an LGBT person.

But sexual orientation is not all that one should look for in a therapist. It is also important to ask questions about the therapist’s education, training, and understanding of the issues that can face LGBT clients. Your therapist should be familiar with issues of sexuality, coming out, internalized homophobia, HIV/AIDS, depression, and self-destructive behaviors, as well as more traditional issues like couples, dating, social skills, and relationships as they pertain to the LGBT population. Not all gay therapists will be experts on all of these topics, but you want to find the one who has the knowledge to address your personal needs.

Beware of therapists who promise to treat or “cure” homosexuality, as this type of therapy has been found to be unsuccessful. It can often be damaging and lead to low self-esteem, guilt, self-destructive behavior, and even suicide. A good therapist will assist you in finding your personal comfort with your sexuality and not try to “cure” or “fix” you.

Another issue that can come up for discussion in therapy is sex. For many gay people, it is important to have a forum where they can talk openly about sex and the myriad issues that surround intimacy. Ask your therapist whether he or she will be comfortable talking openly about sex and other personal issues that affect you as a client.

As much as it is important to learn about your therapist’s sexuality and commitment to working with LGBT clients, it is equally important to make sure that your therapist will maintain appropriate boundaries in regard to discussing his or her personal experiences. Under no circumstances should there be sexual contact or behavior between client and therapist.

An excellent way to find an LGBT therapist is to use the Advanced Search function here at GoodTherapy.org and enter the search term “LGBT Issues.” You can also check with your local gay and lesbian center, which will often have a resource list of local therapists who work with the LGBT community. Referrals from friends are another great resource in the search for a good therapist who can address your personal needs.

Finding the right therapist for you is vital in order to create the most beneficial outcome of your commitment to go into therapy. Take the time to interview your therapist, making sure that you find the right person who will be able to assist you in your rediscovery of yourself. Whether the therapist is gay or gay-friendly, the right match of therapist and client is the foundation for an exceptional therapeutic experience.