1 CHAPTER 1 Introduction The True Colors of Authenticity I see your true colors Your true colors (Written by Billy Steinberg and Tom Kelly) The quest to know our true identity is a challenging process that evolves over a lifetime. Transitions are inherent for everyone, yet these shifts of physical, intellectual, emotional, social and spiritual change are even more challenging for transgender or gender non-conforming (GNC) youth. Transitions include birth, childhood, adolescence, adulthood, death and everything in between those phases that embraces a shift or an adjustment to a life circumstance. When these life phases also include an evolutionary change of the individual as well, it can be a difficult and seemingly never ending journey. The journey toward self starts with the pronouncement of our biological or assigned sex. The moment the declaration boy! specific gender begins. For many of us gender simply is. It is not something that is questioned, debated, or defended. 1 2 What happens to the transgender child when that declaration of assigned sex or in other words, their gender identity or gender expression does not conform to the sex of their body? How might they adapt healthfully into a world that often rejects atypical presentations of what it means to be a boy or a girl? How can mental health care professionals best guide, assist and support these children and their families through this process? Kate Bornstein (2013), author and transgender activist, stated The genders well-rounded, creative, loving people I . (p. 73). When transgender youth are insistent, persistent and insistent regarding their gender, we need to look and listen to what they are really saying because they are providing us with invaluable information about themselves and how they relate to the world. Transgender children and adolescents are an underserved and poorly researched population that has very specific medical and mental health needs (Olson & Forbes, et.al, 2011). Finding comprehensive medical and mental health services is extremely difficult for these youth who are at risk for multiple psychosocial problems including family and peer rejection, harassment, trauma, abuse, inadequate housing, legal problems, lack of financial support, and educational problems. The Purpose of the Study This descriptive, qualitative study will address the various ways trained counselors may begin to understand concerns facing transgender youth and their families. The author will describe how the expressive arts therapies might be used as an adjunctive modality to help clients navigate and cope with core issues often seen in a counseling setting. This will include timely medical interventions paired with affirmative mental health approaches to minimize 3 negative outcomes and maximize positive futures for transgender youth. Latest research on counseling transgender youth and their families will be discussed, particularly through the use of the expressive art therapies: with an emphasis on poetry and narrative therapy; art therapy and music therapy. After describing a personal relationship to the topic of transgender youth and the expressive art therapies, the study will include three case examples of transgender youth and will incorporate their poems, stories, and drawings. Informed consent informed assent from the clients was obtained prior to the study (see Appendix B). Pseudonyms The questions that this study sought to explore included: How might a counselor employ solid practices to assist the transgender child and their family develop awareness, obtain professional assessment and treatment approaches and finally foster acceptance that will promote healthy communications, transitions and daily living? What are the various ways clinicians can help trans-variant children to express the unfolding story of their lives in a way that will lead toward psychological fulfillment, balance and maturity? My interest in studying transgender populations or transsexuals (as it was commonly called then) began in the early 1980s when I was completing a genogram (family tree) for my graduate class in family therapy so that I could understand patterns and connections that made my family unique. However, there were parts of my family tree that were truncated or left blank and I had questions that only certain people could answer. I went to my mother for clarification. She had difficulty answering at first and finally said, just some things that families eds to know this, anyway? sex and other private matters, but I was relentless and needed to complete my assignment. She 4 gave me just enough information to satisfy me for the moment and then never spoke about it again. I completed the genogram with her minimal information, but my curiosity was piqued. I wanted to know more about my cousins in particular, but realized this information would not be forthcoming any time soon, and certainly not from my mother. Did mom swear to secrecy not to reveal certain information about our family that she felt were taboo? Was she embarrassed or of authority or knowledge to answer? Sorting out the necessary facts from the assumed or unknown is no trivial matter. It takes steadfast research and acceptance of particular findings. Sometimes what is uncovered is not palatable as this often includes an exploration of the areas of discord or dissonance. Even when equipped with a strong flashlight, accessing these dark spaces can feel a bit intimidating. Most families have secrets or skeletons that they choose not to reveal. For some, this may include sexual orientation, infidelities, divorce, or mental illness. This emotional baggage can be difficult to carry, let alone unpack. For transgender youth and their families, this developmental process of privately and publicly coming out can be challenging. Becoming a Gender-Sensitive Counseling Professional Treatment approaches for gender identity issues in youth generally falls into 1 to 3 categories. The first of these is affirming approaches that are based on certain fundamental concepts, including the idea that being transgender is not a mental illness. Affirmative approaches actively promote exploration of gender identity and assist adolescents and their families in learning about and engaging in appropriate gender transitioning interventions, such 5 as social transitioning and hormone therapy. The second treatment approach involves supportive therapies, which generally endorse a wait and see approach on how gender identity unfolds as the child ages; supportive interventions are not focused on gender specifically and do not advocate any gender- identity with biological sex. The corrective strategy is the treatment that has been researched in the most depth; however, many experts express serious concern about how success is defined in these studies and the harm done to youth by invalidating their sense of self (APA, 2009). Gender- what they are truly saying about themselves. It is imperative that these children are given a chance to grow, discover and articulate their story in their own time frame and in their own way. Gender-sensitive professionals offer services not to fix the child, but to build resistance, sort out conflicts, facilitate family and community supports, supply evaluations and recommendations to other health professionals. In addition, they provide a private, creative and safe space when needed for children to express and explore their gender selves, selves that may radically go against the grain of the culture in which they live (Ehrensaft, 2011). Successful outcomes will rely on the ability to form and network with a team of experts in all areas of emotional, physical and spiritual knowledge and support. Clinicians will need to also be mindful of the possibility of burn out, especially if they are working in a vacuum as a sole practitioner without the support and necessity of such a vital team of experts. The successful clinician works as a liaison for resources regarding family concerns as well as providing contacts within the community to assist with school, medical or social issues. Reinforcement of family acceptance and understanding of transgender youth is also highlighted. 6 For the first time, researchers have established a clear link between accepting family attitudes and behaviors towards their lesbian, gay, bisexual, and transgender (LGBT) children and significantly decreased risk and better overall mental health in adulthood (Family Acceptance Project, 2010). The study shows that parental support and advocacy fostered greater self esteem and social support in young adulthood. The behaviors of support helped to protect against depression, substance abuse, suicidal thoughts and suicide attempts in early adulthood. No prior research had examined the relationship between family acceptance and support for LGBT children. The LGBT acronym has finally changed to include the T for transgender people. Sometimes the acronym appears as LGBTQIA, with Q representing questioning or queer people, I for intersex, and A for allies (straight supporters), or, less frequently, asexual. However, for the purpose of this study, I will use LGBT. The very act of naming is powerful. It is a declaration and a construct of our own identity. According to Lori Selke, a poet included in the anthology, Troubling the Line: Trans and Genderqueer Poetry and Poetics , (2013) its own rules, its that cannot be expressed in traditional grammatical forms can be articulated in another way ... through allusion, through sound, through wordplay. Genderqueers