- Written by Anna Marasco, LCSW
Being transgender is often a trauma in itself, and we like to have great empathy for individuals who are trans when welcoming them to Bridge House. It is important to fully understand what it means to be transgender before treating or supporting a person who identifies as such. To be transgender simply means that a person identifies as a different gender than their biological birth gender. Research has shown that people who identify as transgender often possess the brain of the gender with which they identify, and not their biological gender assigned at birth (Cleveland Clinic, 2019).
Trans people are often victims of violence and discrimination. An open transgender status frequently finds individuals forced into unemployment, poverty, homelessness, and/or survival sex work. In 2019, at least 22 transgender and non-conforming individuals have been victims of fatal violence. This number also does not accurately depict the number of deaths because many police reports have misgendered these victims (Human Rights Campaign, 2019). Trans women of color face some of the highest levels of discrimination in any population nationwide (National LGTBQ Taskforce, 2019). Access to healthcare is very limited, as they are frequently turned away by doctors, therapists, and medical professionals due to personal beliefs, fear, or not specializing in transgender care. They also face daily persecution due to others not using their preferred pronouns, which results in daily revisiting of trauma and magnifying what the individual sees as “wrong” with them.
Most people who are transgender learn from an early age to feel uncomfortable in their own bodies—they look in the mirror and see the parts that aren’t supposed to be theirs, they look at what’s wrong with them. There was an instagram post by @TBESTIG that circulated social media recently about what it was like to be trans. It shared about how people who don’t fully understand often say, “I identified as a dinosaur when I was six, kids that age are too young to know they’re trans.” The post then continues, “Nah, mate. You didn’t identify as a dinosaur. You didn’t cry yourself to sleep because you couldn’t figure out why you had no tail. You didn’t feel inexplicable sense of shame at your lack of claws. When you saw yourself in a mirror in a dinosaur costume, you weren’t upset about all the non-dinosaur bits you could still see. When others saw the costume, you weren’t brought to tears by them treating you like a child-wearing-a-costume instead of a real dinosaur” (@TBESTIG, 2019).
Being transgender creates an identity crisis from an early age because your body—something that you should be able to rely on and trust—is telling you that you are not allowed to be yourself. This results in struggles with self-confidence, self-esteem, and difficulty finding a place in society because transgender individuals often feel like they don’t belong in social settings due to their foundational feeling of not belonging in their own body.
When we approach treating people who identify as transgender, the most important thing we remember is: if someone says they are trans, we believe them. When this person shares their preferred pronouns and names, we use them. Not only does this validate who they identify as, but it validates them as a human in a world that often treats them less-than. A person who is trans has already decided their gender and their place, it is not anyone else’s place to decide that for them. We are not here to change their identity, but we are here to support them through the process of reinforcing who they are and who they want to be.
People who identify as transgender are not seeking attention and are not “going through a phase.” Being transgender is a risk in today’s society—it is unsafe, it is a target for discrimination and violence. It is imperative to consider how important it is for someone to transition if they are willing to face the risks of transitioning (violence, discrimination, loss of relationships, loss of family, homelessness, poverty, etc.), versus living as the wrong gender. This isn’t a choice, but the individual’s biological makeup, as shown in the Cleveland Clinic research (link below).
In understanding a person’s experience in being transgender, therapy can often lead into the exploration of the person’s relationship with gender throughout their life. Being trans inherently brings trauma, and it is important to explore this in therapy in a non-threatening approach that builds from a non-judgmental foundation of safety in the therapeutic relationship. People who have experienced trauma often will resort to behaviors of survival.
Being trans isn’t bad, and it isn’t something to change. And when we step out of the individual’s way and don’t try and change who they identify themselves to be, we empower them to take control of the life they want and deserve.
Cleveland Clinic (March 27, 2019). “Research on the Transgender Brain: What You Should Know.” https://health.clevelandclinic.org/research-on-the-transgender-brain-what-you-should-know/
National LGTBQ Taskforce (2019). Website: www.thetaskforce.org
Human Rights Campaign (2019). Website: www.hrc.org
Interview with Connie Anast-Inman (November, 2019), Executive Director for TEA (Transgender Education Advocates) of Utah from April 2011 to June 2015.
- Written by Dr. Chris McRoberts
We are frequently asked by potential residents, their families, and members of the therapeutic community how we developed the ideas, assessment procedures, and therapeutic modalities utilized at Bridge House. This is a difficult question to answer because it was a plan developed over a period of nearly two decades. This plan began when Dr. Chris McRoberts created a psychological testing and evaluation firm with psychologists specializing in evaluating children, adolescents and young adults in schools, therapeutic programs, and private practice settings around the United States and even internationally. Over the years, it became clear to Dr. McRoberts that a majority of people with mental health, cognitive, learning, substance-abuse, and behavioral difficulties were not being adequately assessed or accurately diagnosed prior to beginning costly and time-consuming therapeutic regimens. Many people were being tested during times of crisis or while in a hospital when test results could be erroneous. Additionally, many people underwent psychological, educational or neuropsychological testing when they were experiencing the lasting effects of drugs or alcohol or immediately after significant medication changes which might impact their test results. Some were evaluated in the midst of a severe psychotic, manic, or depressive phase of their illness. Others had physical illnesses, chromosomal abnormalities, dietary problems, family situations, or histories of trauma that could cloud test results and lead to inaccurate diagnosis. It became clear that a slower, comprehensive, integrative, and community-based assessment strategy should be implemented.
In 2016 Dr. McRoberts partnered with Rod Andrus, a skilled clinician and manager with more than 20 years of experience creating and implementing therapeutic programming in residential settings. Together they developed a strategy for working with a diverse array of people experiencing mental health and adjustment problems with the goal of understanding the complex underlying reasons for the struggles people were experiencing. They utilized research evidence showing that people in acute and chronic distress must experience a caring and nurturing environment with their caregivers to feel safe and secure enough to make therapeutic gains. The assessment program they developed at Bridge House focuses on this type of environment while also providing structures to keep residents safe while they develop stability and with it the ability to heal. As this program is implemented, medications are adjusted and residents undergo medical, dietary, occupational therapy, DNA, and other comprehensive assessments before efforts are made to accurately diagnose and understand their problems.
Mr. Andrus and Dr. McRoberts also determined that a necessary component of the assessment process was to effectively communicate assessment results to each resident, to their families, and to future treatment providers so that a plan could be developed for lifelong health and healing. Because it often takes some time for people to understand the complexity of their issues, an integral part of the Bridge House process is helping each individual understand their diagnosis and the types of supports and therapeutic interventions they will need in order to function optimally in society. To this end, each individual at Bridge House participates in a wide variety of community activities in order for their ability to function outside of residential treatment to be evaluated and future plans can include interventions tailored to their reactions to real life experiences and challenges.
It was also clear that during the three month assessment process developed at Bridge House people could make significant change. This is accomplished through a wide variety of therapeutic interventions including eight hours a day of various forms of group therapy made available to residents, intensive individual therapy, and effective medication management. These interventions have consistently enabled Bridge House residents to make tremendous gains, which in turn, allow them to transition to the least restrictive level of care possible.
At Bridge House a fundamental tenet backed by many years of research is that caring relationships heal. Because of this, we hire the most kind, compassionate, and caring people we can find who are also able to set good limits and boundaries. This contributes tremendously to the healing process and creates an environment of peace, safety and security within which our residents feel secure enough to try new behaviors and to risk their deepest selves in order to make change.
Finally, the environment at Bridge House was chosen specifically for the peace and calm it engenders. Our beautiful home sits on five acres with a serene pond, outdoor living spaces, grassy areas, and beautiful trees away from the hubbub of city life. Our residents are free to move around the property, and, when they are safe to do so, can regularly go off the property to engage in service, athletic, and community activities.
We are trying something new at Bridge House, and it’s working to reduce the revolving door that so many people with mental health problems go through with multiple therapists, hospitalizations, medications, and other interventions that were ineffective due to an inaccurate diagnosis and a lack of understanding of each complex individual. We work hard at Bridge House to develop understanding, to create effective interventions, and to communicate our understanding of each resident and what will benefit them long-term.