 The Distract, Relax, and Cope technique is a Dialectical Behavior therapy technique that can help you with anxiety and feelings of dissociation that many are experiencing during this stressful time. 1. Distract: Sometimes, the best way to distract yourself from painful emotions is by doing pleasurable activities. You do not have to wait until you feel overwhelmed to try a pleasurable activity. The recommendation is to do something pleasurable every day as it can help stave off depression by activating endorphins in the body. Some examples of pleasurable activities you could try are:
Other things you can try to distract yourself are: Doing something for someone else can be very useful, distracting your thoughts by keeping a prayer or special saying with you, distract with tasks and chores, or distract by placing your hand on your belly and counting your breaths (or counting anything) 2. Relax and Soothe Yourself: Relaxation is essential for our health and well-being. When you relax, your blood pressure lowers, your heart beats more slowly, and you can get out of your flight or fight response, which allows your brain to think of healthier ways to cope with your problems. A great way to relax and ground (perfect for dissociation) is to utilize the five senses. Focusing on and engaging with what you smell, see, taste, hear, or feel in the present moment can help you relax and soothe. Smell
Sight
Hearing
Taste
Touch
3. Cope: Put your relax and distract skills into practice! Pick some from these lists that work for you or come up with some new ideas your own! Keeping your stress levels down keeps your cortisol down, which helps your immune system function better and promotes feelings of well-being. So, the next time you are feeling stressed, remember to distract, relax, and cope!
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 All About Spectrums is a three-part blog series, so if you are just now tuning in, there are two previous parts that are full of helpful tips for having challenging conversations, educational information, and terminology that will be helpful when reading this installment. All three parts follow the storyline of a conversation I had with my mom about gender and sexuality, and what that looks like for different people. In Part 3: Gender Expression, I will be tackling how we all make decisions about expressing ourselves, and how physical appearance is a window into which others can begin to know who we are and, also misjudge us. After sitting in the small hotel café for over an hour and a half, our cups and plates long empty, our minds were spinning with all the layers of conversation about gender spectrums, sexuality spectrums, how transgender people know they are transgender (the short answer, they just know!), pronouns, and the importance of being seen and acknowledged as a whole person, including all of the various aspects of identity. There was an element that I felt was missing from what we had discussed so far. We touched on it here and there but had mostly avoided or made assumptions about it. Breaking the #1 rule about not defining a term with the term, gender expression is simply how someone expresses their internal gender experience outwardly. Despite the first impression seeming simple, gender expression is something that is very complex, wrought by history, culture, location, society, gender roles, and many other contextual factors. When I first learned about Queer Theory in college, I became fascinated with the concept of a set of ideals and meanings being constructed by and within a social group. Even though my mom did not directly ask about gender expression, I could not resist exploring the topic. What is Gender Expression? When you think of what a woman or a man looks like, images probably come to mind, features are highlighted as seemingly belonging to each. Where do you think that you learned these from? Maybe you learned them from your care givers and how they presented themselves. These care givers may have provided certain clothes for you and had your hair cut a certain way when you were a young child, and the embarrassing photos of the awkward years may still be immortalized in frames on the walls. Maybe you learned what people of different professions, cultures, and genders looked like in school. Eventually, you began to make more decisions for yourself about the colors, the designs, the brands, and the types of items you wore. You may have had some say about the length of your hair, the color, how it was styled. I would imagine, however, that many of these choices were limited to a range of options decided by, or at least influenced by, what caregivers, friends, teachers, commercials, social media, celebrities, authority figures, leaders in your religious or spiritual community, or people within your culture deemed appropriate for a person of a certain age, ethnicity, sexual orientation, or gender identity. Without saying a word, how we appear tells a story, from likes and dislikes, to our membership to certain groups, to how we are or hope to be perceived. Though gender expression is linked to gender identity, it is separate because how we appear is an external manifestation of an internal experience. Additionally, gender expression may be limited by others, as discussed above, or a need for safety. It may also be something we experiment with because it does impact and reflect how each of us feels on a given day and how each of us is perceived by others. Gender expression is not limited to just our physical appearance, which is a personal choice of how a person presents themself to others. It also includes the social and cultural norms that we learn are associated with particular genders and how a person of a certain gender presents. Simultaneously, gender expression includes an additional set of socially constructed rules about gender roles, or cultural ideals, about how a person of a particular gender acts, including behaviors, mannerisms, what their voice sounds like, how they communicate and express their emotions, and how they move (Brill & Kenney, 2016). The complete interwoven makeup of culture and gender expression shows us how malleable and often superficial our assumptions about gender are, because these social ideals of what is associated with a particular gender continue to shift and change from one location to the next, from one time period to the next, from one culture to the next. Gender expression is a conversation between an individual and those around them because it is a personal statement communicated about us, that is perceived by others, as intended or not. What we look like and how we act often leads to others making assumptions about us from a distance. These messages we give may be intentional, communicating that we are a member of a group, a certain profession, going to the gym, or simply confident and proud of being ourselves. Assumptions can also be incredibly harmful when they violate what we know about ourselves, and we are mislabeled, misgendered, called names, or shut out. Confusion, intolerance, lack of language, or inability to categorize, resulting from inaccurate assumptions can limit our ability to remain open to connection and mutual understanding. As discussed in Part 1: Tips for Collaborative Conversation, leaving assumptions and expectations at the door leaves room for opening the door to access each other. Femininity and Masculinity Diving deeper into gender expression, the qualities that we learn from our cultural and social upbringing and associate with gender can also be understood in terms of spectrums! I am going to refer to the helpful diagram from the Trans Student Educational Resources, The Gender Unicorn, designed by Landyn Pan and Anna Moore (TSER, 2014). As discussed in the previous section, there are physical features, appearances, and actions that are associated with being male/man/boy and with being female/woman/girl. These can be understood as masculinity and femininity, respectively. Defining these qualities in terms of masculinity and femininity more accurately separates gender identity from gender expression. A person identifying as a man may in fact express himself as more feminine than masculine. Similarly, a woman may want to present as traditionally more masculine. Their decisions to present as more feminine or masculine do not say anything about their sexual orientations, despite what stereotypes portray. Or a person may want to mix and match masculine, feminine, and more neutral qualities day to day or in a single ensemble. A person who is gender non-conforming expresses their gender in a way that does not align with cultural or social expectations of gender (Brill & Kenney, 2016). Incorporating spectrums allows for a more accurate understanding of gender expression, by attempting to account for the variations in gender expression. Based on The Gender Unicorn, a person can have none or any level of masculine, feminine and/or other qualities making up their gender expression (TSER, 2014). Raised in a culture and society that categorizes gender as binary, the automatic attempts to classify others is usually also within that binary (Brill & Kenney, 2016). This is something that will hopefully change with time, as more people expose themselves to the diversity of life, but this is still the unfortunate reality for most of us. When someone does not fit within this artificial image of man/masculine and woman/feminine in gender presentation, confusion can lead to anger and discrimination because someone’s gender expression does not fit within social expectations for their gender identity. Most discrimination about people who do not fit within social and cultural expectations comes out as homophobia even though the intolerance is about gender expression. Additionally, discrimination about gender identity, using gender identity language, also focuses primarily on gender expression, though there is still significant discrimination based on gender identity as well. The more a person presents themselves outside of cultural expectations, the more discrimination they are likely to face (Brill & Kenney, 2016). Even though gender expression is about reflecting our internal experience and showing that to the world, we are not always seen as intended. Most people do not fit 100% within these discrete markers of masculinity and femininity. As we begin to realize how much energy and effort we are putting into trying to conform, we can begin to be more authentic to ourselves and start accepting each other (Brill & Kenney, 2016). Congruence Working towards congruence involves aligning the internal experience with the external experience and becoming closer to your authentic self. This is something that every person goes through when discovering all the different aspects of their unique identity, expressing this, and working towards authenticity. These aspects are not limited to the various spectrums of gender identity, gender expression, and sexuality, discussed in the three parts of the All About Spectrumsblog series. Being authentic impacts quality of life, the interactions we have with others, and our relationships. For a person who is transgender or non-binary, this journey can be demanding, challenging, freeing, and lifesaving. Gender is an innate part of who we are, and to bring into alignment all aspects of gender leads to feeling more complete and more whole (Brill & Kenney, 2016). This process looks different for every person, even though steps taken may resemble each other. The steps taken towards the alignment of gender identity, body, and gender expression is the process of taking congruence measures. When a person reaches the point of acceptance of their gender identity and feeling like their gender expression is an adequate representation of who they are physically and socially, they reach gender congruence (Brill & Kenney, 2016). Gender transition is a general term for changing externally from one gender to another, but this does not automatically mean a medical transition! Gender transition can include one or more of the following subcategories: social transition, medical transition, surgical transition, and legal transition. Social transition is changing many of the factors of gender expression such as clothing, hair, gender roles, mannerisms, pronouns, name, and more. Medical transition involves medical interventions like hormone suppressants or cross hormones, hormone replacement therapy (HRT), that promote body changes towards one’s gender identity. Surgical transition involves surgical interventions that either add or remove traits that are associated with a certain sex and/or gender. And legal transition is the process of changing identification documents, including gender marker change and name change (Brill & Kenney, 2016). Every person’s journey towards personal harmony is unique to them. Finding ways to seek support or be supportive of a person in your life who may be working towards gender congruence is vital to helping every person be their whole and authentic self. *This story was told with permission from my mom. Thanks, mom! Terminology *Note: Language is constantly evolving and many of these terms may change in the future. Terms are, generally, ordered as they appeared in the text above. Additional terms were added to the list for clarity.
References
Brill, S., & Kenney, L. (2016). The transgender teen: A handbook for parents and professionals supporting transgender and non-binary teens. Jersey City, NJ: Cleis Press. TSER: Trans Student Educational Resources (2014). The Gender Unicorn. Retrieved from https://www.transstudent.org/gender/  If you are just joining us for the All About Spectrums three-part blog series, welcome! Though this blog post can be read independently, it would be helpful to visit Part 1: Tips for Collaborative Conversation, where this conversation began and for a list of previously defined terms. To bring everyone up to speed, here is a quick reminder of what inspired this discussion of spectrums: My mom and I were eating breakfast together in a small hotel café when she decided to inquire about how a couple consisting of a transgender man and a transgender woman have sex. Shocked by her bluntness? So was I! Following the Tips for Collaborative Conversation, I moved through my initial reaction towards an open discussion of mutual learning. In Part 2 of this series, I will discuss the first phase of explanation to tackle my mom’s loaded question by providing explanations of what is gender identity, why is gender identity a confusing topic for many of us, what distinguishes gender identity from sexuality, and what do I mean by the word spectrum. As a disclaimer, all of what will be discussed is subject to change and evolve as more people share their authentic selves and diversity flourishes, instead of being stunted by fear and forced to conform into boxes that do not really fit. I am simply sharing to the best of my ability, and I hope that some or all of this will be helpful. Spectrum Spectrum is typically defined as a scale between two extremes, or possibly more known as a band of colors, such as a rainbow. For our purposes, I will be referring to spectrum more as a continuum where someone can exist at any point on multiple spectrums simultaneously. By using the term, spectrum, I am also acknowledging the natural variety of life. Unpacking Loaded Questions Unpacking my mom’s question took a few iterations. Firstly, my mom was asking about the couple from the lens of gender being limited to the binary of boy/man/male and girl/woman/female. She also assumed that when this couple has sex they would want to only use the anatomy they were born with, which is both a denial of any discomfort they may experience about their bodies, an assumption about their experiences of themselves and each other, and a restricted view of sexuality. Additionally, she wondered about their sexual orientations before and after transitioning, assuming both people had transitioned. To begin, I started with the two sets of spectrums: gender identity and sexuality. Gender Identity Gender does not exist in the binary, but instead on a continuum, as described above. As such, gender identity can occur within what Western culture outlines in limited categories of a gender binary of man and woman, and between or separate from these. This does not mean that gender identities that fall within the gender binary are bad or wrong, because there is a place for these. Rather there is now, and hopefully more in the future, acknowledgement and recognition of other gender identities. Anyone who has not given much thought about their own gender, usually because their assumed gender matched their assigned sex at birth, may find it challenging to understand someone else’s gender when it does not fit within the traditional gender binary (Brill & Kenney, 2016). For the above example referenced by my mom, a man was assigned female at birth by the doctor who delivered him based on his physical anatomy and he coupled up with a woman who was assigned male at birth based on her physical anatomy. For this example that my mom specifically asked about, we are assuming that both identify as transgender and on the ends of the male/female spectrums that align with the gender binary, but it is very possible that a couple resembling this example would identify differently. Both may have experienced discrepancies between their bodies and their minds, and both, individually, may have decided to find ways to align their bodies, through transitioning and their gender expressions, with their gender identities. With a statement like this, it is important to remember that being a transgender person is not a mental condition but rather a medical condition. A person experiencing gender dysphoria, will have distress, anxiety, or discomfort about their gender and/or assigned sex at birth (Brill & Kenney, 2016). A person is born transgender, and medical intervention may be a necessary component of aligning a person’s body with their brain. Additionally, transgender individuals may also want to simply be accepted as their gender identity with the body that they have. Transgender individuals may also desire to simply be seen and accepted as being their gender identity without the adjective, ‘transgender.’ Trans Student Educational Resources (2014) offers a helpful graphic for visualizing all the spectrums I will be discussing here and in Part 3: Gender Expression called The Gender Unicorn, designed by Landyn Pan and Anna Moore (TSER, 2014). For the fictional couple in the example, I am assuming the following based on my mom’s question: the trans woman identifies exclusively as a woman, 100% as a woman, 0% man, and 0% any other gender, while the trans man identifies exclusively as a man, 100% as a man, 0% woman, and 0% other gender. I am only using percentages here as a way for me and the reader to imagine, visualize, and quantify this in a similar way, but gender is not something that can be quantified or calculated, unless someone decides to explain their gender in this way. Gender is rather a unique, important, and inextricable part of someone’s identity. As such, gender identity is a huge part of someone being their authentic self. Gender is much more complicated and expansive than chromosomes or physical anatomy, especially when we learn how little chromosomes and physical features actually align with previous definitions of assigned sex at birth. I want to emphasize that gender, no matter where it falls on, around, or off of any spectrum is valid and not a choice, though many choices are made with expressing one’s gender, following or not following traditional gender expectations (Brill & Kenney, 2016). Gender identity is an internal experience of one’s sense of self and can include identifying as part or wholly female/woman, part or wholly male/man, neither, or part or wholly other gender(s). As an innate part of a person’s identity, gender identity is an internal experience that others cannot know unless they ask (Brill & Kenney, 2016). Most individuals know at a very young age what their gender identity is, including cisgender, transgender and non-binary children. Additionally, a person with limited exposure to genders beyond the gender binary may experience feeling different but lack the language to describe themselves. Through familial or social pressures, and even the potential for or actual physical and/or emotional harm or death, many non-binary and transgender people live as a gender identity that they would not claim under more accepting and supportive circumstances. Doing so can be extremely mentally and physically damaging, as is clear when faced with the statistic of 40% or more of trans and non-binary people attempting suicide (Brill & Kenney, 2016, Save.org, 2018). As a transgender person begins to explore their gender identity, the various gender identity spectrums may change. This does not mean that their gender identity is changing, but that they are becoming more authentically themselves and gaining clarity through experimentation and exploration. Very few people will decide at a later point that they are not transgender, though this does happen. Additionally, someone who identifies as gender fluid, experiences their gender as shifting and not static, flowing within and between more than one gender (Brill & Kenney, 2016). Back to the case example of the couple in my mom’s question, I imagined the context of this couple being adults who grew up in less understanding and aware circumstances resulting in the trans man spending many years living as and identifying as a woman, despite the discomfort of doing so, and the trans woman, similarly, living many years as a man before being able to live authentically. Pronouns As we begin to learn language, we also learn ways to refer to people without always using their names. Many pronouns in the English language are assigned to a specific gender within the male/female binary. Thankfully, language continues to evolve, words are created, and meanings shift. With all the amazing strides being made towards equal rights and acceptance for marginalized communities, personal pronouns are getting revamped. Female/Woman/Girl pronouns include: she, her, hers, herself (TSER, 2014). Male/Man/Boy pronouns include: he, him, his, himself. Gender neutral pronouns include: they, them, theirs, themself/themselves (all referring to a singular person!), and ze, hir/zir, hirs/zirs, hirself/zirself (TSER, 2014, MYPRONOUNS.ORG, n.d.). Individuals may prefer that their name is used instead of any pronouns. As a person becomes more authentically themselves, they may try on different pronouns to find out what feels right. Some readers may have noticed the use of gender neutral pronouns throughout this blog series! Using correct pronouns is incredibly important, so it is helpful to ask what for a person’s pronouns and provide your own. This will send the message that you care, you are supportive, you do not want to assume, you do not want to harm, and you acknowledge a person’s complete self and their existence in the world. Mistakes happen, and there will probably be times that you accidentally misgender someone (I know I have!), but the acknowledgement of the mistake and attempt to continue trying makes such a difference (MYPRONOUNS.ORG, n.d.). Sexuality/Sexual Orientation Sexuality is the expression of sexual feelings and attractions. Similarly, sexual orientation is about who a person is attracted to physically, romantically, or otherwise (TSER, 2014). Just like gender identity, sexuality exists on a spectrum. Also, like gender identity, sexual orientation is not a choice. Sexual orientation can be a limiting term because it tends to group physical, romantic, and emotional attraction as all occurring towards the same type of person. This, however, is not always the case. Physical attraction exists on three spectrums: attraction to women, attraction to men, and attraction to other gender(s). Similarly, emotional attraction exists on its own set of the same three spectrums. Additional spectrums can be added including level of attraction to femininity or masculinity, regardless of gender identity. I will be discussing femininity and masculinity more in Part 3: Gender Expression of this blog series. Similar to the spectrums of gender identity, an individual can have different levels of attraction on each spectrum, including lack of attraction to any or all genders. There are many contextual factors that can result in attraction shifting over time and situation, but, again, sexual orientation is not a choice. As a society, labels are created to categorize based on sexuality and sexual orientation and have become something that is claimed as part of our identity. Labels can be helpful for creating community and uniting marginalized populations, especially to fight for equal rights. But labels can also be limiting and not convey all the complexities of who we are as humans. Many of these labels are gender-dependent and focused only on physical attraction, which is why the separation of gender identity and sexuality can be so confusing. For example, homosexual means that a person of one gender is sexually attracted to a person of the same gender, and heterosexual means that a person of one gender is sexually attracted to someone of the other gender. Both these terms usually assume that all parties identify within the gender binary of man and woman, and usually assume that all parties are cisgender. I want to note here that the term homosexual, because of its history of being used in a derogatory way medically, politically, religiously, and otherwise, is rarely used to self-identify today. Terms like lesbian and gay also imply knowing the gender identity of both the individual who is labeled and the person they are attracted to or in a relationship with, though it is important to let people label themselves. Instead of relying on labels, the various spectrums provide a more accurate portrayal of who we are, in each of our uniqueness. For the couple in my mom’s question, I am going to very cautiously assume they would consider themselves a heterosexual couple of man and woman. As I told my mom, it is none of my business what is between their legs nor how they express themselves sexually. As a man, he may or may not have had hormone replacement therapy or gender affirming surgeries, but no matter what he is still a man. Without surgery, he may feel more fully himself using a prosthetic penis that, when worn by him, is his penis, or he may not use a prosthetic penis at all. And as a woman, she may or may not have had hormone replacement therapy or had gender affirming surgeries, but no matter what she is still a woman. How this couple expresses themselves sexually and romantically is for them to communicate about and decide. I would imagine that no matter how this couple has sex, he wants to feel like and be seen as the person that he is by the person he loves, and she wants to feel like and be seen as the person that she is by the person that she loves, and no one, except the participating parties, is entitled to tell them what that looks like. More Layers of Spectrums In this blog post, I dove into the many layers of gender identity and sexuality spectrums. I discussed the importance of pronouns as a means of acknowledging the whole selves of all people. Another important factor in this discussion to try to answer my mom’s question is the concept of gender expression, which will be tackled in Part 3: Gender Expression of All About Spectrums. A list of terminology can be found at the end of Part 1: Tips for Collaborative Conversations, and additional terms discussed in this segment can be found below. *This story was told with permission from my mom. Thanks, mom! Terminology *Note: Language is constantly evolving and many of these terms may change in the future. Terms are, generally, ordered as they appeared in the text above. Additional terms were added to the list for clarity. Gender Terms:
Sexuality Terms:
References
Brill, S., & Kenney, L. (2016). The transgender teen: A handbook for parents and professionals supporting transgender and non-binary teens. Jersey City, NJ: Cleis Press. MYPRONOUNS.ORG: Resources on personal pronouns (n.d.). Retrieved from https://www.mypronouns.org/ SAVE: Suicide Awareness Voices of Education (2018). Suicide Facts. Retrieved from https://save.org/about-suicide/suicide-facts/ TSER: Trans Student Educational Resources (2014). The Gender Unicorn. Retrieved from https://www.transstudent.org/gender/  Sitting across from my mom at a small hotel café, I would have expected her to mention something about the quality of the coffee or variety of pastry selections. Previous mornings we talked casually about the latest updates in our family, plans for the next few months, and, of course, the latest breakfast special offered. This morning, however, was different. Unlike the crowded café of the weekend, the weekday breakfast brought reprieve from pushy people arriving just before breakfast was put away and the buzz of dozens of conversations. The quiet calm of our table brought something else to my mom’s mind. I was surprised by her question about the difference between gender identity and sexuality/sexual orientation. As you may imagine, she did not phrase her question with that language, but rather voiced her confusion about how a couple consisting of a transgender man and transgender woman have sex and make decisions about their transitions in relation to having sex. As humans, we need connection and shared learning. But sometimes the language that is used to ask questions feels charged because the topic feels taboo, the words used carry prejudice with or without the speaker’s knowledge, or there is a general sense of fear of the unknown where one or both parties simply do not know. In this three-part series, I will begin with tips for answering challenging questions and transforming them into collaborative conversations. Parts two and three will go into more detailed explanations of the various spectrums of gender identity, gender expression, sexuality, and sexual orientation. Terminology that may be new to some readers will be found italicized throughout, at first mention, and in a succinct list at the end of each post. The list is not comprehensive, but a place to start. Along the way, my mom’s question will be answered and some! Join me and my mom as we journey through our collaborative conversation. The Disclaimer As a cisgender woman, meaning that my gender identity aligns with the sex I was assigned at birth and the assumed gender based on this, I gave my mom the same disclaimer I want to give the reader: 1) I am, thankfully, not an all-knowing being, so what I shared with my mom, and in these posts with you, is from my current understanding, which could contain human error and will most likely evolve in the future. 2) As stated above, I am a cisgender woman and do not identify as non-binary gender or transgender, and therefore I will never fully understand what it is like to live in a body that does not feel right, should not belong to me, or does feel right but others do not see as matching my gender identity. I have only occasionally been misgendered, meaning that others have assumed and incorrectly labeled my gender based on my appearance and used gender specific terms, such as pronouns, for me that I do not align with, and I, for the most part, appear and act as socially constructed rules project (more on this in Part 3). 3) I believe that each person is unique and the expert on themselves so my story and explanations may not fit for everyone, but I will attempt to provide as much general information as possible. What I am is a fellow human being who is empathetic and understanding. What I can do is educate on language, answer questions from my knowledge base, and speak from my own feelings and experiences that can relate to others’ life experiences. Two P’s and Three C’s Talking about topics that are unfamiliar or that we may not have the appropriate language for can be frustrating, scary, and maybe offensive, even if that is not our intent. The purpose of this discussion is to provide tips and language for having these potentially difficult and uncomfortable conversations in a collaborative, constructive manner. The tools I used to talk with my own mom can be summarized into the following concepts: Presence, Patience, Calm, Curiosity, and Context. The first step to answering my mom’s question, after the disclaimer, was to check in with what feelings came up for me, sit in any discomfort and remain present. Presence, or being present, involves staying in the moment, remaining mentally and physically in one place at the current time. To do this takes practice with becoming aware of yourself, what feelings and emotions are surfacing, where tension shows up in your body, what is happening with your breathing, and where your thoughts are taking you. Is your mind wondering to your to-do list or trained on the person in front of you and the topic at hand? Is your breathing shallow in your chest or deep in your belly? Are your shoulders on the rise, heading straight for your ears, or relaxed? Feelings like anger or sadness, and reactions such as defensiveness or shutting down may arise, as they did for me at first mention of my mom’s loaded question, but I had to remember to recognize and utilize these as fuel for our conversation. Being aware of yourself also gives you the opportunity to voice feelings to your companion. These observations provide clues about the meaning that you give the topic, what your companion may be experiencing, and ways to self-soothe to remain open. With presence comes the ability to tend to your needs, which in turn helps you attend to your companion. My initial surprise at my mom’s blunt question left me with tightness in my chest and the urge to change the subject. After checking in with myself, I found that I was proud of my mom for having the courage to ask questions and realized that my initial anxieties mirrored those in my mom. I drew upon patience and calm to promote an environment of mutual learning. To lay the foundation for collaborative conversation there needs to be a sharing, and often teaching, of language and meaning, which can take time and effort. This is where patience for your companion comes in! Shortness and urgency leave many of us feeling anxious, ready to shut down and check out. Having patience improves openness and the ability to have a shared learning experience. Remaining calm, facilitated by efforts to self-soothe, such as deep breathing and consciously releasing areas of tension, reduces shaming and defensiveness. This, in turn, allows for openness and the reciprocation of calm as a shared state of being. Additionally, both patience and calm provide the atmosphere for giving each other the benefit of the doubt, where both participants can accept that they do not know everything, including the intentions behind challenging questions. Staying curious creates space for both parties to feel comfortable to ask questions, be heard, and form collective understanding, even if both parties do not agree. Key to curiosity is leaving expectations and assumptions at the door. Ask for clarification and remain willing to clarify. Curiosity provides the opportunity for transformation by creating a shared experience of openness and understanding. In the conversation with my mom, curiosity allowed my mom to be vulnerable and ask her question and helped me share the information I could provide, while being willing to admit when I did not know. We could then accept the limitations we share in our understanding, create room for us to continue revisiting the topic, build our shared knowledge, and strengthen our relationship. To maximize the effectiveness of all the previously highlighted concepts is the consideration of context. Context is the background and stage setting that each of us carries with us. Each interaction and experience contributes to every person’s evolving context, and this shapes and guides us through all future interactions. For my conversation with my mom, I had to keep in mind many contextual clues. The first was the generational gap between me and my mom. My mom was never exposed to anything beyond gender being body and chromosome related and limited to the gender binary until a few years ago. Even I had limited exposure to genders outside of the gender binary until college. Additionally, my mom grew up in a small, conservative, Southern town, while I grew up in a more liberal Southern city. We also have different backgrounds in knowledge about the LGBTQ+ community, where I have a formal education in gender and queerstudies while my mom has only been exposed to informal discussions of gender and sexuality in the last few years through new friendships in the LGBTQ+ community. One major contextual factor is that we are both cisgender women discussing gender identities beyond our own. Awareness of context provides insight into what we know and do not know, the language we use, the meanings we assign, and how we can continue to evolve and learn from each other. My mom and my contexts provided lenses through which we approached our conversation, and awareness of these created room for forgiveness, understanding, and all the previous P’s and C’s. Just as my mom loves to see how I continue to grow and change as a person as I age, I am constantly amazed at how much my mom has grown and changed in her tolerance, understanding, and acceptance. Discussions like this one in the hotel café have contributed to both of our evolutions over the last several years. Even with all the factors working against a collaborative conversation, I am amazed and appreciative of my mom’s willingness to be vulnerable and ask tough questions that are outside of her comfort zone. My hope in sharing this experience is to appeal to the very human quality of making mistakes and learning from them. In doing so, we can be more forgiving, more tolerant, and more open to all. *This story was told with permission from my mom. Thanks, mom! Terminology *Note: Language is constantly evolving and many of these terms may change in the future. Terms are, generally, ordered as they appeared in the text above. Additional terms were added to the list for clarity. Sexuality Terms:
Gender Terms:
References
Brill, S., & Kenney, L. (2016). The transgender teen: A handbook for parents and professionals supporting transgender and non-binary teens. Jersey City, NJ: Cleis Press. It’s Pronounced METROsexual (2012, May). What does the asterisk in “trans*” stand for?. http://itspronouncedmetrosexual.com/2012/05/what-does-the-asterisk-in-trans-stand-for/\ TSER: Trans Student Educational Resources (n.d.). Definitions. Retrieved September 9, 2018 from https://www.transstudent.org/about/definitions  As discussions of gender, especially gender expansiveness and gender affirmation, enter our everyday lives, I wonder: what is the deal with gender reveal parties? I did not really give these heteronormative, the assumption that heterosexuality and being cisgender are the norm, excuses to party and celebrate becoming parents a second thought until I was pregnant myself. Then the questions started filling my head about why I suddenly abhorred the idea of a gender reveal party, what I wanted to do when people inevitably asked, “what are you having, a boy or a girl?,” how I would educate my family about my wishes for my child, their gender, and messages about gender, and what choices will I make for my child before they can make their own discoveries about their gender? As a therapist who specializes in working with the LGBTQ+ community and providing affirmative care that promotes living authentically, I would not be a very authentic person or practitioner if I did not ask these kinds of questions or practice what I promote. Gender reveal parties are wrought with cultural ideas about what being a boy or girl means and looks like and assumes that gender is limited to this binary. Some examples of these are in the names of the parties: “lashes or stashes,” “pink or blue,” “touchdowns or tutus.” Gender is an individual experience of self, and therefore not for others to decide or project what this means or looks like. It is understood within the context of location, culture and time, and a person’s gender identity is theirs to define and express, whether within the socially constructed gender binary of male and female, in between, separate from, or without gender. Gender expansiveness is a more accurate representation and understanding of gender identity and expression because it acknowledges gender as an individual experience and challenges the wider social understanding of gender. Now back to babies. During pregnancy, a time comes when medical professionals can scan your belly, see your fetus, and tell you about the health of your baby and, of course, make a determination of the assigned sex of your baby based on the genitalia they see. But, as I quickly found out, the medical professional will not only assign the sex of your baby as male or female in the medical record but also tell the expecting parents that their baby is a boy or a girl. These are assumed genders based on the assigned sex and assuming that the baby will be cisgender, meaning that a person’s gender identity aligns with their assigned sex at birth, or in this case way before birth. Assigned sex that is limited to male and female based on body parts and/or chromosomes already has its problems by not recognizing the variety of life. As soon as an assigned sex or assumed gender are shared with others, the assumptions about that baby will almost automatically come at new parents from all directions. As a parent wanting the best for your child, what can you do to support your child and provide space for their discovery of their own gender? We are constantly exposed to messages about gender, what people of certain genders wear, how they talk, what toys they play with or roles they have. And these are often engrained in us from birth as our families, friends, strangers, medical providers, media, and culture tell babies what qualities they have or will have based on their assumed gender. Each parent, whether they realize it or not, or want to have a (assumed) gender reveal party or not, makes decisions about how they will nurture their child that will influence how their child will know themselves within the world and culture they live in. These decisions are largely based on how those parents experience and understand gender themselves. Making decisions for a baby who is yet to begin exploring what gender means to them is a challenge for parents to think about how they will create space for their child to be themselves as they grow and learn. Like a lot of new parents, I am wondering if I am already messing this up for my child. My spouse and I assumed a gender and pronouns for our baby. We requested that friends and family be mindful of the assumptions they make about gender in their words and gifts to us and our baby. We asked that gifts of items and clothes be of all colors without cultural messages about gender and use the whole spectrum of adjectives to describe our child. We converse about how our baby can be whatever gender they decide to be, and we discuss how we can provide the language and environment for our child to explore and be themselves. With our own upbringings engrained in our thoughts and actions, exposure to a culture that often struggles with gender nonconformity, gender identities beyond the binary and non-cisgender people, it is difficult to avoid assuming the gender of children and giving them messages about what gender means to us. Some examples of these are “strong, handsome, little man” for a baby assumed to be a boy and “sweet, sensitive, little princess” for a baby assumed to be a girl. These words carry a lot of meaning about what kind of people these babies are meant to be to fit into the world they just entered. I hope that my little one will grow up in a more open and understanding world, where gender identity and expression can be freely explored and lived. In asking questions about assuming gender, space is created for this reality to exist. Even if a parent assumes incorrectly, asking questions and being aware of the messages we send our kids about who they are supposed to be based on family history or their assumed gender is the first step. My hope in writing this is to challenge others to begin thinking in more gender expansive terms, explore what gender means to them, and be open and supportive of children discovering and defining their own gender.
 Each year the day after Father's Day, it is International Father's Mental Health Day. This year is the 4th annual IFMHD. Why is this so important? We want to shed light on the needs of Dad during the perinatal period. Did you know that suicide is the leading cause of death in men under the age of 50? 1 in 10 fathers experience postpartum depression or anxiety after the birth of a child. 50% of women who have postpartum also have a partner who has postpartum depression. What do perinatal mood and anxiety disorders look like for men? Much like women, men also have a change in hormones. It's not the same magnitude that women do. Still, men do have a decrease in testosterone, an increase in cortisol, an increase in estrogen, and increase in vasopressin, and an increase in prolactin. Depression may mask anger, addiction, or withdrawal. Those behaviors may be increased drinking, affairs, problems sleeping, low-stress tolerance, suicidal ideation, feelings of emptiness, always feeling tired or abusive, to name a few. Anxiety is also common along with depression and can manifest in anxiety around caring for the child, work/life balance, relationship issues, and irritability. This list is by no means exhaustive but gives a glimpse into what a father may be experiencing. These symptoms may begin 4-6 months postpartum and can last for a few years. The question is how to support fathers who may also be experiencing this alongside their partners. The first step is assessing and checking in with them. The second step is helping fathers find ways to be included to foster attachment to their babies and wives:
Here at Curis, we have mental health providers ready to support those willing to reach out and take that step.
 The search for a therapist for you and your loved ones can be a daunting process. There are a lot of choices out there, and it is essential to find a therapist that you feel will understand you, help you, and make you feel comfortable. Throughout this search, you may have a lot of questions ranging from insurance and cost, location and convenience, and maybe even modality and therapist license type. One of the most important things to consider when picking a therapist is to find someone who is a good fit for you, and if they are not, knowing you have the choice to find someone else who is. FINDING A THERAPIST AFFIRMING LGBTQ+ In therapy today, the chance of having a therapist who says that they are LGBTQ+ affirming is pretty good! This is a beautiful thing because it means that the therapist intends not to discriminate or turn someone away and to treat that person who identifies as part of the LGBTQ+ community with respect. Being LGBTQ+ affirming, however, means a bit more than merely being welcoming to minority sexualities and genders. Affirmative therapy is having unconditional positive regard for LGBTQ+ clients and their relationships, being able to address how discrimination, both individually and culturally, negatively impacts these clients, and that LGBTQ+ identities and relationships are perfectly normal and healthy (Maurel, 2016; Ouer, 2016; Rock, Carlson, & McGeorge, 2010). Living in a heteronormative and cisnormative world when you do not identify as heterosexual or cisgender is to:
This experience usually repeats throughout life as you meet new people, enter new workplaces, move from city to city or even neighborhood to neighborhood, enter and exit relationships, expand your family, and grow older. From my own experience in the LGBTQ+ community, even with accepting and supportive family members, friends, and coworkers there can still be an internal struggle and fear about not fitting into the social, political, economic, medical, etc. structures that have been created to privilege others. PRIDE, SELF-LOVE, WARM AND LOVING RELATIONSHIPS Pride, self-love, warm and loving relationships, support systems, community, and success can ease these added stressors considerably. But you may still experience times of uneasiness, self-doubt, real threats of or actual verbal or physical harm, inequality, and unfounded hatred, or you may witness this happening to others and empathize or fear this for yourself. If this is not part of your experience, then you are still navigating the same human struggles that everyone else is from new relationships to heartbreak, communication stumbles to the conflict in relationships, job loss to fitting in with new coworkers, financial struggles to sickness, feeling unworthy or undeserving, feeling lonely or isolated, or simply feeling stuck and wanting something different. What I have found is how, with all these experiences comes incredible resilience and strength. Living authentically can be unburdening and freeing, alleviating the heaviness and exhaustion of carrying the responsibility for making others more comfortable by squishing ourselves into the awkward, ill-fitting molds and categories laid out for us. To me, a genuinely LGBTQ+ affirming therapist, who is doing affirmative therapy, understands what these experiences are like, does not have to be taught all of the language, and has done their work to understand their own experience of gender and sexuality. They will not assume they know what you use to describe yourself mean for you but will have the base knowledge to understand and ask questions without surprise or judgment. They will encourage and support your ability to choose, advocate for yourself, and take care of yourself and your relationships. And they will strive to create a safe and comfortable place for you to express and be yourself, even if the therapy office or virtual session may feel like the only place to do this. When I work with LGBTQ+ identifying clients or those who are still figuring out who they are, no labels required, I invite all parts of you, your whole and authentic self, into therapy. Anyone identity is not all of who you are or why you are struggling, but one part of a bigger picture. To be able to work on the focal issue that you are seeking help for requires a contextual understanding of what lies in the background. Whether you want to work on challenges related to your identities or just want to be treated as a whole person with an everyday problem, an LGBTQ+ affirming therapist may be the perfect fit for you.
References
Maurel, L. (2016). Beyond tolerance: Affirmative therapy with LGBTQ individuals. Retrieved from https://www.goodtherapy.org/affirmative-therapy-lgbtq-web-conference.html Ouer, R. (2019). Solution-Focused Brief Therapy with the LGBT community. Routledge. Rock, M., Carlson, T. S., & McGeorge, C. R. (2010). Does affirmative training matter? Assessing CFT students’ beliefs about sexual orientation and their level of affirmative training. Journal of Marital and Family Therapy, 36(2), 171-184. Now, more than ever collaboration with these multiple disciplines is vital for the benefit of our patients and our communities. Curis has done something that has NEVER been done before in healthcare. Watch this discussion about how our disciplines work together and collaborate, as well as how to join our business model for a WIN-WIN-WIN.  Sometimes as adults, we have forgotten what it's like to be a toddler.
Mainstream parenting focuses on modifying superficial behaviour and resorting to tactics like punishments, time-outs, threats, bribes and rewards under the justification that perpetuating a dominance hierarchy is somehow serving the greater good. But, what if, there’s absolutely nothing wrong with our children? Nothing to be fixed. What if the problem is a lack of knowledge, understanding, and empathy within our society? And what if these techniques threaten to erode the ONLY influence you truly have with your child – your relationship. Read the full article from Raised Good here.  Doctors at Cook Children’s Hospital say they believe the stresses from the coronavirus pandemic are linked to six cases of severe child abuse seen at the hospital just this week.
This is usually what Cook Children’s says it sees over the course of a month. All of the children admitted this week are under 4 years old. “We knew an increase in abuse was going to occur, but this happened faster than we ever imagined,” said Christi Thornhill, director of the Trauma Program, the Care Team and Fostering Health at Cook Children’s. “I mean this happened in a week and these are really bad abuse cases.” Read the full article and watch the segment here. SCHEDULE AN APPOINTMENT WITH A CHILD THERAPIST HERE |
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