Dr. Mary Nedela (she/hers) and Dr. Evan Thomas (he/him), Conference Co-Chairs

Therapist Know Thyself: The Importance of Self-Of-The-Therapist Work in Gender Affirming Care

Shawn V. Giammattei, PhD

In this keynote presentation, Dr. Giammattei will discusses the impact of personal bias, the key person-of-the-therapist work necessary for all of us doing gender affirmative work, the importance of this knowledge on relational reflexivity with transgender, non-binary, gender expansive clients and their families, and ways to use what we learn about ourselves, our narratives, and our relationships with our clients as advocates for change.

What’s in a Name?: Revisiting the Power of Words in Practice

Markie L. C. Twist, LMFT, LMHC (she/they)

Lucille Byno, LMFT (she/her)

Vanessa Perocier, LMFT (she/her)

Maxine Notice, LMHC (she/her)

Maya Iturra, LMFT, LMHC (they/them)

Description: One of the primary tools that we have in our clinical relationship is our ability to share language and relatedly meaning with each other. Our clinical and supervisory participants come in with their words and the stories that are formed using their words and we as family therapists and supervisors must do everything we can to understand, co-create, co-evolve, and collaborate with our participants around the power these words have in their narratives. This is not a new view of words and their significance–indeed in the field of psychotherapy it is as old as psychoanalytic thinking and in systemic practices we see it discussed by foundational postmodern thinkers and therapists like Goolishian and Anderson (1987) and DeShazer (1994). In discussing the power of words in practice, DeShazer even calls back to Freud’s idea that “words were originally magic and to this day words have retained much of their ancient magical power....” and Anderson (1997) even developed a whole therapy positionality around the power of words in practice—collaborative therapy. One of the foundational ideas of collaborative therapy is that knowledge is created as language evolves and thus the process of therapeutic growth happens through dialogue. A second core idea of collaborative therapy is that multiple realities exist, which means there is no single way to see a situation, including the languaging of it. In the current context, the panelists discuss the power and evolution of languaging in modern practice with particular attention to words that have considerable power in terms of clinical, supervisory, and educational demographic intersectional identities–like gender pronouns (with specific attention to two-spirit languaging), professional pronouns (including discussion around capitalization and first and last name considerations), Hispanic American versus Latinx American, Black American versus African American, polyam versus poly (with specific attention to Polynesian considerations) versus consensual nonmonogamy, and ‘vanilla’ versus non-kinky. In discussing the languaging and words used around these intersectional identities, we will also discuss the clinical, supervisory, and educational implications associated with having such necessary dialogues in such practices.

Faculty Experiences of Teaching Sexuality Content in Marriage and Family Therapy Training Programs

Jillien Kahn, LMFT, CST (she/her)

This qualitative research explores the subjective experience of faculty when incorporating sexuality content into marriage and family therapy training programs. Ecological Systems Theory is used to examine challenging and supporting factors, as well as faculty training and support needs around topics such as sexual diversity, polyamory, and sexuality. The findings of this research may be useful to better support faculty and therapists in teaching about and/or working with sexually diverse clients, and to more comfortably incorporate important conversations about sex and sexuality with all clients.

Joyful Authenticity: Nonbinary People Navigating Gender Norms

Katelyn Coburn, PhD, LMFT (they/them/theirs)

Amber Vennum, PhD, LMFT (she/her/hers/they/them/theirs)

This presentation will focus on research findings from a qualitative grounded theory study about how a racially diverse sample of nonbinary people navigate gender norms in their lives. Nonbinary people encounter gender norms resulting from the Western gender binary on a day-to-day basis and can experience depression and anxiety at higher rates than cisgender and transgender people as result of gender-based discrimination (James et al., 2016; Matsuno & Budge, 2017). Using constructivist grounded theory methods and analysis, this study sought to understand and identify processes nonbinary people use to navigate gender norms internally and interpersonally, with attention to the contextual factors that inform these processes. Semi-structured interviews were conducted with 21 racially diverse, nonbinary people to answer three research questions: 1) What contextual factors inform the processes nonbinary people use to navigate gender norms internally and interpersonally? 2) How do nonbinary people navigate gender norms internally? 3) How do nonbinary people navigate gender norms in interpersonal relationships? Results from this study indicate that the contextual factors of societal and cultural expectations of gender; community and being seen; and the contextual impact of holding multiple identities inform nonbinary peoples’ internal and interpersonal processes of navigating gender norms. Participants used internal process that involved reclaiming ways of being that were congruent to their gender identity, as well as creating affirmation and authenticity within themselves through self-talk and gender-affirming actions. Additionally, participants described processes in their interpersonal relationships that aided them in navigating the complexity of being perceived (or not) as nonbinary and ways that they created space from non-affirmation to center their own well-being and congruency. This presentation will focus on how results of this study can be used to inform helpful, inclusive therapeutic interventions to counter the negative mental health impacts of systemically enforced gender norms and gender-based discrimination. This study highlights important implications for family therapists’ self-of-the-therapist work including engaging in self-education about the history and impact of the gender binary on nonbinary people’s lives. Results also indicate that therapists should practice from intersectional frameworks to embrace the multiple identities nonbinary people may hold that inform their relationships to gender norms and work with clients to deconstruct and understand the intertwined nature of cissexism, heterosexism, classism, and racism on nonbinary peoples’ lives. Additionally, family therapists should work with nonbinary clients to construct ways they can affirmatively connect to themselves as well as ways to authentically navigate interpersonal relationships.

Join our various rooms on OhYay! to catch up with colleagues!

Queering Our Emotions

Daniel Stilwell, LMFT (he/him)

This presentation is at the intersection of emotional theory and clinical tools. The presentation will start off with an overview of what emotions are from a biopsycho perspective: essentially the body communicating to the mind through sensations we call “feelings.” The metaphor of emotions as visitors will be used to articulate the 5 steps of emotional mindfulness: notice an emotion is occurring, recognize which emotion(s) are present, listen to the purpose or message of the emotion, demonstrate gratitude to the emotion, and let it go away. Since the purpose or message of the emotions is the least understood and utilized aspect of this process, the presentation will lay out a very useable chart participants can take with them to help clients grow in their emotional intelligence. The chart focuses on the primary and universal emotions of sadness, anger, joy, fear, and “I feel bad” feelings. They will all be unpacked on the dimensions of timeframe, catalyst, and message. The messages are then connected to human needs that the self has and how the body participates in meeting those needs. Nuances such as feelings about feelings, the importance of perception, and the continuum of each emotion will be expanded upon. Avenues for how to channel each emotion’s energy will be discussed. Lastly, queer theory will be employed to play with how emotions are a vital part of how we identify and perform gender and sexuality. While this tool has been honed over years with a variety of clients from a variety of backgrounds, cultural and contextual factors will also be addressed. Participants in the presentation will also be encouraged to discuss their own experiences in concert or difference with the chart. We will understand and queer emotions together!

Doing Psychotherapy While Queer and Trans: Bearing Witness

Michelle Allison, LMFT (she/her/hers)

This presentation is not primarily about being a trans therapist, nor is it about being primarily a therapist to the queer/gender variant community (two thirds of my clients are not queer or trans). Rather, I will elaborate a queer informed psychotherapy paradigm which is informed by some of the common factors of doing psychotherapy within the queer community. I will then demonstrate how those factors are found in the emergent practices among forward thinking psychotherapists who rely on the perspectives of Interpersonal Neurobiology, Accelerated Experiential Dynamic Psychotherapy, Polyvagal Theory, co constructivist and attachment based therapies, among others. I will describe and name some of these queer informed ideas, and demonstrate how doing psychotherapy from a marginalized stance with marginalized populations enables queer informed psychotherapy to make important contributions to this emerging paradigm. This queer informed style of clinical practice is guided by a core precept of Interpersonal Neurobiology: that psychotherapy is inherently relational and works best when practiced as a voluntary interpersonal enterprise. It also postulates that the client is the best authority on their own experience: that they are privy to an inherent wisdom about what is subjectively true and ‘right’ for them. Second, doing psychotherapy while queer and marginalized presents a variety of opportunities to dismantle power dynamics and credential privilege. It directly challenges the practices promoted by the reductionist medical model and behavioral health industrial complex that leave most clients feeling marginalized, objectified and ‘one down’. Queer informed therapy is relatively non hierarchical (we do have degrees and licenses—to be used for good); affirming and non pathologizing (we use diagnosing for client understanding, obtaining resources for our clients, and reimbursement). We are radically accepting of our clients as they present to us: there is no preferred version of the client that need appear. Clients are grateful to learn what queer therapists have known all along: ‘symptoms’ are the subjective truth of our adaptive response to our own unique, lived experience. Finally, queer informed psychotherapy appreciates the ‘co marginalization’ of its participants (whether they are queer or cis). We are committed to continuously establishing and maintaining an emotionally safe space as the necessary precondition for the emergence new learning and healing. We divest ourselves of our professional privilege in favor fostering corrective attachment and Social Engagement. We bear witness to how we have responded to our outsider status and fallibility to discover our own positive narrative of triumphant authenticity.

Teaching Anti-Heterosexism in Clinical Assessment

Tina Timm, LMFT, LMSW (she/her/hers)

It is simply not enough to be aware of potential heterosexist biases in clinical practice. It is our obligation to create safety for all clients. To do so, we must actively engage in anti-heterosexist practices. This begins with the first point of contact with clients – the assessment. Many clinicians, new and seasoned alike, inadvertently “out themselves” as unsafe with traditional assessment questions. Questions are powerful both in what we ask and what we DON’T ask. When a therapist asks about marriage this potentially marginalizes long-term relationships where partners can’t or don’t want to get married. When a therapist assumes heterosexuality when someone is in a opposite sex relationship, that potentially misses out of an important part of a bisexual partner’s identity. When a therapist assumes monogamy in a long-term relationship it sends a clear message about not having space to talk about an open relationship with same gender and opposite gender partners. This presentation will focus specifically on how to conduct anti-heterosexist clinical assessment with individuals, couples, and families. I will start by defining what is meant by “anti-heterosexist”. Next, I will share two experiential exercises to help the clinician become more aware of the implicit heterosexist biases that they may have and not even know. Lastly, I will share specific examples of assessment questions that create safety and clearly send a message to clients that as a clinician you are open and comfortable embracing queerness.

Queer-Contextualized Family Therapy: Reimagining Family Therapy Theory

Erica E. Hartwell, PhD, LMFT (she/her)

Lindsay L. Edwards, PhD, LMFT (she/her)

Most family therapists use an established clinical model to assess clients’ presenting concerns, to conceptualize client process, and to make decisions about treatment (Blow et al., 2007; Gerhart, 2017). Clinicians use these clinical models since they provide a framework for understanding how clients’ concerns emerge and what can be done to address them. Given this function, it is problematic that a majority of these models are centered on white, middle-class, heterosexual families (Giammattei & Green, 2012; Hardy & Laszloffy, 1994; Knudson-Martin, 1994; Long et al., 2006). Family therapists risk pathologizing and marginalizing queer and trans clients when they use these established clinical models without consideration for their heteronormative, patriarchical, white supremacist, and binary based origins. In this workshop, we will collaborate with participants to reimagine established family therapy models from a queer-centered perspective so that these models can be used for inclusive practice with all clients. We will begin by sharing a three-step framework for queer-contextualizing any theory: 1) identify the norms and assumptions about gender, sexuality, race, and class; 2) evaluate how these assumptions center and marginalize queer and trans people and relationships; 3) revise, expand, and reimagine these assumptions from a queer context. We will demonstrate the application of our queer-contextualizing framework on two established family therapy models: Bowen Family Systems Theory and Satir Experiential Therapy. Participants will then practice using this framework with other family therapy models in small model-specific groups. For each step in the three-step framework, we will offer a set of questions participants can use to interrogate the assumptions and norms of their clinical model, consider how these assumptions and norms might be different if developed around queer and trans people, and describe a revised, expanded, and reimagined version of their model. Sample questions include: What assumptions does this model make about family structure? Who do these assumptions center; who do they marginalize?, and If we start from a queer context, what assumption would this model make about family structure?” Finally, we will discuss self-reflective practices that are essential to the practice of a queer-contextualized clinical model.

Trans-Affirming Skill-building Using Deliberate Practice

Dr. Sheila Addison, LMFT (She, her, hers)

Jessee Lovegood, AMFT (Ey, em, eirs or they, them, theirs)

This presentation will demonstrate the use of Deliberate Practice (DP) to strengthen clinicians’ ability to provide affirming services to gender minority (GM) clients and their families. DP for therapists is a tool that can be used to focus on specific clinical skills, in this case increasing one’s ability to flexibly interact with diverse clients while maintaining an attuned relationship.

No More Gatekeeping: Assessment & Letter Writing

Van Ethan Levy, LMFT (they)

We all hold internalized transphobia, nobody is immune to it. When we lack awareness of the ways in which we engage in transphobic micro/macroaggressions, we continue to perpetuate the violence on the trans, non binary and many more non cis identities. The workshop assists in developing an awareness of the ways in which we perpetuate the harm and oppression while exploring ways in which we can address the harm we are engaging in within ourselves, how to advocate & educate with/for others, and how to make the the world a little more safer and affirming for trans/non binary & many more non cis folx. This presentation also provides a trauma informed approach while working towards engaging from an anti-oppressive positionality to provide an assessment for our community to access hormones/surgery and/or other affirming care. I also provide step by step instructions on how to write a letter in one session.

Eliminating Barriers to Transgender and Non-Binary Affirmative Therapy

Molly Setzekorn (She/her)

Christopher Belous, LMFT, CST, CSE (He/Him)

Transgender and nonbinary individuals experience unique challenges in every day life based on their marginalized identities. These challenges are not limited to outside of the therapy room for many folx.

Dr. Evan Thomas (he/him)

Exploring Complex Gender Identity and Dysphoria

Michelle Allison, LMFT (she/her/hers)

Even seemingly comfortable and straightforward transition experiences are frequently more complex than they appear. What underlies the DSM 5 definition of gender dysphoria: stated as 'simply' the desire to live in a preferred gender at variance with assigned physiology. The dominant global culture views any gender variance as 'unnatural' and/or morally unacceptable; in this sense gender dysphoria is a cultural construction derived from a particularly limited view of human nature. This workshop is grounded in the assumption that gender identity (and therefore gender variance) is fundamentally, but certainly not exclusively neurobiological . Gender variant persons inevitably become ‘marked’ and then subjected of a wide variety of questionings, invalidations and disqualifications by that invisible majority. Thus, gender dysphoria is a predictable reaction of the human brain and mind to the lived experience of persons whose inner identity is at variance from the invisible majority. Transition pathways can be complicated, convoluted and traumatizing . Many individuals experience significant invalidation by family (attachment stress), and most are marginalized in some way by the the culture as a whole. They can struggle with self alienation, self loathing, body dysmorphia, dissociation, internal polarization and fragmentation of self. Despair, depression, hopelessness and self harm can follow; some are led to consider and undertake a de-transition. Others partition off a gendered part of themselves and express their authentic identity either exclusively in private or in only very selective ‘safe’ spaces. There are a number of widely used clinical paradigms we can turn to as we explore the complex gender identity experience. These include: Internal Family Systems, Coherence Therapy, Interpersonal Neurobiology and the Structural Dissociation trauma model. Contemporary neurobiology offers many insights into how gender dysphoria is an exemplar of genetic variance, neurodiversity, ‘embodiment of self' and unconscious emotional learning. Gender variant clients are subject to all the same challenges as the cis population (and more). These include identity formation and clarification. Gaining a more positive understanding of their gender dysphoria is a core accomplishment in developing resilience in the face of inevitable marginalization. When treating gender variant persons, elucidating the complex interactions between gender and the non gendered aspects of the psychological floor of their identity demands our attention. Working through the lens of complex gender dysphoria helps gender variant individuals appreciate that there is no universal template they must fit into. It confronts the doubt expressed by: Am I trans enough? Is my unique lived experience valid?

Trans-formation, Trance Formation: The Opportunities and Challenges of Hypnosis in Therapy

Christian Skoorsmith (he/him/they/them)

Mixing personal narrative, professional perspective, and instructional guidance, the presentation will (1) orient participants to what hypnosis actually is, (2) why it is difficult for people to change (and how we can do that better), and (3) explore a variety of ways that hypnosis can benefit transgender people particularly (and everyone, generally). The narrative/biographical arc begins with Christian’s own struggles with gender and orientation identities (not atypical in many respects) through young-adulthood, and their journey into the transgender community in the hands of two of their school-age children. It then examines the cognitive and emotional demands of both parenting and working with transgender clients in hypnosis, lifting up parallels in intrapersonal anti-racism work (especially at the unspoken intersection of race, gender, and sexuality in white supremacy culture). Peppered throughout with personal highlights, information, professional perspective and experience, the presentation lands on the therapeutic potential and power of insight-driven hypnosis in working with people generally, and the transgender community particularly.

What is there and what is missing: A scoping review of attachment-related research for lesbian women

Caitlin Edwards, M.A., MFTC, LPCC (she/her)

Robert Allan, PhD, MFT, LPC (he/him/his)

Attachment theory (Bowlby, 1969) provides a framework for understanding how people develop their view of self and view of other in a relational context as well as describes how individuals seek, develop, and sustain significant relationships. While attachment theory has been extensively studied in heterosexual populations, minimal research exists applying attachment theory to queer relationships. This is problematic, as therapeutic modalities such as Attachment-Based Filmily Therapy (ABFT) and Emotionally Focused Therapy (EFT), use attachment theory as their base for clinical interventions. A recent scoping review (Allan & Westhaver, 2018) assessing gay male relationship in the context of attachment theory concluded while attachment dynamics are similar between heterosexual individuals and gay men, gay men have unique relational and societal experiences that impact their attachment relationships. To add to this understanding, we conducted a scoping review of attachment-related research for lesbian women. We searched eight databases using several key words such as lesbian, queer, bisexual, same-sex, and LGBT. The search yielded 4,290 citations. The authors subsequently conducted a screening of title and abstracts, and 4,060 articles were eliminated. The authors then conducted a full text review of the remaining 230 articles. Fifty-one articles were extracted and assessed using thematic analysis. Several themes emerged from this process. First, lesbian women were often included in the discussion of gay men and bisexual individuals despite the differences in their relationship dynamics. Second, the discussion of lesbian women’s relationships often focused on lesbian motherhood. Third, attachment dynamics for lesbian relationships were often discussed in the context of either fusion or intimate partner violence (IPV). Fourth, there is very little research discussing the application of attachment theory for clinical use with lesbian women; what is written is generally theoretical without researching support. Finally, as all authors are members of the LGBTQIA + community, the lack of reflection of their attachment and relational experiences in the research literature was particularly striking. In this presentation, the authors will provide a review of the literature discussing lesbian women and attachment, provide clinically relevant information on working with lesbian women, and engage in discussion of their own self of the therapist experience while conducting this research.

Subversively Queer: A Conversation about Coming Out

Christy Song, LMHC/LMFT (She/They)

The presenter plans to discuss and identify how clinical work within anti-queer and heteronormative spaces impacts themselves as a provider, their clinical work, their identity, and their occurrence of burnout. Further, the presenter has interests in the pass-on effects in client care when working with populations that are LGBTQIA+, while also attempting to maintain personal safety within anti-queer spaces.

Voices of the Queer Community

Amanda Veldorale-Griffin, PhD, LMFT-S (she/her)

Morgan R. (she/her)

JP Holcomb (they/them)

Moss DiRatberry (they/them)

Erika Hale (they/them)

This will be a panel presentation with members of the queer and trans community. The session will begin with an introduction of each panel member. Then, each panel member will provide a brief summary of their experiences interacting with the mental healthcare system and mental health practitioners. They will share what they wish therapists, counselors, and others providing care to the queer and trans community knew about their lives, their experiences, and their needs. The panel moderator will ask some questions of each of the panelists regarding their experiences and the areas they think are most critical for mental health practitioners to understand. The session will close with a facilitated question and answer segment for members of the audience to ask questions, which will be answered by the panelists.

Join our various rooms on OhYay! to catch up with colleagues!

From Queer Caucus to the AAMFT's Clinical Guidelines for LGBTQIA-Affirming Marriage and Family Therapy
Historical and future-oriented perspective on trans and queer activism in our field

Presenters / Panelists:

• Alex Iantaffi, PhD MS SEP CST LMFT (They/Them/He/Him)

• RJ Green

• Markie Twist, PhD (she/they)

• Sheila Addison, PhD (she/her/hers)

• Christi McGeorge, PhD

• Kristen Benson, PhD (she/her/hers)

This panel will discuss the history of trans and queer activism within marriage and family therapy and, more specifically, within our national professional association, AAMFT. From the initial, informal gatherings of the queer caucus, to the establishment of the Queer and Trans Advocacy Network as an official topical interest network, until the recently released clinical guidelines for LGBTQIA-affirming marriage and family therapy, our association has a long history of queer and trans engagement. The panelists will talk about their own experiences with this history as well as discuss their hopes for the field moving forward. 

Dr. Mary Nedela (She/Her) & Dr. Evan Thomas (He/Him) - Conference Co-Chairs