Shawn Giammatei, Ph.D. - Guest
Shawn Giammatei, Ph.D. is the founder and director of the Gender Health Training Institute and the TransFamily Alliance, and contributor to the edited book, The Gender Affirmative Model: An Interdisciplinary Approach to Supporting Transgender and Gender Expansive Children. Shawn also has a clinical practice specializing in trans young people and their families, and couples therapy. Shawn teaches at Alliant International University in California, School of Professional Psychology and helped develop the Rockway Institute's LGBTQ Human Services Certificate, as well as being the first to teach a semester long Transgender Mental Health course for Psychology graduate students. Shawn does ongoing research in collaboration with Kaiser Permanente and Emery University, doing consultation on issues in trans health. |
W. Keith Sutton, Psy.D. - Host
Dr. Sutton has always had an interest in learning from multiple theoretical perspectives, and keeping up to date on innovations and integrations. He is interested in the development of ideas, and using research to show effectiveness in treatment and refine treatments. In 2009 he started the Institute for the Advancement of Psychotherapy, providing a one-way mirror training in family therapy with James Keim, LCSW. Next, he added a trainer and one-way mirror training in Cognitive Behavioral Therapy, and an additional trainer and mirror in Emotionally Focused Couples Therapy. The participants enjoyed analyzing cases, keeping each other up to date on research, and discussing what they were learning. This focus on integrating and evolving their approaches to helping children, adolescents, families, couples, and individuals lead to the Institute for the Advancement of Psychotherapy's training program for therapists, and its group practice of like-minded clinicians who were dedicated to learning, innovating, and advancing the field of psychotherapy. Our podcast, Therapy on the Cutting Edge, is an extension of this wish to learn, integrate, stay up to date, and share this passion for the advancement of the field with other practitioners. |
Keith Sutton, Psy.D: (00:22)
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area and the director of the Institute for the Advancement of Psychotherapy. Today, I'll be speaking with Shawn Giammatei, who is a psychologist in the San Francisco Bay Area. And the director of the Gender Health Training Institute. He is also a contributor to the edited book "Families in Transition, Parenting, Gender Diverse Children, Adolescents, and Young Adults". Shawn has a clinical practice specializing in trans, adolescents and their families, and couples therapy. He teaches at Alliant International University in California, School of Professional Psychology and developed the Rockway Institute's, LGBTQ Human Services Certification program, as well as being the first to teach the transgender mental health course for psychology graduate students. Shawn does ongoing research and collaboration with Kaiser Permanente and Emory University, and does consultation with their representative trans health studies departments. Let's listen to the interview. Hello Shawn. Welcome.
Shawn Giammatei, Ph.D.: (01:32)
It's great to be here.
Keith Sutton, Psy.D: (01:34)
Yeah, glad you could join me today. So I know you from, gosh, we had been at the same internship post-docs many years ago at the Family Institute of Pinole and you're very involved in the Association of Family Therapists, Northern California, which I'm also involved with. I've seen some of your talks on working with transgender kids and adults in families. I would love to hear about kind of your work and kind of share that with others and hear about what you're working on these days.
Shawn Giammatei, Ph.D.: (02:11)
Great. I'd say that's a long, long story. I think, predominately I was thinking about talking to you about this stuff and my focus, which is very different, I think, than a lot of people that work with the transgender community, is the focus on families. And that has been sort of my wheelhouse and where I love to work. And actually originally I wasn't planning on working with the trans community at all. I was just wanting to focus on working with families and as luck would have it, or I don't know, fate, whatever it was, while I was doing my residency at Kaiser, it ended up that I was the only person who knew anything about family therapy and gender identity issues and so I ended up getting families from all over Northern California, which cause at the time there wasn't anybody apparently doing that work. There's a lot more now. Still most people focus on, if they focus on kids, they focus on individual child therapy or play therapy and that kind of thing, or just working with the adolescents and parents. Family are considered peripheral or they work with adults. And again, I think very much like we learned with the LGB community, that people tend to think of people as not having families. You know, their issues around sexuality or gender identity and we don't think about the whole context and as many people have said, and I continue to say as well, that when one person in a family transitions, the whole family transitions and everybody's impacted. Also part of what brought me to this is, I'm also trans. The reason why I didn't want to work in X, cause I like to stay away. I want to keep my personal life separate from my work, but that just isn't how things fall out. And I'm also a true believer in that you bring yourself to your work, there's no blank slate. So, in doing that, it ended up, you know, obviously that's where I ended up getting things incorporated. And also I had people, I realized there was a hole in the training and the knowledge base that people had. So I just kind of fell into that hole and I love it. I mean, I really do. I love the work.
Keith Sutton, Psy.D: (04:39)
I remember when you shared with me that you are transgender and you transitioned and you're one of the first trans people that I've ever known more on a deeper level or so on. And so it was really great to get to know you. And I know for a lot of people too, I think, again correct me if I'm wrong, that many people are trans, sometimes aren't necessarily wanting to necessarily be out. They're oftentimes transitioning from one gender to another and wanting to, you know, that's the gender, they experience themself out. But being out as a transgender person then kind of shifts that, you know, from being a man to a transgender man. I've just been interested about, I had a couple interests in, one about how you came to family therapy and actually we've done so much work around family therapy. I've never actually quite heard the story because there's a lot of people like you're saying, don't do kind of individual or mostly do individual work or so on. How you decided to become more out in the work that you're doing?
Shawn Giammatei, Ph.D.: (05:49)
Yeah. I mean, you address a couple of big deal issues for me. I was very stealth for a long time and people just didn't know and nobody ever reads me as trans, which is lucky, cause I'm tall and I have no hair, sorry, other than the beard. It all fell. So as far as me, let me step back into the family therapy stuff, cause that happened first. And I was thinking about like in my early graduate school career, I was trying to find my fit and I will say that I have always had a focus on family. Maybe it's the Italian culture I was raised in, but I've always had this sense of family being very important and very central. And when I went to graduate school and then I took a family therapy class that really resonated for me and actually a part of what resonated for me. And that also was a narrative, there was a lot of, it was moved me into narrative therapy, which has been one of the big areas that influences my work that this idea that I'm not the expert in that the people are the experts on their own lives. And at first that was like, what, I'm spending all this money to go to graduate school and not be the expert. And then that was like a relief, "O,h I don't have to do that". So, but learning to work systemically and to work, I just found that for myself, I work better in that arena. And I do like things that are complicated. I do like things that get wild on occasion and, you know, couple and family therapy will take you there. It's certainly not boring. Yeah, go ahead.
Keith Sutton, Psy.D: (07:39)
And with that idea too, of the narrative piece and not being the expert, that there's this one piece that like, "Oh, wait a second, I'm not the expert", but at the same time, it's also a bit of a relief of responsibility and that you can actually bring in other parts of the system to help. Because I think that that's so important. I know when I was training in grad school, I went home and visited family over the holidays and I was thinking, "My gosh, I wouldn't be able to just change all this", as a therapist, that really, this is something that we would all have to come together around. But yeah, I spent a year focusing on narrative in the beginning. So foundational.
Shawn Giammatei, Ph.D.: (08:21)
Yeah. I always put that as my foundation as being very post-modern in that sense and systemic, in the way I approach, no matter what I do, but I'm very integrative because over the years and the long time it took me to get out of graduate school, I studied a lot of different models. And I've learned to pull all those pieces together in ways that what I call therapy that works when it comes to that. But it always comes from this frame of thinking more narratively and more systemic. And recently I've gotten really pulled in by liberation psychology and the whole notion around that because beyond just family systems in the small form, it's sort of going into networking community therapy and also using the wisdom, the cultural wisdom of people and what they bring in, in a way that fits so well with the narrative upbringing that I had to incorporate like, I would say indigenous, but I mean, across whatever your culture is, your own ways of knowledge and spirituality and all those things that we'd like to leave out in psychology. So, that's become a new thing for me. Not necessarily so new, but it's like, it's been grabbing a hold of me for a little while.
Keith Sutton, Psy.D: (09:42)
So where your interests have been kind of going,
Shawn Giammatei, Ph.D.: (09:42)
Yeah. And it fits with the whole, it fits in that whole thing.
Keith Sutton, Psy.D: (09:49)
Well, what you're doing too is you're really kind of expanding your matching to the community and the clients that you're working with, it's pretty significant. But we'll get there in a moment. So tell me a little bit about...
Shawn Giammatei, Ph.D.: (10:03)
About my story? About why did I decide to come out? You know, there are a few things that actually, I got outed in ways that were not okay with me. And I was and I experienced a lot of discrimination in various ways, which is interesting cause I never really put it together that those things had happened, but I was trying to avoid that. And part of it too was when you come out, everybody around you does too. So my partner, my family, like everybody gets a lens on them about having this trans family member. And it was probably some of my own internalized transphobia as well, and not wanting to be, I just wanted to just live my life as a man. And I don't tend to identify as a transgender man. I identify as a man with a transgender history cause that feels more fitting to me. And I know a lot of people who do identify that way. And part of it too, was that my dissertation chair had told me in the beginning, be careful about coming out because when you do you get labeled as that therapist, so the gay therapist or the trans therapist or that stuff. And I wanted to be known as a family therapist, not as that. So I wanted to establish myself, I guess at some point, and then the Pulse shooting happened. And when that happened, it kind of upended my whole world in a way that was, and I'd been through a lot of different, violent things in our community, but there was something about that that felt like I could have been there. My friends could have been there. And then I watched people that I cared about, spin it in a totally inappropriate direction and make it look like it had nothing to do with the LGBT community and that kind of stuff. And I kind of felt like I was done being quiet and that it was time to come out. And of course the scariest time to come out because here's the Trump administration. You don't know whether it's even safe to be out there and doing that, but I decided it was no longer okay to be silent. And so I started incorporating a lot of who I am into what I do, not just, I mean, clinically my clients know what they need to know about me, in a sense that whatever they care about and most of the trans clients know I'm trans, although they often forget. But I usually am fairly out about that stuff. And in the trainings I do when I'm training clinicians or when I'm working in the Trans Family Alliance with the parents, I'm very open about my story. So I share pieces of what that is, and I've found that I'm a much better teacher when I'm fully present and engaging as myself. So, it's been a beautiful experience and there's a part of me that has kept myself distanced from other people. And even my close community, meditation communities and other folks that I hang with, that I haven't let them know who I am and they always feel like I'm somewhere out there. And then when I'd come out, they're like, "Oh", and then all of a sudden we all feel bonded, you know? So it had a backlash for me to keep things stealth as well, which I've learned in the process. So, yeah. And I would say also the thing I'm going to go back to the question you had, but the family therapy piece, what actually taught me about family therapy was that I was working in a middle school with kids that were, it was infested with gang violence and I was feeling hopeless for the kids and really realizing that as I was in this school, I was working one-on-one with these kids or in groups. And I might be able to make a change for a moment, but it was clear that if the family wasn't engaged or I couldn't somehow engage them, nothing was going to happen. They were going to go back into an environment that was going to keep the same process going. And that was really the thing that sent me over to like, I absolutely do not work. I do not want to work with one kid by themselves. I wanna influence the whole system in a way that is helpful and also is acknowledging of where families are coming from and not just putting, cause that's the other thing. When you work with one person, you tend to, you can demonize everybody whose not in the room. Right. And that's not fair.
Keith Sutton, Psy.D: (14:31)
Yeah. Sometimes if you're just validating the client, but you're not necessarily seeing the larger context. Sometimes it's tougher and not that you'd necessarily would invalidate the client, but sometimes you can psychologically jump on their side against the other and demonize and such. But bringing in that the rest of that structure really kind of opens up the context and creates that lasting change so that when you're gone, hopefully there's still kind of a shift that has happened in that system.
Shawn Giammatei, Ph.D.: (14:59)
Yeah. And I often tell parents that, like I'm with your kid 15 minutes every week or every other week. You're with them how much? Hopefully a lot more than that. And you have a lot more influence, so let's work all together as a team.
Keith Sutton, Psy.D: (15:15)
Yeah. And sometimes when I talk, when I'm training folks or interviewing folks for our group practice, they kind of talk about,, the way that I think about it is, that the measure of that therapy is not necessarily how good of a relationship you have with the kid, which of course the base, if you want to have a good relationship, but really how good of a relationship have you helped develop between the kid and the parents so that you're ultimately putting yourself out of a job and the attachment figure is the attachment figure rather than the therapist being, the attachment figure for six months.
Shawn Giammatei, Ph.D.: (15:46)
Absolutely. Yeah. I always say that my job is to make myself obsolete so.
Keith Sutton, Psy.D: (15:53)
So tell me about, I know that you've done research, you've done writing, you've done work with families. Can you say a little bit about that?
Shawn Giammatei, Ph.D.: (16:05)
So all of the things I do? You know, it's funny that I jokingly said I was going for a Ph.D. because I wanted to do everything and I didn't want to have to go back to school to learn it all. And also that I would at least get a master's along the way. Cause I have a tendency to start things and get all involved in them and not quite finished stuff, or at least I did. I'm getting better at doing that. I am still like, got my fingers in all kinds of stuff, but I would say I have a clinical practice that is way over full and a part of my new things that I'm launching into are related to the fact that I have right now, I just counted, I think I have 36 families on my wait list. And so I'm having to think outside the box about how to deal with that. Some of it is thinking about hiring some, as a colleague of mine said, like a junior associate or somebody who really wants to build their practice and work with them on working because it's, I would say 90% trans youth and their families and a few couples. And so it's a specialty area that I feel like more people need training. And the problem is, the reason I have a wait list. So does everybody else that does what I do. So everybody works with families and kids, they also have waitlists, so it's like, there's nobody to send anybody to. And so that's one piece of thing. So I do have my clinical practice where I do mostly work with family and I would say probably maybe 70% are youth. I work with people across the lifespan from like four years to 80. So, I also have adults and one of the things I really enjoy also is working with couples. And so I work with a lot of couples where there's a transition happening or with couples where they're expanding their relationship to be on the two of them. Maybe as a part of that. And so that becomes a part of whether they're poly or non-monogamy or whatever it is, and figuring out how to stay a family and deal with all the changes that are coming up. So that's kind of my clinical practice and what I do, and I'm in San Francisco and Santa Rosa, but really I'm virtual so I'm everywhere now, which is less helpful for my wait-list. But then you know, I've been teaching at Alliant International University in California School of Professional Psychology, which I developed there, I was hired as a postdoc actually, to develop the Rockway Institute's, LGBTQ Human Services Certificate and helped develop all the courses that were in that to begin with and then taught several of them and then hired a lot of faculty to teach the various parts of it. And I've slowly over time pulled out of that and they've kind of morphed into other things. They still offer it. And it actually was the very first transgender mental health course for graduate psychology students. That was a semester long. So there were like weekend workshops and things like that because the first semester long one and even in a semester, it's still hard to get information out there. So, and I have continued to teach, although I've just pulled away from doing the foundations of LGBT mental health and I teach a LGBT couples and families course with them, so that's been sort of the teaching arm of what I was doing for the university. And I've written a lot of articles. I've done a lot of things, family process and international journal transgenderism, actually it's called something else now. And local things. And I've been involved in research and I loved research. So a lot of the recent stuff has been a collaboration with Kaiser Permanente and Emory University and doing a consultation with their trans health studies that are looking at people that are in those systems to figure out what's happening with transgender people across the lifespan as well. So mostly it's been adults, but we've also gotten a study out, a couple of studies out now, on youth and their experiences and mostly it's medical focus.
Keith Sutton, Psy.D: (20:48)
I'm interested too in that kind of lifespan and youth and so on. And, for clinicians that maybe aren't as familiar with working with transgender clients something that, and particularly, I think your training was one of the first trainings I took on working with kids and families transgender. And, our lab came out for that conference. It was really great. That was also helpful, but there was one part where you had the audience kind of think about how old they were. Can you kind of describe that exercise? Cause that was really striking to me.
Shawn Giammatei, Ph.D.: (21:23)
Yeah. And actually I'll let you know that one of the, I guess it would be more like a bootcamp, so I've started developing different kinds of courses, which we'll talk a little bit about what the other one, the other arms of what I'm doing for clinicians who are already licensed. And, one of them is that a workshop that I run both for professionals and for parents, which is called Unpacking and Decontextualizing Gender. And so in every workshop I do, even if it's like an hour webinar or something like that, I'll usually start with the question of, do you know what your gender identity is? And I actually got that from, and I just did it for w path as well. One of the things Jamison Green and in his book, "Becoming A Visible Man", where he talks about his transition stuff. And he was doing a lot of educating, talks about going into classrooms and asking people what their gender was and kind of working through the responses. And I thought that was so awesome that I just started doing it. And what I realized was you ask somebody their gender identity, 99% of the audience, if not all, are going to raise their hand and say, yeah, I know what that is. And then if I was to pick a few people out and ask them, well, what, what is it if you're willing to share? And how do you know that? A 90% of those people would say, unless they have some training, would say that they know who they are. Say they were a guy, "So well, yeah, I'm a guy and I'm a man and I know that because I have a penis". You're like, "Okay" and then I challenge it. So basically the whole thing around it is I challenge whatever it is you think, you know. There's two pieces to that. I challenge it because I want you to understand what your gender identity really is. I didn't ask your sex, which is actually your body.
Keith Sutton, Psy.D: (23:23)
One aspect. Yeah.
Shawn Giammatei, Ph.D.: (23:23)
Right, right. And so my comment to that person was usually be "Okay, if you lost your penis and your scrotum and all of that stuff between your legs was no longer there, would you cease to be a male? Would you cease to be a man?" and most guys would say, "Oh no, I'm still a guy". And I'm like, "Okay, so it's not your parts. What is it?" And that's usually a question that's like, "What?" Like, cause it's something you never thought about. If you're a cis-gender, it's something you've never thought about. So there's a whole process of actually unpacking gender from sex, from gender role from gender expression. Because a lot of people confuse like, "Well, I'm really a feminine, so I must be somewhere in the middle". And it's like, well, what's your actual gender identity? How do you identify in this? "Oh no, I identify as a guy" like, okay, but you like to do it in a feminine way. So are those, you know? And so for some people that is an identity for other people, that's an expression. So there's a way that you can unpack all that for yourself that most people, unless you're trans, have never done. Yeah. And the other side of it is that when I walk people through that particularly professionals, I walked them through the process of that and I asked them those questions and I get them to ask each other and they can't answer them. And then somebody saying, well, but explain it to me and they try and explain it. So it was like, yeah, I don't quite get it. Can you tell me more? Like, I don't, I'm not sure you've sold me on the fact that that's who you are. Can you explain more about that? And the more and more somebody goes into that, the more they realize how hard that is to answer that question. And then you have to turn around and think about what is it like for your trans client? Why is it they're supposed to know these things when you don't?
Shawn Giammatei, Ph.D.: (25:19)
And so, and I think it's absolutely important. This is a self of the therapist work. If you're going to work with a community, I don't care what community is, but when it's the trans community, you need to look at and understand your own gender identity, because we all have one and we don't think we do if we haven't been challenged on it, but understanding what that is and how you came to know, it helps you connect with the community rather than it being the other. It's like, oh yeah, we all have a gender identity. You just had a different kind of struggle around it than I had.
Keith Sutton, Psy.D: (25:50)
And that's the privileged position. To not even think about it and take it as an assumption. There was something too that that you did in the workshop that was really interesting. You had us think about how old we were when we knew what our gender was. And for most people, they were remembering back to like preschool age and something that you had said, if I'm remembering right, is that many kids, adolescents, adults who are trans knew then. And I think that that particularly was interesting. I hadn't necessarily thought of that. And oftentimes that like, especially as kids or adolescents going through kind of their own feelings about sexuality and gender or so on, and this, they thought about it even earlier than that. I mean, both for gender as well as sexuality.
Shawn Giammatei, Ph.D.: (26:46)
Right. Well, I think that's an important thing and it's a part of unpacking gender, which is to separate it from sexuality. And I mean, sexual orientation in particular, because most people conflate the two.They think, "Oh, I didn't like," I'll even ask people in my courses because in all my courses, I actually have people unpack their gender and their sexuality and I will ask them. How old were you when you were clear about who you were as a gendered being? When you really knew what that was? And a lot of people that have never thought about it, equate it to their sexuality. Like I knew I was a guy the first time I found myself attracted to a girl and I'm like, "Really? So before that, if somebody would have called you a girl and you would have said, sure?" And they're like, "Oh no, no". And so they mix those up so that it really is learning to separate because most people, gender identity, and even the developmental model say, you're supposed to know before the age of six. If you don't know before the age of six, this is the old models. But if you don't know before the age of six, then you're delayed in development. And somehow that's true for cisgender folks, but not for trans folks. Somehow trans folks can't know it. Like if they're really young, they're under six and they know it. And most know it's somewhere between 18 months to three years, four years, somewhere in there. But if they don't know it, then if they are, if they do know it, then they're too young. They couldn't possibly know this. It could be anything, they don't really know. Then if they hit adolescence, which is usually when most people come out, because that's when the discrepancy around puberty happens, then they can't know it then either because if you didn't know when you were six or when it was earlier than like, now you're too old, but then again, you're also an adolescent. So you really don't know anything about anything anyway. So therefore, how can you possibly know what you're also too young. Right? And then I see that with people in their twenties. It's like, well, you know, twenties is an experimental time. And really, how can it be real in your twenties if you didn't know it when you were two? Right. And so there's, and it's a complicated thing. So I would say that most people have a sense of their gender identity. Some people who are not as dysphoric, people who are very dysphoric will know it really young. People who are not as dysphoric may be able to bend and shift and put it in some of their box or that kind of stuff and it doesn't become an issue until either their body changes in the wrong direction or they are trying to be sexual in their body and they realize it's not the right fit. Those are the areas where I see people, like it's untenable after that. And some people still try not to do that cause they just, it's a hard thing to do in our life. So yeah. So those are big deals in understanding that usually sexuality comes on in puberty, and it is a different thing who you like versus who you are.
Keith Sutton, Psy.D: (29:48)
Definitely. Yeah. I really found, I don't know if you use it, but the gender bred person, kind of looking at those kind of variants of biological sex, sexual orientation, what we're attracted to romantically versus sexually and so on. Which I've used with my own kids to talk about the different levels.
Shawn Giammatei, Ph.D.: (30:12)
Yeah. I'll let you know that the gender bred person is a little out of favor now. It's transformed to the gender unicorn.
Keith Sutton, Psy.D: (30:18)
Oh, the gender unicorn? Okay!
Shawn Giammatei, Ph.D.: (30:25)
Right. Yeah. The trans community is like one of the things about the community is that things are always changing and they change really quickly, particularly around language and what's favorable and what's not favorable and what's okay and what's not okay. I'm sure there's things that I will say that other people will just be agast at. Things are always morphing. It's important to stay kind of on top of what those things are a little bit, but also know you're never going to know it all and so somebody will teach you along the way and you gotta be open to that's okay. That's how it works. Can be teachable all along the way. So yeah.
Keith Sutton, Psy.D: (31:02)
Yeah. Being open and I think too that, I think a thought that even comes to my head sometimes is the whole "is this a phase?" kind of piece, which I think that oftentimes the dominant culture really has this narrative, that it's just a phase, whether that is even more focused on sexuality before and now kind of much more focused now on gender. I'm just wondering, how do you talk about that with therapists? About kind of navigating that and being affirming and working with a family that may be in that place of "it's a phase", or again some kids that maybe are, going through that kind of a phase of understanding their self and their identity may not necessarily end up identifying as opposite gender.
Shawn Giammatei, Ph.D.: (32:00)
Yeah. I think there's so much in that. One, I gotta name the political backlash that's happening right now, and that there is a huge pushback against particularly those assigned female at birth transitioning and anybody helping children, like somehow children can't know their gender. And this goes back to that initial exercise where when I'm working with clinicians, I really want them to understand how they know what they know, because when you understand how, you know what you know, it's much easier to recognize it in other people and how they know it. Kids are often very clear about it. We also need to remember that, I mean, the data that's coming out about the physiology, the brain structures, the neurology stuff that's going on around gender is what it looks like is that trans folks, that their brain function and structure is much more similar to their affirmed gender than to their biological or assigned sex. So, when they look at brain scans, both functional MRIs and CAT scans and stuff like that, what they notice is that like trans boys look more like boys than they do at girls and vice versa. This is before hormones or any other kind of stuff that's happened so you can't blame it on anything other than this. So there is, it may be, I'm not going to call it an intersex condition because that's not appropriate, but there is something about that there's a development that has happened that is unique to these folks and that there is a biological component to it. It's not all biological, but it's that the sense that what needs to happen as a medical intervention and this is part of where people get really upset. Like they confuse medical necessity with cosmetic surgery. And often with kids, we're not even talking about surgery at all. That's later, but we're also talking about a medical issue and it really shouldn't be a psychological issue. It should be a psychological issue as the effect of a medical issue and the ICD is now taking it out of psychological stuff and put it in the medical category. The rest of the world seems to be following that suit, that this is what's happening, that there is actually a medical issue going on with that discrepancy between what you see in your mind's eye about what you're supposed to look like versus how it shows up. It's like the mind did go one way and the body went another. I think I help clinicians both with understanding yourself, then understanding the data that's out there, both the psychological and the medical data, neurobiological data, and then learning to ask the questions and listen and pay attention to the response that you're getting from the kids. That's a piece of help, and that can happen across the lifespan, no matter how old the child is, or the adult, trying to understand who they are and where that all fits and where the truth lies for them in that identity. For some people, they are exploring it. They're still trying to figure out how it fits, or maybe they have a clear sense of who they are, but they're not sure how to present it to the world. Some people may feel very much one gender and present a different gender to the world because that's more comfortable for them and they keep that other very close and everybody has a unique way of how they get to do it. When it comes to talking to parents who believe this is a phase, I do the same kind of work with them. So if I teach you how to deconstruct that. I do that with parents. It's like, let's look at how you know who you are. Let's look at what this is and why would your kid be different. Who is your kid? Who do you know them to be? You know because a lot of parents will talk to me about how amazing and smart and brilliant their kid is and how they do all this stuff. And they're really on the ball about this and on the ball about that. And then you ask them, "W"ell, what about their gender? They're like, "Oh, they're totally confused about that". So it's like they've got it across the board, except they can't know who they are. Right. And so it's a bit of, I think first it's joining always because if the parents don't feel like you understand their perspective and what their fears are and what they're going through, they will not hang around to figure out what's going on with their kid because you don't get them. So as much as you want to help the kid, that's why the family work is so important. The family has to be brought on board because they're going to be a part of all that and it impacts them in a huge way. You've got a lot of catching up to do. And part of what I also talk about is, transgender people go through a journey. They go through a journey from when they first figure out that something's going on to try to make it go away, to then realizing, no, this is the thing. And then try and figure out what to do about it. And what does it mean? Where am I going to go? And then telling people this whole process, right? Parents have the exact same journey, a little bit different, but mostly it's the same. Problem is they start out. So say their kid has gone through, I've gotten all the information. I know who I am. I now know what I need. I figured out all the things I need and I've come out to you. I'm down here. You find out about this. You're here, you're back at the beginning with like "what?!". I just need to make sure that this is real and then you got to go gather all the information and I find parents are way behind their kids. Right. And part of my job is to help them catch up. And then I find that therapists are in the same place. So you get a therapist who has a family who comes into them or a kid who comes out and they didn't realize. And maybe as a kid that they've got a really great relationship with and they don't want to refer them out somewhere. And they're like, "Oh, I don't know this stuff". And we get afraid that, "Oh, I'm outside of my competency level". So then we're running around trying to get informed. How do I learn this stuff really quickly? How do I figure out how to do this? And there is this process that we have to go through and then part of the process is understanding ourself and then learning all of the various things that the family needs to go through and trying to understand it's a developmental process for the therapist to go from being, "oh my God, I have a trans client", or "I have a trans family member" and "I don't know about this stuff" and to a place where they feel like they're a gender affirming therapist or even a specialist they may get so involved in it, they're like, "Oh, I want to specialize in this work". And for me coming back to my wait-list, that's a part of it. It's like, if I can help train more people to be able to do that kind of work, there will be more people out there and we won't have these terrible long wait lists.
Keith Sutton, Psy.D: (39:00)
What is your institute called that you started?
Shawn Giammatei, Ph.D.: (39:06)
Gender Health Training Institute. So yeah. The whole focus of that is to help therapists on their own gender journey of becoming a gender affirmative therapist, which is both a personal journey of understanding yourself and also a professional journey of understanding things like you need to be able to understand minority stress. You need to be able to understand the language and you need to understand not how to change your model, so like I'm not teaching a model of therapy so much more systemic, but whatever model you use, you need to know where it's transphobic, where it's heteronormative, CIS normative, and more often it's in those realms and how to shift what you're doing so that you can meet your clients. So it's about a bit about learning that kind of stuff. So yeah, it's the Gender Health Training Institute. I do a lot of surveying of the community to find out what people need and what they want and the biggest issue right now, a big topic, hot topic with the trans community, adult community, in particular and a lot of clinicians is writing letters for medical interventions. As a clinician, how do you do that properly and not be a gatekeeper because we don't need any more gatekeepers, but how do you do that and help your client. And yet you're also held accountable. Partially if you write a letter that you've recommended that this is something that they need, how do you hold your position as a therapist where you're not a medical provider and giving insight into the psychology of that client without gatekeeping them. And how do you do a proper gender health evaluation to be able to do that depending upon the complexity and age and all that kind of stuff. So to do that, I've decided, in actually in the beginning of June, I'm going to offer a bootcamp, which I decided rather than, because I like things to experiential and people have a tendency, like I can throw all this information at you and you'll kind of like, it'll hit you and you might take a little piece of it and remember, oh, there was that thing, but we don't tend to use it. So I wanted to do something that was a "do it with you" kind of experience so we're going to go in and actually go through building gender health evaluation that works for your practice and learn how to write the letters. What kind of letters are involved and you'll come away with your own templates and then I'll throw in some of mine as well, but then you'll have some skillset in that. So it's not a gender 101 kind of thing. There's some expectation that, you know some stuff, but I'm going to try and do a little bit of some free kind of training in advance so people can get up to speed with some of those things and take enough away from that they can use that. So what I decided is to sort of offer more of those kinds of courses or bootcamps. And then I also am developing, which I'm going to start this summer, a coaching and mentorship program, because I'm much better when I have a group of people and they say, I want this. And then I'm like, okay, I can create that and was like, "oh, you need a course or a workshop in that? Okay, let me do that for you". So, then it's meeting people where they're at and what they need. So if I get a group of clinicians who really want a particular kind of training, then they're getting exactly what they're asking for. And so we're all working well together with that. So those are some of the things down the road for the institute. And what I'm hoping to do is just sort of have developed more of these kinds of trainings and some will be like, you don't have to show up live, like I'll record those and then we'll make things available if you can't make it live and that kind of stuff. But, that's that piece. And then the other part is I'm hoping as it develops that we're going to be able to offer two other parts, which is assessment materials, in the sense of that there's a lot of things that we need to think about around depression and anxiety and all these other kinds of things and minority stress and various factors that show up in the trans community and to develop a database of ways that clinicians can actually send their clients in to do these things and may get a feedback. It kind of tells them where their clients are at in a way that can help them figure out how to better treat in the moment or what the focus is. There may be things they're missing because they're not asking the questions and they show up in the surveys. So that's one piece and the other piece is to do some kind of a certification so as people get a certain level of training that I can let it be known that they've had that level of training so that they're able to actually build a viable practice beause that's another piece is that I think we can't help people if we don't have a practice that's thriving and we need people to know that we're there.
Keith Sutton, Psy.D: (44:09)
What's a way to identify that somebody has some of the key elements and for clients to be able to be more informed consumers? I think that sometimes that a lot of people say they do stuff that they haven't necessarily had the training and they might think they even know how to do it, but sometimes if they don't have the extent of the training clients don't get what they need.
Shawn Giammatei, Ph.D.: (44:37)
Yeah. I was just talking to, I do an interview for the Trans Family Alliance, which is the other piece that I started because of my wait list, was to house a membership community for parents where I've actually been taking them through their own gender journey as a part, that's not what I initially intended to do. That's what it became because that's kinda what I do I guess. But I decided to do a lot what we do at the conferences and to start developing the materials that they would normally get at a conference that they can get at 24/7. And so I've been interviewing once a month, an expert based on what they want to learn more about. And we just had Nick Teich, come from Camp Aranu’tiq, which is the first camp for transgender and gender expansive youth, to come to talk to the parents about camps. Whether it's sleep away camps or day camps and that kind of stuff and how to vet them and things like that and one of the things he said and how this fits is that a lot of people, a lot of camps will say that they are LGBT affirming. Well, they want to be so they put in a policy, but they don't get the training. Then they don't actually know how to do it. So your kids go there and they actually aren't treated well, or they're not protected in the way that they need to be. And I think that the same is true with our clinical work, that there are a lot of clinicians who put out that they are something or that they're on an insurance panel and they pick LGBT and they maybe know something about sexual orientation, but haven't really studied the gender stuff or they know little pieces on it, but they don't know how to do these other parts. And so I think there's a lot of folks who are very affirming, want to be affirming, but they haven't had the training to actually do that, particularly with the trans community.
Keith Sutton, Psy.D: (46:26)
Well, that's great that you're making that resource available for people. That'll be really, really helpful. Yeah, beause even when I was hearing about writing the letter, I was like, "oh gosh, I don't know if I would, I wouldn't feel like I want a lot more training". I have, unfortunately I've only worked with one kid who is a trans identified, which came out through the work and there was oppositionality and so on. And it was really good work where he was able to talk to his family about it and but then I transitioned them to the expert in that area because they were also interested in looking into hormone blocking medications and so on. But I think that it's great that you're having that training because I'm sure that's a big question mark and also, there's also the do no harm, so I'm sure there's therapists and I know I would kind of be like, "Ooh, I want to make sure I get this right". Especially if it's something that's going to be potentially irreversible.
Shawn Giammatei, Ph.D.: (47:24)
Right. And the do no harm piece is really important. I think that a lot of parents and therapists feel like they need to slow way down and that's often what happen. "Oh, wait a minute". Back up, gotta slow down. Let's really look closely at this and that's not necessarily a bad thing, but if you have somebody who's in crisis and they've been waste load down for a long time, it just so happens that they came out when they couldn't stand it anymore. You're not in a position where you can just hang out and wait and often it's an area where not doing something can be more powerful and harder, more harm than doing something. So, there are no neutral options, basically whether you're a therapist. I think it's really hard also on clients to have a well-established, how long it takes for a kid to really connect with a therapist, feel like you get them. And then it's like, "oh, sorry, I can't work with that part of you" and then send them on. And how helpful is that to your client? Sometimes that's great. It's time to do that. But, I find often that there's a special relationship and they trust you and they need your help and they need you to understand this stuff and so it really requires getting up to speed and not punting that stuff or collaborating in some way. You know, like I collaborate with a lot of folks when it comes to things like that because maybe I don't hold the case, but I helped do the gender health evaluation because they need that. They don't have time to do that piece or that kind of thing. There are ways to do that kind of stuff.
Keith Sutton, Psy.D: (49:09)
I imagine that's a balance too, right? Because some therapists, they have that good relationship and sometimes if it's a more relational kind of dynamic approach, then kind of shifting that feels not so great so they might want to go out and get that training, but at the same time, sometimes it is okay to let somebody go. Especially like this family I was working with, they wanted, they were like, "okay, now we know what's going on". Let's get to the expert in this area. And so kind of, I think that balance of figuring out, cause yeah, that other experience of like, "Ooh, I can't do this. Like I'll give you three names." Is also not a good experience.
Shawn Giammatei, Ph.D.: (49:47)
Right. Well, and one of the things I can tell you from somebody who sometimes gets those kids that are, "Oh, I have a therapist, but you're the gender specialist" is that we don't get the full picture sometimes. It takes a lot longer to get all that information. And also the kid feels like, "No, you're the gender person. I'm not gonna talk to you about any issues. I got talk to you about the gender stuff". And so it becomes a sort of encapsulated thing that isn't always the best and the most helpful for the client. And there's a couple of other things that come up around the letters in particular and why it's a big deal right in the community and it always has been is the gatekeeping component. So it used to be that therapists were the gatekeepers and they would decide whether somebody had a right to transition or not, regardless of what the person felt or believed or knew about themselves. There is a difference between talking about youth and families versus adults. When an adult has gone through whatever their thing is and you're still asked to write a letter on their behalf. And luckily there are a lot of things letters are not required for, but insurance companies will require them. For adults, there are groups out there like, I don't remember what it stands for, GALAP, that will do either pro bono, like one session where they meet with somebody and they'll write letters, you know? If I have somebody come to me, who's been transitioned and they're really looking to have lower surgery, I'm not going to walk them through the evaluation to go, do you really know who you are., Obviously, you know who you are even living it, and that you need these various things. And so I think we tend to take things out of the context of the person and where they're at. I mean, same with a kid. If I have a kid whose family has, they've transitioned, like when they were 18 months or two years, and they've been living as their affirmed gender for four years and then they come to me because they need a gender specialist on their team to write the letters, to get the hormone blockers and all this kind of stuff. I'm going to learn the history around that, but I'm not gonna expect them to go through the same kind of thing. I want them to be fully informed about each phase of treatment. But, they know who they are. That's not the issue. It's harder when we're talking about kids who are non-binary, not because they don't know who they are, but because we're struggling to get language around, what is it going on and what does it mean to be in middle space. That somebody can clearly identify as that is very true and we have trouble understanding how to write about it. How to make sense out of what their language is when they're doing that. That's often confused as a phase when it's not. Now, I will say it's like bisexuality, in the sense that bisexuality for a long time was considered a phase from one sexual orientation to the other and that when you had finished your phase, you'd end up in one camp or the other, this binary. Right. I think the non-binary folks are getting that same kind of misconception. There are some people who do wander into non-binary or gender queer space, just trying to figure out what fits best and then end up in a binary place. But there are a lot of folks who don't, that they are in that non-binary space, and that's really who they are. They might have to choose a binary physiologically, and they may choose something that looks like the opposite of their assigned sex, because that's way more comfortable, but they're still living in non binary space. We don't understand it very well and because we don't understand it, us who are not non-binary, we tend to dismiss it and I think that's really unfair to do that. I understand the fear of therapists, right? Because I find therapists to be very risk averse and much like insurance companies are. And so you're trying to protect yourself as long and as well as not do harm and all that kind of stuff. And sometimes we get so over-protective around that we harm our clients in the process. We have to be careful about that dance.
Keith Sutton, Psy.D: (54:26)
Well, it sounds like you're doing great work and it's definitely sounds like it's a needed area cause I think that especially with more clients being more aware and being able to learn how to be more affirmative and help take care of their clients' needs and respond to them in the ways that they need is so important. So that's great that you're doing that.
Shawn Giammatei, Ph.D.: (54:47)
Yeah. Well, I'll say before, I know we're getting near the end, but one thing that I really want to comment on is this term authenticity, and I just kind of want to leave things in a way with that because that's what we're doing. You know, that's what we're doing as individuals who are trans, we're trying to be the most authentic us we can be in the world, whatever that happens to be. That's who families are trying to be. They're trying to help their kid be the most authentic. They're trying to be the most authentic in their representation of all that. And as clinicians we have to do that, we have to think about how do we help people be the most authentic and step into their community and culture in those ways. And how do we be the most authentic in doing that? I find that the more authentic, like I said at the beginning , the more authentic I am, the better this all lands and the better I am. So yeah.
Keith Sutton, Psy.D: (55:42)
And that kind of connection and kind of being able to connect with others is really there. Thank you so much for taking the time today. This is really great, and I really appreciate hearing about what you're doing. It's always good. I'm looking forward to the upcoming trainings. Will definitely have to check that out myself too. Cool. Well, thank you so much.
Shawn Giammatei, Ph.D.: (56:05)
Thank you. This was fun.
Keith Sutton, Psy.D: (56:07)
Take care. Bye. Thank you for joining us. If you're wanting to use this podcast to earn continuing education credits, please go to our [email protected]. Our podcast is brought to you by the Institute for the Advancement of Psychotherapy, providing in-person and remote therapy in the San Francisco Bay Area. IAP provides training for licensed clinicians through our in-person and online programs, as well as our treatment for children, adolescents, families, couples, and individual adults. For more information, go to sfiap.com or call 415-617-5932. Also, we really appreciate feedback and if you have something you're interested in, something that's on the cutting edge of the field of therapy and think clinicians should know about it, send us an email or call us. We're always looking for the advancements in the field of psychotherapy to help in creating lasting changes for our clients.
Welcome to Therapy on the Cutting Edge, a podcast for therapists who want to be up to date on the latest advancements in the field of psychotherapy. I'm your host, Dr. Keith Sutton, a psychologist in the San Francisco Bay Area and the director of the Institute for the Advancement of Psychotherapy. Today, I'll be speaking with Shawn Giammatei, who is a psychologist in the San Francisco Bay Area. And the director of the Gender Health Training Institute. He is also a contributor to the edited book "Families in Transition, Parenting, Gender Diverse Children, Adolescents, and Young Adults". Shawn has a clinical practice specializing in trans, adolescents and their families, and couples therapy. He teaches at Alliant International University in California, School of Professional Psychology and developed the Rockway Institute's, LGBTQ Human Services Certification program, as well as being the first to teach the transgender mental health course for psychology graduate students. Shawn does ongoing research and collaboration with Kaiser Permanente and Emory University, and does consultation with their representative trans health studies departments. Let's listen to the interview. Hello Shawn. Welcome.
Shawn Giammatei, Ph.D.: (01:32)
It's great to be here.
Keith Sutton, Psy.D: (01:34)
Yeah, glad you could join me today. So I know you from, gosh, we had been at the same internship post-docs many years ago at the Family Institute of Pinole and you're very involved in the Association of Family Therapists, Northern California, which I'm also involved with. I've seen some of your talks on working with transgender kids and adults in families. I would love to hear about kind of your work and kind of share that with others and hear about what you're working on these days.
Shawn Giammatei, Ph.D.: (02:11)
Great. I'd say that's a long, long story. I think, predominately I was thinking about talking to you about this stuff and my focus, which is very different, I think, than a lot of people that work with the transgender community, is the focus on families. And that has been sort of my wheelhouse and where I love to work. And actually originally I wasn't planning on working with the trans community at all. I was just wanting to focus on working with families and as luck would have it, or I don't know, fate, whatever it was, while I was doing my residency at Kaiser, it ended up that I was the only person who knew anything about family therapy and gender identity issues and so I ended up getting families from all over Northern California, which cause at the time there wasn't anybody apparently doing that work. There's a lot more now. Still most people focus on, if they focus on kids, they focus on individual child therapy or play therapy and that kind of thing, or just working with the adolescents and parents. Family are considered peripheral or they work with adults. And again, I think very much like we learned with the LGB community, that people tend to think of people as not having families. You know, their issues around sexuality or gender identity and we don't think about the whole context and as many people have said, and I continue to say as well, that when one person in a family transitions, the whole family transitions and everybody's impacted. Also part of what brought me to this is, I'm also trans. The reason why I didn't want to work in X, cause I like to stay away. I want to keep my personal life separate from my work, but that just isn't how things fall out. And I'm also a true believer in that you bring yourself to your work, there's no blank slate. So, in doing that, it ended up, you know, obviously that's where I ended up getting things incorporated. And also I had people, I realized there was a hole in the training and the knowledge base that people had. So I just kind of fell into that hole and I love it. I mean, I really do. I love the work.
Keith Sutton, Psy.D: (04:39)
I remember when you shared with me that you are transgender and you transitioned and you're one of the first trans people that I've ever known more on a deeper level or so on. And so it was really great to get to know you. And I know for a lot of people too, I think, again correct me if I'm wrong, that many people are trans, sometimes aren't necessarily wanting to necessarily be out. They're oftentimes transitioning from one gender to another and wanting to, you know, that's the gender, they experience themself out. But being out as a transgender person then kind of shifts that, you know, from being a man to a transgender man. I've just been interested about, I had a couple interests in, one about how you came to family therapy and actually we've done so much work around family therapy. I've never actually quite heard the story because there's a lot of people like you're saying, don't do kind of individual or mostly do individual work or so on. How you decided to become more out in the work that you're doing?
Shawn Giammatei, Ph.D.: (05:49)
Yeah. I mean, you address a couple of big deal issues for me. I was very stealth for a long time and people just didn't know and nobody ever reads me as trans, which is lucky, cause I'm tall and I have no hair, sorry, other than the beard. It all fell. So as far as me, let me step back into the family therapy stuff, cause that happened first. And I was thinking about like in my early graduate school career, I was trying to find my fit and I will say that I have always had a focus on family. Maybe it's the Italian culture I was raised in, but I've always had this sense of family being very important and very central. And when I went to graduate school and then I took a family therapy class that really resonated for me and actually a part of what resonated for me. And that also was a narrative, there was a lot of, it was moved me into narrative therapy, which has been one of the big areas that influences my work that this idea that I'm not the expert in that the people are the experts on their own lives. And at first that was like, what, I'm spending all this money to go to graduate school and not be the expert. And then that was like a relief, "O,h I don't have to do that". So, but learning to work systemically and to work, I just found that for myself, I work better in that arena. And I do like things that are complicated. I do like things that get wild on occasion and, you know, couple and family therapy will take you there. It's certainly not boring. Yeah, go ahead.
Keith Sutton, Psy.D: (07:39)
And with that idea too, of the narrative piece and not being the expert, that there's this one piece that like, "Oh, wait a second, I'm not the expert", but at the same time, it's also a bit of a relief of responsibility and that you can actually bring in other parts of the system to help. Because I think that that's so important. I know when I was training in grad school, I went home and visited family over the holidays and I was thinking, "My gosh, I wouldn't be able to just change all this", as a therapist, that really, this is something that we would all have to come together around. But yeah, I spent a year focusing on narrative in the beginning. So foundational.
Shawn Giammatei, Ph.D.: (08:21)
Yeah. I always put that as my foundation as being very post-modern in that sense and systemic, in the way I approach, no matter what I do, but I'm very integrative because over the years and the long time it took me to get out of graduate school, I studied a lot of different models. And I've learned to pull all those pieces together in ways that what I call therapy that works when it comes to that. But it always comes from this frame of thinking more narratively and more systemic. And recently I've gotten really pulled in by liberation psychology and the whole notion around that because beyond just family systems in the small form, it's sort of going into networking community therapy and also using the wisdom, the cultural wisdom of people and what they bring in, in a way that fits so well with the narrative upbringing that I had to incorporate like, I would say indigenous, but I mean, across whatever your culture is, your own ways of knowledge and spirituality and all those things that we'd like to leave out in psychology. So, that's become a new thing for me. Not necessarily so new, but it's like, it's been grabbing a hold of me for a little while.
Keith Sutton, Psy.D: (09:42)
So where your interests have been kind of going,
Shawn Giammatei, Ph.D.: (09:42)
Yeah. And it fits with the whole, it fits in that whole thing.
Keith Sutton, Psy.D: (09:49)
Well, what you're doing too is you're really kind of expanding your matching to the community and the clients that you're working with, it's pretty significant. But we'll get there in a moment. So tell me a little bit about...
Shawn Giammatei, Ph.D.: (10:03)
About my story? About why did I decide to come out? You know, there are a few things that actually, I got outed in ways that were not okay with me. And I was and I experienced a lot of discrimination in various ways, which is interesting cause I never really put it together that those things had happened, but I was trying to avoid that. And part of it too was when you come out, everybody around you does too. So my partner, my family, like everybody gets a lens on them about having this trans family member. And it was probably some of my own internalized transphobia as well, and not wanting to be, I just wanted to just live my life as a man. And I don't tend to identify as a transgender man. I identify as a man with a transgender history cause that feels more fitting to me. And I know a lot of people who do identify that way. And part of it too, was that my dissertation chair had told me in the beginning, be careful about coming out because when you do you get labeled as that therapist, so the gay therapist or the trans therapist or that stuff. And I wanted to be known as a family therapist, not as that. So I wanted to establish myself, I guess at some point, and then the Pulse shooting happened. And when that happened, it kind of upended my whole world in a way that was, and I'd been through a lot of different, violent things in our community, but there was something about that that felt like I could have been there. My friends could have been there. And then I watched people that I cared about, spin it in a totally inappropriate direction and make it look like it had nothing to do with the LGBT community and that kind of stuff. And I kind of felt like I was done being quiet and that it was time to come out. And of course the scariest time to come out because here's the Trump administration. You don't know whether it's even safe to be out there and doing that, but I decided it was no longer okay to be silent. And so I started incorporating a lot of who I am into what I do, not just, I mean, clinically my clients know what they need to know about me, in a sense that whatever they care about and most of the trans clients know I'm trans, although they often forget. But I usually am fairly out about that stuff. And in the trainings I do when I'm training clinicians or when I'm working in the Trans Family Alliance with the parents, I'm very open about my story. So I share pieces of what that is, and I've found that I'm a much better teacher when I'm fully present and engaging as myself. So, it's been a beautiful experience and there's a part of me that has kept myself distanced from other people. And even my close community, meditation communities and other folks that I hang with, that I haven't let them know who I am and they always feel like I'm somewhere out there. And then when I'd come out, they're like, "Oh", and then all of a sudden we all feel bonded, you know? So it had a backlash for me to keep things stealth as well, which I've learned in the process. So, yeah. And I would say also the thing I'm going to go back to the question you had, but the family therapy piece, what actually taught me about family therapy was that I was working in a middle school with kids that were, it was infested with gang violence and I was feeling hopeless for the kids and really realizing that as I was in this school, I was working one-on-one with these kids or in groups. And I might be able to make a change for a moment, but it was clear that if the family wasn't engaged or I couldn't somehow engage them, nothing was going to happen. They were going to go back into an environment that was going to keep the same process going. And that was really the thing that sent me over to like, I absolutely do not work. I do not want to work with one kid by themselves. I wanna influence the whole system in a way that is helpful and also is acknowledging of where families are coming from and not just putting, cause that's the other thing. When you work with one person, you tend to, you can demonize everybody whose not in the room. Right. And that's not fair.
Keith Sutton, Psy.D: (14:31)
Yeah. Sometimes if you're just validating the client, but you're not necessarily seeing the larger context. Sometimes it's tougher and not that you'd necessarily would invalidate the client, but sometimes you can psychologically jump on their side against the other and demonize and such. But bringing in that the rest of that structure really kind of opens up the context and creates that lasting change so that when you're gone, hopefully there's still kind of a shift that has happened in that system.
Shawn Giammatei, Ph.D.: (14:59)
Yeah. And I often tell parents that, like I'm with your kid 15 minutes every week or every other week. You're with them how much? Hopefully a lot more than that. And you have a lot more influence, so let's work all together as a team.
Keith Sutton, Psy.D: (15:15)
Yeah. And sometimes when I talk, when I'm training folks or interviewing folks for our group practice, they kind of talk about,, the way that I think about it is, that the measure of that therapy is not necessarily how good of a relationship you have with the kid, which of course the base, if you want to have a good relationship, but really how good of a relationship have you helped develop between the kid and the parents so that you're ultimately putting yourself out of a job and the attachment figure is the attachment figure rather than the therapist being, the attachment figure for six months.
Shawn Giammatei, Ph.D.: (15:46)
Absolutely. Yeah. I always say that my job is to make myself obsolete so.
Keith Sutton, Psy.D: (15:53)
So tell me about, I know that you've done research, you've done writing, you've done work with families. Can you say a little bit about that?
Shawn Giammatei, Ph.D.: (16:05)
So all of the things I do? You know, it's funny that I jokingly said I was going for a Ph.D. because I wanted to do everything and I didn't want to have to go back to school to learn it all. And also that I would at least get a master's along the way. Cause I have a tendency to start things and get all involved in them and not quite finished stuff, or at least I did. I'm getting better at doing that. I am still like, got my fingers in all kinds of stuff, but I would say I have a clinical practice that is way over full and a part of my new things that I'm launching into are related to the fact that I have right now, I just counted, I think I have 36 families on my wait list. And so I'm having to think outside the box about how to deal with that. Some of it is thinking about hiring some, as a colleague of mine said, like a junior associate or somebody who really wants to build their practice and work with them on working because it's, I would say 90% trans youth and their families and a few couples. And so it's a specialty area that I feel like more people need training. And the problem is, the reason I have a wait list. So does everybody else that does what I do. So everybody works with families and kids, they also have waitlists, so it's like, there's nobody to send anybody to. And so that's one piece of thing. So I do have my clinical practice where I do mostly work with family and I would say probably maybe 70% are youth. I work with people across the lifespan from like four years to 80. So, I also have adults and one of the things I really enjoy also is working with couples. And so I work with a lot of couples where there's a transition happening or with couples where they're expanding their relationship to be on the two of them. Maybe as a part of that. And so that becomes a part of whether they're poly or non-monogamy or whatever it is, and figuring out how to stay a family and deal with all the changes that are coming up. So that's kind of my clinical practice and what I do, and I'm in San Francisco and Santa Rosa, but really I'm virtual so I'm everywhere now, which is less helpful for my wait-list. But then you know, I've been teaching at Alliant International University in California School of Professional Psychology, which I developed there, I was hired as a postdoc actually, to develop the Rockway Institute's, LGBTQ Human Services Certificate and helped develop all the courses that were in that to begin with and then taught several of them and then hired a lot of faculty to teach the various parts of it. And I've slowly over time pulled out of that and they've kind of morphed into other things. They still offer it. And it actually was the very first transgender mental health course for graduate psychology students. That was a semester long. So there were like weekend workshops and things like that because the first semester long one and even in a semester, it's still hard to get information out there. So, and I have continued to teach, although I've just pulled away from doing the foundations of LGBT mental health and I teach a LGBT couples and families course with them, so that's been sort of the teaching arm of what I was doing for the university. And I've written a lot of articles. I've done a lot of things, family process and international journal transgenderism, actually it's called something else now. And local things. And I've been involved in research and I loved research. So a lot of the recent stuff has been a collaboration with Kaiser Permanente and Emory University and doing a consultation with their trans health studies that are looking at people that are in those systems to figure out what's happening with transgender people across the lifespan as well. So mostly it's been adults, but we've also gotten a study out, a couple of studies out now, on youth and their experiences and mostly it's medical focus.
Keith Sutton, Psy.D: (20:48)
I'm interested too in that kind of lifespan and youth and so on. And, for clinicians that maybe aren't as familiar with working with transgender clients something that, and particularly, I think your training was one of the first trainings I took on working with kids and families transgender. And, our lab came out for that conference. It was really great. That was also helpful, but there was one part where you had the audience kind of think about how old they were. Can you kind of describe that exercise? Cause that was really striking to me.
Shawn Giammatei, Ph.D.: (21:23)
Yeah. And actually I'll let you know that one of the, I guess it would be more like a bootcamp, so I've started developing different kinds of courses, which we'll talk a little bit about what the other one, the other arms of what I'm doing for clinicians who are already licensed. And, one of them is that a workshop that I run both for professionals and for parents, which is called Unpacking and Decontextualizing Gender. And so in every workshop I do, even if it's like an hour webinar or something like that, I'll usually start with the question of, do you know what your gender identity is? And I actually got that from, and I just did it for w path as well. One of the things Jamison Green and in his book, "Becoming A Visible Man", where he talks about his transition stuff. And he was doing a lot of educating, talks about going into classrooms and asking people what their gender was and kind of working through the responses. And I thought that was so awesome that I just started doing it. And what I realized was you ask somebody their gender identity, 99% of the audience, if not all, are going to raise their hand and say, yeah, I know what that is. And then if I was to pick a few people out and ask them, well, what, what is it if you're willing to share? And how do you know that? A 90% of those people would say, unless they have some training, would say that they know who they are. Say they were a guy, "So well, yeah, I'm a guy and I'm a man and I know that because I have a penis". You're like, "Okay" and then I challenge it. So basically the whole thing around it is I challenge whatever it is you think, you know. There's two pieces to that. I challenge it because I want you to understand what your gender identity really is. I didn't ask your sex, which is actually your body.
Keith Sutton, Psy.D: (23:23)
One aspect. Yeah.
Shawn Giammatei, Ph.D.: (23:23)
Right, right. And so my comment to that person was usually be "Okay, if you lost your penis and your scrotum and all of that stuff between your legs was no longer there, would you cease to be a male? Would you cease to be a man?" and most guys would say, "Oh no, I'm still a guy". And I'm like, "Okay, so it's not your parts. What is it?" And that's usually a question that's like, "What?" Like, cause it's something you never thought about. If you're a cis-gender, it's something you've never thought about. So there's a whole process of actually unpacking gender from sex, from gender role from gender expression. Because a lot of people confuse like, "Well, I'm really a feminine, so I must be somewhere in the middle". And it's like, well, what's your actual gender identity? How do you identify in this? "Oh no, I identify as a guy" like, okay, but you like to do it in a feminine way. So are those, you know? And so for some people that is an identity for other people, that's an expression. So there's a way that you can unpack all that for yourself that most people, unless you're trans, have never done. Yeah. And the other side of it is that when I walk people through that particularly professionals, I walked them through the process of that and I asked them those questions and I get them to ask each other and they can't answer them. And then somebody saying, well, but explain it to me and they try and explain it. So it was like, yeah, I don't quite get it. Can you tell me more? Like, I don't, I'm not sure you've sold me on the fact that that's who you are. Can you explain more about that? And the more and more somebody goes into that, the more they realize how hard that is to answer that question. And then you have to turn around and think about what is it like for your trans client? Why is it they're supposed to know these things when you don't?
Shawn Giammatei, Ph.D.: (25:19)
And so, and I think it's absolutely important. This is a self of the therapist work. If you're going to work with a community, I don't care what community is, but when it's the trans community, you need to look at and understand your own gender identity, because we all have one and we don't think we do if we haven't been challenged on it, but understanding what that is and how you came to know, it helps you connect with the community rather than it being the other. It's like, oh yeah, we all have a gender identity. You just had a different kind of struggle around it than I had.
Keith Sutton, Psy.D: (25:50)
And that's the privileged position. To not even think about it and take it as an assumption. There was something too that that you did in the workshop that was really interesting. You had us think about how old we were when we knew what our gender was. And for most people, they were remembering back to like preschool age and something that you had said, if I'm remembering right, is that many kids, adolescents, adults who are trans knew then. And I think that that particularly was interesting. I hadn't necessarily thought of that. And oftentimes that like, especially as kids or adolescents going through kind of their own feelings about sexuality and gender or so on, and this, they thought about it even earlier than that. I mean, both for gender as well as sexuality.
Shawn Giammatei, Ph.D.: (26:46)
Right. Well, I think that's an important thing and it's a part of unpacking gender, which is to separate it from sexuality. And I mean, sexual orientation in particular, because most people conflate the two.They think, "Oh, I didn't like," I'll even ask people in my courses because in all my courses, I actually have people unpack their gender and their sexuality and I will ask them. How old were you when you were clear about who you were as a gendered being? When you really knew what that was? And a lot of people that have never thought about it, equate it to their sexuality. Like I knew I was a guy the first time I found myself attracted to a girl and I'm like, "Really? So before that, if somebody would have called you a girl and you would have said, sure?" And they're like, "Oh no, no". And so they mix those up so that it really is learning to separate because most people, gender identity, and even the developmental model say, you're supposed to know before the age of six. If you don't know before the age of six, this is the old models. But if you don't know before the age of six, then you're delayed in development. And somehow that's true for cisgender folks, but not for trans folks. Somehow trans folks can't know it. Like if they're really young, they're under six and they know it. And most know it's somewhere between 18 months to three years, four years, somewhere in there. But if they don't know it, then if they are, if they do know it, then they're too young. They couldn't possibly know this. It could be anything, they don't really know. Then if they hit adolescence, which is usually when most people come out, because that's when the discrepancy around puberty happens, then they can't know it then either because if you didn't know when you were six or when it was earlier than like, now you're too old, but then again, you're also an adolescent. So you really don't know anything about anything anyway. So therefore, how can you possibly know what you're also too young. Right? And then I see that with people in their twenties. It's like, well, you know, twenties is an experimental time. And really, how can it be real in your twenties if you didn't know it when you were two? Right. And so there's, and it's a complicated thing. So I would say that most people have a sense of their gender identity. Some people who are not as dysphoric, people who are very dysphoric will know it really young. People who are not as dysphoric may be able to bend and shift and put it in some of their box or that kind of stuff and it doesn't become an issue until either their body changes in the wrong direction or they are trying to be sexual in their body and they realize it's not the right fit. Those are the areas where I see people, like it's untenable after that. And some people still try not to do that cause they just, it's a hard thing to do in our life. So yeah. So those are big deals in understanding that usually sexuality comes on in puberty, and it is a different thing who you like versus who you are.
Keith Sutton, Psy.D: (29:48)
Definitely. Yeah. I really found, I don't know if you use it, but the gender bred person, kind of looking at those kind of variants of biological sex, sexual orientation, what we're attracted to romantically versus sexually and so on. Which I've used with my own kids to talk about the different levels.
Shawn Giammatei, Ph.D.: (30:12)
Yeah. I'll let you know that the gender bred person is a little out of favor now. It's transformed to the gender unicorn.
Keith Sutton, Psy.D: (30:18)
Oh, the gender unicorn? Okay!
Shawn Giammatei, Ph.D.: (30:25)
Right. Yeah. The trans community is like one of the things about the community is that things are always changing and they change really quickly, particularly around language and what's favorable and what's not favorable and what's okay and what's not okay. I'm sure there's things that I will say that other people will just be agast at. Things are always morphing. It's important to stay kind of on top of what those things are a little bit, but also know you're never going to know it all and so somebody will teach you along the way and you gotta be open to that's okay. That's how it works. Can be teachable all along the way. So yeah.
Keith Sutton, Psy.D: (31:02)
Yeah. Being open and I think too that, I think a thought that even comes to my head sometimes is the whole "is this a phase?" kind of piece, which I think that oftentimes the dominant culture really has this narrative, that it's just a phase, whether that is even more focused on sexuality before and now kind of much more focused now on gender. I'm just wondering, how do you talk about that with therapists? About kind of navigating that and being affirming and working with a family that may be in that place of "it's a phase", or again some kids that maybe are, going through that kind of a phase of understanding their self and their identity may not necessarily end up identifying as opposite gender.
Shawn Giammatei, Ph.D.: (32:00)
Yeah. I think there's so much in that. One, I gotta name the political backlash that's happening right now, and that there is a huge pushback against particularly those assigned female at birth transitioning and anybody helping children, like somehow children can't know their gender. And this goes back to that initial exercise where when I'm working with clinicians, I really want them to understand how they know what they know, because when you understand how, you know what you know, it's much easier to recognize it in other people and how they know it. Kids are often very clear about it. We also need to remember that, I mean, the data that's coming out about the physiology, the brain structures, the neurology stuff that's going on around gender is what it looks like is that trans folks, that their brain function and structure is much more similar to their affirmed gender than to their biological or assigned sex. So, when they look at brain scans, both functional MRIs and CAT scans and stuff like that, what they notice is that like trans boys look more like boys than they do at girls and vice versa. This is before hormones or any other kind of stuff that's happened so you can't blame it on anything other than this. So there is, it may be, I'm not going to call it an intersex condition because that's not appropriate, but there is something about that there's a development that has happened that is unique to these folks and that there is a biological component to it. It's not all biological, but it's that the sense that what needs to happen as a medical intervention and this is part of where people get really upset. Like they confuse medical necessity with cosmetic surgery. And often with kids, we're not even talking about surgery at all. That's later, but we're also talking about a medical issue and it really shouldn't be a psychological issue. It should be a psychological issue as the effect of a medical issue and the ICD is now taking it out of psychological stuff and put it in the medical category. The rest of the world seems to be following that suit, that this is what's happening, that there is actually a medical issue going on with that discrepancy between what you see in your mind's eye about what you're supposed to look like versus how it shows up. It's like the mind did go one way and the body went another. I think I help clinicians both with understanding yourself, then understanding the data that's out there, both the psychological and the medical data, neurobiological data, and then learning to ask the questions and listen and pay attention to the response that you're getting from the kids. That's a piece of help, and that can happen across the lifespan, no matter how old the child is, or the adult, trying to understand who they are and where that all fits and where the truth lies for them in that identity. For some people, they are exploring it. They're still trying to figure out how it fits, or maybe they have a clear sense of who they are, but they're not sure how to present it to the world. Some people may feel very much one gender and present a different gender to the world because that's more comfortable for them and they keep that other very close and everybody has a unique way of how they get to do it. When it comes to talking to parents who believe this is a phase, I do the same kind of work with them. So if I teach you how to deconstruct that. I do that with parents. It's like, let's look at how you know who you are. Let's look at what this is and why would your kid be different. Who is your kid? Who do you know them to be? You know because a lot of parents will talk to me about how amazing and smart and brilliant their kid is and how they do all this stuff. And they're really on the ball about this and on the ball about that. And then you ask them, "W"ell, what about their gender? They're like, "Oh, they're totally confused about that". So it's like they've got it across the board, except they can't know who they are. Right. And so it's a bit of, I think first it's joining always because if the parents don't feel like you understand their perspective and what their fears are and what they're going through, they will not hang around to figure out what's going on with their kid because you don't get them. So as much as you want to help the kid, that's why the family work is so important. The family has to be brought on board because they're going to be a part of all that and it impacts them in a huge way. You've got a lot of catching up to do. And part of what I also talk about is, transgender people go through a journey. They go through a journey from when they first figure out that something's going on to try to make it go away, to then realizing, no, this is the thing. And then try and figure out what to do about it. And what does it mean? Where am I going to go? And then telling people this whole process, right? Parents have the exact same journey, a little bit different, but mostly it's the same. Problem is they start out. So say their kid has gone through, I've gotten all the information. I know who I am. I now know what I need. I figured out all the things I need and I've come out to you. I'm down here. You find out about this. You're here, you're back at the beginning with like "what?!". I just need to make sure that this is real and then you got to go gather all the information and I find parents are way behind their kids. Right. And part of my job is to help them catch up. And then I find that therapists are in the same place. So you get a therapist who has a family who comes into them or a kid who comes out and they didn't realize. And maybe as a kid that they've got a really great relationship with and they don't want to refer them out somewhere. And they're like, "Oh, I don't know this stuff". And we get afraid that, "Oh, I'm outside of my competency level". So then we're running around trying to get informed. How do I learn this stuff really quickly? How do I figure out how to do this? And there is this process that we have to go through and then part of the process is understanding ourself and then learning all of the various things that the family needs to go through and trying to understand it's a developmental process for the therapist to go from being, "oh my God, I have a trans client", or "I have a trans family member" and "I don't know about this stuff" and to a place where they feel like they're a gender affirming therapist or even a specialist they may get so involved in it, they're like, "Oh, I want to specialize in this work". And for me coming back to my wait-list, that's a part of it. It's like, if I can help train more people to be able to do that kind of work, there will be more people out there and we won't have these terrible long wait lists.
Keith Sutton, Psy.D: (39:00)
What is your institute called that you started?
Shawn Giammatei, Ph.D.: (39:06)
Gender Health Training Institute. So yeah. The whole focus of that is to help therapists on their own gender journey of becoming a gender affirmative therapist, which is both a personal journey of understanding yourself and also a professional journey of understanding things like you need to be able to understand minority stress. You need to be able to understand the language and you need to understand not how to change your model, so like I'm not teaching a model of therapy so much more systemic, but whatever model you use, you need to know where it's transphobic, where it's heteronormative, CIS normative, and more often it's in those realms and how to shift what you're doing so that you can meet your clients. So it's about a bit about learning that kind of stuff. So yeah, it's the Gender Health Training Institute. I do a lot of surveying of the community to find out what people need and what they want and the biggest issue right now, a big topic, hot topic with the trans community, adult community, in particular and a lot of clinicians is writing letters for medical interventions. As a clinician, how do you do that properly and not be a gatekeeper because we don't need any more gatekeepers, but how do you do that and help your client. And yet you're also held accountable. Partially if you write a letter that you've recommended that this is something that they need, how do you hold your position as a therapist where you're not a medical provider and giving insight into the psychology of that client without gatekeeping them. And how do you do a proper gender health evaluation to be able to do that depending upon the complexity and age and all that kind of stuff. So to do that, I've decided, in actually in the beginning of June, I'm going to offer a bootcamp, which I decided rather than, because I like things to experiential and people have a tendency, like I can throw all this information at you and you'll kind of like, it'll hit you and you might take a little piece of it and remember, oh, there was that thing, but we don't tend to use it. So I wanted to do something that was a "do it with you" kind of experience so we're going to go in and actually go through building gender health evaluation that works for your practice and learn how to write the letters. What kind of letters are involved and you'll come away with your own templates and then I'll throw in some of mine as well, but then you'll have some skillset in that. So it's not a gender 101 kind of thing. There's some expectation that, you know some stuff, but I'm going to try and do a little bit of some free kind of training in advance so people can get up to speed with some of those things and take enough away from that they can use that. So what I decided is to sort of offer more of those kinds of courses or bootcamps. And then I also am developing, which I'm going to start this summer, a coaching and mentorship program, because I'm much better when I have a group of people and they say, I want this. And then I'm like, okay, I can create that and was like, "oh, you need a course or a workshop in that? Okay, let me do that for you". So, then it's meeting people where they're at and what they need. So if I get a group of clinicians who really want a particular kind of training, then they're getting exactly what they're asking for. And so we're all working well together with that. So those are some of the things down the road for the institute. And what I'm hoping to do is just sort of have developed more of these kinds of trainings and some will be like, you don't have to show up live, like I'll record those and then we'll make things available if you can't make it live and that kind of stuff. But, that's that piece. And then the other part is I'm hoping as it develops that we're going to be able to offer two other parts, which is assessment materials, in the sense of that there's a lot of things that we need to think about around depression and anxiety and all these other kinds of things and minority stress and various factors that show up in the trans community and to develop a database of ways that clinicians can actually send their clients in to do these things and may get a feedback. It kind of tells them where their clients are at in a way that can help them figure out how to better treat in the moment or what the focus is. There may be things they're missing because they're not asking the questions and they show up in the surveys. So that's one piece and the other piece is to do some kind of a certification so as people get a certain level of training that I can let it be known that they've had that level of training so that they're able to actually build a viable practice beause that's another piece is that I think we can't help people if we don't have a practice that's thriving and we need people to know that we're there.
Keith Sutton, Psy.D: (44:09)
What's a way to identify that somebody has some of the key elements and for clients to be able to be more informed consumers? I think that sometimes that a lot of people say they do stuff that they haven't necessarily had the training and they might think they even know how to do it, but sometimes if they don't have the extent of the training clients don't get what they need.
Shawn Giammatei, Ph.D.: (44:37)
Yeah. I was just talking to, I do an interview for the Trans Family Alliance, which is the other piece that I started because of my wait list, was to house a membership community for parents where I've actually been taking them through their own gender journey as a part, that's not what I initially intended to do. That's what it became because that's kinda what I do I guess. But I decided to do a lot what we do at the conferences and to start developing the materials that they would normally get at a conference that they can get at 24/7. And so I've been interviewing once a month, an expert based on what they want to learn more about. And we just had Nick Teich, come from Camp Aranu’tiq, which is the first camp for transgender and gender expansive youth, to come to talk to the parents about camps. Whether it's sleep away camps or day camps and that kind of stuff and how to vet them and things like that and one of the things he said and how this fits is that a lot of people, a lot of camps will say that they are LGBT affirming. Well, they want to be so they put in a policy, but they don't get the training. Then they don't actually know how to do it. So your kids go there and they actually aren't treated well, or they're not protected in the way that they need to be. And I think that the same is true with our clinical work, that there are a lot of clinicians who put out that they are something or that they're on an insurance panel and they pick LGBT and they maybe know something about sexual orientation, but haven't really studied the gender stuff or they know little pieces on it, but they don't know how to do these other parts. And so I think there's a lot of folks who are very affirming, want to be affirming, but they haven't had the training to actually do that, particularly with the trans community.
Keith Sutton, Psy.D: (46:26)
Well, that's great that you're making that resource available for people. That'll be really, really helpful. Yeah, beause even when I was hearing about writing the letter, I was like, "oh gosh, I don't know if I would, I wouldn't feel like I want a lot more training". I have, unfortunately I've only worked with one kid who is a trans identified, which came out through the work and there was oppositionality and so on. And it was really good work where he was able to talk to his family about it and but then I transitioned them to the expert in that area because they were also interested in looking into hormone blocking medications and so on. But I think that it's great that you're having that training because I'm sure that's a big question mark and also, there's also the do no harm, so I'm sure there's therapists and I know I would kind of be like, "Ooh, I want to make sure I get this right". Especially if it's something that's going to be potentially irreversible.
Shawn Giammatei, Ph.D.: (47:24)
Right. And the do no harm piece is really important. I think that a lot of parents and therapists feel like they need to slow way down and that's often what happen. "Oh, wait a minute". Back up, gotta slow down. Let's really look closely at this and that's not necessarily a bad thing, but if you have somebody who's in crisis and they've been waste load down for a long time, it just so happens that they came out when they couldn't stand it anymore. You're not in a position where you can just hang out and wait and often it's an area where not doing something can be more powerful and harder, more harm than doing something. So, there are no neutral options, basically whether you're a therapist. I think it's really hard also on clients to have a well-established, how long it takes for a kid to really connect with a therapist, feel like you get them. And then it's like, "oh, sorry, I can't work with that part of you" and then send them on. And how helpful is that to your client? Sometimes that's great. It's time to do that. But, I find often that there's a special relationship and they trust you and they need your help and they need you to understand this stuff and so it really requires getting up to speed and not punting that stuff or collaborating in some way. You know, like I collaborate with a lot of folks when it comes to things like that because maybe I don't hold the case, but I helped do the gender health evaluation because they need that. They don't have time to do that piece or that kind of thing. There are ways to do that kind of stuff.
Keith Sutton, Psy.D: (49:09)
I imagine that's a balance too, right? Because some therapists, they have that good relationship and sometimes if it's a more relational kind of dynamic approach, then kind of shifting that feels not so great so they might want to go out and get that training, but at the same time, sometimes it is okay to let somebody go. Especially like this family I was working with, they wanted, they were like, "okay, now we know what's going on". Let's get to the expert in this area. And so kind of, I think that balance of figuring out, cause yeah, that other experience of like, "Ooh, I can't do this. Like I'll give you three names." Is also not a good experience.
Shawn Giammatei, Ph.D.: (49:47)
Right. Well, and one of the things I can tell you from somebody who sometimes gets those kids that are, "Oh, I have a therapist, but you're the gender specialist" is that we don't get the full picture sometimes. It takes a lot longer to get all that information. And also the kid feels like, "No, you're the gender person. I'm not gonna talk to you about any issues. I got talk to you about the gender stuff". And so it becomes a sort of encapsulated thing that isn't always the best and the most helpful for the client. And there's a couple of other things that come up around the letters in particular and why it's a big deal right in the community and it always has been is the gatekeeping component. So it used to be that therapists were the gatekeepers and they would decide whether somebody had a right to transition or not, regardless of what the person felt or believed or knew about themselves. There is a difference between talking about youth and families versus adults. When an adult has gone through whatever their thing is and you're still asked to write a letter on their behalf. And luckily there are a lot of things letters are not required for, but insurance companies will require them. For adults, there are groups out there like, I don't remember what it stands for, GALAP, that will do either pro bono, like one session where they meet with somebody and they'll write letters, you know? If I have somebody come to me, who's been transitioned and they're really looking to have lower surgery, I'm not going to walk them through the evaluation to go, do you really know who you are., Obviously, you know who you are even living it, and that you need these various things. And so I think we tend to take things out of the context of the person and where they're at. I mean, same with a kid. If I have a kid whose family has, they've transitioned, like when they were 18 months or two years, and they've been living as their affirmed gender for four years and then they come to me because they need a gender specialist on their team to write the letters, to get the hormone blockers and all this kind of stuff. I'm going to learn the history around that, but I'm not gonna expect them to go through the same kind of thing. I want them to be fully informed about each phase of treatment. But, they know who they are. That's not the issue. It's harder when we're talking about kids who are non-binary, not because they don't know who they are, but because we're struggling to get language around, what is it going on and what does it mean to be in middle space. That somebody can clearly identify as that is very true and we have trouble understanding how to write about it. How to make sense out of what their language is when they're doing that. That's often confused as a phase when it's not. Now, I will say it's like bisexuality, in the sense that bisexuality for a long time was considered a phase from one sexual orientation to the other and that when you had finished your phase, you'd end up in one camp or the other, this binary. Right. I think the non-binary folks are getting that same kind of misconception. There are some people who do wander into non-binary or gender queer space, just trying to figure out what fits best and then end up in a binary place. But there are a lot of folks who don't, that they are in that non-binary space, and that's really who they are. They might have to choose a binary physiologically, and they may choose something that looks like the opposite of their assigned sex, because that's way more comfortable, but they're still living in non binary space. We don't understand it very well and because we don't understand it, us who are not non-binary, we tend to dismiss it and I think that's really unfair to do that. I understand the fear of therapists, right? Because I find therapists to be very risk averse and much like insurance companies are. And so you're trying to protect yourself as long and as well as not do harm and all that kind of stuff. And sometimes we get so over-protective around that we harm our clients in the process. We have to be careful about that dance.
Keith Sutton, Psy.D: (54:26)
Well, it sounds like you're doing great work and it's definitely sounds like it's a needed area cause I think that especially with more clients being more aware and being able to learn how to be more affirmative and help take care of their clients' needs and respond to them in the ways that they need is so important. So that's great that you're doing that.
Shawn Giammatei, Ph.D.: (54:47)
Yeah. Well, I'll say before, I know we're getting near the end, but one thing that I really want to comment on is this term authenticity, and I just kind of want to leave things in a way with that because that's what we're doing. You know, that's what we're doing as individuals who are trans, we're trying to be the most authentic us we can be in the world, whatever that happens to be. That's who families are trying to be. They're trying to help their kid be the most authentic. They're trying to be the most authentic in their representation of all that. And as clinicians we have to do that, we have to think about how do we help people be the most authentic and step into their community and culture in those ways. And how do we be the most authentic in doing that? I find that the more authentic, like I said at the beginning , the more authentic I am, the better this all lands and the better I am. So yeah.
Keith Sutton, Psy.D: (55:42)
And that kind of connection and kind of being able to connect with others is really there. Thank you so much for taking the time today. This is really great, and I really appreciate hearing about what you're doing. It's always good. I'm looking forward to the upcoming trainings. Will definitely have to check that out myself too. Cool. Well, thank you so much.
Shawn Giammatei, Ph.D.: (56:05)
Thank you. This was fun.
Keith Sutton, Psy.D: (56:07)
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