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being non-binary?’: Non-cisgenderist c trauma


of cisgenderism: pathologising – treating people’s own understanding of their genders and bodies as pathological or clinically problematic, and misgendering – describing people using language that disregards their own understanding of their gender and body. We found authors from mental health professions, particularly those associated with gender clinics, were more likely to engage in cisgenderism than authors from other fi elds. Since my fi rst publication on cisgenderism (Ansara, 2010) and the fi rst empirical study of cisgenderism (Ansara & Hegarty, 2012), researchers in the emerging fi eld of cisgenderism studies have applied the cisgenderism framework to diverse systemic contexts. For example, Blumer et al. (2013) identifi ed cisgenderism in everyday family therapy practice. Riggs et al. (2015) combined the cisgenderism framework with the decompensation framework to understand the mental health experiences of Australians of trans experience. Our cisgenderism framework has also been used to challenge cisgenderism in domestic violence discourses (Rogers, 2017) and to explore programmatic barriers in homelessness services for young people (Shelton, 2015). Ansara (2012) examined cisgenderism in medical contexts, and Ansara (2015) identifi ed methods to challenge cisgenderism in ageing and aged care. Research on cisgenderism in these diverse contexts illustrates why non-cisgenderist clinical practice must be inherently systemic. One of the key insights in the fi eld of cisgenderism studies is that experiences of cisgenderism are inherently systemic and, consequently, oſt en result in systemic trauma. T erapeutic methods that treat distress among people of trans and/or non-binary experience as primarily intra- psychic – a term for problems that originate within a person’s own mind – are likely to underestimate how people’s interpersonal relationships and everyday environments contribute to their systemic trauma. By missing these key factors, therapists may overlook sites for possible intervention and may prolong or infl ict further systemic trauma.


Context 155, February 2018 Events that may be viewed as joyous


milestones or routine tasks of daily living for those who do not experience pervasive cisgenderism can present existential threats for people faced with the stark choice between negating their own existence or losing their sense of meaning and belonging in their lifeworlds. Kit, a non-binary person whose best friend was get ing married, described the existential crisis and stress that accompanied being invited to at end the wedding. Despite their best friend’s eff ort to consider Kit’s needs and ensure Kit was included, the highly binarised structure of weddings made it challenging to fi nd appropriate non-gendered language, role, and seating for Kit. One therapist told me she responds


to people of trans experience who report distressing experiences of being misgendered by saying it happens to everyone and describing instances when it has happened to her. Despite her benefi cial intention, this therapist has failed to grasp the context of systemic trauma within which people with a trans and/or non-binary experience are misgendered. T e systemic consequences of being misgendered are far greater and far more insidious for people whose ability to use public toilets, prevent public harassment and assault, and maintain social roles are endangered by acts of misgendering. Without understanding this context, which is both extra-psychic – a term for problems that originate outside of a person’s own mind – and systemic – in the sense that it occurs within social relationships and systems, therapists’ responses are likely to come across as ignorant or callous. Without recognising the need to consider people’s interpersonal roles and relationships, clinical approaches cannot address the relevant sources of systemic trauma from cisgenderism. Jaysen, a man of trans experience coming


to me for therapy, had been distressed by his family’s refusal to use his male name and to call him ‘he’. His previous therapist had insisted his distress would resolve once he changed how he viewed their behaviour. By


demonstrating increasing acceptance of his family’s diffi culty in viewing him as a man, the therapist told him, Jaysen could then achieve greater comfort in his home life. T is former therapist’s at empt to use cognitive behavioural therapy (CBT) to address systemic trauma from misgendering, backfi red spectacularly. Jaysen told me he had experienced the therapist’s clinical approach as victim- blaming, invalidating, and, ultimately, ineff ective. Unlike some therapeutic methods, CBT requires therapists to identify which thoughts are ‘distorted’ or refl ect a ‘negative bias’. Although the number of therapists of trans and/or non-binary experience has increased, the chasm between most therapists’ everyday lives and those of people who experience cisgenderism means that many therapists will struggle to determine whether thoughts are, in fact, distorted and overly negative or entirely reasonable and accurate perceptions of situations that may be ordinary for many people of trans and/or non-binary experience. It is not only the cisgenderist misuse of


CBT methods that can fail to meet people’s clinical needs and perpetuate systemic trauma from cisgenderism. Piper came to me aſt er having experienced workplace bullying in a healthcare company that marketed itself as being ‘LGBTI-inclusive’. T is position had been the fi rst job in which Piper had felt safe to ask for their boss and co-workers to refer to them using the non- binary pronouns they/them/theirs. During their time in the new job, Piper experienced simultaneous misgendering by their supervisor, housemates, friends, and by a new partner. T ey felt there was nowhere to go where their existence was acknowledged. At fi rst, their criterion for who would be a ‘safe and affi rming’ partner in their life was determined by who would give them the basic respect of using non-binary language about them. Piper explained they were afraid to set the bar ‘too high’ for fear so few people would be able to respect their boundaries that their world would become increasingly small and insular.


25


‘What’s fabulous about being non-binary?’: Non-cisgenderist clinical responses to systemic trauma


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