Sasha Ayad, M. Ed., LPC is a therapist with extensive experience working with teens, and gender defiant teens in particular. When she started to notice her bright, creative gender defiant teen patients feel that they needed to define themselves by picking a label that then sometimes encouraged them to make permanent changes to their bodies, Sasha found herself thinking critically about this trend. She has researched gender identity issues in teens extensively, and has a private practice where she works to support gender questioning youth. In Sasha’s words:
“I use non-judgmental, compassionate, dialogue that focuses on exploration rather than immediately seeking to affirm and transition your child. Together with your teen and family, we consider multiple complex factors that may contribute to their dysphoria, including social, cognitive, environmental, physical, and emotional factors. Treatments may include mindfulness, somatic, and integrative techniques as well as confidence-building, and age-appropriate sexual identity exploration. I also educate parents about the topic of gender identity, break down stereotypes, discuss risks, and encourage parents to become deeply invested in the process so they can best support their child outside of therapy sessions. While transition may be the best option for some kids, many others have had very painful and negative experiences with their transition, and I help families prevent this from happening. I believe I owe it to your child to be thorough and careful in my approach, placing safety, well-being, and happiness above all else.”
The following piece was posted originally on Sasha’s blog. While the current narrative around helping trans identified teens creates a false dichotomy between affirming a teen’s identity and being unsupportive or rejecting, Sasha’s work beautifully illustrates how one can offer unconditional support while helping a teen to navigate the confusing waters of identity.
I was busy working on a behavior plan for a very fidgety 6th grade boy when I heard an assertive knock on my office door. This was the third time this week Sally had left class without permission to come talk to me.
“Ms Ayad, how can I transfer schools? I really don’t think I can get a proper education here and none of the teachers know what they’re doing”, so began our 45 minute conversation. She often got fixated on one or two teachers, who despite their best efforts, could not find a good way to work with Sally. I had a very different relationship with her though, and I was able to help her work through some of her generalizations and logical leaps.
Her hair was always pulled back hastily in a low ponytail, the eczema around her mouth, though visible, wasn’t as noticeable as the smudges that covered her glasses – she pushed them up from the lenses every time. Often a curious little smirk would lift the corner of her mouth, even when she was clearly upset or discussing something serious.
She is one of those kids who teachers were often exacerbated by, but I got to see her in a different light, and I found her endearing, creative, and incredibly interesting.
Once we were able to conclude that switching schools was not the best option, and I taught her some self-regulation skill using a squeeze ball, it seemed she was much more at ease. She took a deep breath and said “Ms Ayad, can we talk about that other thing now?”
“You mean gender?” I replied. She nodded.
Sally and I had been talking for the last several months about her “gender identity”. When she first brought this up to another counselor, they referred her to me, knowing that I am experienced and confident in working with kids around this topic. However, Sally had certainly been exploring this issue online for months she brought it to the attention of her school counselors. Our first conversation on the topic made it clear that she had a broad vocabulary (straight from gender identity theory) which is not typical for most middle-school students.
My approach was patient, inquisitive, and I challenged her… just a bit. When she talked about her parents pressuring her to wear dresses and “act more like a girl”, I made a point of breaking this down, deconstructing what that means, and sharing ways that we all behave outside of gender stereotypes: and that’s a GOOD thing!
When she told me, weeks later, that she was looking for binders online and asked me to stop using the pronouns “her” and “she”, I felt deep pangs of worry, but took it slow. I asked her where some of these ideas were coming from: she was spending hours on tumblr, trans-advocacy sites for teens, and chat groups with other kids who she believed were “just like her”. I treaded very carefully, but told her about the medical dangers of binding and what the long term consequences may be. Our limitations in the school system made it hard to get too deep on these topics, but in every brief interaction with Sally, I found ways to empathize with her struggle, instilling pride in who she is, and still gently challenge her flawed ideas.
I deliberately pointed out all of the ways she doesn’t conform to gender stereotypes, without implying that she’s in the wrong body: her love of manga comics, her cargo pants, her disdain for dresses and “girly” clothes, in my eyes, made her a unique and awesome person. Hearing those compliments always brought that endearing little smile to her face.
Eventually, as her classroom behavior improved, her anxiety lessened, and she started making friends, she relied less and less on me for support that year. Several months passed and before I knew it, the school year was coming to a close. I wanted to follow up with Sally, so I pulled her from her PE class and we talked outside on a particularly nice, sunny afternoon.
I started with, “Sally, I’ve missed you, how are things going? It seems like we haven’t talked in forEVER!” A huge smile emerged on her face, and since her glasses were less smudgy than normal, I could actually see that her eyes were smiling too.
“Doing great! I’m getting along better with Ms Barnay and I haven’t been walking out of class when I feel frustrated”. We talked about the anime club, her plans for summer, and how her other classes were going. She paused, looking ready to tell me something that meant more to her than academics. “Ms Ayad, remember how we used to talk about gender a lot? Well, I’m kinda over it”.
“Ok, tell me what you mean by ‘over it’, Sally”.
“Well before, when I didn’t have any friends at school, I was meeting a lot of people online and I thought they were my friends. Then when I actually started hanging out with people in real life, things felt different. Before, I really wasn’t comfortable with myself so I felt like I needed to change. But now, I’m ok with myself”.
I nearly fell off the bench. This was one of the most profound realizations a therapy client can make – and she, even in her young 13 year-old body and mind, came to this conclusion by herself: “I really wasn’t comfortable with myself, so I felt like I needed to change. But now I’m ok with myself”.
I was grinning from ear to ear by this point. I told her how incredibly proud I was, that I was so happy she was feeling good about herself.
Over the summer I thought often about Sally’s story. While she turned things around largely on her own, I can’t help but wonder how things might have unfolded had I followed the prescribed gender identity model.
What if I had asked about using male pronouns?
What if I had been very supportive of her desire to bind her chest?
What if I had affirmed the idea that because she doesn’t like dresses and feels like she identifies with trans kids online, that she too may be a boy stuck in a girl’s body?
And what if I hadn’t directly (though gently) challenged some of her flawed beliefs – that stereotypes and clothing styles are a good foundation on which to question your biology, to modify your body parts, and to change your entire identity.
These are questions gender therapists HAVE to ask themselves, and it frightens me that most aren’t. Our kids are dynamic, different, and unique. But they also have insecurities, self-doubt, and are vulnerable to finding “solutions” in the wrong places. When a teenager feels isolated and misunderstood, trans-advocacy sites can convince them that hope lies in changing who they are. And isn’t this the opposite of what we’ve always tried to instill in kids: self-love, confidence, and embracing their uniqueness?
Regardless of the misinformation and wayward perspectives currently taking over the mental health field, I will continue to focus on self-acceptance for my clients. Sally’s story, and many others like it, will be our reminder that in counseling, self-loathing should never be promoted over self-love.
*The names in this story have been changed to protect the identities of the people involved.