Transgender & Gender Non Conforming Care: Gender Euphoria, OT Resources, Clinician Strategies: Part 3 of Pelvic Floor Series
The 3rd part of our Pelvic Floor Series is highlighting affirmative clinician strategies for working with transgender and gender non conforming (TGNC) folks. This newsletter doesn’t get into the potential pelvic floor goals or sexual goals of TGNC clients, but is a good prerequisite for any OT/OTA clinician - not just pelvic health OTs.
TGNC individuals may utilize gender-affirming practices such as tucking, binding, packing and can experience gender euphoria when they do so. Gender euphoria is the experience of feeling joy related to your gender, gender expression, and participation in gender affirming experiences. It’s important to mention that gender euphoria can be experienced while engaging in any occupation, not just during sexual activity.
Gender dysphoria is a discomfort or distress related to a disconnect between a person's gender identity, sex assigned at birth, and genitals. The medical model focuses more on gender dysphoria as a justification for interventions, while practicing in accordance with OT philosophy, gender euphoria is much more indicative of a client centered outcome.
Before you even start with intervention, consider this:
As a result of existing systemic and sociopolitical systems such as anti-LGBTQIA+ laws and transantagonism, TGNC folks are more susceptible to experiencing housing insecurity and displacement, unemployment, abuse, discrimination, self-harm, trauma, poverty, and substance abuse. For these reasons, when a TGNC client comes to work with you, it’s important to be prepared and have strategies at the ready to ensure your environment and practice are safe and affirming for your client.
Here are some strategies for enhancing your gender-affirming practice:
Engage in trauma informed education and training
Trauma informed training is a must for OT/OTAs, especially pelvic health therapists. Read Chapter “Addressing LGBTQIA+ Trauma: Your Role and Your Responsibility in AOTA Press’ textbook “Trauma, Occupations, and Participation: Foundations and Population Considerations in Occupational Therapy”
Prioritize patient’s comfort and safety
Delay a pelvic floor assessment to the next visit as needed in order to establish trust, safety, and belonging during the first visit.
Use your client's correct name (chosen name) and pronouns
Explain any physical touch before you touch your client and ask for consent to touch your client.
Familiarize yourself with resources provided by LGBTQIA+ rehab professionals focused on preparing rehab professionals to provide affirmative care to TGNC clients
Watch AOTA’s free webinar “It’s Within Our Scope: Gender Inclusive Practice Panel Series”
Read “Caring for transgender and gender diverse individuals: ADLs and IADLs”. As mentioned above, tucking, binding, packing are dressing techniques that individuals use to express their gender and can experience gender euphoria from doing so. This resource provides education, guidance, and intervention strategies for each activity of daily living.
Reference The Rainbow OT’s inclusive intake form
Consider hiring Hey Wes for a Queer and Trans Cultural Responsiveness training at your facility.
Check your own biases and privilege
Engage in educational opportunities that challenge your bias and continually self-reflect on your own areas of discomfort or confusion - it is likely there is a bias there.
Read Chapters “Guided Self-Reflection of Self as a Sexual Being” and “Sexuality, Bias, and Impact: Preventing Clinician Harm” in AOTA Press’ textbook “Sexuality and Intimacy: An Occupational Therapy Approach”
Consider enrolling in This Institute’s certification, The Certified Sexuality OT, which includes the 1 hour CEU “Guided Self-Reflection of Sexuality Values, Beliefs, Attitudes, and Bias". This course is informed by best-practice in cultural humility and sexuality curriculum for healthcare providers.
Familiarize yourself with the Gender Unicorn
Educate yourself on the facts to help uncover some biases
Take the Harvard Implicit Bias Test
Seek more “need to know” information with open ended questions instead of making an assumption
Do not make assumptions about your clients, their occupations, and routines. Gather this information by utilizing inclusive intake forms and by utilizing open ended questions throughout your assessments and interventions to leave space for clients to share what they are comfortable sharing.
Ask people what words they use to describe their genitals. If they don’t understand the question, you can give an example of “do you use ‘breast’ or ‘chest’?”
Use phrases like “tell me more,” and “can you expand on that” to learn more about what is important to your client and how you need to shape intervention.
Tell them in the first session, “You are the expert on you, you know best what is important to talk about today. If there is any question I ask you that you don’t want to answer, don’t answer it and we can move on. That said, if you at any point want to address the question again in future sessions, feel free to. ”
OT/OTAs are perfectly situated to bring holistic and comprehensive care to our clients. The activity analysis is the easy part, while having culturally responsive practice and implementing cultural humility can often be the more difficult part. TGNC people are not monoliths and they all have nuances just like all of our clients. As OT/OTAs we will never know it all, and it would be impossible to understand all of the nuances of each individual client. It is our duty to continue to learn, accept feedback from those with lived experiences, and do our best to mend any harm caused as a result of a deficit of knowledge, bias, and at times compassion.
Understanding our clients and providing responsive care to each one requires lifelong training and education. This is not an exhaustive list of resources available for OT/OTAs. Continue to seek out resources and continuing education related to trauma informed care, LGBTQIA+ affirming care, and working with TGNC clients in addition to these wonderful resource.