Although a large portion of transgender individuals and their families seek therapy, therapists report not possessing the necessary knowledge and skills to work with this population (Brown et al., 2018; Shipherd et al., 2011). Transgender clients may present in therapy to discuss specific issues related to gender identity, including gender affirmative medical procedures (Bettergarcia & Israel, 2018). Transgender clients, whose gender identity is not defined within biological male or female terms, live in a systemically oppressive society with rigid norms and expectations which serve to maintain positions of power (Ansara & Watson, 2013). Because their gender identity deviates from the expectations of a cisnormative society, transgender individuals are at an elevated risk for mental health issues and abuse (Giovanardi et al., 2018; Roberts et al., 2011). Thus, therapists must be aware of the influence of gender identity on mental health.

Although this population has unique needs, most counselor or therapist training programs do not provide sufficient education on these issues (Nguyen et al., 2016; Singh, 2016; Winston & Piercy, 2010). For example, transgender issues are often only discussed within the overall LGB population in a multicultural counseling course (Bidell, 2014). Thus, marriage and family therapists (MFTs) may not receive transgender education unless the information is incorporated through other means (Stryker et al., 2021). This may reflect the assumption within the field of marriage and family therapy that therapists do not need specialized knowledge or skills to work with the transgender population (Brown et al., 2018; Perosa et al., 2008). This is quite concerning, as many transgender clients report that their provider does not possess knowledge of transgender care (Bauer et al., 2015). Consequently, transgender competency is not guaranteed through the completion of a graduate curriculum.

The American Association for Marriage and Family Therapy Code of Ethics (AAMFT, 2015) mandates that MFTs do not discriminate on the basis of gender identity and that supervisors must ethically ensure the transgender competency of their supervisees. Although gender identity is a required competency area, guidelines for what is considered competent practice is unclear. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE, 2017) requires a minimum of three semester credit hours on competencies serving diverse, marginalized, and underserved communities that includes practice with sexual and gender minorities. Since there are not guidelines about the amount of time that must be dedicated to gender minorities, it is unclear how much training MFTs may receive about transgender identities. By training competent MFTs, there are likely to be fewer barriers for transgender clients in accessing mental health care. Due to the above knowledge disparities in training, MFT supervisors have an ethical responsibility to facilitate competency in this area. However, given that supervisors likely have not received the training themselves, just as students have not received adequate training (Stryker et al., 2021), it is critical that supervisors strive to develop post-graduate knowledge of transgender affirmative care.

The potential lack of transgender competency presents a distinct challenge for ethical and competent supervision (Cohen-Filipic & Flores, 2014). MFT supervisors have power over how trainees develop clinical knowledge and skills (Green & Dekkers, 2010), and it is incumbent upon them to promote competency with transgender issues. Moreover, supervisors are in a unique position to guide their trainees through the process of exploring how a cisnormative society has impacted the experience of being transgender in the therapy room (Conlin, 2017). However, since most supervisors and therapists will not receive adequate preparation through traditional MFT training (Stryker et al., 2021), a model or framework would help supervisors to navigate transgender competency development. Feminist models of supervision have been shown to provide frameworks, guidance, and language for facilitating the exploration of critical issues for marginalized and diverse populations (Haddock et al., 2000; Prouty, 2001). The purpose of this paper is to demonstrate how adapting a feminist approach to supervision can empower supervisors to help marriage and family therapy trainees develop competency in transgender care.

Feminist Supervision

Feminist theory concepts have heavily influenced the field of family therapy, including the clinical training of new therapists (Avis, 1988; Prouty et al., 2001). A collaborative supervisory alliance characterized by empowerment forms the basis for feminist supervision (Degges-White et al., 2013). In addition, feminist-informed supervision focuses on the complexities and intersectionality of identity, society, and systems of power (Prouty, 2014). A central tenet of feminist theory and supervision is that individuals cannot be separated from their culture (Evans et al., 2005). Supervisors are expected to educate and mentor their trainees, therefore supervisors’ understanding of culture and social justice is critical (Gentile et al., 2010). Gender, a critical component of feminist-informed supervision, is discussed in terms of social construction from culture (Rodis & Strehorn, 1997). Following the findings from Prouty’s (2001) grounded theory study, the feminist-informed supervision areas of intersectionality, power, gender, diversity, emotion, and socialization are described in terms of their relevance to building transgender competency in supervision. Examples of feminist-informed questions based on the areas of intersectionality, power, gender, diversity, emotion, and socialization are presented in Table 1.

Table 1 Feminist informed supervision questions to ask the supervisee
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Intersectionality

A key component of feminist-informed supervision that is applicable to therapy with transgender clients and their families is intersectionality. Intersectionality, coined by Kimberlé Crenshaw (1989), refers to how race, gender, and other identities interact to produce differentials in experiences across society that result in experiences of racism, sexism, and other forms of discrimination or marginalization. Systems of oppression interlock, creating worse experiences for those with double or triple minority statuses (Combahee River Collective, 1978). These multiple identities and statuses also intersect with various systems within society, such as the healthcare system (Prouty, 2014). For example, Black, Indigenous, and other People of Color (BIPOC) transgender and gender non-conforming (TGNC) individuals experience significantly higher levels of gender identity-based discrimination and violence compared to Caucasian TGNC individuals (Human Rights Campaign, 2020; Kattari et al., 2015). Similarly, approximately 26% of BIPOC TGNC adults report experiencing discrimination when accessing the medical system, compared to 18% of Caucasian TGNC adults (Kattari et al., 2015). Intersectionality, with its roots in Black feminism, is grounded in social justice, providing a framework that feminist informed supervisors can utilize in supervision (Crenshaw, 1989, 1991).

Supervisor Role in Addressing Intersectionality

Gender identity and race, for example, are intersectional identities which affect transgender clients’ experiences. Therefore, a Critical Genogram may be an effective tool for both family therapists and supervisors (Kosutic et al., 2009). The Critical Genogram is intended to raise critical awareness, which is the ability to recognize how systems of oppression are institutionalized (Kosutic et al., 2009). Similarly, Garcia et al. (2009) emphasize the importance of critical consciousness, or awareness, of systems of privilege and oppression. Feminist-informed supervisors work with trainees to identify systemic oppression so that they can in turn work with clients on understanding institutionalized oppression. Kosutic et al. (2009) describe the procedure for the Critical Genogram, which includes drawing a basic genogram, mapping out systems of oppression and using reflective questions. Feminist-informed supervisors assist their supervisees in mapping and identifying the transgender client’s systems of privilege and oppression. Various social identities and experiences (i.e., transphobia, racism, etc.) are mapped onto the genogram within supervision. The supervisee is then encouraged to finish the genogram with their therapy session.

Therapists often conceptualize family dynamics in terms of traditional views of sex and gender that assume family members are cisgender (Ansara & Watson, 2013). In this regard, the power of the therapist intersects with societal attitudes about gender that have been internalized by practitioners. These various challenges can be addressed through feminist-informed supervision and associated feminist interventions. Supervisors assist supervisees in developing reflexivity about how gender, power, and socialization have influenced the experience of being transgender for their clients.

Power

Attending to power differentials is a key component of feminist family therapy and supervision. According to feminist-informed supervisors, power describes how influential someone is over the life of another person or group (Arczynski & Morrow, 2017). Analyzing how power impacts transgender clients is essential to developing competency in this area. Power impacts transgender individuals across several domains, including therapy, the medical system, and the socio-political context (Eyssel et al., 2017). The gatekeeping model of transgender care places a tremendous amount of power on practitioners in determining when transition can occur (Schulz, 2018). Specifically, transgender clients may be required to attend psychotherapy as part of an agreement with their practitioner or physician for receiving gender affirmative care, which may result in the assignment of the Gender Dysphoria (GD) diagnosis (Budge, 2015). The GD diagnosis can be viewed as pathologizing the experience of being transgender, as it views gender dysphoria as a mental illness (Winter et al., 2016). Thus, applying the GD diagnosis as a mental condition reflects both the power differentials between providers and transgender clients and the cisgender assumptions held in society.

Practitioners and therapists hold considerable power over transgender clients if they are seeking therapy to discuss their gender identity (Budge, 2015). Despite clients decisions of how and when to transition, the decision of when to transition is often not within clients’ control due to systemic barriers faced by clients in accessing transition-related services (Dalton et al., 2020). Transgender healthcare coverage has also been impacted by the power of insurance companies to determine coverage level for gender affirmative procedures. Although companies cannot deny preventative care related to gender, insurance providers can choose whether or not to pay for gender-affirmation surgeries and hormone replacement therapy (U.S. Centers for Medicare & Medicaid Services, n.d.). Transgender individuals often have to recognize their lack of power over their transition and try to execute autonomy where possible (Pitts-Taylor, 2019).

Supervisor Role in Addressing Power

Therapists and supervisors must be sensitive to these systemic power differentials that impact clients. Feminist-informed supervisors are aware of their power over supervisees and strive to acknowledge its influence over supervisees (Arczynski & Morrow, 2017). Supervisors utilize these experiences in supervision to create an isomorphic process, where supervisees become aware of their power over transgender clients. Since power can be inherent in both supervision and therapy, the goal is not to remove power but to attend to how it influences the processes. Specifically, supervision provides a safe haven to explore how gender identity has been oppressed by the mental health field, the medical system, and society as a whole. Supervisors strive to model transgender-inclusive language and a willingness to explore one’s own gender identity privilege (Benson, 2013; see Table 1).

Supervisors also guide supervisees to expand the power analysis to other client relationships outside of the therapy room. Clients’ intersecting identities (age, education, nationality, etc.) afford them different levels of powers in different relationships and contexts, such as in romantic relationships or places of employment (Cech & Rothwell, 2020; Knudson-Martin, 2012). For example, being an older transgender male may produce different power differentials in different relationships, where age can increase power in one relationship and decrease power in another (Barken, 2019). As such, supervisors model an openness and curiosity to considering how supervisees’ clients may have different levels of power depending on the intersection of their various identities.

Gender

Gender continues to be a strong focus of feminist-informed family therapy and supervision. Gender is defined as a socially constructed classification and represents a critical focus for therapy with transgender clients (Whitehead et al., 2012). The term cisgender refers to the congruence between an individual's assigned sex at birth and their gender identity (McGeorge et al., 2021). Specifically, transgender clients have reported poor experiences in therapy when therapists lacked gender-related competence (Rachlin, 2002). This may reflect cisgenderism in family therapy practices. Cisgenderism refers to non-transgender (cisgender) people and their assumptions about gender being only binary and related to biological sex (Ansara & Watson, 2013). Ansara and Watson (2013) argued that cisgenderism occurs in family therapy through binarization, misgendering, erasure, pathologizing, and marginalization. Their argument is that binarization occurs when family therapists assume only two categories exist (male/female) and reflect these assumptions on paperwork and in conversations with supervisees and/or clients (Ansara & Watson, 2013). To avoid binarization, supervisors and trainees should include non-binary options on supervision contracts and intake forms as well as ask clients to identify their pronouns in an open-ended manner. Non-binary options may include gender neutral pronouns, such as they/them.

Supervisor Role in Addressing Gender

Misgendering, failing to acknowledge or accept a person’s definitions of gender identity or assume the client’s pronouns based on biological sex, also perpetuates cisgenderisim (Ansara & Watson, 2013). To combat this issue, supervisors seek to correct supervisees when misgendering occurs. This is achieved through a nonjudgmental stance, where supervisors gently point out that misgendering occurred. To balance power within the supervisory relationship, supervisors also communicate to supervisees that they have the power to correct supervisors when they misgender a client or supervisee. Feminist supervision addresses the issue of misgendering by urging supervisors not to assume supervisees’ gender and to model how to appropriately ask about gender. To appropriately inquire about gender, supervisors model a curiosity about their supervisees’ gender by asking about pronouns and gender identity. The supervisory relationship should begin with an active discussion about supervisees’ pronouns to role model for supervisees.

Nonbinary transgender identities can be erased when therapists do not question the gender binary and assume their clients are male or female (Ansara & Watson, 2013). Supervisors encourage supervisees to consider that clients may not identify as female just because of their appearance and presentation. In addition, pathologizing can occur through diagnosis and through the assumption that gender variance is bad or pathological (Ansara & Watson, 2013). Finally, marginalization can occur when therapists view nonbinary identities as being less valid than cisgender or traditional transgender identities (Ansara & Watson, 2013).

Given that these cisgender assumptions can damage the therapeutic alliance (Rachlin, 2002), gender must be addressed in the therapist training process. Transgender clients report dissatisfaction with educating their therapists about their gender identity (Benson, 2013). Therefore, therapists must seek the information through different means. Supervisors need to facilitate the exploration of supervisees’ assumptions about gender and their use of cisgender language within their therapy sessions (Ansara & Watson, 2013). Supervisors gently point out when cisgender language and assumptions are used by supervisees. This creates an opportunity for supervisees to develop self-awareness of their language.

In addition, exploring the impact of supervisor and supervisee gender identity and associated gender roles are a critical component of feminist supervision (Arczynski & Morrow, 2017). Supervisors develop awareness of their thoughts, beliefs, and emotions related to the gender binary and how that may impact the supervisory relationship. To develop this awareness, gender related reflexivity can be cultivated through self-reflection, gender focused genograms, and bibliotherapy (Prouty, 2014). Gender focused genograms are utilized by supervisors to identify rigid gender roles, gender variance, and cultural views of gender that may influence how supervisees view transgender identities.

The gendergram is a gender focused genogram which examines significant relationships and influences on gender identity (White & Tyson-Rawson, 1995). The gendergram may be used as an isomorphic process in both supervision and in trainees’ therapy sessions. Like the genogram, the gendergram procedure includes a semi-structured interview to collect information on relevant events, life cycle stages, and roles, patterns, and themes (White & Tyson-Rawson, 1995). Examples of questions that can facilitate constructing gendergrams are provided in Table 2 (White & Tyson-Rawson, 1995). Genograms are explored in supervision, with supervisors facilitating the discussion of what supervisees discovered. Additionally, supervisors ask questions about religion and culture and how that impacts supervisees’ assumptions about transgender clients. To balance power, supervisors also construct gender focused genograms prior to supervision (see Table 2). This will allow a discussion of the challenges of looking at one’s own history with gender.

Table 2 Suggested questions for creating the gendergram
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Gender Identity Diversity

Attending to diversity in supervision has been linked to supervisees’ satisfaction with supervision (Green & Dekkers, 2010). Similarly, feminist-informed supervisors view diversity as an important pillar of supervision (Martinez, 1999). Diversity within feminist supervision involves gaining knowledge about clients who are different than supervisees and enhancing cognitive flexibility about those differences (Prouty, 2001). Thus, supervisors educate about transgender clients and explore what thoughts, beliefs, and values supervisees have about transgender identities. There is tremendous diversity within the transgender umbrella, which includes nonbinary and agender identities (Acker, 2017). Supervisors encourage their supervisees to consider how gender identity diversity is influenced by racial diversity, as Black, Indigenous, and other People of Color (BIPOC) transgender individuals experience significantly higher levels of gender identity-based discrimination and violence compared to White transgender individuals (Human Rights Campaign, 2020; Kattari et al., 2015).

Transgender identities also include those who do not identify with any gender, those with changing gender identities over time, and those who identify with a third gender (Twist & de Graaf, 2018). The above descriptions, such as agender, gender fluid, and pangender, represent various nonbinary identities. Additional terminology includes genderqueer, gender nonconforming, and gender creative (Bass et al., 2018). Within these nonbinary gender identities is the assumption that gender is fluid and exists on a spectrum (Hyderi et al., 2016). Supervisors and clinicians should avoid assumptions about medical transitions for nonbinary clients. Nonbinary transgender clients may not desire to medically transition (Bass et al., 2018). If medical transition is the goal of treatment, supervisees should consider the GD diagnosis and how it may not fit for nonbinary clients.

Supervisor Role in Addressing Gender Identity Diversity

Feminist-informed supervisors are called upon to challenge their supervisees to expand their knowledge about nonbinary identities. To assist with this goal, supervisors can offer resources about transgender and nonbinary identities, including books and relevant literature (e.g., APA, 2015; Chang et al., 2018). Supervisors also consider assigning supervisees to read literature, attend events, or watch media created by transgender or nonbinary individuals. In addition to resources, supervisors lead conversations about nonbinary clients and how society has traditionally marginalized these identities. The goal of supervision is to model a nonjudgmental curiosity about clients’ self-defined transgender identity. Through this process, supervisors assist supervisees in developing methods of asking about transgender identity that does not assume binary identity.

Emotion

Increasing supervisees’ comfort with their emotions and those of their clients is a critical task of feminist-informed supervision (Morgan & Sprenkle, 2007; Prouty, 2001). Feminist supervisors encourage supervisees to “learn to value their own emotional reactions, and to be emotionally and verbally congruent in therapy” and supervision (Morgan & Sprenkle, 2007, p. 190). Genuine emotional reactions from supervisees are cultivated within the supervisory relationship through the use of supervisor immediacy. Consequently, feminist-informed supervision not only recognizes emotions, but helps supervisees to value their own emotional responses and work within their emotional system to understand their own experiences with privilege, trauma, bigotry, discrimination, and other sources relevant to therapeutic and supervisory processes. This work is especially important for increasing transgender care competency.

Supervisor Role in Addressing Emotion

Feminist-informed supervisors can elicit emotions related to both hearing transgender clients’ experiences as well as their own experiences with gender identity. These experiences can include exploring and developing value for their own and their clients' emotional experiences with diagnoses, trauma, education (e.g., graduate curriculum), with other therapists, the medical system, and other forms of systemic oppression. Supervisors also seek to elicit affect related to pathologizing terminology for the naming of transgender people (Ansara & Watson, 2013).

Consequently, there are essentially three steps that feminist-informed supervisors use for exploring emotion. First, feminist supervisors elicit and develop safety for the exploration of emotions. Second, feminist supervisors create value for those experiences, recognizing that all emotional experiences are valid and have value. Third, feminist supervisors may work to transform those emotional experiences as they intersect with other domains of feminist supervision (e.g., socialization, power, gender, diversity). These three steps are conducted on the multiple levels of the supervisory relationship, within both the supervisee-client subsystem and the supervisor-supervisee subsystem. The ability to process emotion is crucial for work with transgender clients, as they have often faced significant trauma related to their gender identity (Weir & Piquette, 2018; Weir & Piquette, 2018).

Socialization

Understanding the socialization of each person in the supervisory system represents an important piece of feminist-informed supervision. Prouty (2001) describes socialization as “the influence of larger systems such as culture and society, wherein the political affected the personal” (pp. 183–184). Prouty described socialization as understanding how society has influenced and constructed notions of gender, power, diversity, and emotion.

Supervisor Role in Addressing Socialization

Through processes of socialization forces, supervisors can help supervisees understand and deconstruct the origins and influences that form their own biases and beliefs, as well as that of their clients. When supervisees work with transgender clients, it is especially important for supervisees to process the socialization of transphobia. In particular, it is important to not only process the larger systems of society but also the more immediate socialization within MFT training and education. In a study of transphobia and students in the helping professions (psychology, social work, and nursing), Acker (2017) found that 45% of students had moderate to severe levels of transphobia. Since the accrediting education standards for transgender care are similar for social work, psychology, and MFT, we have no reason to believe the findings from Acker (2017) would vary significantly for MFT students. Moreover, since all supervisors were once students, these findings may be similar, if not higher, for supervisors themselves. Based upon this information, it may be likely that supervisors will have supervisees who hold transphobic attitudes and that supervisors themselves may also hold transphobic attitudes. As a result, supervisors also need to attend to their own self-of-supervisor both prior to initiating work with supervisees and while providing supervision. Seeking out mentorship from another supervisor mentor or personal therapy may be necessary for supervisors to do first, so that they can understand their own socialization processes and biases for transgender care.

After supervisors have attended to their own socialization, they can help supervisees explore their own socialization of negative transgender attitudes, such as from society, family of origin, and training experiences. If supervisees were raised with strict rules about gender presentation, that may provide valuable information about how to broaden views of gender. To explore this, supervisors ask questions about how family members express gender and how supervisees were raised in terms of gender socialization. Specifically, supervisors can ask questions such as, “How does your family treat females compared to males?” Additional questions such as, “How is gender nonconformity viewed in your family of origin?” are asked to enhance supervisees’ understanding of gender socialization (see Table 1). Attending to the socialization process is a critical aspect of feminist-informed supervision.

Vignette

The following vignette provides an example of how feminist-informed supervision principles may look when they are applied to transgender issues. The vignette is a hypothetical situation from a supervision session for Sally, a provisionally licensed MFT supervisee and a therapy session between Sally and a client.

  • Supervisor: What has it been like to work with a Black nonbinary transgender client? [Supervisor seeking to incorporate intersectionality and elicit emotion.]

  • Sally: It has been really challenging because I feel like I keep using the wrong pronouns!

  • Supervisor: It can be challenging to use new pronouns that you are not used to. You sound frustrated. [Supervisor elicits emotion.]

  • Sally: You’re right. I am frustrated. It is hard for me to think of “they” as being grammatically correct. It just feels wrong still. [Supervisee discussing their gender socialization and expressing affect.]

  • Supervisor: We have been socialized to believe that “they” is grammatically incorrect as a pronoun due to our society’s focus on the gender binary. Our society has instead normalized the gender binary, which is why “he” and “she” are what we tend to think is grammatically correct. [Supervisor balancing power by acknowledging their own privilege. Supervisor highlighting gender socialization.]

  • Sally: I have heard my family members tell me that they do not understand why people are using gender neutral pronouns.

  • Supervisor: Family can often affect how we understand the world and it can be helpful to explore how we learned about gender. I would like to guide you through a gendergram exercise during our supervision. The gendergram is a type of genogram that explores significant relationships and influences on gender identity. [Supervisor introducing gendergram to help supervisee understand what she learned about gender identity from socialization.]

  • Sally: I haven’t really thought about how I learned about gender. I don’t think about it but I have never really had to think about it. [Supervisee acknowledging cisgenderism and privilege.]

  • Supervisor: Growing up, how did family members express gender? [Supervisor highlighting how gender is performed.]

  • Sally: I always dressed pretty feminine because my mom would buy that type of clothing for me. My mom would express her gender by the clothes she wore, curling her hair, and wearing purses.

  • Supervisor: Growing up, how was conformity to your family's gender norms rewarded? How was nonconformity punished? [Supervisor emphasizing the implicit and explicit messages that may have influenced supervisee.]

  • Sally: My brother and I are twins, but my parents had different rules for each of us. My brother was allowed to date at sixteen and I wasn’t allowed to date because ‘girls need to focus more on school than dating’. If my brother and I came home after curfew, they would take my car away for a week and my brother would not face any consequences. I learned there were different gender norms for my brother and I and if I didn’t conform, I was punished. [Supervisee acknowledging cisgenderism and power differentials within her own family of origin. Supervisee acknowledging how gender norms were policed within her family].

  • Supervisor: It sounds like you understood you and your brother had different rules based on gender. Howdid what you learned about gender impact your definition of yourself as a woman? [Supervisor reflecting supervisee’s awareness of gender norms and consequences for nonconforming. Supervisor connecting supervisee’s experiences to her beliefs about gender.]

  • Sally: Yeah, I knew we had different rules and my parents would usually compare ‘girls versus boys’ because of my brother and me. The binary of girls or boys seemed normal because this was the language my parents used. I think learning about gender norms based on whether you are a man or a woman caused me to think about gender in binary terms. [Supervisee highlighting her own gender socialization.]

  • Supervisor: Because of the norms and language used in your family of origin, you understood gender as a binary. Cisgenderism refers to the assumption that gender is only binary and related to biological sex. However, gender identities may fall within or outside a spectrum of masculine to feminine. [Supervisor highlighting supervisee’s gender socialization. Supervisor educating supervisee about gender conforming and nonconforming identities.]

  • Sally: I was seeing gender in terms of a binary and that was why I struggling to accept my client’s gender neutral pronouns. [Supervisee connecting gender socialization to her client conceptualization.]

  • Supervisor: I am curious how you are conceptualizing the ways that race may intersect with nonbinary identities for your current client. [Supervisor exploring intersectionality.]

  • Sally: My client is a person of color and has faced oppression and discrimination based on their race. They have also experienced oppression and discrimination based on their nonbinary identity. I understand that this black nonbinary transgender client has had different experiences than one of my black cisgender clients. [Supervisee acknowledging the oppression and discrimination faced by marginalized populations. Supervisee conceptualizing her client based on their intersecting identities. Supervisee acknowledging cisgender privilege.]

  • Supervisor: How would you use a gendergram like we have done in supervision with your own client? [Supervisor highlighting the isomorphism of the gendergram activity by acknowledging what was used in supervision can also be used by the supervisee in session with her client.]

  • Sally: I think exploring how my client’s family reinforced gender norms could be helpful in working toward my client’s goal of embracing their gender identity and coming out to a group of friends.

Sally in Session with Client

  • Sally: Cisgenderism refers to the assumption of binary gender related to biological sex and cisgender norms reflect these assumptions. There are often rules about gender conformity within families of origin. Growing up, how was conformity to your family’s gender norms rewarded? [Supervisee highlighting her knowledge in nonbinary transgender identities and not depending on client to educate her. Supervisee exploring the explicit and implicit messages about gender that client may have experienced in their family of origin.

  • Client: I was expected to play football and basketball throughout high school and college. I always conformed to my family’s rules by being athletic and I was rewarded with praise from my parents. When I first came out as nonbinary to my parents, they threatened to stop paying for college. [Client explaining gender assumptions and norms within their family of origin. Client explaining how their family punished them when they were nonconforming.]

  • Sally: You used to receive praise from your parents for your athleticism and being athletic was a gender-specific quality? [Supervisee clarifying the client’s experience related to gender.]

  • Client: Yeah, football and basketball were seen as hypermasculine sports in my family, and I was expected to participate. I liked sports and was good at them, but I also did not feel like the hypermasculine person my parents wanted me to be.

  • Sally: And when you came out to your parents, you learned you had to conform to their gender norms if you wanted their help paying for your education. [Supervisee summarizing what client learned from their family in terms of gender nonconformity].

  • Client: Yeah, I felt trapped in this one ‘box’ of masculinity, but it didn’t feel right and the other ‘box’, femininity, also didn’t feel right for me. Just wavering in my masculinity threatened my relationship with my parents. [Client explaining their experiences in gender identity exploration.]

  • Sally: You tried for years to make yourself fit into a box that felt true to who you are. After exploration, you discovered the gender binary is incongruent to your identity and that you identify as nonbinary. [Supervisee highlighting her client’s journey in their gender identity without cisgender biases or assumptions.]

  • The supervisor began the conversation by bringing awareness of the nonbinary client on Sally’s caseload. Following feminist supervision principles, the supervisor begins to elicit Sally’s affect related to working with the nonbinary client. Through this process, the supervisor discovers that Sally is frustrated with how she has been socialized to view the nonbinary pronoun. This becomes an opportunity for the supervisor to balance power by acknowledging how socialization processes have also impacted the supervisor. Throughout the supervision session, the supervisor provides education about gender identity diversity and about tools available to Sally to explore aspects of gender identity with her client (i.e., gendergram). In future supervision sessions, the supervisor would process the gendergram activity to explore how the experience was for Sally and her client.

Discussion

The purpose of this paper was to demonstrate how feminist-informed supervision principles can be applied to enhance supervisee competency of transgender issues. Transgender competency continues to be an area of improvement for marriage and family therapists, as they have reported feeling unprepared to work with this population (Mallory et al., 2017). Although the AAMFT Code of Ethics (2015) encourages therapists to become competent in working with gender identity, there is not always a detailed focus on the unique issues experienced by transgender clients. Given the disproportionate therapy utilization of transgender clients (Shipherd et al., 2011), training and comfort of transgender issues are necessary. Feminist-informed supervision methods provide a way to bridge the gap between training programs and clinical practice in fostering transgender competency. Specifically, feminist-informed supervision requires an exploration of how intersectionality of identities, power, gender, diversity, exploration of emotion, and gender socialization impact the supervisory process. Supervisors are committed to cultivating a nonjudgmental and accepting stance toward transgender clients and instill this in supervisees.

This article outlines the benefits of feminist supervision for supervisors that are not as familiar with transgender issues and how they impact the supervisory process. Supervisors who draw upon a feminist lens are sensitive to the societal oppression that transgender clients experience and how that is perpetuated in the therapeutic system. With that sensitivity comes an awareness of how supervisee gender socialization can impact the delivery of therapy services. It is crucial that supervisors are aware of the unique challenges supervisees face with providing treatment for transgender clientele. Feminist supervision offers a systemic framework to consider societal factors that impact transgender persons and their families.