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DID and Trans Folx · System Speak: Complex Trauma and Dissociation

• 0:11
  Speaker 1: Welcome to the System Speak podcast, a podcast about dissociative identity disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to longtime listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 0:59
  Speaker 2: Hello, everyone. We have Lou Hines here by request. They've been so gracious to show show up today and talk to us about DID and trans folks and that experience. To broaden the audience a little bit. And, for those who will be listening later, even if you do not identify as trans or do not work with trans clients.
• 1:25
  I would really want you to or encourage you to listen to this episode and conversation for the humanity of it, for the normalizing what it means to try to get care, how many of us have the shared experience of rupture without repair in therapy, things like that. And then just a reminder for listeners who have been listening to the podcast for ages, the first time that Lou came on the podcast and talked about gender and orientation and the unicorn and all the things, that was the conversation that led to my therapist saying, when are we gonna talk about you and your husband are both gay? Because I do not identify as trans, so I don't wanna intrude this space, but I wanna normalize how important the questions are and the nuances are. Because after my conversation with Lou or through my conversation with Lou and that podcast interview, I thought about so much what feels good and right and congruent with me and my system. I thought, okay.
• 2:39
  So I feel I'm I feel pretty congruent and okay and happy with my gender as assigned. That feels good. I feel this and I feel that, and I'm okay with not being I make jokes about the doilies. Right? I think was the joke on the podcast that I wasn't that kind of girl that could do makeup and doilies.
• 2:59
  But as I am, as I present, I felt pretty congruent with that. But when I learned about things like roles and expressions, if I am attracted to women, why am I married to a man? Which was a hard question. But that led me to my religious trauma questions of how did that happen? How did I get myself in that situation?
• 3:22
  Not just because of DID, but those dynamics that we share in some of the issues talked about in this conversation with miss Atuman and being misunderstood and having to, fake our way through life to mask to all the things to be well enough to perform what feels safe enough to get our needs met. That's how I ended up in that that situation. So it's not about Nathan. No drama there. You guys know this.
• 3:52
  We've talked about it and shared in checking groups and things through the process, but I can't be married to a man if I'm a lesbian. That's that's not congruent with myself. And so a conversation okay, guys. I'm not even kidding. Literally in the closet because it was during the pandemic.
• 4:13
  Right? And so I had all the kids home, and I had to hide from them literally in the closet in this conversation with Lou. And I'm like, why am I back in the closet? Right? So how did I go backwards?
• 4:27
  How did I go backwards? And doing the work over the last few years to get myself in these conversations of just what feels right to me and my system and what doesn't. So in this conversation, it's very specific to trans, but I think the application is so much broader for all of us and really important for us to be asking ourselves these questions about what feels good to us and what doesn't and how we are living congruent with those experiences or not and just the curiosity of why. Maybe there are situations we can't change or it's not safe to do something about right now or maybe there's incongruence but there's a purpose. Like, I'm not saying we all have to make really big life changes, but I am saying what does it mean and why is it happening and being aware of it rather than being more dissociated because of things I actually can do something about when there is so much in my past I couldn't do anything about.
• 5:34
  It's a way of taking back our power, which is a whole different gender conversation even, right, for a different time and different day. But, oh my goodness, it's really, really important. And so in addition to holding space for and understanding trans folks and our friends that we care so much about, and I am so glad and so impressed that you all were so brave to say, hey. Can we have a specific conversation about this? So with that, I will pass it to Lou Himes who can share with us just a little bit about trans folks and then also DID in that intersection.
• 6:16
  Awesome.
• 6:17
  Speaker 3: Thanks. And and, well, I guess I'll start by talking and then hopefully open things up to all of you because I really would love to just know what it is that I can do to help you and, you know, how what you're looking for. But I'll give you a little bit of background kind of how I found my way here, and I guess we can start there. So in, let's see, 2033, maybe 2012, I have been working very briefly, at a university in the Bronx and had a student come up to me or actually come in, to the office and say, I'd like to I'd like to see that person who just came in. They look queer, and I think they can help me.
• 6:59
  And turns out that, it was a trans student, who was wanting a letter of support, and that kind of started my journey with working with trans folks. I wanted very desperately to be able to help that student, get what they needed and also knew that though, you know, I had had gender questions and was at that point kind of identifying as genderqueer, but didn't really have a strong sense of myself in that yet. But I I wanted to be able to help from from a professional standpoint. And, also, one of my best friends, transitioned at that point. And so I knew a little bit about things from the personal side and and all of that, but I really wanted to know how to help people as a professional.
• 7:42
  Professional. So I sought out a really fantastic mentor, who actually started the Fenway Clinic up in Boston, as a postdoc. And that is doctor Randi Kaufman. She's fantastic. She's now don't even know if she's doing private practice anymore, but she is at, oh my gosh.
• 8:02
  I'm gonna lose the the name, of course. It's a child and family services center psychological services center that treats and supports and provides services to trans communities and their families, trans kids in particular, Ackerman the Ackerman Institute. And so Randy supervised me for a while and helped me kinda get my feet under me clinically. And then when I left my university job to go into private practice in 2015, literally, my doors just got flooded with trans people wanting support. And this was in Manhattan, New York.
• 8:33
  So there were a lot of folks there and a lot of work folks seeking services, and and so I started seeing trans almost exclusively. That morphed into me needing to meet the needs of trans folks, beyond letter writing and supportive transitional services, and I realized that I needed to know a whole lot more about trauma in order to adequately serve the community. And I would also say that anybody who wants to serve the trans community needs to know a whole lot about trauma, and how to work with it effectively. And in that journey, I found myself at ISSTD, which is kind of interesting because I I knew Emma through the podcast long before I knew her through ISSTD, but we've kind of connected there as well, and that's been really lovely. So ISSTD has taught me what I needed to know about trauma and working, with populations who have very severe and complex trauma and also begin my journey with thinking about DID as a clinician and realizing, right, pulling my head out of the, proverbial sand of denial that our culture lives in around how significant childhood trauma is in this country and and in the world.
• 9:38
  And so I found myself, you know, with an advanced certificate in trauma and working with DID more and more and very graciously inviting me to the podcast, so I I got some greater exposure, to the DID community as well. My my next stage of the journey actually is, starting to really come to understand what neurodivergence looks like in the trans community. And, of course, there's, of course, there's overlap between neurodiversity and complex trauma because, hello, complex traumatized kids can also be more vulnerable because they have some kind of neurodiversity, and that can be why they're targeted. And so, I'm just starting to learn more and more about the intersections of that as well. So that's kind of my background.
• 10:25
  It's kind of where I'm at right now, and my clinical growth is trying to understand neurodiversity better, how it how to support people in dealing with both trauma flashbacks and, right, neurodiversity, which sometimes mimic each other, and sometimes it's hard to tell what's what. So that's who I am. That's where I'm at right now clinically in my kind of learning and education and growth, and I'm happy to talk with all of you and see where you're at. And as much as you'd like to to share, please feel free because the more I know about, you know, what you're looking for and what your experiences are, the more tailored I can kind of be in my responses.
• 11:01
  Speaker 4: Thanks for being here. Thanks for joining us.
• 11:04
  Speaker 5: So my my big starting point in the question is there are some assumptions that I have learned to make about what it's like to be wanting gender affirming care on the point from the point of view of being, a person who is in transition. Okay. And so I have a lot of empathy for folks about feeling like it's long overdue. And and then from a caregiver side, not just a provider in a mental health setting, but, like, in in a variety of different ways, like a family member. Let me say it that way.
• 11:54
  As a family member, loving somebody who is, let's say, a teenager, there's there's a certain urgency about how how to work with teens that that we know in common about what's happening with puberty and and all the reasons to work with hormones, for example, with young folks. Those two perspectives really clash with this perspective about systems where we've been talking about in the last couple of weeks, this idea that we go as slow as the slowest part in the system. So wanting to go slow enough to accommodate, for example, the youngest in the system who may or may not be wanting transition. And so there's I'm not very good at saying this quickly and comprehensively. So this is me saying there's there can be a competition between wanting to speed up and wanting to slow down in where where is where do hormones come into the process, especially when not everybody is in board onboard internally and, there are so many repercussions to either slowing down or speeding up.
• 13:29
  How's that? That's the best I can
• 13:32
  Speaker 4: do in Pacific time where I am.
• 13:36
  Speaker 3: Oh my goodness. Yeah. Well, let me let me start by saying, I have always worked pretty much exclusively with adults. So I don't have a lot of, like, high level of competence working with younger folks. I can extrapolate a little bit based on what, you know, I've encountered kind of in theoretical spaces, right, in educational spaces, but not necessarily as much in, like, individual personal clinical work.
• 14:00
  But if I was working with, someone like who you're describing, I think my first assessment would be the risk of not moving forward to be because I think as a a trans myself, right, a trans provider who lived a trans childhood experience, there is such incredible helplessness in children. We know that already. Right? We know that, because of our understanding of DID and how helplessness is such an incredible factor in your your mind needing to develop these strategies of splitting. Right?
• 14:38
  And so helplessness in children and especially at adolescence and when as they're in puberty, as they're moving into more late later adolescence is their sense of autonomy, and self determination and safety. And so, though I if again, I don't feel like I can go into this too deeply, I can say there is absolutely no negative side effect that we know of to puberty blockers. So there are two different things here. Right? There are puberty blockers which simply halt the natural biological progression that a body takes at a certain age toward developing more biologically into, sex sexual characteristics that are male or female.
• 15:27
  But and and then additionally, there are hormones, and those are that's a that's step two. That's actually a second step in a a pretty normative pathway for trans youth to take when transitioning early on. Hormones is not the first step often depending on how far along they are in their trend, in their, pubertal transition. And so I don't see and and this is also how I feel. Turn my phone off real quick so I don't get any dings on my notifications.
• 16:02
  There are this is also how I feel about with adults. They don't there's no requirement for a letter of support for hormones for adults. So I see that as an opportunity for an individual to experiment and find out. No well, very few choices in transition are irreversible, very few choices in transition, cannot at least start out in an explorative or exploratory way. And so though, right, the slowest part might not be on board totally, maybe they have reservations, but is there room for the that part to to play, to explore, to see how it goes for a little while?
• 16:50
  And as long as there is enough co consciousness and co conversation between parts, whereas you you, you know, really believe that that they have the capacity to really be processing that together, then I don't think you need to have every part on board, which I think is kind of the standard that as people talk about. And I'll be honest. Right? Like, I'm trans. I'm non binary.
• 17:15
  I I have a little prosocial, antisocial in me. Like, I don't I don't have issues with breaking rules. Okay? I don't have issues with going outside the box. So if for an individual person, there is enough willingness to actually and capacity to actually have conversation amongst parts.
• 17:38
  I do not think you have to have everybody on board with we're gonna transition. But I do think you you need some there needs to be awareness and there needs to be consent. Right? But it doesn't necessarily have to be, well, I'm consenting to becoming a man or I'm consenting to becoming a woman. It can be much more nuanced than that.
• 17:57
  I'm consenting to seeing how this feels in the body. Right? And to giving it a go. And if a system has enough trust, right, in each other to not know whether it's gonna be whether it's gonna turn out great, but can trust each other that they're gonna be able their their opinion is gonna be heard and is gonna be valid in within the system, if they don't like what's happening, then I I think you're you're you're good to go. Right?
• 18:25
  Like, you you're good to take the steps that you need to take to explore. I don't know if that fully answered your question, you know, because each individual case is really complex and individual. And maybe hormones are the stage that, you know, you're you're contemplating, which I would hope might be have been alright. The ideal would be that children would be listened to early. They would have the opportunity to go on puberty blockers before they have to contemplate straight up hormones.
• 18:55
  But that's not always the case.
• 18:57
  Speaker 5: The point I was trying to make that that's challenging for me is looking at the subject as a whole, not a particular, example. So looking at this this whole, I think, especially with young people, puberty blockers is a perfect example of, yes, do it. Life saving.
• 19:19
  Speaker 4: Mhmm.
• 19:19
  Speaker 5: My my point of view. Working with systems and this can include me. Who who and how I present on any given day. I may not realize that I'm coming from a much younger place And for me personally, it's not it's not a hormone thing and it's not a surgery thing. A lot of folks are in a hurry, in general, I would say, among trans folks I know, to have
• 19:49
  Speaker 3: external,
• 19:54
  Speaker 5: an external match for how they're feeling. Yeah. And at the same time, the system work is slower. So it's that mismatch between the the speeds. That's what I was trying to speak to.
• 20:10
  The mismatch between the speeds of this needs to happen because we're over it's overdue. It's long overdue, and this needs to be delayed, in order for folks to process in all the different ways that systems frequently seem to need to process in different ways. Like Mhmm. Color about it, do physical movement about it, for example. Like do you know what I mean?
• 20:42
  So getting, a collective, getting everyone to join in in a collective process to me is is slow, which is tough to do when there are such serious matters around especially around safety.
• 21:01
  Speaker 4: Mhmm.
• 21:02
  Speaker 5: So I think I was trying to ask in a more general way, like, there's a speeding up and a slowing down that can be happening simultaneously within a person and between people, that can get in the way of the care being really good care between people in different roles. And I just wondered if you had something to say about that. I I do disagree with you though about that you're possible. I'm I'm I'm representing sort of a a bear in in in in, at the moment where, if if, people assigned female at birth, do take T and have a a very, pronounced like facial hair growth, for example Mhmm. That it that doesn't exactly easily stop if if
• 21:54
  Speaker 3: it went to just one mind one's mind. So Absolutely.
• 21:58
  Speaker 4: I yeah. I didn't I didn't say easily.
• 22:00
  Speaker 3: Okay. Alright. I feel irreversible. I didn't say easily. Okay.
• 22:07
  It's mute again now. Yeah. No. I agree with you. I agree with you.
• 22:10
  There there are not easy changes. But the other piece of it is is that when hormones are provided, generally now they are provided based on an informed consent model. And informed means that or should mean, that they are being told of the risks of what pieces of change can be reverted and which ones cannot. And I don't necessarily think that that's totally our job as mental health professionals to talk about the physiological changes that can happen and whether or not someone is totally okay with every single one of those. However, I do strongly believe it is our job to ask questions like, have you done your research?
• 22:49
  Do you know what the potential effects are? And are there any that you're worried you might have? Right? You know, some people love their voice, because maybe they use their voice for work or for artistry and they're terrified that they're going to somehow, experience changes in their voice that they don't like. And and so, you know, kind of holding that boundary where holding that reality with folks of like, we can't we can't pick and choose how your body is going to react to this and we can't know in advance.
• 23:18
  So what what what do you need in order to feel safe if you want to move forward? And what do you need to feel safe if you choose not to? Right? Knowing that all of these options are possible and we can't know what you're gonna get from the start. Yeah.
• 23:37
  Yeah. Marty said parts may find. That change is completely unwelcome. Absolutely. Some parts might love some changes, some parts might not.
• 23:45
  So there there could kind of riffing off of that a little, there could be grief. There could be grief that might have to be worked through. Check for any other. Oh, yeah. We have six notifications in the chat here.
• 23:58
  But I don't see any other questions. Would anybody else like to jump in?
• 24:03
  Speaker 4: Hi. I don't really I'm in 12 places at once. I've got my partner sitting over here. He can't hear what you're saying, but he can hear what I'm saying. Okay.
• 24:18
  I, Well,
• 24:19
  Speaker 3: there's no pressure, so take your time. I,
• 24:26
  Speaker 4: I agree with what Mari said about this being, like, a there's a feeling of it being long overdue. Like, I'm just kind of, like, overwhelmed with, rage and hurt. Every time this into a section, it's mentioned, which is so funny because a a lot of the region have heard us about it never being mentioned. And, of course, trans dissociative people are often the tightest lift of all because there's so much at stake for us. And I'm just trying to open myself right now to, like, this is the space.
• 25:03
  What could it what would it be like for this to be here now? You know? Like, I think, I feel there's a lot of inside parts who are just kind of, like, right now about, like, some of the affirming things that we're hearing discussed. He he just, you know, aside from all the other abuse, the the gendered aspects of our childhood were inescapable, suffocating, overwhelming gaslighting, soul binding, compliance, and bonding twenty four seven forcing. You know, I firmly believe that being trans is enough to get TIV without any other abuse, and it's a miracle that we don't all have it.
• 25:53
  And sometimes in trans readings, I wonder if we do all have it. But I don't need to read other people's inventory. I can understand really. Like, I appreciate what you said too about, like, not needing to have everybody on board if there's enough co consciousness. I don't wanna, like, dive into all the trauma, behind that really, but that's a really important thing to hear.
• 26:20
  And I'm just also trying to be, like, right sized about that, like, oh, this is one provider who has that perspective. I'm not going to walk away from this meeting thinking we can just change the mental health world or the surgery world or the hormones world or any of that, but this is a good thing. I wanna, like, voice a different perspective on the issue of slow versus fast too. In our experience, we have, like, a very sudden, like, system change where, like, I guess you could say, like, of the two kind of halves of our system system that kind of predominate in day to day life, one half was totally in denial about gender, and the other half just knew never to talk about it. Like, never ever ever talk about it.
• 27:12
  Do what you want, but don't say a word. And then, like, there was this moment, like, on the first your side of our, one of our perpetrators passing, where all of that turned inside out. And, like, there was all this, like, sudden awareness, and we just started transitioning and never looked back. And so we've been lying to providers left and right. You know, we're still doing it.
• 27:38
  We're about to go up and get our last gender affirming surgery, and we're still lying until that's over. And to be able to get treatment for DIV meant that having one person we wouldn't lie to anymore. Yeah. Well, two, because the first one dumped us like a sack of hot potatoes.
• 28:00
  Speaker 3: Oh my god. I'm really sorry to hear that.
• 28:04
  Speaker 4: But, anyway, I don't know. What was I saying? Oh, yeah. Slow versus fast. Some of the slow ones, like, so much changed in those first years of transitioning.
• 28:13
  Some of the slow ones were, like, frozen or stuck in sludge or something, and they needed a loving parent to help them believe that there was another way for them to live. Sure. So if I had let them slow me down, I would have been abandoning them and reenacting what other parents had done to them in the past. Custodians, not parents. Some of the other slow ones were, like, faking slow.
• 28:38
  Right? Like, they were, like, challenging us, like, looking for reasons to blame the grown ups for continuing to be inescapable, suffocating, overwhelming, gaslighting, all that stuff. Like, oh, you're just like them. Yeah. Why don't you just go slow and be careful and not actually do anything?
• 28:58
  You know? Like, that energy came from a lot of especially the older kids and younger teenager parts. Mhmm. Some of whom have come up to Valentine and joined us since then because we won them over. Wow.
• 29:16
  And we did not slow her down at any point. Mhmm. We, like we did we have to do a lot of system questionnaires at the expense of a lot of fee compensation. Like, we were not ready for that level of inner questioning. I think I know a lot of providers, like, really have no concept of how hard that can be for someone who's just learning about their system.
• 29:41
  Yeah. But we did do a lot of that to put that first provider and ourself at ease feeling like there was consensus enough. But still, like, when it comes to other parts, it's like, if if if a child is in an abusive situation, I don't wait for the child to say, I'm in an abusive situation. Please grab my hand and walk me out of it. You know, I need to do something.
• 30:10
  And I have to take that perspective too. And I am very, very, very aggrieved that the mental health field, sees it as a liability issue instead of a walking children out of abuse issue. But we're here. We've survived. We've made it this far.
• 30:32
  And and thank you for being here. Aw. Everybody is thinking I'm today, but I can.
• 30:46
  Speaker 3: Well, thank you so much for for sharing your story and your perspective, and
• 30:54
  Speaker 4: I I some
• 30:54
  Speaker 3: thoughts that came up for me as you were talking. But, yeah, like, there's a part of me that, like, when you know, because I'm also part of WPATH, the World Professional Association for Transgender Health, which I really think is doing the best possible work that a system, an organization can do to help individuals, which, of course, has excessive limitations. But I do really think, they are on the right track and really good hearted with their intentions despite potential impacts sometimes. But, you know, when I'm talking with other professionals sometimes at conferences or or listening to other people at WPATH talk about DID or talk about, you know, so the standard that WPATH sets, right, is or, that they've talked about is that all mental health concerns of a a transgender person as they are approaching choices around therapy is that any other mental health concern be reasonably well controlled and they train to that language. Right?
• 32:00
  What does it mean to be reasonably well controlled? Well, first of all, there's kind of a myth there that they have all the information. There's this myth that, like, oh, you can just ask your client questions, and then you will have all the information to decide whether or not they should be doing what they're doing.
• 32:23
  Speaker 4: And Yeah. We just went through the Mayo Clinic intake, earlier this year, and it was that's such a stunning experience. That place is so amazing in so many ways, but things like that, that, it's like, we don't wanna see your letters from your providers. We're gonna drag you in here and do our own evaluation, and we're going to conclude whether you're ready for this care or not on the basis of forty five minutes with a trans provider who doesn't even believe in the process, and thank goodness is actually there to help you get the letter that you need from them.
• 33:01
  Speaker 3: Yeah. But
• 33:02
  Speaker 4: it's just so weird, these evaluations. And, of course, they didn't ask about dissociation. Thank goodness.
• 33:11
  Speaker 3: Yeah. Yeah.
• 33:12
  Speaker 4: Because I probably would have stared into space for ten seconds before lying about it, and they would have caught me.
• 33:20
  Speaker 3: Well, I'd like to think it's like, you know, my so once I started to really grasp and come out of my denial around DID, I realized of course that I had someone on my caseload that I had been seeing for years who had DID. And I had already helped them through, right, supported them through their transition. And then they outed themselves to me as having DID years later. And that was my first experience of the intersection between trans identity and trans and transition and DID. And I think that was such a great way to get introduced to the intersection because it really just showed me how absolutely oh, it's gonna be hard not to swear.
• 34:05
  How absolutely irrelevant I was to that process. Right? This person checked off all the boxes, and so they got to get the thing that they needed. How messed up is that? So if somebody doesn't check out the boxes, then what?
• 34:23
  Right? And I'm so grateful, to Doctor. Randi Kaufman because first of all, she told me don't use the word evaluation.
• 34:31
  Speaker 4: This is
• 34:31
  Speaker 3: not an evaluation.
• 34:32
  Speaker 4: Who are you evaluating?
• 34:33
  Speaker 3: What are you evaluating? Get out of here with your evaluation. This is a supportive interview that will hopefully lead to you supporting this person in a process, which includes transition but not in there. And so that has been such a formative, part of my training and my modeling that I got to receive that I'm so grateful for. And one of the other things that Doctor.
• 35:00
  Kaufman said to me because, as a provider who was not yet transitioned when I, or transitioning in any physical or social kinds of ways when I was meeting with Doctor. Kaufman, I had fears. What about my license? This is different, I think, perhaps for social work. I don't know because I've never been in a social work program.
• 35:25
  But in PhD level psychology clinical psychology programs like the one I went to, you are very clearly and specifically trained that there is a code of ethics and that if you break it, you know, it's doomsday. You're gonna lose your license. You're not gonna be able to practice. Your profession is gone. Right?
• 35:44
  Now, there's a lot more nuance to it than that, but that's pretty much how it's trained. Like, your career is over. So you follow the code of ethics or you lose your career. Wonderful. I think it's great training that we get such strong ethical training in our field.
• 35:58
  I think that's great. But one of the one of the pieces of the ethics is one of the pieces of the ethics is, you you cannot practice outside of your scope of training. And so the the conundrum that came to for me was, well, I'm not a medical doctor. So how am I saying that something is medically necessary in a letter? That's outside my scope of practice.
• 36:23
  That puts me in the danger zone. That then threatens my career and my livelihood and my family. Holy shit. Right? Like, scary.
• 36:32
  And I remember taking that to Randi, and I remember her saying, people make bad life choices in your therapy office every day. They marry people that you think they shouldn't marry. They stay in relationships you don't think they should stay in. They, apply discipline to their children in ways you don't think they should even if they're not, you know, abusive. Still not your best practices.
• 36:58
  Right? And you you it doesn't sit well with you, but you don't say then, well, you can't have something that you need because I I disagree with this one way that you're doing this thing. And she said if if every clinician let the fear of, oh, the this choice that my client is gonna make is gonna come back to bite me in the ass, we wouldn't have any clients. We wouldn't be able to sit there and tolerate that. And so just like you wouldn't tell a client, I don't think, you know, you should marry this person because I think that might end up being a bad situation years down the line.
• 37:38
  Now maybe maybe you might. But, like, for the most part, that's not really our job. We don't live our clients' lives. We can offer concerns and reservations when they come up, but we don't tell them what to do. Neither should we be doing that around transition related stuff.
• 37:56
  And if someone is insistent that this is the choice that they need to make and that they are ready to make it, and we really don't have any reason to believe it's just a choice that we're not sure about, not our place. And we need to get out of the way and open the door, because that's our job, actually. Our job is not to be a gatekeeper. Unfortunately, our job should be to be a door opener, not a door closer. Right?
• 38:27
  Because there really shouldn't be people on this door anyway. But, Mara, do you wanna share your comment? Because I only read the first little half of the sentence. Would it be okay to share
• 38:36
  Speaker 5: that? I just wrote in the chat. I'm a student in a mental health field, and I do understand the intent of the structure around ethics. I wrote it because I wanna say something else, and I want you to know that so that we're not arguing. We see the value.
• 39:00
  And having been a casualty of somebody else's career as a psychologist, Her career as a psychologist in many ways, was alienating. She entirely did not catch that I was dissociative and did not catch that I exist in a trans way in the world and and and and and a lot went wrong. And her engagement with her career and all that the all that the career did to protect her and, theoretically, for her to be prepared to protect me failed over decades. So I'm very upset about it. Still, I don't know that I'll ever stop, and it interferes with my ability to go on as a student.
• 39:53
  And I relate to people in the field who are colleagues and teachers, mentors, friends, ex lovers. It's very complicated. I'm just it's impossible for me not to say this. It's worse for me as a Jew. I almost never say that out loud in the systems community, but I gotta say it's extraordinarily painful being a Jewish survivor with a a social world full of other Jewish therapists where we get it on a gut level, and yet I feel so failed, and I don't know how
• 40:38
  Speaker 3: to go on to be an
• 40:39
  Speaker 5: advocate with others. It's when I first heard from a terrific, terrific therapist who's a terrific person in the field, and I have no complaint about his impact on the field, when I first heard him say we have to be very careful in how we support our clients who are yearning for transition. I felt offended. I felt hurt. I felt afraid of my own clinical wisdom because I was relating on so many different levels.
• 41:15
  And I was being cautioned against being open with anyone in the field who could give me professional feedback about how to deal with what then was called countertransference. It is so much more complex when I factor in my own feelings and I just say, like, I can do the mental part of this. I can write a paper on this. Mhmm. You know, with having witnessed peep having lost people and trans people in my own family, it feels very overwhelming to trust the structure around the field, how the field is designed to to help providers help us.
• 41:58
  I'm just gonna say I feel very divided between who The Us is around Mhmm. You know, and currently, I do not see myself as a provider in the And, it's so profoundly I I alienating. I just can't sit through this without sharing that out loud. I'm not expecting anyone to be able to fix this. What kind of boy let me just say I'm gonna just go to go to the child experience of being trans for a second.
• 42:42
  I was four when I knew I was a boy. I'm living with this boy. I am responsible for this boy, and this boy does not experience myself as having had good puberty. We're still four, so it's not about hormones or surgery for us. And we're looking out through these eyes and don't have a problem seeing seeing the world this way because we've always we've always been here, and we don't
• 43:15
  Speaker 4: know how
• 43:15
  Speaker 5: to we don't know how to approach. Staying safe, staying alive, and and belonging. And no one else can do for us. This is our work.
• 43:39
  Speaker 3: Maura, I feel like anything that I might say right now might be not really hold the full gravity of what you've just shared. And so I wanna be really careful because what you I'm I'm glad to hear that you are getting the help now that you need and that you can feel seen with that because you need it. You need it. We all do. Every one of my clients does.
• 44:07
  I certainly do. And if we are gonna be working in this field, trans, or or DID identified or multiplicity identified. If we're gonna be working in this field, we all need it. And when every layer you add on, right, with your your Jewish cultural heritage and the trauma that comes with that, your transness, you name it. Like, every layer you add, we need safe places to be able to to for all of us to belong, whether that's, dissociative parts like DID parts, multiple parts, or, you know, singular individual parts.
• 44:52
  But we all have parts, Faye, and this is something I believe is we all have parts, and all of our parts need to be seen and validated in order for us to heal. So I just wanna say thank you for sharing that, and I'm so sorry that you had such a hard time. I know how challenging it can be. I too, had a very, very painful rupture, with a therapist I've been seeing for almost a decade. And it was a round.
• 45:22
  Stupid fucking letter. So I get it. I get it. I really do. And I'm sorry.
• 45:31
  But I'm glad it seems that you have some community here too, where perhaps you can sit with all of those parts of yourself and all the parts of this conflict, and be in conversation, which I think is what we really need. We just need to be heard, and we need to find spaces that where we can hold all of the pieces together.
• 45:52
  Speaker 2: Mars, I just wanna add that I loved hearing how you held space for so many parts of you in that very vulnerable sharing without excluding parts who are professional and parts who are family and parts who are all the things that so much of you just included in that sharing. And I wanna thank you for that. Well done. Not in a patronizing way, just in a beautiful to witness way. Really, really.
• 46:21
  Misty, did you have a question or a comment?
• 46:25
  Speaker 6: Hey. I don't know about switching back into some cognitive space after Mar's beautiful share. Is is that okay with you, Mar? I don't wanna dismiss Yeah.
• 46:41
  Speaker 5: I Okay. I let me just close that one part of what I was attempting to say. The colleague who said to me it was at a conference, and it said to me, we need to be very careful to make sure with our, dissociative clients, dissociative trans clients that, that we're not premature with with encouraging them to transition. He didn't know I was multiple. And just for full disclosure, neither did I.
• 47:08
  So the impact it had on me ten years ago is still reverberating through my system. So it's taken me ten years really to come to this session, and I've had a few feelings since then. So it's really helpful to be here, and I much prefer the cognitive. So looking forward to hearing what you have to say.
• 47:28
  Speaker 6: Oh, okay. Well, so I'm a mental health provider, and I do lots and lots of letters. There's always new hoops, and one of the things that Idaho is requiring right now is that people receive a letter from somebody with a PhD or higher, and there's, like, two of us in Idaho that will do it. And so I write a lot of letters. And one of and one of the things that I'm always kind of cognizant about is that stinking language that's, like, reasonably well controlled.
• 48:09
  And part of my job is not gatekeeping, but making sure that the letter is accurate and you get access to the services you need. And with DID, I'm always kind of, like, befuddled because I'm super aware that who is presenting for the session may not include everybody because why the heck would you be authentic with me when I'm the gatekeeper in in so many ways to getting the services that you have you have needed or wanted for so long? And so I am always trying, in all of my little speeches at the beginning of those appointments. I'm always saying, like, I know we just met, and, there's no reason for you to trust me. And I want you to know that nothing that you could say today is going to preclude me from from giving you access to this service, and here are the things that I need to meet.
• 49:17
  But I'm also curious about how far you go in your assessment of dissociation, when you're doing those, like, initial I call them appointments. I don't call them evaluations either, but those initial appointments when the intent is gender affirming services.
• 49:39
  Speaker 5: Yeah.
• 49:39
  Speaker 3: So, Missy, I'm really glad and sorry to say that I live in New York state, and we have legally protect we have legal protections for trans people in health care. So regardless of what WPAD says or doesn't say, if a trans person comes in and says I'm trans and I need this, they they're gonna sue if and they can sue if anybody says, well, no. Now here's the thing, and this is something that I also found to be a really helpful distinction. Nobody can tell a trend there is not a single provider who can look a trans person in the face and say, you cannot have a trans affirming surgery. I know that sounds bizarre, but hear me out.
• 50:31
  You can go get any doctor to do any procedure on you if you can pay for it out of pocket. Right? So what I like to tell people is, look, this is not even necessarily the the health field or the mental health field that is a big problematic here. What's problematic is that you need to use health care in order to get this service met. And health care has really ridiculous, really exclusionary criteria because they don't wanna spend money.
• 51:03
  And they don't wanna spend money to take out your birth appendix that is literally rotting inside of you and killing you. They don't care. These are, in my opinion, evil entities that we are all forced to interact with. K? I see my job as a mental health provider to know the system well enough to help you navigate it, actually.
• 51:31
  That's what I see my job as. So we can talk. I can provide as much support. If unless there's some wild reason why it would not be appropriate, I can help. I'm going to, you know, write you a letter to help you get what you need.
• 51:47
  That's my job here, to navigate this really atrocious system. You don't have to actually do this if you wanna go start a GoFundMe or there are plenty of surgeons who will do surgery for relatively reasonable amounts if you're not using health care. So, I know they used to, I can't remember the name of the provider now, but in Florida, you still would go down and get a gender affirming either top or bottom surgery for about $6,000 out of pocket because there's no insurance involved. And if you could come up with six g's, you walk in, you don't need a letter, you don't need anything. I would like my and he was one of the most, like, prolific surgeons ten, twenty years ago.
• 52:33
  Okay? Because he didn't use insurance and anybody could access him and there were really no rules. And turns out, thank god, he wasn't a quack. He was actually doing good work, and was really leading, I think, the field in a lot of ways. But, right, you take your chances with that.
• 52:50
  That's risky. So operating within a traditional health care system has more assurances too. Still not great. You can still end up with a really not great provider. But my job here is to help you navigate getting the insurance to pay for what you need.
• 53:08
  And I have my own beliefs about what we should be paying for health care. And that wouldn't be surprising to anyone who knows I'm trans because, like, that's that's just trans people seem to get that things shouldn't be this hard. So let's navigate the system. Let's figure out how to do that. Let me help you use my expertise in the health care system to help you figure out how to navigate this to the extent that I can.
• 53:36
  But it again, it's always kind of a crapshoot. I'm sorry, Misty. Coming back to your point, what do you do when you don't have legal protections and all the boxes do have to be checked? First of all, you're doing great work, and thank you for doing it. Yeah.
• 53:53
  I that's hard. That is so hard, because in order for us to truly support trans people through this process, we need to know everything. Right? You you need to know everything in order to really provide adequate care. But the bottom line is the way the system works, if you wanna go into the traditional health care route and get it paid for by insurance, you're probably at this point in time better off without your provider knowing everything.
• 54:26
  The provider who's going to be writing you a letter. Now something paid for you. Yeah. I have worked so I was in a I was a part of a a trans triad, a trans therapist working with a trans patient who needed another trans provider to write their letter because this person was so injured and so angry that even though they were working with a trans provider long term, year almost a decade of work together, the trans provider was like, you gotta go see somebody else because this will end our relationship. And he was right because this person came to see me and literally just raged at every question I asked over the course of three or three sessions because we couldn't get anything done very quickly because I'd have to help deescalate and manage the rage at at literally every question I asked.
• 55:24
  Right? And so and I almost left without the letter because they I you know, I what I off what I offer folks is, look, I'm gonna send you a copy of the letter unsigned. If there are things that make you uncomfortable, things you feel like need to change, if I got something wrong, let me know. As long as it's not my fabrication, I'm happy to change the letter to help you feel that you got the most autonomy and the most control in this process. And when I did that with this particular individual, he wanted to go back and forth about 10 times, like, making, like, grammar changes.
• 56:02
  And I finally had to say, I'm not doing that with you. I'm sorry. This is where my services end. I've provided you with a letter. And he blew up and was like, I'm out of here.
• 56:12
  I'm not I'm not taking your effing letter. Right? Like, you piece of trash. And I finally had to write him a letter that said, you know, Jim, understand why this process feels absolutely terrible to you and why you're so enraged that it even has to happen. And also, you have a finished letter sitting here that I can sign if you just tell me that's okay and then you could be on your way and it's done.
• 56:34
  And thank God he took it. Right? I just want to emphasize, like, if if my first trans client or my trans first trans client with DID had told me from the beginning, five years before I had any training at DID, that he was DID, and I was a young professional who was just learning about working with trans people and writing letters and being supportive, I probably would would have gotten in his way out of my own ignorance, not out of a desire to help or not help. I just would have been afraid, and I would have not known what to do or who to even talk to to get adequate supervision on the on the intersection of these two experiences. And I would have failed him.
• 57:24
  And luckily, I didn't have to fail him. And we still are working together, over ten years now, and he's fully transitioned, and he's living a really stable life and doing really well. And now in his mental health growth, now that he doesn't have to think about his trans identity being ignored. I I really it scares me to even think about what might have happened, if he had told me, to be honest with you. Right?
• 57:51
  And so I don't think it's our job to even know before we write letters. I'm I'm sorry. Our job to know how stable are you, you know, how how do you handle stress? What's your plan for this? Are there any triggers that you are concerned about in terms of what this might bring up for you that you might need some help dealing with?
• 58:14
  Can I provide some suggestions on how you might deal with that? And I'll I'll say when, when folks need a second letter because not because WPATH requires that anymore, let's be clear, but when people do need a second letter because their insurance is pushing for one, I will often say, I can meet with you once if you give me consent to just speak to the first letter writer. Because I'll be your I'll give you my little credential. I'll give you my little letters, and I'll put my name on it. As long as I can at least if I have concerns or questions, I can talk to your provider who wrote the first letter and, like, get my questions answered.
• 58:50
  Right? And so that's often what I do. For a second letter, I'll say, let me talk to your doctor if I need to. I'm not gonna do that if I don't have to. Let's meet once as long as I don't have any major concerns, you know, we're good.
• 59:04
  So I try to expedite the process that way for folks who are on the second letter writer because we need a PhD. Yeah. Now you have your hand up, I think.
• 59:13
  Speaker 4: Yeah. And I wanna say thank you for for raising this consciousness because it's, like, such preciously important information for dissociative trans people who aren't trying to transition. And I really feel shame that I'm unable to help raise this consciousness because the stakes are still too high for me to open my mouth. Right? Like, I just mentioned that I'm about to file suit.
• 59:38
  So even after this surgery, I still won't be going to public about all these experiences for some time. Who knows knows how long that will last? Sure. And I just want to kind of make explicit how huge the costs are. Like, what we're essentially talking about like, when I talk about just lying, lying, lying, lying, lying, lying, you know, that's that's a splitting experience.
• 1:00:04
  There's parts of my system who can lie comfortably and other parts who have to go and hide because they can't be around that and other parts who are, literally accusing us of being the perpetrator now because we're doing that behavior. It's impossible to heal in that relationship where that's happening. Yeah. And making that explicit is can be like the difference between life and death
• 1:00:32
  Speaker 5: for we had
• 1:00:35
  Speaker 4: you know, we went into crisis for the for the first time since we got into recovery when we lost that that other therapist who we finally decided to be. Well, we had been working our way up to being honest with her for for a couple of years at that point. And then what what really did it for her was when we told her we wanted face based therapy for dissociative identity disorder. And if she didn't wanna diagnose us with that, that was fine. We wanted face based therapy for whatever she wanted to diagnose us with.
• 1:01:04
  Speaker 3: Uh-huh.
• 1:01:05
  Speaker 4: And that was what did it for her. She could not hold the, being the letter writer, which is, like, her job, you know, she built this, like, amazing practice to be a door opener for trans people. She could not hold that role and also the role that we had learned to want from her. Over several years of what felt like really good, positive, productive therapeutic relationship. We were ready to attach and do the journey, and it was that that cost us the relationship.
• 1:01:39
  And I still have to, like, remind myself that that really is the way it works because so many of the grown up parts just don't care about attachment stuff. But when we're in healing for a dissociative disorder, it's about attachment. And when we're looking for letters to access surgery, it's about manipulatively getting the doors to be open. Like, these two things can't coexist. Right?
• 1:02:04
  Like, and and I think that as trans people with dissociative disorders, we have to know that. And we we're the only ones who can teach ourselves that, and no one's teaching us that. And it's just, ah. So again, you know, like, the rage is coming up, and I just wanna remind myself that this is the space where the good thing is happening.
• 1:02:26
  Speaker 3: Yeah. I mean, bringing these two things together, it's so easy for the rage to come up and and to be hard to hold. Right? Like, there's a lot here. There's a lot here.
• 1:02:40
  Yeah. Mara, I wanna see your comment. You said something about peer counseling. That's where peer counseling
• 1:02:46
  Speaker 5: I'd say that peer peer counseling can step in. Certainly, I think that can work for everyone. I think somewhere between, free for all with volunteer peer support and, very, very structured legal, ethical dynamics in the professional world, there's this place in between that that it seems to me, recovery coaching I work as a recovery coach right now because it seems to me that's where I can have conversations like the one I just heard, not not speaking to your experience because obviously, you and I don't know each other that well. Right. But, I do work with folks that are are trans and and, dissociative.
• 1:03:29
  And, it seems like I have permission. I have training. I have supervision. There are legal and ethical guidelines. Sure.
• 1:03:39
  And I support among, my, consulting group to be able to stand beside folks and identify as being one of us. And that is a distinct support that, I didn't I didn't know was even, like, it's an additional way that we can provide a safety net together. Mhmm. And and I know that it is possible that system speak will become a community where we can have that kind of training and that kind of support with one another so that we can create those one to one relationships. Because in some ways, we are we are the people who can, walk beside one another and, maybe sidestep some of the pitfalls of this the institutional harm.
• 1:04:43
  I'm very idealistic. I realize that. I wanna believe that we can we can create supports that don't currently exist by coming together and helping each other live through this stuff that is so dangerous. Absolutely.
• 1:05:01
  Speaker 3: Yeah. I'm looking forward to maybe engaging more with the system speak community. And I think you're right, Mar. Like, there's, I mean, you're talking about you're you're talking about grassroots organizing to to use, you know, more of a political kind of terminology there. Right?
• 1:05:18
  Like, people coming together who have a common need and a common goal and figuring out what works for them and doing that to I think that is absolutely, has been the the the origin of so much positive social change, and that can absolutely happen in a health care system. May hopefully one of hopefully one is messed up as alongside it for a long time. Right? Yeah.
• 1:05:45
  Speaker 2: That is absolutely something we'll be doing now that we've got our five zero one c three, and we're we are moving that direction to be able to have some people paid and certified to be compensated for their time and efforts in the community. And in addition to holding space for and understanding trans folks and our friends that we care so much about. And I am so glad and so impressed that you all were so brave to say, hey. Can we have a specific conversation about this thing? And so grateful for Lou being here today.
• 1:06:22
  Thank you.
• 1:06:23
  Speaker 3: Thank you, Emma. I'm so glad of all of you. Like, when I said, like, I'm absolutely flattered and and surprised and very welcome welcome the idea very much, and I'm even more glad that I said yes now that we've had this conversation. And and to your point about, even if you think this conversation might not apply to you, you know, from a from a clinical perspective, I would also say just because you're a provider who doesn't think that you work with trans people doesn't mean that you don't have a a budding trans person on your caseload that you don't know about. And what are you gonna do if you are five years in to a treatment with someone and they're starting to suddenly question gender?
• 1:07:09
  Right? Do you refer them out because you don't do trans work? It's kind of the same idea as DID. Like, it takes time and safety in order for some of these issues to come into the work, to even be brought up into the work or be brought into consciousness. And so, like, your therapist who said, okay, we're gonna talk about this now.
• 1:07:31
  That's so awesome. Like, we need therapists who are willing to say to the clients they've had for a number of years, you know, do we need to have questions and con talk about dissociation? Do we need to have questions and talk about transness? All providers need to be competent is what I'm trying to say. All providers need to be getting an education around dissociative disorders and around transness so that we don't get, you know, a decade into treatment and then like, oh, well, I can't help you with that.
• 1:08:03
  It's just it's so, often retraumatizing. Thank you so much, Lou. I appreciate everyone being here today. Thanks, everybody.
• 1:08:19
  Speaker 2: Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemspeed.com. We'll see you there.