This third of a four-part series for practitioners and service providers, includes contributions from those with lived experience (survivors) and from interviews with mental health practitioners conducted for CBRC’s learning course, Mental Health, Conversion “Therapy” Practices in Canada.
2S/LGBTQIA+ people can experience systemic oppression, discrimination and trauma in multiple contexts including families where their existence is denied or condemned, schools where they are bullied or assaulted, faith communities where they are judged or excluded, doing basic activities like trying to use a restroom in a public place. All of these can contribute to, or amplify, the impact of conversion practices and change efforts.
One of the potential settings where conversion practices may happen is the healthcare system. Many trans and/or gender expansive individuals require affirming medical care to reduce the risk of negative mental health issues, including depression, anxiety, and suicidal ideation. Gender affirming care is life-saving care, and change efforts that have occurred in a medical context can be especially dangerous and amplify the harms of other forms of trauma or discrimination.
“One of the biggest issues I experienced was inaccessible and or prejudiced mental and medical healthcare... who refused to treat me or who treated me incorrectly.… I didn't even know that what I went through could be considered conversion therapy.” (Survivor)
While many survivors have symptoms that are typical for PTSD, these symptoms can be aggravated by conversion practices and change efforts that are rooted in religious paradigms. Adverse religious experiences can impact a survivors’ ability to derive meaning, comfort or resilience through spiritual frameworks. This amplifies their anxiety, the acuity of their symptoms, and the severity of their traumatic responses. While many can find deep healing through spiritual practices or religious communities, these are generally impaired or challenged for this community. Leaving one’s faith community is a common experience of survivors, often resulting in grief, anger, fear, and isolation.
“My church was my only known and trusted community—in which I was hiding. I felt all alone in the universe.” (a survivor)
“Yeah, it affected my religious beliefs, definitely… I can't be around very religious Muslim people for certain reasons. My partner is religious. He's a practising Muslim. But I mean, we always clash about this … It was too much for me … the thought of it just makes my body ache.” (a BIPOC survivor)
Care must be exercised when suggesting spiritual coping resources such as mindfulness, meditation or other interventions like encouraging attendance at an affirming religious community. Gently helping the individual expand their awareness of the many options that exist can empower the person to discern what will be most healing for them. Letting the person guide the intervention and proceeding slowly is recommended to reduce unintentional harm.
Like all traumas, the severity and intensity is often worsened by the start age of these experiences. The earlier that a person’s identity feels invalidated, the more impacted: thus gender change efforts can be especially traumatic, because of how early a child’s sense of self tends to develop. The ability to know oneself and trust oneself is related to the ability to set appropriate and healthy boundaries, predisposing them to additional traumatic experiences.
There are multiple therapeutic modalities that a service provider may want to consider, as part of the clinical approaches in which they have been trained or with which they tend to practice:
- Narrative therapy can help uncover shame-based or negative narratives and reframe them or redefine themselves.
- Trauma-informed somatic therapeutic practices can facilitate sensory integration and diminish the intensity of the traumatic responses.
- Memory reconsolidation work can assist the individual in identifying core beliefs to understand how they originated.
- Internal family systems or parts therapy is often helpful for integration of dissociative symptoms.
As with any therapeutic encounter, service providers are encouraged to offer 2S/LGBTQIA+ affirming care that is trauma informed and culturally sensitive, and to consider the following principles:
- Be aware of the power that you may represent.
- Recognize that therapy may not feel safe and may remind the person of the trauma experienced.
- Focus on creating safe spaces and invite the person to share what helps them feel safe.
- Meet them where they are and honor their presenting concerns.
- Don’t make assumptions about faith/spiritual identity and needs. Consult with someone with expertise in this area.
- Don’t assume that sexuality or gender is the issue that the person wants to address.
- Be guided by the person and encourage them to begin to recognize when they are reaching the limits of their comfort. Help them to set boundaries.
- Think about how you want to self-disclose, and what may or may not help facilitate the relationship.
- Consider the role of parallel process and how the individual's behavior in the clinical context may reflect external or previous dynamics.
- Support the person as they recognize or name something as a change effort or a conversion practice.
Recovery often requires understanding how one's needs were neglected as well as the ways in which one was prevented from being true to oneself. Many clinicians find that a narrative framework can be especially helpful to assist survivors in redefining for themselves who they are. Other therapeutic modalities can support individuals in healing from the trauma associated with the change efforts, which can facilitate the recovery from trauma and the recovery of self.
The therapeutic goal, with survivors, as with everyone, is to support them in identifying and validating their emotions and in strengthening their ability to relate to themselves with increased care, kindness and internal self-compassion.
Contributors:
Rahim Thawer, MSW, RSW, is a psychotherapist, clinical supervisor, facilitator and public speaker, sessional lecturer, writer, and community organizer. Nearly half of Rahim’s clinical practice has evolved into clinical supervision and consultation work.
Sly Sarkisova, MSW, is a queer and nonbinary trans-identified psychotherapist working in the field of mental health, addictions, and trauma therapy. He provides consultation, clinical supervision, and training around trauma informed, holistic, anti-oppressive practices in mental health.
Naj Siritsky, MSSW, BCC, RSW, D.Min., (he/they), is a Professional Practice and Advocacy Consultant at the Nova Scotia College of Social Workers. He is a social worker with doctoral training in spiritual counseling, a survivor of conversion practices, and the first transgender nonbinary Reform rabbi in Canada.
