Accepting our gender in a world of prejudice can often feel like a butterfly trying to dodge a rain storm. This is where Acceptance and Commitment Therapy (ACT) can make a real difference. By asking us to accept our complete emotional experience without avoidance, ACT is ideal for affirming gender identity, working through internalized transphobia, and holding true to one’s values.

But how does ACT work?

ACT is built on Relational Frame Theory (RLT) which states that everything we know is framed in relation to everything else. This allows us to make inferences without ever having to be told. Just as front infers back and up infers down, our thoughts link together in a web of hierarchical frames, comparative frames, oppositional frames, and even frames of causation, just to name a few. And while these mental associations are useful, they’re not always accurate.

Nesting one idea inside the other in a hierarchical frame, little kids will often believe that if someone has short hair then they’re a boy, and if they’re a boy then they have a penis. Of course, as they get older they find out that both boys and girls can have long hair or short hair, and because of the existence of transgender and even intersex people, some boys have a penis and some boys don’t. If a person is mentally flexible, they’re able to digest this new information and adapt their relational frames, accordingly. But if they’re mentally rigid they might get quite upset, adhering to black and white thinking and rule governed behavior. Boys can’t do this, boys have to do that. Girls can’t do this, girls have to do that. To be a man you have to be macho. To be a woman you have to be feminine.

Going beyond the socially constructed rules that apply to genders, people can hold onto all kinds of rigid and self limiting rules. Encounters with prejudice and transphobia can lead people to avoid their internal truth, barricading their authenticity behind “I can’t,” and “I shouldn’t,” and “if only I could…”

Using mindfulness exercises, ACT helps people accept their feelings, while helping them differentiate themselves from these rigid, self-limiting thoughts via a process called defusion. By being present with one’s authentic self, it becomes apparent how even distressing emotions act as signals for one’s values. Consider how we become upset when what’s most important to us is threatened or compromised. By identifying these values, and committing to a value congruent action plan, ACT can help navigate all kinds of gender related issues, from gender exploration, to personal disclosure, to the highs and lows of gender euphoria and gender dysphoria, to even falling in love and starting a family.

Take heart that the world is changing. The 2016 census performed by UCLA’s prestigious Williams Institute found that, in less than a decade, the number of transgender Americans had doubled from 0.3% to 0.6%. That’s approximately 1.4 million remarkable human beings. Of course, 700,000 transgender individuals didn’t suddenly materialize out of thin air. We were always here, but after decades of advocacy, social education, hard-won political battles, fallen friends, gained allies, and massive changes in the field of mental health, the chrysalis finally cracked.