Gender Affirmative ACT

Accepting our gender in a world of prejudice and transphobia often feels like a butterfly trying to glide through a rain storm. Having come so far and transformed so much, navigating life’s maelstrom feels overwhelming. Despair is common, and loneliness doubly so. Outrage is understandable, and the torrential shame is blown on gusts of fear and bias. 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. The youth of America are finding more liberty to express themselves, while those who have spent their lives hidden are beginning to emerge with both community support and even community celebration.

With such a diverse array of people, many therapists strive to be trans-positive by increasing their awareness of gender based psychosocial issues, yet literature providing an actual therapeutic modality is scarce, meaning that even when therapists know what’s wrong, they don’t always know how to help. In recent years, the popularity of Acceptance and Commitment Therapy (ACT) has steadily been on the rise, due in part to its wide applicability and Zen-like mindfulness. ACT is unique in its focus as it encourages us to accept our complete emotional experience without the pitfalls of avoidance, which makes ACT ideal for building emotional resilience, and affirming our self-defined gender identities.

Steven Hayes, the founder of ACT and celebrated author of Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy (2005), presents six ACT precepts easily adapted to gender affirmative therapy:

Acceptance: Relinquishing avoidance strategies to accept our emotions allows gender variant individuals to come to terms with the full experience of who we are. This is a vital step as many of us endure closeted or compartmentalized periods of our life as a maladaptive survival mechanism. Furthermore, attempts to ignore or power-through both macro and micro aggressions can have a detrimental effect on both physical and mental health.

Cognitive Defusion: Understanding cognitive-emotional fusion (being at the mercy of our thoughts and feelings) and cognitive-emotional defusion (being able to take a step back to allow for calm objectivity) allows us to move from emotional reactivity to living a proactive, self-actualized life. Shifting our relationship with our thoughts to observe cognitions and emotions without judgement is a key step when coming to terms with both who we are and how we feel.

Being Present: Implementing mindfulness in the here and now helps to cultivate direct contact with our senses and our environment. In doing so, past trauma and intrusive thoughts are able to enter the mind and dissipate via meditative practice.  

Self As Context: Utilizing perspective taking and metaphors, ACT develops an understanding of how language forms our locus of perspective (here vs. there, now vs. then, I vs. you). By increasing our mental flexibility, and recognizing how we naturally develop a multi-faceted identity—inclusive but not limited to our gender—we are able to develop emotional and psychosocial adaptability.

Values: Developing awareness around our values in order to make healthy, pro-active life choices helps us nurture our self-knowledge and personal pride in order to combat internalized homophobia and transphobia. While validating gender identity is integral, validating our core value construct is both clarifying and empowering.

Committed Action: Making active steps to embody our value constructs in order to maintain a healthy identity has always been the most difficult and ultimately most rewarding step of the coming-out and self-affirmation process. This stage of ACT is most akin to other behavioral modalities, as it requires measurable, concrete steps to shifting behavior.     

How we cope with the hardships of the outside world is, was, and will always be the source of both our pain and our victory, our despair and our passion. Indeed, with the client on the couch, it becomes clear that both the storm and that courageous butterfly exist together within them, with every original hope and internalized fear. Uniquely, ACT provides a route through this inner storm, useful to any practitioner striving to help gender variant clients come to terms with both identity and emotional acceptance.

To learn more, pick up a copy of ACT for Gender Identity: The Comprehensive Guide.