The Transgender Journey

What Role should therapists play?

Jean Malpas

By Jean Malpas

I’m a white Belgian American gay man. I was a gender-expansive child, and I now identify as a cisgender adult. My pronouns are he, him, and his. I’m an ally.

On a sunny Sunday in June 2015, I’m walking in New York City’s Pride March on Fifth Avenue, a rainbow tutu adorning my jeans shorts. I’m also wearing a bright purple T-shirt that reads “Pride Is For Kids, Too.” It’s the slogan for the Ackerman Institute’s Gender & Family Project, a program I founded in 2010 to support families of gender-expansive children and families of transgender youth. The sidewalks are filled with cheering crowds---and right in front of us, a rainbow flag waves fiercely from the Flatiron Building.

Maria, the mother of Lila, a 12-year-old transgender girl, has been marching next to me in front of our float. As we wait to cross a street, she falls into my arms, tears streaming down her face. “I’m crying from joy,” she says. “I can’t believe I’m walking in the middle of New York City with my husband and my child, and everyone along the way is clapping for her. She’s happy and proud of who she is. And I’m not ashamed. I’m happy, too.”

I’m Lila

As I embraced Maria, I thought back to the remarkable journey she and her family had made since the more somber day, five years earlier, when I’d met them for our first session. Peruvian-born Maria was a teacher in the Bronx, while her husband, Ray, was a white computer programmer from the Midwest. They’d consulted me because their 7-year-old child, assigned male at birth and until then known as Leo, had long behaved and expressed himself in a traditionally feminine fashion, gravitating toward colors and activities usually associated with girls. She became obsessed with princesses when she discovered Disney characters in pre-K and openly preferred her girl-identified classmates in kindergarten. In many other ways, Lila was a typical child who loved physical activity and never missed a chance to romp in the backyard with cousins of both genders.

Both Maria and Ray were from conservative family backgrounds, but they were trying to make peace with the idea that Leo was probably going to be gay and enjoy a range of feminine and masculine things. But Lila had a whole other experience of herself, one that went beyond the question of gender stereotypes and expression. She wasn’t a feminine boy or a gay preteen. Her dilemma had to do with her deeply-felt gender identity. She felt like a girl trapped inside a boy’s body. Every night, she prayed for God to take Leo away and send Lila back to earth instead. A couple of years later, her parents found the diary she’d started in second grade. Page after page, Leo called himself “she” and “Lila.” “How can I ever tell them who I really am?” she wrote. “What if they stop loving me? What if God doesn’t want me in heaven?” Interwoven in these agonizing questions were thoughts of suicide, and the fear of losing their child was the catalyst to reach out for help.

The possibility of having a gay child was already outside their comfort zone, but having to accept a transgender child was beyond their wildest imaginings. Like them, many parents of transgender kids experience the news as if hearing their child has a disability. After all, parental hopes and dreams are commonly tied up with their child’s gender and gender identity. So it makes a big difference to most parents whether their child is a boy or girl, simply because they express their love and envision future prospects for that child in the largely gendered terms society lays out for them. Rearranging that internal mind map requires tremendous effort and adjustment.

I started my sessions with Leo by asking him how I could help and what name and pronoun he’d like me to use. He was quick to tell me that Lila, she, and her were what she wanted. I then asked things like what she knew about herself and when she started feeling that who she was inside didn’t quite match who she was expected to be. When I gave her crayons and paper, she drew herself as a beautiful girl in the past, present, and future, most often wearing purple and with very long hair. I could see that it was an enormous relief to find a space outside of her diary that reflected her sense of self.

Gender Diversity

In my initial sessions with Lila’s parents, Maria cried as if she were literally mourning the loss of her child, while Ray seemed shut down and puzzled. Adequately supporting Maria and Ray was challenging. I had to be careful to stay right where they were in terms of how affirmative they could be while I expressed compassion and understanding. Now and then, when I sensed an opening, I cited psychoeducational facts that would help them put their experience in perspective. Indeed, they had a lot to discover about gender. “Gender identity is about who we each are, deep inside, as a boy, a girl, man or woman, both or neither,” I explained. “But it’s different from our biological sex and whether we’ve been assigned male or female at birth. It’s also different from whom we love and choose to have sex with as adults.”

In between sessions, they worked hard to educate themselves on the issue and kept arriving with new questions. Gradually, they began to make sense of Lila by understanding the fundamental differences between the body she was born in (biological sex), who she felt she was on the inside (gender identity), what she showed the world (gender expression), and whom she’d one day love and desire (sexual orientation). They even learned to give themselves a new name, cisgender, which applies to those whose biological sex is aligned with their gender identity. The prefix cis means “on this side” and can be thought of as referring to being aligned with something. When there’s a discrepancy among our biological sex, our culturally assigned gender role, and our gender identity, we can call ourselves transgender.

The Path to Acceptance

For Maria and Ray, joining the Gender & Family Project’s parent support group---and acquiring a community of peers, caregivers, and family members who shared the experience of parenting a transgender child---was transformative. It normalized their situation, widened their resources, and allowed them to get to know other parents who were also struggling with a sense of loss, fear, and helplessness. While Leo connected with other kids in the program and was affirmed as Lila in the playgroup, her parents could cry, laugh, and find relief with other loving parents who were trying to figure out their next steps.

Over time, Maria and Ray began to see that the world is made of unique individuals who are all over the gender spectrum. They became avid readers of the topic of transgender kids and were soon more up to date than me on the visibility of the transgender community.

Maria and Ray once believed that being protective meant refuting Lila’s deep feelings about her gender, but they now realized that it was the other way around. Accepting Lila was the best way to protect her. With that new sense of purpose and agency, bolstered by a community of parents who were cisgender allies, they felt ready to take on the big challenges ahead.

Many parents confront new definitions of gender as pioneers, some never having heard the word transgender or cisgender before, all of them hacking their way through a wilderness of confusion, panic, and shame. As we work together, they slowly begin to understand—and act on—what we’ve found to be three essential elements of healing. First, follow your child’s lead. If your daughter says, “I’m a boy” persistently, you’ve heard the truth. For many parents, understanding this comes as an enormous relief. The endless inner questions---What should I do? Try to change him? Hope she’ll grow out of it? Refuse to talk about it at all?---fall away. The work is acceptance.

Second, there’s no pathology here. Your child isn’t disordered, doesn’t have a disability, doesn’t need treatment for being transgender. However, your child may need therapeutic support for anxiety, depression, or other difficulties that come with the challenges of trying to live outside prescribed pink and blue boxes. As a parent, you may need professional support, too. But there’s no underlying condition to treat. Fundamentally, your child is fine. So are you.

Third, we need each other. Gender-diverse kids and their parents need to belong to a community of folks who truly get who we are, share some of our struggles, and genuinely care for us. By now, “community” as a cultural prescription has become so familiar that it’s in danger of losing its meaning. We need to wake up and hear it freshly. Especially for those who are wrongly made to feel deviant and repugnant for who they are, a validating peer group is more than just a helpful accompaniment to therapy: it’s a first-line, essential element of healing.


This blog is excerpted from "The Transgender Journey" by Jean Malpas. The full version is available in the March/April 2016 issue, The Mystery of Gender: Are Therapists in the Dark?

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Photo © Robin Rayne Nelson/Zuma Press/Corbis


Topic: Sex & Sexuality

Tags: being gay | children/adolescents | gay clients | gender | gender issues | gender roles | parenthood | Parenting | raising kids | Sex & Sexuality | suicide | traditional parenting

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