Your Therapist Needs Therapy 97 - AAMFT’s Guidelines for Ethical Gender-Affirming Care

Jeremy drops in this week looking at the recent guidelines released by the American Association of Marriage and Family Therapist (AAMFT) for working with Trans, Non-Binary, and/or Gender Expansive (TNBGE) clients. It’s a really good set of guidelines that were released in a time of political strife, and it does a good job of not giving into the pressure that exists in this climate. Jeremy hits some highlights, and examines some of the recommendations for providers, and how that benefits clients and the profession as a whole. 

To access the document, follow this link for a pdf (it is free, but you do need to “checkout” with it still). Also, worth reading the AAMFT position statement on gender-affirming care, as that provides the wider context that these guidelines exist under. 

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Transcript

xcr-bvyw-uyp (2025-05-12 10:26 GMT-5) - Transcript

Attendees

Jeremy Schumacher

Transcript

Jeremy Schumacher: Hello and welcome to another episode of Your Therapist Needs licensed marriage and family therapist. I am ill. Probably hear it a bit in my congestion. Just a early summer colds, whatever it is.  I'm on the decongestance and doing a solo episode here trying to protect my voice before I have to do real therapy with people virtually so as not to spread any diseases. I have an episode today that has sort of been percolating.

Jeremy Schumacher: it is I don't want to say It's affirming news that while the world may be on fire, there are good people out here doing good work. And it is important to highlight that as much as I spend time highlighting the stupidity of this current authoritarian regime. so maybe some positive talking points.

Jeremy Schumacher: that I'm excited to jump into I want to cover briefly again trying to protect my voice. The American Association for Marriage and Family Therapists gender affirming care recommendations. they put out some guidelines for working with transgender, non-binary, and gender expansive clients. it's a really good document actually, which is why I wanted to highlight it. I am a clinical member of the AMFT again, American Association for Marriage EMother Therapists and I'm also a clinical member of the Wisconsin Association of Marriage Family therapists. as licensed professionals, we have all sorts of groups that we can be a part of. and it's nice when a group that you're a part of puts out something that is well done and that e is ethically aligned.

Jeremy Schumacher: again there's a certain level of screaming into the void that I think can happen on the internet and it's really grounding to have community and relationships with folks who are ethically aligned with you. So this document from AMFT comes out sort of in response to the attack on gender affirming care last October.  So, this would have been pre2024 election. they released a document that sort of solidified their stance on it. And this is just, I think, expounding on some of those talking points and, coming with the receipts really. again, it's a well done document. It's well cited. highlights a lot of current research. The other thing that it does really well that I'm happy about is it sort of takes the stance of nothing about us without us.

Jeremy Schumacher: And so one of the things that the current authoritarian regime is doing is it has non-experts in charge of things and it is not having marginalized communities have their own voice. It is having Trump sign an executive order that's written by the Heritage Foundation or worse yet Steven Miller or it is having RFK stand in front of a podium and make up statistics. Pam Bondi or whomever it might be, whatever white person is in the administration And what we know from fighting for civil rights is we want to center the voices of people who are affected by this thing. So nothing about us without us.

Jeremy Schumacher: was sort of a rallying cry in the 90s around fighting for advocating for disability rights which again growing up in the 90s there were wheelchair accessible things places but that was a recent change not that long ago and some of what the current administration is trying to dismantle is that right the attack on DEI they dropped the A but that's always been included which is accessibility the original acronym was idea, inclusivity, diversity, equity, and accessibility. and so again, you look at Nazi Germany, u one of the first things they did was go after gender non-conforming folks, then they went after folks with disabilities. deeply alarming stuff, but again, really good document from the AMFT saying, "We're going to keep fighting and advocating.

Jeremy Schumacher: We're going to keep using science and evidence-based practices as our backbone for this. We're not interested in being pulled into the political sphere. This is all settled science. We're not interested in rehashing so the AMFT partnered with the Queer and Trans Advocacy Network which is also a professional group that that's just part of through, spending some of my membership money paying additional membership money so that they can go and do things like lobbying because it's needed.

00:05:00

Jeremy Schumacher: So, lots of queer and trans folks, non-binary, gender expansive folks were involved in the writing of this. Majority of the people who wrote this document would fall under that heading. So, I'm just going to start by highlighting that because I think that's really good and important. And again, I'm summarizing what is a 60some page document that they're admitting upfront that hey, this is too short.

Jeremy Schumacher: we cannot summarize all of the decades worth of work that has gone into researching these topics in these short pages, but allow us to try and then I'm coming in and saying, "Hey, I'm going to summarize even more for the sake of a podcast." But I will also link to the document. It is free and accessible to folks. I do think you have to go in and check out on the AMFD website. I guess that's so they can track how many people are downloading it. yeah so let's jump in. the main takeaway is that gender affirming care is ethical care. therapists are ethically bound to provide gender affirming care. This is not special treatment. It's about respecting human dignity and autonomy. AMFT makes it very clear affirming someone's gender identity is not an option.

Jeremy Schumacher: it is the baseline for competent practice.  And I think this is really important because if you sort of look at the political talking points and this concept of the Overton window which is how political conversation can get shifted left or right we have lurched far right in our conversations where Roie way being overturned is a really good example this was supposedly as perjury proof apparently of Supreme Court justices being certified. They said this was settled law again going back to the 1970s and yet here we are on doing that. So the Overton window has definitely shifted right. I like that this document takes a hard stance and says we are not interested in debating this. This is settled baseline for competent care.

Jeremy Schumacher: Anyone who is practicing under our banner is ethically bound to practice in this manner. Which is to say it is baseline competent care to provide Affirming your client's gender is not optional. The next thing that it gets into is gender identity is not a disorder. the guidelines laid out in this document reject pathizing trans and gender diverse people. Being trans is not a mental illness. the distress that is talked about with something in gender dysphoria the distress comes from social oppression not from a person's gender identity itself. When we are talking about working with somebody with gender affirming care, we're working through the social construction of gender norms.

Jeremy Schumacher: We're working through the bureaucracy and loopholes that marginalized communities have to go through to get care that would help their perceived external gender match with their internal gender. I don't love my language there. but what they're showing is going to match with what they feel and that's allowable, and that we can support them in that process. We're not trying to treat that they're trans.  We're not trying to say that being trans is something that needs to be treated. We're saying this is a difficult thing that you're going through, whether you're transitioning or not. Just having a non-conforming gender, an expansive gender, being non-binary, is something that is difficult given the social norms surrounding it and the oppression that comes from social structures. all of this is based on decades of research.

Jeremy Schumacher: These are not new best practices. These are things that that AMFT is publishing again saying, "Hey, this has been our standard for a long time and will continue to be our standard despite what political pressures might exist, despite what cronies might trot out and try and apply pressure. Again, licensed marriage family therapists should be practicing this way.  This is the ethical standard of our profession based on decades of research. Not whatever came out of the UK that a Dantis administration member did. Not whatever is going to come out of the Trump administration as they dismantle well done research and decades worth of research to drum up political talking points.

00:10:00

Jeremy Schumacher: Trump himself has said in interviews that he likes to trot out the quote unquote, the trans issue. whenever there's an election, he's not interested in doing much policy-wise, he is interested in just using it as a talking point.  Although the military ban was just upheld by the Supreme Court, for now it is working its way through appeals, banning trans members from military care based on the idea that simply being trans means that they cannot be honorable in the way that the military requires, whatever that means. Again, it's just bigotry suggesting that being trans itself is some sort of problem that cannot be overcome. Again, gender identity is not a disorder.

Jeremy Schumacher: decades worth of evidence backing that up. AMFT goes on to say that therapists must set aside personal, cultural or religious bias to provide care that supports being as to find by what the clients are doing, right? So, this is on page 12 here.  Ethical practice with non-binary, gender expansive clients requires MFTs to evaluate MFTs as marriage family therapists to evaluate their own competence, bias, and willingness to practice in an affirming manner. our role as a provider is not to determine if clients are trans enough, but rather to explore the transition process with them and ensure that they can make informed decisions.

Jeremy Schumacher: Unlike cisgender's methods that weaponize questions to revert individuals to cisgender identities, affirming practices encourage inquiries aimed at informing the client and accepting their conclusions. this is all really good stuff, this stuff that I am ethically aligned with. This is stuff that when you're practicing from this lens, it's really great to have again an overarching governing ethics body come out and say this stuff and put it in paper. clinicians must stay informed about non-barian, non-binary, and gender expansive individuals unique challenges and proactively advocate for their rights and This awareness must translate into deliberate actions that challenge and dismantle systems of oppression. Again, this is not a stand on the sidelines. This is not something that we can hem and haw about.

Jeremy Schumacher: This is something that ethically practicing therapists must again set aside personal, cultural or religious bias to provide care that supports clients with just going to go ahead and call out all Christian therapists. Then I'm oversimplifying but based on my experience when I was practicing Christian counselors are not abiding by ethical standards. They are saying that their Lord matters more than their ethical standards.  If you encounter something like this, you can make a complaint to whatever licensing board they're practicing under because that is not ethical practice. And again, this is something this is where accountability matters. this is what religious leaders have been fighting against. this I believe is in California right now or no Washington state. they just passed a law saying that religious leaders including Catholic priests are mandated reporters.

Jeremy Schumacher: The Catholic Church then promptly responded by saying if Catholic priests break confidentiality, quote unquote confidentiality of confession, they will be excommunicated. So basically saying, "We're going to need you to go ahead and ignore that law and keep protecting predators instead of protecting victims because that's been the church's stance for millennia. how fun.  But again, if you are somebody who has been discriminated against because of your gender identity, because of a therapist's perceived religious bias, then we can go ahead and report that person and you can talk to a better therapist about how that process works and they'll help you.

Jeremy Schumacher: the guidelines that AMC posted emphasize how race, disability, class, and other identities intersect with gender, especially how systems harm trans people. Again, a basic sort of understanding of intersectionality is important here. It's not the breadth of the podcast I'm hoping to get into. basically that trans people aren't required to educate you on these topics. You need to be educated on these topics. These are not hard concepts.  The idea that socioeconomic status, race, class, ability status, gender, sex, all these things intersect and there's an interplay between those things. I have a lot of privilege because I am white and I am male. I didn't have privilege based on my socioeconomic status because I grew up very poor. So, that looks different than someone else.

00:15:00

Jeremy Schumacher: you could look at and say, Jeremy, don't you go to private school?" I did go to private school. I went to s***** religious schools that were expensive and the only way that I could go to those were because my parents were teachers there. And so, I did go to private school and I'm privileged in the education I got. And the way I was socialized was I was marginalized because I was the poor kid at all of my schools. so again being able as a therapist to hold I use my own example there to highlight there's complexity in these things and that's for a cisgendered white dude. the complexity increases exponentially for marginalized communities who have more than one marginalized status.

Jeremy Schumacher: whether that's again race, gender, sex, religion, disability, class, all these things are intersections and trans people, gender non-conforming, gender expansive, non-binary folks are some of the most marginalized across those different intersections. especially when we start talking about race and some thinking looking at something like trans men and the specific and unique intersectionalities that they're going to be dealing with. yeah, it's a whole thing. And so again, it's not our client's job and it's not our client's responsibility to educate us on that. It's our responsibility as providers to be educated on these topics so that we can hold space for clients in a way that they need. Gender affirming care.

Jeremy Schumacher: again going back to the guidelines laid out here, gender affirming care has to be anti-racist, anti-abbleist, and trauma informed to be legitimate. again, and why am I saying this? Again, if you're one of a therapist who listens to the podcast regularly, you've heard a lot of these talking points. I've had people on to talk about these things specifically. if you know me personally you're here with me but also there are therapists out there who are still trying to debate I don't know maybe therapists should be politically neutral no therapists are politically active trying to be neutral is taking a stance which is saying I am not going to use my privilege to advocate for marginalized communities therapy is political it is decidedly

Jeremy Schumacher: affected by the political sphere in which we are operating and how clients can work with us is affected by politics. Therefore, therapy is political. People who are on the sidelines are taking a stance which is saying they are not being aware of these systems of oppression and they are not interested in fighting against them. That's  The AMFT calls out therapists who are doing that, which is Too many family therapists still lack the training or courage to support gender diverse clients. Neutrality is a copout. When one side is being dehumanized, therapists must actively resist neutrality is a copout. I have no time or tolerance for that.

Jeremy Schumacher: I'm glad that the professional group that I'm a part of is calling that out. I see that too often online from therapists who have big followings online, from therapists who are doing a lot of things. It is a problem. and then there's a lot of u best practices laid out.  So again, the document spends most of its time sort of looking at different intersections of identity that clients could show up with. whether that is sorry, I'm scrolling up back to where is it? it talks about religious.

Jeremy Schumacher: talks about monogamous versus non- monogamous, couples and relationships, family dynamics, sex and intimacy, neuro complexity, rural health care, cis therapists working with trans and non-binary and gender expansive clients, younger adults, children, teens and their families. it just looks at a lot of different of these sort of developmental stages that clients could be showing up in.  Then also different considerations that providers should be taking into the care. Again, the document is not designed to be expansive in what it is covering. It is sort of laying out it is the best practice to be informed on these things. And so if this is a topic that you are ill informed on or underinformed on, you should not be practicing with those clients.

00:20:00

Jeremy Schumacher: some that I want to highlight just real quick is un name and pronoun use is not optional or a courtesy. It is foundational of ethical practice. We are not gatekeepers of gender affirming medical care. Our job as therapists not to police someone's identity. again this is swimming upstream for how the system is designed.  Again, people who are looking for medical transition, have a lot of hoops to jump through. One of them is generally six months of therapy that can vary from state to state. and this document is again saying it is not our job to police that. It is our job to support clients as they're going through that process. Informed consent, autonomy, and collaboration are key themes throughout this document, which is all thumbs up.

Jeremy Schumacher: making sure our clients are well informed on the process, supporting our clients autonomy and making their own decisions in this process and collaborating with our clients. We are not coming in as expert on our clients identities. We are coming in as people who are trained in how to navigate the process and support our clients through that process. not again top- down expert and non-expert but rather collaborative in people walking that path together in a supportive nature. So it's really lovely. Again I like how the document takes a strong stance calling out the both sides of rhetoric.

Jeremy Schumacher: this is the paradox of intolerance that to be a tolerant society we cannot tolerate intolerance. When eraser is the goal when taking away the rights and stripping rights away from marginalized communities is what is happening. When there is dehumanization going on, You need to use that privilege. therapists are privileged, we have our little office spaces.  We are from societal's view the expert. People come to us for professional help. so yeah if you're not using that privilege to dismantle oppressive systems you are supporting those oppressive systems. and then the document highlights how advocacy is important that therapists not only need to be informed but taking direct action.

Jeremy Schumacher: guidelines are a form of resistance and professional backbone in a dangerous moment. It gives therapists a thing to fall back on and highlight as they continue to provide ethical care for their clients. And I think that's what needs to happen. non-binary, and gender expansive folks are the targets of discrimination, eraser, bigotry, and violence. to a very high degree. They hate crimes under Donald Trump are up again because of course we can change that but not immediately. And we need to offer people support and care as they're having to deal with that in their day-to-day lives. trans non-binary and gender expansive folks need therapists to go where they can't.

Jeremy Schumacher: They need people who have the privilege, who are not coming from that marginalized community to stand up and use their voices to advocate for them in this political moment, in this idea, this time where science and evidence based practices are under attack, in which our system of care, our vehicles for delivering care are being dismantled. this document and documents like these from other groups are very important to align therapists and to give us that sort of documented backbone to the way that we're going to practice from an ethical perspective. and your the podcast is designed to sort of be highlighting how therapists take care of their mental health. this document is part of that, right?

Jeremy Schumacher: this is an uplifting document for providers to fall back on and say, "Hey, this group that is in Washington at the state level doing advocacy lobbying for good mental health regulations, lobbying for supporting providers, supporting clients even when that we are swimming upstream against an authoritarian regime.  These are things that like, we don't all need to be in state courouses lobbying, we can't be often. and so choosing to support organizations that are doing these things, our professional memberships, our dues that we pay, go to support things like advocacy, go to support things like fighting s** legislation legislation. So, is an uplifting document for me as a provider.

00:25:00

Jeremy Schumacher: It's an uplifting document for other providers, I think, who are ethically aligned with this. It's nice to have it laid out in such stark terms that these things are non-negotiable. These are a baseline and therapists need to then continue to do their own work to grow in these areas and stay informed in these areas or they shouldn't be treating these clients because they could do harm. and clients needing support and expecting clients again to educate their therapists or expecting clients to jump through a bunch of hoops to find a therapist who can support them the way they need to be supported is already an injustice. Putting more work on the marginalized community just so they can get baseline competent care is not what we want. We need therapists to do better and documents like this are good starting point.

Jeremy Schumacher: It's really nice again as somebody who works in this realm and works with clients who are from this marginalized community to have a document like this come out. It's just like for me it's nothing that's new but it's very confirming affirming it's normalizing that this is good. There are people who are doing the fighting. There are people who are aligned.  This is what people know based on decades of evidence. whatever right-wing crazy authoritarian nonsense is going on, it's designed to be crazymaking, isn't going to undo decades worth of research and evidence-based practice. So, yeah. I will link to where to get the document. I think it's worth if you're a therapist, certainly.

Jeremy Schumacher: And if you're not a therapist, I mean it's got some lovely takeaways. again, really well sourced really well written document. So I think if you want to sort of know where therapist stand, if you're in that journey of finding a good therapist, this is a good document to sort of have and see that therapists are aligned with it. I've always been biased towards MFTts. that's my lensure.  I feel strongly that having that systemic lens is really important not just for doing couples therapy but obviously for doing couples therapy but very much for understanding things like systemic injustice and systemic oppression. having that background of a systemic lens and understanding how systems interact with each other is really important for doing this work. So if you're a therapist please check out this document.

Jeremy Schumacher: if you're not a therapist. also worth checking out, but good to know that there are people out there who are advocating for this and doing this work. If you happen to be just a wealthy patron and want to support me and my work, that's cool. Or supporting these groups. Again, one of the things with activism is we do not need to rebuild it from the ground up. We do not need to reinvent the wheel. There are people who are doing the work.  and if you don't have the time or the knowledge to be a lobbyist or an activist to support people who are already doing the work. So, as always all, thanks for tuning take of take care of somebody else. We'll be back next week with another new episode. Peace.

Meeting ended after 00:28:48 👋

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