Podcast Summary: Creating a Transgender Inclusive and Affirming Private Practice

Podcast: Private Practice Startup
Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Dr. Andre Caruso
Episode: 139
Date: June 8, 2019

Episode Overview

This episode focuses on how mental health professionals can foster a transgender-inclusive and affirming private practice. Host Katie Lemieux (flying solo without Kate Campbell this week) interviews Dr. Andre Caruso, a clinical psychologist with expertise in LGBTQ+ mental health. The conversation covers essential terminology, practical tips for inclusive paperwork and office spaces, understanding pronouns, and the importance of ongoing education.

Key Discussion Points & Insights

1. Why Focus on Transgender Inclusivity?

• Dr. Caruso highlights the need for affirming spaces: “It is still one of the last known populations that we can still be prejudiced, discriminated against openly.” (04:29)
• Transgender identities are not new or a “trend” — they’ve existed throughout history but are only now entering public consciousness in modern ways. (05:05)

2. Core Terminology & Definitions

Dr. Caruso provides foundational definitions for clinicians:

• Sex: “The part you were born with in between your legs when you came out at birth.” (06:53)
• Gender: “How you feel. You can be born with male sex at birth, but you can identify as a female.” (07:06)
• Gender Identity: “How you identify...any point on a spectrum.” (07:16)
• Gender Expression: “How you express yourself... doesn’t have to match what we traditionally think.” (07:49)
• Sexual Orientation: “Separate from your gender.” (08:11)
• Cisgender: “If you match your gender with your sex at birth, that’s considered cisgender.” (04:36)
• Transgender (adj): “An umbrella term, but also very specific to how you feel. It is an adjective, not a noun.” (09:03)
  • Important: Do not say “a transgender” or “transgendered.”
• Non-Conforming / Nonbinary / Gender Fluid / Genderqueer: Different expressions that do not fit neatly into binary gender boxes.
  • “There is no steadfast rule...It’s unique to the person.” (11:35)

3. Handling Mistakes and Showing Respect

• It’s common to worry about offending or making mistakes. The best course is always to ask respectfully, rather than assume.
  • Katie: “My biggest fear is offending people. I want to always make sure I’m speaking to them in the way that they want and showing compassion.” (12:07)
• Dr. Caruso: “The best practice is to ask...We should do this almost naturally with everyone.” (12:59)
• If you misuse a pronoun or make a mistake: apologize, correct yourself, and move on. Don’t dwell or over-explain.
  • “If you do make a mistake with a pronoun...apologize and move on.” (20:12)

4. Inclusive Paperwork and Administrative Practices

• Dr. Caruso recommends specific approaches:
  • For names: avoid “preferred” name; simply use “name.”
  • Provide blanks for “Name,” “Legal Name (if different),” “Gender Identity,” and “Pronouns.”
  • For EMRs: if you must use dropdowns, “make sure there’s at least a spot for ‘other’ at the very least” and lobby for more inclusive options. (13:50)

5. Understanding & Using Pronouns

• Pronouns: she/her/hers, he/him/his, they/them/theirs, and less commonly, ze/zir/zirs. (16:26)
  • “If you’re ever unsure, always go to the singular ‘they.’ It fits everyone.” (17:05)
• Increasing presence of “Mx” as a gender-neutral prefix (e.g., Mr., Ms., Mx.) in forms and licensing. (17:25)

6. Office Environment & Facilities

• Bathrooms: Make spaces as gender-neutral as possible; lobby for inclusive signage or policies if possible.
  • “If you’re renting space in a bigger office building...as long as people use the bathroom that fits their gender identity, they are more aware than we are.” (19:05)
• Discuss clients’ preferences and reservations in session for their comfort and safety. (19:40)

7. Being an Ally and Ongoing Education

• Be a conscious, active ally by not assuming, asking respectfully, and consistently educating yourself.
  • “Just understand it and respect that everyone is different...If you make the effort, that’s really appreciated.” (20:24)
• Language evolution: “Everything...is constantly changing, so just do your best to keep educating yourself.” (23:49)

8. Difference Between Gender and Sexuality

• “Your gender identity and your sexual orientation are two totally different things.” (25:02)
  • Explains how a transgender person's sexual orientation is defined just like anyone else's, depending on attraction rather than gender identity. (25:13)

Notable Quotes & Memorable Moments

• Dr. Caruso, on history and terminology:
  “We think of it [transgender identity] as a new thing, but it’s been around since the beginning of time.” (05:05)

• On paperwork:
  “We don’t say ‘preferred’ anymore...it puts that wrong connotation...It’s not preferred, it’s just their name.” (13:30)

• On pronouns:
  “The ‘they’ is the easiest one...We use it all the time.” (17:05)

• On making mistakes:
  “If you do make a mistake...apologize and move on. Everyone usually is open to mistakes and people learning.” (20:12)

• On inclusivity:
  “Everyone is equal and everyone is a person. If we break down those stereotypes...and just work together to change our language a little bit...we can help everyone become equal.” (27:21)

Practical Takeaways & Inclusive Actions

• Ask respectfully about name and pronouns; never assume. (12:59)
• Revise paperwork: Remove “preferred,” provide blanks for open answers, and distinguish “Legal Name (if different)” for records. (13:30)
• Use inclusive pronouns and language: Adopt singular “they” when unsure, and explore “Mx” as a gender-neutral prefix. (17:05, 17:25)
• Advocate for gender-neutral spaces where possible; discuss comfort with facilities directly with clients. (19:05)
• Emphasize curiosity, humility, and willingness to learn as an ally: If you don’t know, ask and keep up with evolving terminology. (20:24, 23:49)
• Understand the distinction between gender identity and sexual orientation; educate clients and yourself on this point. (25:02)

Recommended Resources

• Local: SunServe.org (Fort Lauderdale), YES Institute (Miami)
  • “They have a lot of links on their website also...always a place you can go...” (22:56)
• Global: WPATH, the World Professional Association for Transgender Health
  • “It’s the biggest organization...it is the one that’s leading the world.” (23:10)
• Other: Seek ongoing training, consultation, supervision. Refer out when not within your scope. (24:15)

Memorable Moments & Giveaways

• Unicorn as a symbol:
  Dr. Caruso’s practice logo is a unicorn, “because all people are unique...it also signifies hope and caring for everyone.” (26:05)
• Free consulting offer:
  “If you want...a little bit more info, or if you just want to talk a little bit more of the topic, I’d love to talk. Please just give me a shout.” (26:48)
  • Contact: Dr. Caruso’s practice – Psychological Health and Therapy Center, drcaruso@center.com

Timestamps for Key Segments

• Introduction & personal context: 00:27–04:14
• Core definitions & history: 04:14–08:45
• Clarifying terminology (transgender, nonbinary, etc.): 08:54–12:53
• Practical inclusivity (paperwork, pronouns): 12:53–17:25
• Office environment, bathrooms, allyship: 18:19–22:17
• Resources for therapists: 22:56–24:15
• Difference between gender and sexuality: 25:02–25:59
• Unicorn practice logo explanation: 26:05–26:38
• Dr. Caruso’s consulting offer: 26:48–27:13
• Final takeaways & sign-off: 27:20–30:22

Closing Thought

The journey to building a transgender-inclusive and affirming practice is ongoing and, above all, built on respect and willingness to learn. As Dr. Caruso put it:

“If we break down those stereotypes and thoughts that we have and just work together to change our language a little bit...we can help everyone become equal.” (27:21)