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Private Practice Startup Podcast
Episode 139: Creating a Transgender Inclusive and Affirming Private Practice
00:31:00
Andre Caruso
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- [00:03]
A
Welcome to the Private Practice Startup where we inspire you from startup to mastery. We chat with entrepreneurs, experts in the mental health and business arenas, and successful private practitioners to give you the tools needed to make your dream practice a reality. Visit theprivatepracticestartup.com for awesome resources, free trainings and so much more. Here are your hosts, Dr. Kate Campbell and Katie Lemieux.
- [00:28]
B
Hey Startup Nation, what is up? Welcome back to another episode of the Private Practice Startup podcast. I think we are episode like139 at this point. How crazy is that? We will be celebrating actually after this episode is released. We will have just hit our three year podcast mark. So if you've been with us from the beginning, I'm sure you have had some good laughs as we have evolved over time in regards to our podcast skills and the stuff that we talk about on our podcast. So I am actually flying solo today again. I know that you're probably thinking like oh my gosh, does Kate have strep throat three weeks in a row? No, it's because we actually time batch our podcast. So we do all of our podcasts for the month in one day. So it is just me again and you guys and Dr. Andre Caruso. So welcome Andre, how are you?
- [01:15]
C
Wonderful. How are you doing today?
- [01:17]
B
I am fantastic. Thanks so much for being here with us. We are going to be talking today about creating a transgender, inclusive and affirming practice. And selfishly, this is actually a podcast that I wanted to do knowing that if I wasn't exactly clear on this information, probably a lot of you also needed some help on this information. But before we dive into our topic, I want to talk about a really important podcast that we did last week with Noreen Van Der Hooven. We talked about five things to reduce suicide risk in Private practice. This is a topic that we all need to have better training on and really was really helpful for me. I even learned some really great stuff. So make sure you go ahead and check out that podcast that was on last week if you haven't heard that already or if you're binging on podcasts like Game of Thrones or something else. Definitely want to check out that one as well. And if you are brand new to us, we wanted to say welcome to the Startup Nation family. We have a gift for you. That is our free customizable attorney Approved Private Practice HIPAA form. Head over to Private PracticeStartup.com find out where the resources tab, it's sitting up there on the right hand side and look for the free HIPAA download, Completely customizable. That is our gift to you. So let's jump into today's podcast with Andre, and I think before, like, I turn it over to you, Andre, one of the reasons that I really wanted to do this podcast with you, I've known you for a little bit now is I remember. And, you know, I guess there's, for me, like, there's that therapist, like, embarrassment or shame. Like, I think, like, we feel like we should know everything in our field, right? We should know everything about transgender or, like, we just talked about suicide. I know I should know how to do the perfect suicide assessment. And I remember Kate and I had cat love on a webinar several years ago, and at that time, we were not aware that Kat goes by the pronouns they, them, theirs. And I remember when we announced Kat on the webinar, we used she. And we had got an email after, and it was really, like, harsh, saying, like, you know, how dare we? And Kate goes by they, them there. And it was interesting because Kate cat goes by they, them there. Kate had said, oh, my God. Like, I thought, like, they were referencing that they had a new company, and it wasn't just, like, making sense. And I know with the shift in being transgender inclusive and different pronouns and things like that, like, sometimes for me personally, it's just been kind of hard on that, like, thinking that we've had in grammar, right? Like, the pronoun doesn't match up with the tenses or verbs and stuff like that. And it's had to be this, like, big shift. And, you know, I know if I'm having difficulty or have had difficulty, I've been in practice of it for a bit. You know, maybe others are having difficulty. So that's really why I wanted to be able to talk about this and really help clinicians that might not be as aware of this, of what to say, what to do, what not to do. And you're gonna kind of educate us a little bit, so I'm gonna turn it over to you.
- [04:14]
C
Awesome. Thank you. So My name is Dr. Andre Caruso. I'm licensed clinical psychologist. I am a cisgender male, and my pronouns are he, himself. So a little bit about that. There are 1.4 transgender population in our community in the US and millions more worldwide. And it is still one of the last known populations that we can still be prejudiced, discriminated against openly. We've done a good job in the country of ramping out a lot of the other things that we. We were prejudiced and discriminated against over time. But this is the last one that is still open and you can see it more and more in news coverage today and on tv and just some of the laws that are being passed that we would never think about doing that to anyone else, any other population. So it is very important. That's kind of how I got my interest in working with the population is. And the community to, you know, bring awareness and try to help out, raise just awareness that people can see the differences, that it isn't as scary. It's been around forever. We think of it as a new thing, but it's been around since the beginning of time. It was actually a lot more welcomed even back during the Greek times when sexuality and gender were a little bit more fluid to society. So that was a good intro to that. Cisgender, what I said in the beginning. That's a little term that's new for a lot of people. So cisgender is just how we normally think of gender. And I hate to use the word normal because there really is nothing that is normal, but it's every day. So if you match with your gender, with your sex at birth, that would be what's considered cisgender. And the reason we use that is to kind of help normalize that there is differences in gender for people. So that's something simple that you can add to your dialogue when you introduce yourself, when you're talking to masses, when you're doing some trainings. So simple things like that. And I also mentioned my pronouns, which I'll go over a little bit later, but those are just little tricks that you can throw into your introduction to make it a little more normalized for. For everyone.
- [06:36]
B
Awesome. So share with us some of the definitions a little bit, educate us a little bit in regards to, you know, working with, serving, or just really being all inclusive in regards to our practice, what do we need to be doing?
- [06:50]
C
So some basic terminology. So sex, when you hear sex, that is not gender. Sex is what you were the part you were born with in between your legs when you came out at birth. So that's how we identify sex. Then gender is how you feel. So you can be born with the sexual at birth, male, but you can identify as a female. So at least a gender identity. So gender identity is how you identify. You can identify as a male, you can identify as female, you can identify in between. There is no. I like to think of it as a spectrum. Genders on the spectrum. Sexuality is on the spectrum. Really, everything we do is on a spectrum. We Just kind of like to put things into binary. We do it with politics. We do it with colors. We do it with race. We like to put everything into a easy one or two box. And it's really. Nothing's really like that. So if you think of it more of as a spectrum, it's a little easier to kind of take in as that information. That also is gender expression. So gender expression and gender identity, while they can go hand in hand, they are still separate. So gender identity is kind of how you feel internally. Gender expression is how you express yourself. They do not need to match what we traditionally think of as our gender expression. So you can identify as a female and then still dress more masculine. There's no rules to how you express yourself. Again, that's just what we like to do, is put people in those kind of boxes that you have to fit what you look like, but all those are easily changeable for the person. So sexual orientation is also separate. I'll go into that a little bit later. I just want to make sure that you know that it is. Your sexual orientation doesn't have anything to do with your gender.
- [08:46]
B
I think people do kind of confuse that. Or it's like, well, if you like this person but you identify this way, does that make you and all that.
- [08:54]
C
I'll delve a little bit deeper into that. Not too. Too much, but a little bit deeper into that later. I just want to. I'll go through a little bit more definitions, just so we're on the same page. Transgender, that is, it's an umbrella term, but it's also very specific to how you feel. It is an adjective. It's not a noun. So we don't want to say someone is a transgender, or we don't want to say that they included many transgenders because that would be improper way to talk about it. We also don't want to add Ed to the end of it. No one is transgendered. They are transgender male. They're transgender female. They're a transgender community. So that's the easiest thing that gets confusing for a lot of people is trying to put it into the wrong part of speech and adjective.
- [09:39]
B
Yeah. I find as a therapist, I think just naturally, I kind of go about educating and correcting people just in my life on how to identify folks or what to say. I think that's really important. And I've definitely heard that a lot like, is it transgender? And it's like, no, when you hear.
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C
It, too, and it just sounds wrong. Right.
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B
It doesn't sound natural.
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C
That's how we want to think of it is we are. This is just a part of how they are part of people. Right? We all have. We're cisgender, we match. You know, we're not as cisgender, we're not cisgendered. So it's the same idea for across the board. And that's how it should be. Everything should be equal. There's also some differences. You hear some terminology that comes and goes. Like non conforming. That used to be what everything was called when you didn't match your sex, didn't match your gender. Non conforming is not used as much in that sense, but it still does apply to certain situations where you. Your gender identity and your gender expression don't match. You would kind of. That would be the term when you'd use non conforming. Not conforming is not the same exact as transgender. So don't adequate those two words all the time. Where a transgender could be an umbrella term, it is a little bit more specific. So it also doesn't mean that if you're transgender, you have a third gender. You tend to. Again, most times if someone identifies as a female, their gender expression matches their gender identity when they're transgender. Now, if you are non binary or gender fluid or genderqueer, those are all different terms that mean slightly different things. There is a little bit more fluidity is almost in the term. So if you're non binary, you don't really fit either gender. Don't want to say somewhere in the middle. That's usually how you kind of see it as expressed. But there is no steadfast rules to any of this also. So it makes it a little more challenging when you're training folks. But it is part of how it is. It gets to be a lot too. And I think that's what I see when I talk to people about this, that sometimes it's overwhelming because I don't understand. It changes the vocabulary changes. It is because it is unique to the person.
- [12:01]
B
Totally. And I definitely can relate to that. And I remember when gender fluid was introduced and someone said, oh, we'll check out this video. And it was like 10 different types. And it was like, I feel like I'm just getting a handle on everything as it is. And now what do we do with that? And I know for me as a person, as a human, my biggest fear is offending people. I want to always make sure that I'm speaking to them in the way that they want and showing compassion and empathy and things like that. As we either Come across people that we're working with who identify in these types of ways. Or maybe you're in a place where you want to build and grow a practice serving this population. What are some of the things as clinicians that we can be mindful of in regards to, you know, working with gender, transgender and all those different things? Andre.
- [12:53]
C
So the simplest thing to do and the best thing to do, best practice is to ask. So when you first meet someone and if you have any question, you probably have a good reason, just ask. And we should do this almost naturally with everyone. Right. On paperwork, which a little plug. I did buy the private practice startup paperwork when I got started because it saved a lot of time.
- [13:18]
B
You actually also helped us in regards to the gender question. So thank you. And we're always looking at ways to improve our paperwork. So you actually helped us.
- [13:25]
C
So that was one of the few things that I did have to change. I know we discussed about it. The best thing you can do is obviously you put name and then leave a blank. And hopefully that's when they're putting their name that they want to be called by. We don't say preferred anymore. Also that's something you see a lot of times where you see preferred name, preferred pronoun because it also does put that wrong connotation of it that it's like a choice, right. This is their name. So it's not preferred, it's just their name. So then underneath it, because it is medical, we have to have a legal name. So what I do is I write legal name and then if different in parentheses around it and again leave a space and then gender identity, I leave a blank. And then pronouns, I leave a blank. So anytime you can, the best thing to do is just leave a blank so that people can fill in their own natural responses. Some of the challenges, I know some of us use some EMRs that have drop down menus. So the best thing to do is you have to use a drop down menu, make sure that there's at least a spot for other at the very least. So he, she, then at least a male, female playing for other. If there is a. If you are using one that is not doing it, please write to them. Send them some emails that they can simple change on their part. Most of them have, but we're still running costs on that. Don't. Yeah, I was the simplest way.
- [14:47]
B
I find a lot of folks that do work with therapists are very collaborative. Right. In regards to what we need and really how to serve our clients best. But before we go on. Let's just take a quick break. For our sponsor, knowing you need legal, ethical and competent paperwork is overwhelming, time consuming and let's face it, expensive. We're clinicians, not lawyers. We put in 100 plus hours of work scouring through the laws and ethics and paid thousands of dollars in expensive attorney's fees so you don't have to save yourself time, money and headaches.
- [15:17]
A
We're Kate and Katie from the Private Practice Startup and we invite you to experience the quality of our paperwork with our HIPAA form, our gift to you. Go to privatepracticestartup.com head over to our Resources tab and download the free HIPAA form today. You can also shop our a la carte and paperwork options under the Paperwork tab. Enjoy. There are so many ways to keep your practice organized, but TherapyNotes is by far the best. They're easy to use, secure platform, lets you not only do billing, scheduling and progress notes, but also create a portal to share documents and request signatures. Plus they offer amazing unlimited phone support. So when you have a question, they're there so you can get help fast. Get started with TherapyNotes today, trusted by over 60,000 professionals. Go to therapynotes.com and enter promo code PPS as in Private Practice Startup and you'll get two months for free. Also, you can listen to episode 54 where we interviewed Brad Pliner and took an in depth view into their ehr.
- [16:21]
B
What's next? How else can we really create the unaffirming practice?
- [16:27]
C
So some simple things you can do. Before going to that, we did talk about pronouns a lot. I feel like I haven't told anybody what a pronoun is. So pronouns are things that we use every day. She, he is what we're used to. There's so she, hers and her her, she heard hers, he, his and him. There's they, them and theirs. Then there is z, z, zir and zirs. See, even I get tongue tied sometimes with it.
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B
I've heard of that one recently actually.
- [17:01]
C
And then so the they is the easiest one. So if you're ever unsure, always go to the singular they. It fits into everyone. We use it all the time anyways when we'll say like hey, they're coming to dinner, we're talking about one person, right? But we still use they them in singular. So that is your easiest way to do it. Obviously the best thing to do is ask somebody what their pronoun is and then be consistent when you're using it. Something else we're seeing pop up a lot now, which is great and it's coming on a lot of like licenses and forms is the MX prefix. So as you, as you use Mr. Or Ms. MX is one where you can do it. So especially if you're non binary, it's very helpful. So you don't have a gender that you more identify with as a transgender as see I almost slipped there. Someone who is transgender male, they would usually use Mr. As transgender female they would usually miss. But when you're non binary or gender fluid, MX is a mix is a good way to, to have that. So that's also if you have a drop down menu or you have forms that need to be filled out with that prefix, that's a good way to help include the population.
- [18:15]
B
Nice. That's something new. I've never heard of that. Thanks for sharing.
- [18:20]
C
So other things you can do in your, in your practice or in any office. So if you talk to anybody else who has any kind of offices. Bathrooms are a big thing right now. It's a hot topic, which it's crazy because no one, you never really know who's in the bathroom with you anyways. A lot of countries bathrooms are gender neutral anyways. This one of the things that we again like to put into kind of boxes over here. Really if you're going to the bathroom, you should be worried about yourself. So it's not a big deal, just. But making it just welcome to use the bathroom that fits their gender identity, sometimes we don't have control over that.
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B
Yeah, I was going to say like what if you're renting space in a, you know, bigger office building where it's a male and female very specifically.
- [19:05]
C
Right. Again, as long as they match with their gender identity though and how they're comfortable, they'll go to the bathroom. That must fits their identity and expression. They're more aware of it, the community is more aware of it than we are. So we would make a bigger deal if we saw something, but they kind of every day it happens and you never know. So the best you can do is if you can, you know, lobby to your business to kind of put a little bit more gender neutral verbiage, that's fine. I know sometimes we can't do that. So we just do the best that we can just to be supportive also. And then, you know, if you are working with a, with someone that identifies as part of the community, you can talk about the stuff in session. How do they feel comfortable? What would they like to use? You know, do they have any reservations? Is there anything that they're concerned about just so that they feel comfortable, nice, some other things to be a great ally. And that's, I guess what we really are striving to do is just understand it and respect that everyone is different. So you're not going to make assumptions, you're not going to judge, you're just, you're not going to guess, you're gonna ask if there's anything that you're unsure about. And if you do make a mistake with a pronoun, with some verbiage, apologize and move on. You don't want to kind of go over it over, you know, make it a bigger deal. Everyone kind of expects no one to be perfect in everything. So everyone usually, I say everyone globally, but is usually open to mistakes and people learning. If you make the effort, that's all that really, that's really appreciated for everyone. And I think that goes across the board for everyone.
- [20:58]
B
Yeah, I definitely noticed that. And I know when we did a podcast with Dr. Keeley Combs, I explained to them that this was kind of new to us and please, if we are actually recording and oh my gosh, I misused the pronoun, that we will definitely pause and edit that out. And they were just really appreciative of that. And also I think it reduced like being able to say, like, this is where I'm at with this and I'm trying and things like that. It just like took away everything. And you know, actually there was no, no mistakes made because I think there was just a conversation beforehand. There was an appreciation and I think I just felt more relaxed with like. Again, for me, it's, it's like that, that grammar stuff, right? It just doesn't make sense in the mind. The way that it's been drilled into us is we want to make it singular, single, you know, singular or plural plural. So it's, it's been a learning experience for myself as well as Kate. And a lot of times, you know, we practice with each other in the sense of like, you did it again. You did it. She's like, alright, let me say it again. You know, just because we really want to assure that we are being inclusive. And I really like what you say in regards to when we make the effort and like, let people know we are trying. This is a new area for us. We want to be as inclusive and understanding, compassion, all that stuff as possible. But bear with me because I'm human. I really like that you share that. I think that's. I know that's what I'm Taking away thus far, that that's the most important piece.
- [22:17]
C
That's really what it is. It's just how you can be your best every day for everyone. Right. We are talking specifically right today about the transgender community and their needs. But this really goes across the board for every population. And I think that's just what everybody wants, is just to feel included. Right. That it isn't so crazy and outside of the box. And so a normal. That is, they're just like us. Everyone is, at the end of the day, a person. And we all start and come from those same areas.
- [22:49]
B
Yeah. What are some resources you might suggest to therapists in regards to our topic today?
- [22:57]
C
So for local sunserve.org they are a nonprofit that works in Fort Lauderdale. Very great community. They give away a lot of services. They have a lot of links on their website also. So when in doubt, that's always a place you can go if you're in Miami. The YES Institute also provides a lot of those same things if you're more globally, WPATH is known as the world's idea of how we should be treating people. There is still some work to be done on wpath. So we still, as we're going through it, we find stuff that it's not perfect, but again, it's. It's the biggest organization. It is the one that's leading the world. It is doing great things. So it's really like, you know, keep going and keep learning. I mean, I've been doing this for a while. I've gone to plenty of trainings. I've worked with plenty of patients, and I still learn something new all the time because it is ever changing, you know, how people. I want to identify the terms that we're using. Those are constantly changing. So just do your best to kind of keep educating yourself. If you feel like it is outside your scope, please refer out. You know, a lot of times we know we can help, but there is some special needs and challenges that come along with it. So, you know, operating your scope would.
- [24:15]
B
Be perfect too, and that's important. And. Or seeking consultation, supervision. Those things are always important. I'm glad you mentioned the YES Institute. Interestingly enough, the podcast previous, I was like, I can't remember what YES stands for, because I was thinking about youth emergency services here in Broward County, Florida. But I know that YES offers a lot of education in regards to gender. Talk about, like, communication courses and things like that. And I know that they've had some great courses. I've got to meet some of the People from. Yes. In the past, and they're pretty fantastic folks. And their mission is really to prevent suicide in regards to transgender population and communities. So they're up to big things and definitely something. A great resource to check out for sure. Andrea, any final thoughts on regards to our topic today that you want to make sure that you share?
- [25:02]
C
We didn't talk about the difference between sexuality and gender, and I just wanted to briefly touch on that. Not too much. Just so people understand that it is separate. Your gender identity and your sexual orientation are two totally different things. You can be transgender male, and if you're attracted to males and you would still be gay, if you were transgender male and you're attracted to females, then you would be considered straight. So it is one of those things that is tricky when you're trying to understand it for the first time, but once you realize that they really are separated, it becomes very clear. So we want just people to really understand that sexual orientation and gender are totally separate things.
- [25:46]
B
Awesome.
- [25:47]
C
And then even with the sexuality, like we said, that is on a spectrum too. So there's no set rules on gender and sexuality and having to fit into any kind of box either. Be open.
- [25:59]
B
And for those folks who see you on video, they might actually see your unicorn T shirt. Share with us about the unicorn for yourself.
- [26:06]
C
So that's the logo for practice, the Psychological Health and Therapy Center. Pick. The unicorn is unique. I think all people are unique. I've been called unique. And the horn that glows. I have mine that glows a little bit. Little shout out to Star Wars. But it also kind of identifies hope in helping and curing people. So they have magical powers in the unicorn's horn. So we don't work in magic. We work in evidence. But the idea is still there that we want to provide hope and caring for everyone.
- [26:38]
B
Awesome. And your pillow behind you says you're awesome. So I love that. That's right. So, Andre, you have a giveaway for our audience. What is that?
- [26:49]
C
Very simple. I don't have any products to sell, but I do a lot of consulting with people that would like to learn some more. So if you want. If you have any questions or you just 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. You can reach me at DrCaruSoat Center. That's the Psychological Health and Therapy center, is the fat center. So if you're confused. So it's drcarusoatcenter.com p h a t.
- [27:13]
B
Not fat h a t. Awesome. And what do you want to make sure that our listeners take away from you your message today?
- [27:20]
C
Just that everyone is equal and everyone is a person. And if we break down those stereotypes and thoughts that we have and just work together to change our language a little bit, you know, instead of using daughter, son use child. Instead of using ladies and gentlemen, use everybody or folks or little things like that that we can add into just to make everybody more inclusive. Like I said in the beginning, this is the last population that we can still be discriminated against and we're going to look back at this one day and go, how did we ever do that? So beyond the beginning of that and just kind of help everyone become equal.
- [28:00]
B
Thank you so much and I really appreciate that you kind of helped us get clear on some of the verbiages, terms, pronouns, the difference between gender and sexuality, and also really simple ways to implement the things in our practice to be, you know, affirming and inclusive. From our paperwork to, you know, just letting people know where you're at and asking, that's always the most important thing that we can do instead of guessing. I'm sure as therapists, many of us teach people that just to ask, you know, your spouse needs help, ask. I think it's simple. It's one of those things that's like simple yet complex and just so easy. So being able to ask is really helpful. So Startup Nation we wanted to see and there I go with the we because Kate and I are just like one. So even though she's not here, she is with us in spirit as she feels herself on the throat. So we wanted to thank you for joining us on today's podcast. So next week we don't have our guest yet, but we do have a lot of cool ideas in the lineup. But we would love to hear what topics are most inspiring you or topics that you're most interested. I'm going to actually put our quick reference podcast guide because like I said, we are on podcast episode 139 already. So check out the quick reference podcast guide either for podcasts that you want to tackle that you haven't heard, or maybe there's something on there that we just don't have that you would really like to hear and also you think Startup Nation would find extreme value in that as well. So we are happy and always love to meet your guys needs. But before we go, I just want to give a Startup Nation superhero shout out to Lori Schulz. She says, I love these podcasts because Kate and Katie provide free resources and tools to learn, especially things we didn't learn in school. The guests are relevant and the ease of listening in your free time is the best. Lori we we want to say congratulations to you and continued success in your private practice. And thanks for letting us know about how the podcasts are inspiring you. So Startup Nation, we hope you have an awesome and inspired day. We look forward to continuing to inspire you from Startup to Mastery. Don't forget to check out the show notes page with the tips, resources and Andre's giveaway from today's show. And like he said he is happy to answer questions and talk. I know I've spoke with Andre myself in regards to this topic and he's been a great resource so definitely give reach out to him. Have a great day everyone. Take care.
- [30:22]
A
Thanks for joining us on the Private Practice Startup. Visit the private practices startup.com for awesome resources, free trainings, attorney approved private practice paperwork and so much more.
- [30:44]
C
Sam.