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5 Insights Gained as I Began to Explore the World of Transgender (Ken Cuave, PsyD)

Updated: January 2021, reformated & added Full-Disclosure 

Full-Disclosure: All Kinds of Therapy has many programs that list that they work with transgender teens and transgender young adults. At this point, there is only one place in an advertisement where programs can elaborate on the work they do with gender-expansive or trans clients. It is in the description area. Advertisers make the choice to include or exclude “transgender” in their expertise description.


After reading an article in the New York Times about Phyllis Frye, a Judge in Houston, TX  whose transgender journey began almost 50 years ago, I began to wonder how far the therapeutic world had progressed in its understanding and perhaps treatment of individual issues that may accompany transition. I asked Kenneth L. Cuave, PsyD, a licensed psychologist and President of New Lifestyles for Emerging Adults in Winchester, VA, to write about his experiences as a participant in recent national conferences focused on transgender issues. Dr. Cuave attended both the Philadelphia Trans Health Conference and the Seattle Gender Odyssey Conference (Seattle, WA). At the GLAD (Gay & Lesbian Advocates & Defenders) fundraiser in Provincetown, RI this summer, he met and spoke with Mary Bonauto, who delivered the opening argument in the recently successful Supreme Court case for same-sex marriage. This summer New Lifestyles opened the zE House, the first dedicated trans expansive housing option at a private therapeutic program for emerging young adults that serves those who identify as LGBTQ, specifically transgender, questioning and/or gender fluid.


Insight 1: The best advice you heard from a parent of a gender non-conforming child

Although the Gender Odyssey Conference offered workshops for professionals, it was first and foremost a forum for the transgender community, including parents and their questioning and/or transgender children. I attended as a psychologist intensely committed to learning all I could about an emerging population, at least in my awareness, whose members, not only are under-served but also are largely invisible in the treatment world. As a dad, I wondered about the emotional responses of fathers to their children’s’ journeys; therefore, I joined and was welcomed into a support group just for fathers. It was a group whose members freely expressed their feelings, and I confess, I found myself teary-eyed more than once. In response to the anguish of a father who acknowledged loss and confusion, one father wisely stated, “No damage is done by loving and accepting your child exactly where he/she is.” Another dad, in describing his experience, shared, “he led the way; we just had to catch up.”


Insight 2: The most emotionally intense aspects of the conference for you

Well, in addition to the fathers’ support group noted above, I was moved by listening to all those who spoke of his/her/their personal experiences.

In a FTM (female to male) group focused on identity, I learned that prior to transition, a FTM individual often identifies as lesbian. As one might expect, during the transition to male, the dynamics of relationships begin to shift. Thus, the loss of lesbian friends, and even one’s partner, is not uncommon. The shattering part of this process for me was understanding that this loss occurs as the individual seeks to live his life more authentically. No wonder, then, that many of those I met seemed so grounded in spite of the loss and without regard to gender; self-hood had been a battle hard won.

As I joined another workshop, I learned that although the experience of one’s gender as “male” often occurs early in life, the trans male individual is typically socialized as female. Thus, during the transition process, gender expression must also change. Once transition occurs, insecurity about perceptions by others can remain. One man commented, “I did not use public restrooms until I was in my 30’s.” His reluctance was based on concerns about “passing.” Because transgender individuals, particularly transgender women of color (WOC), are disproportionately represented among victims of hate violence, using a restroom, something so simple and routine for most of us, can be a serious safety risk for a transgender man or woman.

Last but not least, I remember the keynote speaker Andrea Jenkins, a gifted female writer, who passionately noted that more than 18 trans WOC have been murdered in 2015 alone. She read the names of each woman with brief descriptions of their lives. A chill ran down my spine as I listened to their stories, and I felt tremendous sadness and shame for our cultural biases. (Don’t attempt to find these statistics online. Actual numbers are impossible to obtain due to inaccurate binary coding [see below] and inconsistencies in how these crimes are reported by the police. Additionally, despite style guides published by the AP and others, journal reports frequently give misleading and disrespectful accounts in reports about transgender victims of violence.)


Insight 3: The culturally expansive aspect of the transgender world

Culturally, we think of gender as male or female but gender is non-binary)A bit more expansive is to conceptualize gender on a spectrum, with masculine on one end and feminine on the other, with the recognition that most individuals display some aspects of the “opposite” sex. However, to think of gender as nonbinary is to consider not only transsexual identities, but also agender, bigender, gender queer, questioning, neutral, and on top of that, gender fluid. It is interesting that Facebook recently added more than 51 terms to describe one’s gender. Part of the beauty of many in the transgender community is their ability to identify and assimilate all these contributions to who they are. For many of us, I think, an  appreciation of that level of diversity within an individual is difficult to gain.


Insight 4: The most surprising manifestation of gender dysphoria

The most surprising information I heard was during the fathers’ support group. Not one but two fathers mentioned that their child’s gender first manifested as identification with an animal, specifically a cat and a dog (as a child). Apparently this was a way of expressing themselves as transgender. Frankly, I was not only dumbfounded but also humbled. As a psychologist, I have to confess that I was unaware of this phenomenon and could only begin to imagine how many children might undergo not only treatment with psychiatric medication but also psychotherapy to correct an experience that could be healed by following the simple advice of “acceptance and understanding” offered by other fathers in the group as previously noted.


Insight 5:  The most interesting/bittersweet comments you heard

“When I became a trans male, I gained straight privilege. When I became gay, I lost some of that privilege, and ultimately, I found it harder to be a gay male than to be a trans male”.

MTF (male to female) first-time attendee, “I was looking forward to the opportunity to use the ladies room at the conference, only to discover once getting here, that all the bathrooms are marked, ‘Gender Neutral’.” I suspect that, ironically, winning a battle for equal rights might sometimes feel like a loss.


Thanks for sharing your insights.  Clearly, this is an ongoing learning process for all who are working with the transgender teens and young adults.  It is exciting that you are going to have The Gender Education and deMystification Symposium (GEMS) to be held in late January 2016 in Asheville, NC.


About the Author
Dr. Kenneth Cuave is a licensed psychologist who has proudly worked in the field of therapeutic residential programming for the past 40 years. His systemic perspective integrates the utilization of individual measures of performance within a clinically sophisticated environment. His therapeutic milieu design includes not only practical applications to teach a balance of routine daily life tasks with school, work, play, and social involvement, but also intensive personal work accomplished through individual, group, and family psychotherapy. He models a whole-life approach to a mentally healthy lifestyle that includes sound physical, nutritional, and mindfulness practices. Additionally, he invites and welcomes visitors and clients to join him at 6 A.M., M-F for his daily hour of CrossFit training.
New Lifestyles ceased operation in December 2015.