Transgender Children and Youth: Cultivating Pride and Joy With Families in Transition
reviewed by Mollie V. Blackburn - September 05, 2017
Title: Transgender Children and Youth: Cultivating Pride and Joy With Families in Transition
Author(s): Elijah C. Nealy
Publisher: W.W. Norton & Co., New York
ISBN: 0393711390, Pages: 448, Year: 2017
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In Transgender children and youth: Cultivating pride and joy with families in transition, Elijah C. Nealy draws on nine years of professional experience as well as his own experience as a white trans man to guide mental health professionals in meeting the needs of transgender and gender-diverse children and adolescents. There are places throughout the book that speak explicitly to parents, one that speaks directly to educators, and others that are of use to educators. As a parent, an educator, and a cisgender white, queer-identified woman who is not a mental health specialist, I found the book compelling and useful.
The book begins with an account from the authors childhood, one in which his birth-assigned sex and innate gender identity were in conflict. Indeed, there is a lovely balance of vignettes from his life and those composed from the people with whom he has worked. I found the vignettes at least resonant and at most insightful, and never boring. I particularly appreciate when in these vignettes the author acknowledges his conflicting emotions and discusses managing them. Also, throughout the book, theres a deliberate effort, albeit sometimes limited by his own privilege, to interrogate privilege and embrace intersectionality. He considers race, class, immigration status, region, religion, and sexuality (although there is silence regarding asexuality) and considers how they intersect with gender to provide a more complex and heterogeneous reading of transgender experiences.
In the first chapter of the first part of the book, which is entitled Foundations for Understanding Transgender Youth, Nealy articulates and distinguishes sex, gender expression, gender identity, and sexual orientation. Those who are new to reflecting on the lives of transgender and gender-diverse people and even those claiming these identities will learn some terminology to help foster their understandings. Those who are more experienced in this realm will be challenged to think about linguistic and terminological tensions.
Nealy begins the second chapter on Gender Diversity and Gender Dysphoria by challenging readers to consider their privilege, or lack thereof, in terms of gender. He considers how vestiges of archaic conceptions of gender continue to influence current practices, and offers alternative ways of meeting the needs of transgender and gender-diverse children and adolescents, drawing heavily from the World Professional Association for Transgender Healths (WPATH) Standards of Care (SOC). There was an opportunity here to critique the DSM for reifying gender stereotypes as a measure for gender dysphoria, but it was not taken advantage of.
This chapter and the next, which focuses on trans youth in therapy, are not geared toward parents and teachers, but there are aspects that may be of interest to them. Most prominent is the statement that children and adolescents do not become trans or gender-diverse simply by talking about gender identity or expression or watching or listening to the stories and experiences of trans and gender-diverse youth (p. 43). This is helpful for families to be aware of when speaking with their children, and important for teachers to know and highlight in trans-inclusive curriculum and instruction.
The fourth chapter focuses on trans and gender-diverse youth coming out and transitioning socially as continual processes rather than singular events. It discusses the role that schools might play in this process by supporting children and by discussing timelines with families for moving to affirmed names and pronouns and educating others in school about the students transition. The responsibility of families and teachers to support and educate is underestimated here. A concern I have, both in this chapter and again in chapter nine, is the lack of attention to how school staff can support transgender and gender-diverse students in the absence of any obvious parental and familial support.
Chapter Five builds on the research cited in the second chapter, stating that approximately one quarter of prepubertal children diagnosed with gender dysphoria identified as transgender as adults, whereas most young people who come out as transgender during adolescences continue to identify as trans into their adult lives (p. 22). It then builds on research referenced in the fourth chapter by pointing to the fact that the younger a person is when they transition, the less they suffer from mental health disorders, or, in other words, socially transitioning when young contributes to resilience among trans youth (p. 76). To help readers process what might at first seem like conflicting implications, Nealy presents fully reversible interventions, partially reversible interventions, and irreversible interventions. Such a range of interventions, and their thorough descriptions, are imperative for families including gender-diverse and transgender children and adolescents, particularly since many endocrinologists in the U.S. will not offer such options for minors. Another of my concerns, in both this and the previous chapter, is the reliance on the U.S. Departments of Education and Justices directive to protect transgender students, which was written under the Obama administration and has since been undermined by the current Trump administration.
The chapter on transgender adolescents, Chapter Six, references microaggressions transgender youth experience in educational settings, often through the ubiquitous sorting of students by gender, among many other things; but it also celebrates the resiliency of these young people. Of particular importance is a list of guidelines for working with trans youth of color in group contexts. Although these are directed at mental health professionals, they can and should be adapted easily by families and teachers so they might serve as advocates.
In Part Two of the book, Trans Youth and the World Around Them, Nealy turns his attention more decidedly toward families. The crux of the matter is that family acceptance is the critical mediating variable for LGBTQ young adults mental, emotional, and physical well-being (p. 142), and he works tirelessly to find ways to help families accept their transgender and gender-diverse children and adolescents. In Chapter Seven, he offers questions for families to ask themselves about how they communicate acceptance as well as rejection. He also includes a section focused entirely on families advocating for their children in schools, which gets further developed in Chapter Nine. Before that, though, Nealy guides mental health professionals in helping families to develop deeper understandings of their transgender and gender-diverse children and adolescents. Moreover, he guides families in choosing the right therapist. Here, he states plainly:
If the professional is not operating with the assumption that everyone wants the same thing for the transgender child or adolescent to grow up knowing they are loved and that their life has meaning then this is not the right person to be consulting. (p. 165)
Although the same might be said of teachers, there exists little flexibility for families or students to choose teachers. Still, the importance of working with families is highlighted for teachers as well. Nealys recommendations center around harm reduction and love, particularly when working with families from conservative faith traditions.
Chapter Nine speaks in the most developed way about schools, although it is really speaking to mental health professionals and families navigating school systems on behalf of transgender and gender-diverse youth. For this, Nealy offers advice on coming out at school, meeting with the school, what to discuss with school personnel, rights regarding student privacy, and safety issues. That said, the chapter talks about ways of creating a supportive and inclusive environment in schools and developing guidelines that support transgender and gender-diverse students. Further, it concludes with recommendations for teachers, administrators, and other school staff.
The final two chapters of Part Two explore transgender youth living their lives post-transition. The first of these explores body image, grief, and confusion, among other topics. The second focuses on college and work, although primarily college, including questions to ask about how trans-friendly a college campus is. These sections can be of use, particularly to parents of adolescents and secondary teachers mentoring youth who are preparing to transition into a new academic community.
The third and final part of the book is entitled Supporting Trans Youth, and is comprised of two chapters. The first of these final chapters reminds mental health professionals to reflect on their values and biases, and to educate themselves with respect to gender. It discusses various missteps therapists might make, some of which might be easily understood in terms of teachers. The final, brief chapter is powerful. It lists 10 life-affirming practices for adults in the lives of trans kids. It does not mince words in its demand for adults to serve transgender and gender-diverse youth well. It tells us that Transgender children and youth do not just need counselors or therapists or parents but further, advocates (pp. 323324). I would add that they need supportive teachers, too. This chapter also insists that we say I love you often and suggests that if this is inappropriate given your professional role, Find another way to say it then. Find another way to express your connectedness. Find another way to express their value and worth in the world. Find another way to say they matter to you (p. 326). If this compassionate appeal does not connect families and teachers to protecting trans children and adolescents, then I dont know what will.