Welcome to Insight Mind Body Talk, a body-based mental health podcast.
Today’s episode is titled supporting our LGBTQ+ population with what therapists should know.
Our guest is Lisa Koenecke, an experienced and energetic diversity equity and inclusion, professional speaker and facilitator. Lisa specializes in counteracting unconscious bias, and LGBTQ+ inclusion in business. Her impact is amplified through strengthening each person’s allyship with a demonstrated history of working in secondary education and a passion toward community and social services. She is an expert in counseling, crisis intervention, educational leadership, and program development.
After receiving her Diversity and Inclusion certification from Cornell University, Lisa launched her Inclusion Ally business. She has given a Ted Talk and written a best-selling book. Being an expert in LGBTQ issues has allowed her to present in 43 states and keynote numerous conferences. Lisa’s speaking style can be best described as dynamic, energetic and interactive. After 12 years of being a middle school counselor, she’s now an adjunct instructor at Lakeland University training the next generation of school counselors.
Lisa, it is an honor to have you on our show. Welcome.
When we were discussing today’s theme, you felt passionate about our conversation being directed at counselors and therapists. Why us vs. speaking directly to the general population?
I think that it’s so important for those in the lesbian, gay, bisexual, transgender, questioning and Queer and plus, which can be intersex agender, communities to know that a therapist or counselor provides a safe space for them to be their true self. That is why this is so important.
There’s a rise of kids realizing their true selves and becoming transgender. As a mental health therapist, you’re the first stop if people want to transition. You write the letter to the attending physician, the doctor. It’s so important that you know what to say and how to say it.
As mental health therapists, we don’t want to cause harm at any point, but we’re human. We have unchecked biases and different life experiences. When I brought this episode up to our staff, people were really excited to have a place to ask these questions and gain more knowledge in how to better support people, especially teens and children right now.
Even though this is geared toward the mental health therapist, it is advantageous for the entire community. If you just glean one thing from this episode, you might save a life.
Let’s get into the questions, which have all been pulled from therapists.
- How do you create an affirming environment at the clinic and in session for the LGBTQ+ community?
It starts with showing that you are open and affirming. That could be anything from looking at someone’s website to an equality sticker, the blue and yellow equal sign from the human rights campaign, by the coffee maker. Do I feel that I’m going to be safe there? Pictures of therapists? Insight has yoga. It could also be in registration forms, seeing guardian one, not mom or dad. Another thing that I look for pronouns. I love when the therapist has a pronoun in an email signature or in an introduction. Anything that helps to say, ‘they get me’.
One of the reasons the Insight team was so attractive to consider being a part of was because there were statements about social injustice and inclusion and intersectionality on their website. There were pronouns for every employee on the website. Why does that matter? Because people feel seen. That is a signal that we see you.
- Are there ideas or resources for supporting our clients who want to come out to their friends or family?
Lots of resources, lots of ideas. It’s dependent upon the population. One of the best resources for the K-12 world is www.GLSEN.org. That’s the Gay Lesbian Straight Education Network.
The next one is the National Center for Transgender Equality (NCTE); https://transequality.org. Their frequently asked questions page, boom. What you want to know about the transgender population? They tell you from their perspective.
If you’re looking at laws, I love the Human Rights Campaign, www.hrc.org.
It’s important that therapists do their own education to understand the answers that you need.
If you were brought up not agreeing with the LGBT world, you still want to be nice to people, do some research. Make sure that it’s fair and two-sided.
SAMHSA is wonderful too, https://www.samhsa.gov/, from a mental health standpoint, helping out with the LGBT world.
- Are there LGBTQ specific suicide risk assessments, or is it okay to use general assessment knowing that identifying as LGBTQ+ is in itself a risk factor?
Off the top of my head, I don’t know. I teach my grad students about the Columbia Suicide Severity Rating Scale.
When it comes to a specific LGBT risk assessment, GLSEN puts out a National School Climate Survey that gives you national statistics of how students are feeling every two years.
G Safe in Wisconsin, The Gay Straight Alliance for Safe Schools, https://gsafewi.org/ has worked with the people who produce the Youth Risk Behavior Survey, the YRBS. There have been some more inclusionary YRBS questions.
One supportive adult, just one, can reduce the suicide attempt rates by 40%. The best resource there is the Trevor Project, https://www.thetrevorproject.org/. They can give you lots of statistics, and it’s also a suicide hotline, chatline, text line. They also have a safety feature, so if a student is at home or not in a safe place, all they have to do is triple click ESC and it will exit them out of the browser and remove the search history.
- Is the Trevor Project, LGBTQ+ lifeline, the best option for crisis support?
Yes. If you don’t have a phone or internet, your best resource is going to be a safe adult. If you are an adult, who is the safest person for you?
A quick story about the Trevor Project. I was a middle-school counselor and had a 12-year-old student come into my office and say, it’s easier pretending to be a boy than it is to be gay in this town. I was 40 years old, cisgender, privileged, had not come out to the students because I was afraid I was going to get fired. I went home that night and told my wife, I have to come out to the student or they might harm themselves, but I might get fired. My wife said, yes, do it. I came into school the next day, found the student, thanked them for the courage that they had and said, you know, I’m gay too. The students said, no duh Ms. Koenecke, we all know that.
The Trevor Project is so essential and important it.
- What are some resources that provide explanation of terms and concepts such as transgender, gender fluid, et cetera, that can be used for educational purposes, specifically for those who are not part of those communities?
I have a book. If you want to pick up Be an Inclusion Ally, the ABCs of LGBTQ+, it’s readily available.
One of the best resources is the Trans Student Education Resource, TSER, https://transstudent.org/. These are students who are telling the adults, this is what this means. Please do this, please. Don’t say that. They have a wonderful image called the gender unicorn that talks about identity, expression, orientation, intersex, all of those kinds of things in a visual is anyone can get behind. The genderbread person has now been replaced with the gender unicorn. I also like to show the flags that go along with these.
It’s okay to Google any resources or any terms that you don’t know. I had a student who was gender fluid. What does that mean? One day they wanted to present as male and use male pronouns, second day female, et cetera. I met the student at the door every morning I had them show me a number one, if they were going to present as male that day, or a number two, if they were going to present as female, and I sent a quick text to their teachers so that the teachers knew.
There are lots of terms and new terms. I would just bookmark one of these resources just keep up that way.
It’s okay to ask too.
Things are evolving and changing so quickly, so I appreciate hearing that. We always want to be supportive and don’t want to place the burden of educating us on the individual sitting in front of us. Sometimes that creates the confusion of can I ask, or should I already know?
No, you don’t have to know everything. If you aren’t sure about a gender or appearance or something like that, all you have to do is say, hello, welcome, my name is Lisa, my pronouns are she/her and let your client take it from there.
The younger generations might be more forceful in you need to know these things.
As the elder statesperson of the LGBT world, I’m trying to tell them that we have had many people before me blaze trails, so that I’m able to be who I am, you also have a responsibility to be nice to allies who want to know.
If you have a question, please ask and ask from a place of wanting to help, not because you’re questioning if it’s right. If you ask with concern, or even if you mess up, I’m going to say to you. I’m not going to throat punch you. That’s how we educate the world.
If someone gives you a term and you don’t know what that means, say, tell me more, how can I support you?
It’s also not assuming anything. Always, tell me about your family, not who are you married to? Who’s at home, especially for young people, and then let them tell you. Maybe it’s their biological family, maybe it’s not.
- How can we conceptualize gender as a spectrum?
I will give you an example of my dog. We have been taught about pink girl, boy blue, et cetera. My puppy is four years old, she was assigned female at birth, and because we have had so much snow here in Wisconsin, she has learned when, she goes tinkle, to lift her leg. I have a gender-neutral puppy who is not binary because she will squat as well, but I’m not going to change that. Thinking about gender not on the binary for me, a Gen X-er, is a new concept. All I want is for people to just love that person first, let them be who they’re going to be.
When someone presents in different clothes, if they present as non-stereotypical gender, look deeper. Look at that person as a person, not as a stereotype. I grew up playing with tractors and GI Joes. Back then I was a tomboy. Now, I would be maybe gender nonconforming, maybe non-binary. Terms change and that’s okay. The lesson would be to meet them where they’re at. I don’t want people to change me, so I’m not going to change anyone else.
- Are there ways to assess when someone decides that they are transgender or asexual, if their decision is a reaction to trauma?
I would probably follow the lead of the client. There is probably more research out there that I need to do more of. I would go developmentally to answer this question.
I had a student who shared over winter break that mom had become dad. The student came in and told me, mom’s now dad, and I was like, tell me more about that. From a developmental lens, can I say that trauma caused mom to transition to dad? I have no idea. Maybe it was just the point in that person’s life where they felt safe and strong enough to be who they want to be.
This might not be a popular answer, but I think that trauma is in all of us and I don’t know that it necessarily has to do with people transitioning. I think it’s more the trauma of not feeling safe to transition. Maybe some people are living in the Madison, Wisconsin area because they know that it is a bubble of acceptance, inclusion, et cetera. Maybe they’re learn here versus a very conservative area where they’re going to get beat up or disowned or whatever.
When we’re talking about trauma, there are so many different things that can happen. My trauma turned into resilience but it’s what I don’t want people to go through. It is why I do what I do.
Dear therapists out there, I don’t know. How ever you best work with people in trauma, if that client is comfortable going there with you, great. If they’re not, please don’t push them. The last thing that you want to do is re-traumatize anyone.
Again, there are probably statistics out there, maybe from SAMHSA, maybe from the National Center for Transgender Equality, that can talk more about this, but it’s not usually one of the first questions.
We are all wounded individuals walking this earth, there is no one who has not been traumatized. Maybe there’s different levels of insight into those traumatic experiences and how they’ve shaped us, but birth itself is trauma, so we have all been traumatized. Supporting each other and meeting a person where they’re at is one of the best ways that we can provide that care.
Growing up, I did not have safe male role models. Is that what turned me gay? I don’t think so. I think I realized it’s really hard for me to trust a man. I liked women and I’m not seeing that from a sexual vantage point, but that’s who I surrounded myself with. That was my safety. Maybe that is part of that. Who knows.
- How to support LGBTQ+ youth who are quarantined at home with unsupportive parents? I know a lot of Queer young people who have unsupportive parents and are unable to find healthy, safe environments.
The first thought that I have is thank you person who asked this question because you are saving lives right there. That is a huge, huge thing. What I might offer to that student is to find their strength.
Do they like to write? draw? music? What is the solace that that student can have? Not as an escape, but to show them, that identifying as Queer, is cool and it’s just one part of you and until you can get into a supportive environment, how do we get you through one day at a time through positive outlets. We don’t want drugs. We don’t want self-harm. We don’t want risky sexual behavior.
To that student: you’re going to know what your boundaries are at home. What are the safe things that you can do? If you have internet, there are a lot of youth groups online that you could join. Please know that your school counselor is going to be supportive. If they are not, you call me because I’m the past president of Wisconsin School Counselor Association served on the National Board of Directors.
- I had a teen client tell me that she’s exploring her sexual identity and thinks she’s “Ase/Aro”- which she explained to mean asexual and aromantic. I’d be curious to hear Lisa talk about those identities and how to help clients (esp. teens) better understand their feelings around their identity.
I would say that the identity is who you are and romance and sex, is a construct. A young person might not understand that so, I’m going to say, fantastic, how do we embrace who you are so that you can go through this world?
What strategies can we work on that are positive so that when people do ask you this question, you know what to say, or how you’ll say it, express it, draw it or whatever it’s going to be.
Not building up tolerance but developing a healthy strategy. Maybe it’s that you start finding the people who are going to accept you. Maybe your sphere of influence will change. Cliques don’t go away. Find your people who are going to be like, that is fantastic.
The world of the arts is so inclusionary across the country. Maybe it’s music, theater, art, anime, find something that does not identify you with any of the social constructs of sex or romance.
- I’m working with a client who’s preparing for gender affirming top surgery. I will be seeing them for approximately six months to be able to adequately assess readiness and subsequently write a letter of support. Any guidance around what would be helpful?
I personally do not have experience with this. I know we are very fortunate in the Madison, WI area to have UW Hospital System as a phenomenal resource. I
UW Hospital Systems does a really good job of walking you through some of the things we can ask. I would focus on the safety of this person. Do they have social support? Do they have people around them so that they don’t become homeless or go another route. If they feel that no one loves me, they may turn to drugs and alcohol.
I would also take them through their day. What is a typical day for you? If you’re at home or in school, are you going to interact with anyone? What does that look and sound like? Say you go to the grocery store or outside to get the mail, what does that look and sound like? What is your comfort level with that?
It’s not necessarily you, mental health therapists, being the barrier. It’s more you as the bridge to helping this person live their true selves. Especially if it’s an older person, it’s okay to ask them what kind of things they want in the letter. Maybe this person can now leave their home because they feel more confident or can go into a store and look at clothes that feel more comfortable. For me, I don’t want to transition, but I always go to the guy’s section for clothes. I’m a bigger girl and that makes me feel more comfortable.
It’s kind of a journey together. It’s their life, it’s their body, and you are there to support them. If it’s going to give them more clarity, more mental health, then I’m all for it.
- I’m a cisgender white male. How does the patriarchy affect LGBTQ+ folk? What personal biases should I be considering when working with a lesbian couple?
Do not be the savior. Do not lecture. Do not mansplain.
Please know that you might not be our first choice to talk to there. From a cisgender gay white female, I have never ever wanted to talk to a man. I don’t have male doctors. I don’t have male dentists. It’s not necessarily that I don’t trust a male doctor, it is wanting to give power to the females.
Be open to this lesbian couple. Do not judge. Do no further harm. If this lesbian couple gives you a book to read, read it and come back and tell them that was fascinating, thank you for teaching me.
Language is so vital to the work we do and a lot of therapists get nervous that we’ll use the wrong word, pronoun, or concept in session and cause unnecessary harm. I thought it would be fun to play a vocabulary speed round.
I’m going to give you a term or concept from your book Be an Inclusion Ally, the ABC’s of LGBTQ+, and I’d like you to explain what the word means.
- LGBTQ+
- Lesbian, gay, bisexual, transgender, Queer, questioning.
- If someone uses the term Queer, they are giving you permission to use the term Queer. You never use it unless they use it first.
- Queer
- Brought back and relegated to the positive. A term used by the younger generations, kind of turning more into an umbrella term.
- Don’t call someone Queer unless they use Queer first.
- It’s just like their pronouns. If their pronouns start with they, then that’s what they would prefer. If their pronouns are she/they, she would prefer she first.
- ally
- Small ‘a’ ally hears a homophobic transphobic joke and does not say anything.
- Ally
- Capital ‘A’ ally or advocate says that’s not cool. They do something.
- Capital ‘A’ allies save lives.
- Bystander
- Someone who sees something happening but does nothing.
- Gender
- A social construct.
- When you are born, you are assigned a sex, not a gender.
- We no longer say that someone is transitioning male to female or female to male. Now, someone is assigned female at birth or assigned male at birth.
- No gender reveal parties. It is a sex reveal party, or just say it’s a baby.
- Binary and non-binary
- Binary is the construct male and female. Male and female clothing, colors, etc. Most of us think in the binary box.
- Non-binary is someone who might be assigned female at birth but does wears non-female clothing or does non female things. Don’t put me in a box, do not make me male or female. Non-binary people are using MX instead of Mr. or Mrs.
- Cis-gender
- Latin term for all intents and purposes means the same.
- When the trans community was coming out rather than calling us non-transgender, the majority had to come up with our own term so the term is Cis gender, so that I can say that I’m cisgender, my friend can say that they’re transgender.
- Gender dysphoria
- We are no longer in the DSM five.
- That would be something to explore with your client, to say, maybe I have gender dysphoria, maybe I just don’t want people in my business. It can be a real thing for people. This would be one where you can do your own research.
- Inclusion.
- With a capital I
- In the world of diversity, equity and inclusion.
- Equity
- Equality is everybody has shoes. Equity is the shoes fit.
- Intersectionality
- Intersex
- Baby is born hard to determine from the external genitalia, how they’re going to assign male or female or intersex.
- There are more babies born intersex than those who have cleft palates. You probably know someone who’s intersex.
- Doctor gives baby to the adult who has to determine how to socialize this baby on the gender binary.
- Micro aggressions
- Could be saying, you’re not feminine enough. You’re not masculine enough.
- Football coaches saying come on girls, you throw like sissies.
- You have a party at your office and you only say spouses because you don’t want the person with a partner or the person who’s divorced.
- Nonconforming
- I don’t want to fit within that box so I am going to be who I want to be, wear what I want, do what I want to do.
- Riddles scale
- Dorothy Riddle came out with a riddle scale. If you abhor gay people, that would be the lower end. At the very other end it’s nurturance and acceptance.
- There are different degrees of how you’re going to like gay people.
- What we want for the whole world, is that you want to accept, you don’t want to just tolerate. You want to nurture that person to be able to say, welcome to my family. Welcome to my circle.
- Transgender
- Someone who was assigned female at birth and their true selves feel more like male (or vice versa) or could be fluid on all of these things.
- By age three to five, we know how we’re going to identify
- Age seven is when we start expressing how we’re going to identify
- Pride.
- Our celebration in June to commemorate the Stonewall Riots, June 28th, 1969, which was our big gay movement, started by people of color who were trans people. Thank you Marsha P Evans and Sylvia Romero.
- The Safe Zone Project
- A free training if you want to be able to say, I’ve had a training.
- Look it up. Wonderful people.
- If you want an Allyship certification, I’m teaching one through Lakeland University.
Lisa Koenecke, how can listeners find you?
I have a website LISAKOENECKE.com. I’m also on LinkedIn. My cell phone and email are on my website. If you want to ask me questions, you can. If you want me to come and speak to your groups, I love it. You can get my book from my website or Amazon, Barnes and Noble, anywhere books are sold. I love, love, love, helping allies save lives.
Tell me a little bit about your course.
It’s 12 hours, three hours for four nights in a row. If you can’t make it, I do record.
The first week is the history of the LGBT movement so that, you know. Then I take you through vocabulary and current laws that you need to know.
The first two hours are me giving you information and then I give an hour of consultation. Basically, it’s eight hours of information, four hours of consultation.
This is happening in your world, great, here’s this resource. People have questions about religion. Here’s a resource for you. I take you through the bathroom laws, registration forms, title nine. I take you through the things that maybe you don’t even know to ask. It’s super fun. It’s super engaging. Just come with an open mind and you’ll walk away with a certificate on how to be an LGBT Ally capitalized.
It sounds wonderful. I’m so glad it’s here and you’re here. I’m so thankful that you’re a part of our community. Thank you for being here today to support us in supporting the LGBTQ+ community.
Please join us again as we continue to explore integrative approaches to wellbeing. Until then, take care.
