Q&A: One Therapist’s Mission to Train Schools, Parents and Classmates on Transgender Issues

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This is one in a series of articles surveying the complexities of gender identity, the evolving political debate surrounding the transgender rights of today’s youth, and the ways in which these issues intersect with the policies and practices of K-12 schools across the country. To see the complete series, click here.
Susan Landon, a licensed marriage and family therapist, has worked with transgender children and their families in Southern California for years. From individual and family counseling to advising with a transitioning student’s school, she has worked with high-schoolers, grade- schoolers and children who started identifying as young as 18 months.
She recently spoke with The Seventy Four about her experiences assisting transgender students and their families, how she has seen attitudes change over the years, and how she believes education is vital to promoting a culture of acceptance.
T74: What behavior tends to make parents of younger children reach out to you?
Landon: The parents will typically contact me about behavior their children are exhibiting, like when they start making statements along the lines of: “I don’t want to dress like this,” “I don’t want to wear these kinds of clothes” or the children will say “I’m a girl” or “I’m a boy” or “I want to be a girl.” Their declarations can be pretty straightforward. Or they can just begin acting out gender non-conforming behavior in their lives.
When preschoolers and kindergarteners begin school one of the things that I stress when I go to their schools is that this is not something that is just coming off the top of the child’s head. Children from the time they are born are looking for what appeals to them, what they are attracted to, and what they identify with. They are gathering information about themselves before they are verbal so when they acquire language and are old enough to tell their parents, this is not new information for the child, only the parent. Often people are surprised at how young these declarations can start. One child I worked with started identifying at 18 months old, and said to his mother “I a boy.”
Gender identity is something these children are feeling inside and they are telling their parents and society that their identity does not match up with who they are being told they are. What we look for is behavior that is consistent, insistent and persistent. I mean persistent in the declaration of “This is who I am.”
Young children playing dress-up, like a boy dressing in a princess outfit, or a girl in a Super Man costume may just be wearing it because it appeals to them. It’s not necessarily a statement. But if they say “I want to wear this and I don’t want to wear those,” or, “I want to wear more of these clothes, and I want to go outside in them and I want to go to the store in them, it’s who I am,” that’s different. If you see this behavior consistently over time or if the behavior is causing stress in the child’s life, or if the child’s behavior is consistent, insistent, and persistent over a period of time, then it’s important to have a conversation with your child to see what this child is trying to tell you.
There are many older transgender people who would have loved the advantages of coming out when they were younger — but feared doing so
Sometimes this behavior is confusing and difficult for the parents. So they will try to divert the child or say “Well you can wear that in the house but not outside.” However, if the child continues saying “I don’t want to do that,” then it’s very important for the parents to pay attention. It seems to be easier now than it was 10 years ago for parents, when they see their child struggling, to come in and describe the behavior and anxiety their child is going through. This gives me the opportunity to educate and talk over possible options for their child.
I talk to them as I would talk to a school to educate the school. I explain to them what “gender diversity” means and that this is a process over time, that it is a journey for the whole family, and that every journey is unique.
What many families ultimately decide is what’s called “socially transitioning,” and that’s the affirmative model for treating gender diverse children. It includes letting the child wear what they want to wear, call them the name they want to be called, call them the pronoun they want to be called, and let them expand into that identity, experience that, and see if that is true for them.
One of the most important things to remember about socially transitioning is that it is completely reversible. Nothing medically is happening. So when the child goes to school, particularly in the early years, in preschool, I tend to go talk to the teachers and administrators. I give about an hour in-service training about the history of transgender kids and adolescents and adults. I talk a little bit about (how) nature is diverse across the board and in our world and we celebrate it everywhere except for people. We are not quite as embracing when it comes to diversity with people. And yet we are as diverse as anything in nature.
And when I describe the differences, I am very clear in what I tell the teachers. I explain the difference between biological sex, gender identity, gender expression, and sexual orientation. They are all completely different things but are often conflated or overlapped. People often think that gender identity is the same as anatomical sex, which is what our culture has done for years and years. Our binary society says that the cluster of flesh between your legs determines the rules for the rest of your life about what you do, what you wear, and what kind of job you should have.
So I explain that gender identity is a feeling inside. It’s how we know who we are. It’s a feeling. It’s in the brain and it’s not determined by the sex you were assigned at birth.
How does your mission change when dealing with older children – middle-schoolers or high-schoolers?
When children are young, in preschool, social transitioning can be relatively simple. I suggest to the teachers that they just say, “This child wants to be called this (the chosen name), and we are going to call him or her this name and use the pronouns he/her that (child’s name) wants us to use,” and often, at this age, the children will just say OK. I also recommend a number of storybooks that the teacher can share with the class to help them understand about gender diversity.
The push back the school may experience is not generally from the other children but from their parents, particularly parents that are not educated about gender non-conforming children. We don’t see that much anymore, which is good, but historically parents often had a hard time when a child socially transitioned in their school. If a child transitions in the same school they have been attending is when this typically happens. Bathrooms can be a very big issue and sometimes parents don’t want their child to go to the bathroom with the socially transitioned child. However, If a child doesn’t transition in the same school – if they come out of kindergarten in one school and go to a different one where they don’t know anyone else – then the transition can be undisclosed. Under these circumstance the child can just attend school as their authentic self.
Here in the Los Angeles Unified School District, we have one of the best acceptance profiles in the country as far as I know. Children can be go to the bathroom that is congruent with their gender identity, they can use their chosen name and pronouns, be on the sports team, go to the locker room, all of which are congruent with their gender identity.
Unfortunately there are parents signing petitions to say an assigned boy is a boy and an assigned girl is a girl. The bathroom seems to be one of the biggest issues. I’m not sure but I’m guessing that the parents are afraid of some kind of exposure, which is the last thing a trans child would ever do. It may just feel wrong to them because it’s something they aren’t used to. The way a school tends to handle it now, if a parent comes and says to the principal “I don’t want my child going to the bathroom with that child,” then the school provides a separate bathroom, not for the trans-child, but for the other child. So the child of the upset parent will go to the nurse’s bathroom, while the transitioning child will go where they identify. It’s only isolating of the child whose parents don’t want them going to the bathroom with the transitioning child.
Other times, parents may be reluctant to have a play date with a transitioning child or hesitate to ask them to a birthday party because the behavior is confusing to them. If the parents of the student come and tell me about being left out or bullied, I give the child and the parents suggestions about how they might solve being left out and educate them about their legal rights in regards to bullying. The rights that they have in California are far different than a lot of other states.
Are the challenges different in middle school?
Middle school can be harder because kids are entering a time of self identifying at that age and are being met with the challenges of puberty. It can be a more difficult period with classmates. When gender non-conforming children are hitting puberty and are not wanting secondary sexual characteristics to develop, they may become very anxious and depressed. They don’t want to develop and there is so much pressure at this age to “fit in”. This is a period of time when I first see a number of kids. Often at this time, medical intervention is a choice the family will make to block physical development, ease the anxiety and depression, and allow the child and family to determine their next steps.
A lot of the older kids, kids who are 16, 17, or 18, don’t seem to be having as much trouble as they used to transitioning in school. Many teens, both gender non-conforming and cisgender are well educated because of all the recent media exposure and because of all the information on the internet. Transitioning teens tend to be very anxious about telling their friends but are often pleasantly surprised at the acceptance and support they receive. There may be a few kids who make mean statements or ask inappropriate questions but, more recently, their friends tend to be more accepting, which I’m delighted to say. High school tends to be a more flexible environment. Many of the kids, although they may not be transitioning, may be experimenting with their own identities, becoming more gender fluid or androgynous. As a result of more understanding, the children who have been more marginalized historically seem to have more acceptance today.
My granddaughter asked me to come speak to her psych class in Nashville. I talked to 100 kids and asked for feedback and a lot of them said, “I don’t completely agree but I appreciate the information,” while others said “Absolutely, everyone should have the right.” So there’s a lot more openness at the high school level and Tennessee is a relatively conservative state so that was a really promising event for me.
Counseling schools: When would you visit the school of a transitioning child, and what would you do there?
If a school knows that a transitioning child is going to be coming to their school, then often the school will call me. But more typically the parents and the child, particularly if they are older, will go themselves to the school and tell them what they need to feel safe and welcome and then the school will call me. I encourage students and families to go and advocate for themselves.
I would want to find out what a school’s anti-bullying policy is, and what they would do in case bullying happens. My belief is that bullying is not to be tolerated at any level. It is extremely important that all children feel safe at school. That is a very important feature, particularly in the middle school years.
A number of children will transition during the summer time and then begin the next school year as the gender they identify. They may go to a different school where they want to be undisclosed. If they are at a different school and undisclosed, they may only tell a teacher for safety reasons, or they might not tell anyone. And they don’t have to. A student and their parents may feel confident they can take care of themselves.
Some of the older kids, if they are discovering themselves or declaring their gender identity as a junior or senior in high school, may decide to socially and physically transition in their high school because they want to enter college undisclosed. This requires not only socially transitioning but taking cross sex hormones so that their bodies will be congruent with their gender identity and with their peers. They want to have the opportunity to go to college as their authentic self and only disclose if that is their choice.
And what happens when a student starts the physical transition?
I talk to parents and schools about the different levels of development. What you typically see when they are 0-5, 5-9, 9-13, 14 and older. What are the developmental stages that kids go through during each of these periods of time.
For kids who start transitioning when they are younger, 1st  grade, 2nd  grade, 4th grade, when they move into puberty they have socially transitioned and are living as their authentic self but as they enter puberty, their secondary sexual characteristics are not going to align with their gender identity so puberty gets stopped with hormone blockers. This gives the child a period of time to be sure that the feelings they are having are concrete and congruent with how they identify. And if they decide to continue with the transition, they need to make the decision about what hormone they want. To maintain healthy bone development it’s necessary for the body to have either estrogen or testosterone in their system
So if a child identifies as a boy, and has been assigned female at birth, they may go on hormone blockers around 11 and then later on, when the family and the child feel comfortable and the doctor has determined that the child is physically ready, the child would go on cross sex hormones which means they go on the hormones that they identify with. So an identified boy would go on testosterone, and an identified girl would go on estrogen. Their bodies, except their genitals, would go through the puberty of the gender they identify with. Sometimes adolescents will make this change their last year of high school so that their body will change and they will feel more authentic as they move into college.
Let’s talk about younger children. What reaction do you see from parents who come to you with their toddler, and concerns about a gender crisis?
It’s hard for parents, especially parents with toddlers. They want their child to be happy and safe and to not to be bullied or feel left out. They have dreams for their child and these dreams are being challenged. When they think of their child being in these very uncomfortable situations, they really want this to just be a phase, especially for the youngest kids. With the really young children we primarily work with the parents. Affirmative therapy involves following the child, not pushing them or leading them but following them. By that I mean, let the child wear the clothes they want to wear, call them the name and use the pronouns they want to be called, let them play with the toys they want to play with, let them discover what fits for them. Does this cause anxiety for the parents. Yes, it often does, but I would rather have a happy child with anxious parents than an unhappy and depressed child.
But again, the thing to remember, all the way through this journey: social transitioning is reversible as are hormone blockers (when puberty is suppressed, a child does not masculinize or feminize). If a child decides not to transition into adolescence, no permanent decisions have been made. Only in adolescence when cross sex hormones are introduced are there permanent changes to the body. These decisions can be especially hard for the kids who are gender fluid (children who identify as both female and male or neither female nor male) They have to choose one hormone or the other. There is no combination of hormones.
How have you seen public attitudes shift over the years, and how can we continue to move forward with acceptance?
I would say when the term “transgender” became more public, attitudes started to change. There were television episodes, there were many more articles, there have been kids on talk shows. I would say the in the last four or five years, it’s moved more and more rapidly to a place where people are more educated about gender identity. At least today, most people know what transgender means.
There are many older trans people who would have loved to have had the advantages of coming out when they were younger but feared doing so. Our culture has been defined as a binary society for a very long time. If it is clear to a child at an early age that their gender identity will be severely disapproved of by their parents and society, then that child will start adjusting and try very hard to be what they are told they are supposed to be. They will try hard to fit it. Often this older generation lived in a state of conflict for much of their lives. If children are disapproved of but want approval from society and their families, they will try hard to please. Behavior may be able to be changed but their identity can’t be changed and may present the child with a lifetime of challenges. This is what has happened to so many adults who didn’t have the advantages these younger kids have.
One of the main and most important reasons for education in our schools and for society in general is to attempt to save the children that are not accepted in their families, in their spiritual communities, in their schools, or in their communities. The majority of the parents who come to see me are looking for help to understand what gender diversity means and to understand their child.
Because I’ll tell you what the main opposition seems to be, in my opinion: Opposition comes from not knowing. Not being educated. What transgender is, what it’s about, how long it’s been in our culture – which is forever. I think education should be in the classroom and on the news. Being transgender is here. It’s happening and I want people to understand. I want them to have the right information; I don’t want them to have the wrong information. All people deserve to have a safe and welcoming environment in which to live and it is my dream that our world will provide that for everyone.
Like when I went to Tennessee and one child wrote to me and said “It’s very hard for me to incorporate this in my own life and belief system but I appreciate that you educated me.” Another one said, “Thank you for this. I had no idea and I’m totally accepting and everyone should be who they want to be.” It just needs to be out there so people know what we’re talking about.
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