I was busy working on a behavior plan for a very fidgety 6th grade boy when I heard an assertive knock on my office door. This was the third time this week Sally had left class without permission to come talk to me.
“Ms Ayad, how can I transfer schools? I really don’t think I can get a proper education here and none of the teachers know what they’re doing”, so began our 45 minute conversation.
She often got fixated on one or two teachers, who despite their best efforts, could not find a good way to work with Sally. I had a very different relationship with her though, and I was able to help her work through some of her generalizations and logical leaps. Her hair was always pulled back hastily in a low ponytail, the eczema around her mouth, though visible, wasn’t as noticeable as the smudges that covered her glasses - she pushed them up from the lenses every time. Often a curious little smirk would lift the corner of her mouth, even when she was clearly upset or discussing something serious.
She is one of those kids who teachers were often exacerbated by, and student were often laughing at, but I got to see her in a different light; and I found her endearing, creative, and incredibly interesting. Once we were able to conclude that switching schools was not the best option, and I taught her some self-regulation skill using a squeeze ball, it seemed she was much more at ease. She took a deep breath and said “Ms Ayad, can we talk about that other thing now?” “You mean gender?” I replied. She nodded.
Sally and I had been talking for the last several months about her recently questioning her gender. When she first brought this up to another counselor, they referred her to me, knowing that I am experienced and confident in working with kids around this topic. However, Sally had certainly been exploring this issue online for months when she brought it to the attention of her school counselors. Our first conversation on the topic made it clear that she had a broad vocabulary which reflected the growing list of identity labels promoted by some online sites like Tumblr and YouTube. My approach was patient, curious, and inquisitive. When she talked about her parents pressuring her to wear dresses and “act more like a girl," I asked her to share what she thinks, what types of clothing she prefers, and what she likes about her current style of dressing.
When she told me, weeks later, that she was looking for binders online and asked me to stop using the pronouns “her” and “she”, I decided to take things slow. I asked her where some of these ideas were coming from: she was spending hours on tumblr, trans-advocacy sites for teens, and chat groups with other kids who encouraged one another to follow certain steps in "coming out". She described many stereotypes about girls and boys and pointed to those as her validation for the new gender identity she was exploring. When discussing all of the ways she doesn’t conform to gender stereotypes, I avoided implying that she’s in the wrong body. We talked about her love of manga comics, her cargo pants, her disdain for dresses and “girly” clothes. In my eyes, I told her, these cool hobbies made her a unique and interesting person. Hearing those compliments always brought that endearing little smile to her face.
Regarding the binder, I continued to proceed carefully and supportively, but I did tell her about the medical risks of binding and what the long term consequences can be for some people. Our time-limitations in the school system made it challenging to inquire more deeply into her sudden decision, but in every brief interaction with Sally, I found ways to empathize with her struggle, instilling pride in who she is, and companioning her in this new exploration.
Eventually, as her classroom behavior improved, her anxiety lessened, and she started making friends, she relied less and less on me for support that year. Several months passed and before I knew it, the school year was coming to a close. I wanted to follow up with Sally, so I pulled her from her PE class and we talked outside on a particularly nice, sunny afternoon. I started with, “Sally, I’ve missed you, how are things going? It seems like we haven’t talked in forEVER!” A huge smile emerged on her face, and since her glasses were less smudgy than normal, I could actually see that her eyes were smiling too. “Doing great! I’m getting along better with Ms Barnay and I haven’t been walking out of class when I feel frustrated”. We talked about the anime club, her plans for summer, and how her other classes were going. She paused, looking ready to tell me something that meant more to her than academics. “Ms Ayad, remember how we used to talk about gender a lot? Well, I’m kinda over it”. “Ok, tell me what you mean by ‘over it’, Sally”. “Well before, when I didn’t have any friends at school, I was meeting a lot of people online and I thought they were my friends. Then when I actually started hanging out with people in real life, things felt different. Before, I really wasn’t comfortable with myself so I felt like I needed to change. But now, I’m ok with myself”. I nearly fell off the bench. This was one of the most profound realizations a therapy client can make - and she, even in her young 13 year-old body and mind, came to this conclusion by herself: “I really wasn’t comfortable with myself, so I felt like I needed to change. But now I’m ok with myself”.
I was grinning from ear to ear by this point. I told her how incredibly proud I was, that I was so happy she was feeling good about herself. Over the summer I thought often about Sally’s story. While she turned things around largely on her own, I can’t help but wonder how things might have unfolded had I had abandoned the nuanced and holistic approach to working with teens. By remaining curious and neutral, rather that rushing her to change her identity and start binding, I wonder if we left some doors open for her self-compassion to take hold. Perhaps our introspection allowed her to develop greater insights about the origins of her gender-questioning. Kids are dynamic, different, and unique. But they also have insecurities, self-doubt, and are vulnerable to finding “solutions” in the wrong places.
When a teenager feels isolated and misunderstood, trans-advocacy sites might play a role in convincing that a new identity is the answer they are looking for. While this is certainly not the case for all trans-identified teens, taking a slow, holistic approach can safeguard kids who wouldn't benefit from a trans-identity or medical transition. Being OK with herself seems like a pretty good outcome for Sally. *The names in this story have been changed to protect the identities of the people involved.