Surviving Anti-Trans Legislation: A Psychological Perspective

June 1, 2023
Trans Mental Health
By Concerned Members of the PAU Community
It’s Pride month, and the final quarter of the academic year, a time when we should be preparing students for their next clinical training site by reinforcing the importance of timely documentation and good foundational therapy skills. Instead, with rampant anti-trans legislation being introduced across the country threatening the state of evidence-based, gender affirming care, we find ourselves preparing them for a career in which it is increasingly likely they may have to choose between scientific integrity and safety. After all, many of the bills being introduced make following the recommendations of the American Psychological Association, American Psychiatric Association, American Medical Association, World Health Organization, and World Professional Association for Transgender Health, a felony. We know how to teach gender affirming health care here at Palo Alto University. We have done so in different capacities for many years. We know less about how to teach young graduate students ways to prepare for the reality that they may be asked someday to choose between our ethical code, which asks them to “promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology,” and unjust legal consequences. What’s worse, is that many of our students identify as members of the communities being targeted, meaning that, in addition to the increasing dangers inherent in practicing evidence-based care, their basic human rights are in jeapardy. 
Since January of 2023 alone, 549 anti-trans bills have been introduced in the US, more than any year prior. Many of these bills focus on limiting or preventing access to comprehensive, high-quality, safe psychotherapy and other health care, by making the care itself a crime. Other bills seek to pressure clinicians out of the field by limiting the reach of our liability insurance if we are litigated against in cases involving gender affirming care. If these bills are successful, they will become an unprecedented challenge to the integrity of our field--lawmakers and special interest groups, not doctors, deciding without the proper training and qualifications, what care Americans can and cannot receive, as well as what care actual trained professionals, like the graduates of Palo Alto University, can and cannot provide. Whether or not you identify as transgender or gender diverse, that should absolutely terrify you. 
It goes without saying that this slew of proposed legislation also has a direct impact on the mental health of our clients at Palo Alto University’s Sexual and Gender Identities Clinic, a training clinic which provides low cost, sliding-scale mental health services to LGBTQ+ people, under expert supervision. As one student therapist put it, “there is no guidebook for our clients dealing with this. We become their guidebook…we are helping them access care knowing they are likely to face discrimination, and we have to just guide them through it.” Data suggests that anti-LGBTQ+ legislation is associated with mental health concerns such as anxiety, depression, and suicide, as well as increased calls to crisis lines. Anti-trans legislation and anti-trans violence also disproportionally impacts Black, Indigenous, and People of Color (BIPOC) and their communities. We see this at SGIC, even when legislation is proposed or passed in other states. 
We call this minority stress, the building up of stressors from belonging to a minoritized group that often results in poorer physical and mental health outcomes. Traditionally, many approaches for mental health care focus on challenging maladaptive thoughts and beliefs about the world that drive our behaviors and social relationships, or otherwise addresses the root causes of distress. In the case of minority stress, the belief that the world is inherently unsafe is difficult to challenge, especially as anti-trans legislation and rhetoric increases. It is difficult to challenge the belief that the world is unsafe when it is actually quite unsafe in many regards. Likewise, it is difficult to challenge the root cause of distress when said root is society at large. Thus, traditional psychotherapies must be adapted to better address these realities, while also still seeking to reduce overall distress. This is what we are teaching at PAU and SGIC--how to adapt care to more fully meet the needs of trans and gender diverse mental health care consumers. We are proud of this work, but we wish it were not necessary. 
Without undermining how truly dire and concerning this legislation is, we believe it is important to underscore that there are things therapists and mental health care consumers alike can all do to lessen the impact these bills have on individual and communal mental health. Below are some suggestions. 

Read beyond the headline

News headlines are intended to pique interest in an article and draw in readers/viewers. This means that they can sometimes be sensationalized and misleading. Reading a full article or watching a full news clip can help give important context. For example, a headline may imply that a particular piece of legislation has already passed, when it may still be in a stage where constituents have a right to challenge relevant lawmakers. 
When legislation has passed, reading beyond the headline also means reading the legislation itself. Often, headlines will focus on the worst-case scenario of a law, and not the most likely outcomes of a law. In many cases, organizations like the ACLU and Lambda Legal will also litigate anti-trans legislation in ways that may keep it from going into effect immediately, or even overturn it altogether. All this is to say there are a lot of steps between proposed legislation and direct threat to the health and safety of those impacted by the legislation. Knowing how imminent the threat is can help us ground and better address our available options to maintain our safety. 
Sometimes, news stories also call something legislation that isn’t a law. For example, legal opinions and directives, while somewhat enforceable, don’t hold up to the same scrutiny as an actual law. Knowing the difference is important because it impacts yours and other’s individual rights. 

Learn how to spot propaganda

Propaganda is information, often labeled as objective, in traditional or social media, that is actually biased and intentionally misleading to further a particular cause or agenda. This is different than a misleading headline in that most or all of the content is specifically intended to be misleading. Drs. Paul and Elder describe in detail how to spot propaganda, and why this is important in modern media. From an individual mental health standpoint, it is important to spot propaganda because the tactics used to manipulate an audience are meant to trigger strong emotions. Some of those emotions are unpleasant emotions, like fear, sadness, anger, or shame and guilt. In the case of minority stress, those emotions can become internalized, leading to those poorer physical and mental health outcomes previously discussed. Being able to spot that something is propaganda, like reading beyond the headline, can help us ground and reassess the salience of a potential threat.  

Limit news consumption

While it is important to stay informed, it is easy to keep consuming news about anti-trans legislation in a way that becomes ruminative. Rumination is when we entertain a thought over and over to no useful end. It can feel useful in the moment as a way to assess and maintain safety, but it usually occurs without any action towards safety behaviors, and just leaves us feeling more unsafe. Limiting news consumption helps reduce rumination. Strategies for reducing news consumption include 1) limit the amount of time spent consuming news, 2) limit the number of stores you engage with, 3) avoid reading the comments section of news posted online, 4) stop reading/watching news when there is no new information to learn-when stories and facts become repetitive, 5) try reading instead of watching news, in reading you may be more able to notice you our own emotions rather than drawing on the affect of the person you are watching, 6) curate your social media to limit the news you see by using various settings to temporarily silence or permanently block what you don’t want to engage with for mental health reasons, and 7) consume news from suicide crisis resources like Trevor Project or TransLifeline- organizations like these will share news on social media but are more attuned to sharing in a way that promotes psychological wellbeing and self-care. 

Call or text a crisis line

Speaking of crisis lines, call or text a crisis line if you need to! Crisis lines are for more than just suicide prevention. TransLifeline, for example, is a general crisis line for trans people by trans people. It can be utilized in case of a psychiatric emergency, but it can also be utilized to prevent a crisis altogether. TransLifeline is unique in its mission to not involve police in psychiatric emergencies and is an excellent resource for those who have concerns about forced hospitalization or police intervention. Other crisis lines include:
Trans Lifeline (877) 565-8860
Trevor Project (866) 488-7386
Veterans Crisis Line Dial 988, the press 1 

Take action

Part of what makes news about anti-trans legislation feel scary is the lack of power and control we can feel as a result of reading it. One way to counter this is to do what we can to take action. Many actions, like signing a petition or contacting your representatives, can be done without even leaving your home. Some actions include community, such as protesting or volunteering, which can also help us feel more supported and less alone. 

Feel your feelings

It is important to counterbalance taking action with feeling our feelings in ways that does not overwhelm us. Taking action, and other behaviors, can be a great, momentary distraction, but emotions have a way of sticking around. Finding ways to feel and sit with our feelings can help them pass naturally. This is a major component of a lot of mindfulness and meditation practices. Psychotherapists often utilize mindfulness techniques specifically for this purpose. Outside of psychotherapy, yoga and other similar practices may also be helpful in this regard. 
Another important aspect of feeling your feelings is to recognize well-intentioned gaslighting. This occurs when people around us try to minimize the impact of anti-trans legislation in an attempt to self-sooth or make us feel better. It’s usually well-intentioned, but it misses the point and can ultimately leave us feeling isolated or misunderstood. It can be tempting to double down and try to convince others that this is really serious and scary. While there is a place for that in activism and advocacy, it’s also important to make room to validate our own feelings. It is often worth examining our behaviors and whether those are values-aligned, but our emotions are always valid. We cannot control those. If you are attempting to comfort a trans or gender diverse person, be careful not to engage in well-intentioned gaslighting yourself. For example, it can often be more helpful to create space to acknowledge the very real threat while asking what steps (e.g., emotional support, reassurance, etc.) a person would find helpful in the moment.

Find or create a safe space

Since the fundamental disruption caused by anti-trans legislation is a feeling of unsafety, it’s important to find or create safe spaces. A safe space can be a support group, community gathering, informal group of friends, a single person you trust, a therapeutic relationship, or even just the physical space you create around where you live. It’s easier to do things like feeling our feelings when we can create a feeling of safety, even if that safety is only in a single moment in time. 

Look for allies

Looking for allies is a way to build hope and to feel more empowered to take actions towards increased safety. This can mean looking for people in your life who can serve as personal allies or looking to public figures who are expressing support. In the case of anti-trans legislation, this can also mean looking for allies who are actively in our corner and fighting for the rights of trans and gender diverse people, those who go beyond support and take action. 

Engage in self-care

Self-care sometimes gets misunderstood as ‘things you need to spend money on’ like spa days that are not accessible to everyone. Engaging in self-care, however, literally just means taking care of your needs. If a spa day does that, and it’s accessible to you, then spa day away! If that’s not a viable option though, self-care can really be as simple as making time to eat, drink water, sleep, etc. It can even mean just taking a small break in the day to take a few deep breaths. Stress has an impact on a lot of our bodily functions, and vice versa. Taking care of our basic needs often helps us feel more emotionally grounded and ready to continue our efforts to improve the world around us in our personal and professional lives. 

Look in the mirror (your existence is a radical act)

Sometimes, all the things listed above can seem overwhelming to even consider. In that case, there is one action that is relatively easy, which is to simply exist. Your existence, especially if you identify as trans or gender diverse, is a radical act that is worthy of celebrating. Anti-trans legislation, at its root, seeks to delegitimize or erase the existence and histories of our communities. So, no matter how you exist, no matter your specific gender identity or expression, simply continuing to exist in defiance of who that legislation tells you not to be, is a radical act. We don’t mean to downplay how painful it can be sometimes to just exist, but there is also euphoria and resiliency to be found in existence.  
Whether you are a therapist, mental health consumer, or loved one of a mental health consumer, we hope that you will consider these ways to mitigate stress caused by anti-trans legislation. Most of all, this pride month, we hope that you will also take some time to breathe and celebrate LGBTQ+ individuals and communities. Pride started as a means to show up and counterbalance the same kinds of threats that exist in the anti-trans legislation that is being proposed today. Pride month has always been about this. 

Bonus Material

In honor of Pride Month, PAU Director of Alumni Relations Chloe Corcoran and alum and U.S. Navy Lieutenant Nicholas Grant, PhD, sat down for a video conversation. They shared their experiences as national leaders in the LGBTQIA+ community, and offered messages of wisdom and hope. Read more, and watch, here.