Beyond the Binary: Trans‐Negotiations in Couple and Family Therapy

• DOI: http://doi.org/10.1111/famp.12167
• Published date: 01 September 2015
• Date: 01 September 2015
• Author: Shawn V. Giammattei

Beyond the Binary: Trans-Negotiations in Couple

and Family Therapy

SHAWN V. GIAMMATTEI*

,†

Dualistic notions about gender and sexuality have permeated the field of couple and fam-

ily therapy. These binary constructions have been limiting for everyone, especially those

who fall outside the male/female dichotomy. This article examines the impact of these bin-

ary notions, especially on transgender and gender-creative individuals, couples, and fami-

lies. Current theory and research in the field as they relate to gender identity, sexuality,

and gender minority stress in couples and families are presented. Case examples are used

to illustrate affirmative approaches to treatment issues such as coming out, safety, grief

and loss, redefining relationships, and social/medical transitions that may arise for trans-

gender or gender nonconforming (TGNC) individuals, couples, and families.

Keywords: Gender Nonconforming; Transgender Aging; Transgender Couples;

Transgender Families; Transgender Parents; Transgender Relationships; Transgender

Youths

Fam Proc 54:418–434, 2015

The field of couple and family therapy, like much of the world, has become trapped in

dualistic notions of gender. In couples therapy, we talk about same-sex or opposite-sex

partners. On rare occasions, we contemplate those who are bisexual and have relationships

with both men and women, but where does that leave those relationships where one or

more of the partners does not identify as male or female? What labels do we use to describe

these relationships? Furthermore, what are we actually describing with regard to gender

identity, roles, etc., when we stick to binary constructions? How much do we miss in the

nuances of couple dynamics or family processes when trapped in these constructions? How

does this impact our children who do not conform to the societal expectations for their birth

sex? It is time for us as family therapists to deconstruct these notions, not only for TGNC

clients, but also for all of our clients and families who are trapped by gender straitjackets. I

am not proposing that we throw out our constructs but rather that we expand our frame-

works to include the diversity of identities and experiences that may be possible.

Although a majority of people across cultures and contexts experience something closer

to a binary construction of gender, sexuality and gender are not so cut and dried for any-

one. In terms of sexuality, it seems that a primary reason for condemning diversity in sex-

ual orientation is that anything falling outside of a traditional heterosexual orientation

challenges gender norms (Gordon & Meyer, 2007); it is not uncommon to hear anti-gay

rhetoric that proclaims that LGB people are not “real” men or women (Giammattei &

*Online Certificate Program in LGBT Mental Health & Human Services, San Francisco, CA.

†

Rockway Institute for LGBT Psychology, California School of Professional Psychology at Alliant International

University, San Francisco, CA.

Correspondence concerning this article should be addressed to Shawn V. Giammattei, Ph.D., Rockway

Institute for LGBT Psychology, California School of Professional Psychology at Alliant International

University, One Beach Street, Suite 100, San Francisco, CA 94133-1221. E-mail: sgiammattei.rockway@

alliant.edu.

418

Family Process, Vol. 54, No. 3, 2015 ©2015 Family Process Institute

doi: 10.1111/famp.12167

Green, 2012). These binary notions are simplistic and very limiting for everyone,

especially for those who fall outside the gender binary.

To approach work with TGNC people, one must understand the natural diversity of

gender and sexuality in human experience as well as what clinicians will invariably

encounter in their work with such individuals and their families (Coleman et al., 2011).

Across most cultures, the majority has a tendency to fear and discriminate against those

who fall outside of the cultural standard. Yet, when one looks at the natural world, diver-

sity is actually the norm (Roughgarden, 2004). It appears that what is naturally occurring

is much more fluid and expansive than languages represent and most societies accept.

In most cultures, there is limited language or none for describing people who fall

outside this binary construction of gender. For example, there is the word Mahu in Polyne-

sian culture (Roughgarden, 2004), and some Native American cultures have words for the

concept of being Two-Spirit (Williams, 1986), which both describe all who do not identify

as their assigned sex at birth, play out gender roles opposite their assigned sex, or are

attracted to same-sex partners (Roughgarden, 2004). Yet these terms do not fit for man y;

nor do they describe the nuances that distinguish one gender identity from another.

Transgender is a similar term and has distinctly different meanings depending on age

and context. For adults, transgender is an umbrella term that encompasses a wide range

of gender expressions and identities: Female-to-Male (FTM), Male-to-Female (MTF),

agender, bigender, cross-dressers, drag kings/queens, genderqueer, etc. (Lev, 2004).

Despite this, many therapists confuse the term with the older, more clinical term, trans-

sexual. Although transsexuality falls under the transgender umbrella, it certainly does

not describe all, or even the majority, of people who actually identify as transgender. In

fact, many of those who have physically transitioned from one sex to another may no

longer identify as transgender but as their affirmed gender; and they too may also identify

with a binary construction of gender (Lev, 2004). For clinicians working with trans chil-

dren and adolescents, transgender usually refers to youth that meet the DSM-5 criteria

for Gender Dysphoria (GD; American Psychiatric Association, 2013) and have a strong

desire to live in a different gender than the one assigned at birth. Children who do not

meet the DSM criteria for GD but express their gender in ways that do not conform to

society’s expectation for their assigned sex at birth are usually referred to as gender

nonconforming (GNC).

Under the transgender label is a complex and ever-changing range of identities, expres-

sions, and naming systems that show the fluidity and diversity found in the community

(Beemyn & Rankin, 2011). TGNC youth, in particular, tend to use more fluid and spacious

terms to refer to themselves, such as gender queer and gender expansive. Many in the

community find the term transgender too limiting and have moved toward using the terms

Trans*or Trans as an umbrella term when referring to the whole community. This article

uses the term trans to be as inclusive as possible, and the term trans couple to describe all

couples with one or more partners whose gender identity falls under the trans umbrella.

1

Despite outward appearances, trans couples may identify themselves as such or some-

thing else.

Obviously as a clinician, one can never know how a client identifies or what language

they use to describe themselves unless you ask. If you assume nonbinary constructions of

identity, you may offend a trans person who identifies with the binary; and on the other

hand if you only hold two options, your client may feel misunderstood or rendered invisible

(Malpas, 2006). It is good practice to ask clients their name, pronoun, and gender descrip-

tion, as well as honoring their language when interacting with them or discussing their

1

Definitions for italicized words can be found in the glossary (Appendix A) following the references

section for this article.

Fam. Proc., Vol. 54, September, 2015

GIAMMATTEI

/

419