You Specialize in What???: 5 Things My Trans Clients and Pregnant Clients Have in Common
by Heather Branham, LCSW

People sometimes look perplexed when I tell them about my two main counseling specialties: working with transgender clients and treating folks who are pregnant or postpartum. The conversation often goes something like this:

New Friend: What kind of work do you do?

Me: I’m a therapist in a group counseling practice. We focus on family-building and supporting folks through the transitions of pregnancy, postpartum, and parenthood.

New Friend: That sounds great!

Me: It is! Ariel works with a lot with infertility and the adjustment to parenthood. Elizabeth has specialized training in couples counseling and birth trauma and loves working with new parents.

New Friend: That’s awesome!

Me: I work mostly with transgender clients - trans kids, couples, adults beginning transition - and folks who are struggling with depression and anxiety during and after pregnancy.

New Friend: [gears turning, quizzical expression] Huh...that is interesting.

Don’t get me wrong, no one has ever been rude when I give my elevator speech - just a bit befuddled as to how my specialty fits into our family-centered group practice. I think most of the confusion comes from a common assumption that transgender people can’t or don’t get pregnant (not true!). What can follow from that assumption is an expectation that trans people are somehow separate or excluded from family-building. The oft-repeated narrative of a person coming out as transgender and being shunned by their family and living a life of isolation contributes to these assumptions. Many of my trans clients have internalized these messages themselves and wonder how they can maintain or build the families they desire. While it is true that the vast majority of my trans clients are not coming to me because they’re struggling with mood disorders related to pregnancy, I find that my trans clients and my pregnant/postpartum clients have much more in common than you might think. Here are a few areas of overlap that I see almost every week:

  • Experiences of transition - The most basic commonality that my trans and perinatal clients share is the experience of being in transition. Whether we’re talking about a transition from one gender expression to another or the reality of incorporating a new baby into their body and their life, almost all of my clients are moving through some sort of transition. I’m reminded of the words of Maya Angelou, “We delight in the beauty of the butterfly, but rarely admit the changes it has gone through to achieve that beauty.” Changes to a body, a relationship, or a family system are rarely easy and my trans and perinatal clients know this all too well. Transitions are often stressful. The amount of support you have during a transition can make all the difference in how you view the changes you are going through.
  • Expert guidance - The number one thing that my trans clients and my perinatal clients are looking for when they first reach out is expert guidance in navigating the specialized terrain of their transition. They want to know about local resources - knowledgeable medical providers and healers, support groups, the best places to make connections with others who are on a similar journey. Perinatal or trans, the question are the same: Who around here gets what I’m going through? Who can help me without alienating or judging me? Can you please put me in touch with them?
  • Non-judgmental support - One of the reasons that both these categories of clients are so eager for guidance toward knowledgeable, compassionate providers is that all sorts of people want to tell trans folks and pregnant folks what to do with their bodies. Tell someone that you’re pregnant or transgender and just wait for the unsolicited advice to start rolling in. You should have a natural birth. You should schedule a cesarean. You have to breastfeed. Breastfeeding is impossible. You shouldn’t [fill in the latest guidance on what’s dangerous in pregnancy]. Why would you do that to your body? You should wait until you’re older. You should have done this when you were younger. Are you sure this is the right time? Aren’t you ruining your chance to have a family? My trans and perinatal clients want support in navigating the questions that are important to them in order to come to their own answers in their own time using their own values - without the judgement of a culture that treats trans and pregnant people like their bodies are public domain.
  • Hormones, hormones, hormones - Though the details are different, my clients rely on me to understand and explain the role of hormones and hormone fluctuations on their mood and functioning. Hormone therapy and pregnancy aside, the stress of gender transition or new parenthood can wreak havoc on a nervous system and contribute to hormone imbalances that negatively affect mood. Sleep is especially important to healthy nervous system functioning, something that new parents get all too little of. My trans clients are prone to sleep disturbances resulting from the anxiety or depression that living in a transphobic culture can create. These symptoms are often what brings my clients in the door, and our work together usually includes a focus on regulating hormones, reestablishing healthy routines, and expanding their toolkit of positive coping strategies.
  • Family focus - Not a day goes by when I don’t talk to at least one client about how to deal with a complex situation with their family. Some days this is all I do, no matter what my clients’ original presenting concerns were. Lucky for me, this kind of work is my favorite. I’m a huge geek about how we can heal from the wounds of our less-than-perfect early childhood experiences and begin to love ourselves enough to create meaningful relationships with the people we choose to call family today. For my trans clients, this often means unpacking the transphobia they internalized in an unsupportive family. Or patiently waiting for their family of origin to catch up to the changes they are undergoing so that their relationship can move forward. For my perinatal clients, adding a baby to the mix can bring up a myriad of conflicting emotions, including sadness about the inadequacy of the parenting they received and fear that they will repeat the damaging patterns of the past. Again, the details are different, but I hear the same questions in the explorations of my clients around family: Am I worthy of love? Am I capable of relating to others in a loving way? Can you help me figure this out?

One of the most beautiful things about the work I get to do every day is that I see how very much the same we are when we’re at our most vulnerable. No matter the type of transition they are faced with, all of my clients deserve a knowledgeable, affirming, non-judgemental companion for their journey. I feel grateful when they choose me.

Heather Branham, LCSW, a therapist based in Asheville, NC, specializes in helping individuals, couples, and families navigate the complexities of gender, sexuality, and family-building.