While Gender Identity Therapy Can Help, It Can’t Fix Systemic Oppression
Transgender Day of Remembrance is a day where we honor the lives that were lost to anti-trans violence. It’s a time to not only mourn the losses, but to also advocate for systemic change for transgender and non-binary people. As a queer therapist offering gender identity therapy in Philadelphia, I want to name how heavy the world has felt, especially in these past two years. Grief is something that comes up a lot in my clinical work, especially related to body image and disordered eating. Body positivity doesn’t always resonate with trans people and can feel dismissive to the feelings of incongruence that come with gender dysphoria. It can feel like another binary system where there is a right or wrong answer. Body grief is a framework that can feel more relatable because it inherently validates the difficult feelings that come when your body changes. It allows space for fluidity and nuance in a compassion way.
Before I dive in, I want to acknowledge that as a white cisgender therapist, I hold a lot of privilege in how I move through the world. From the perspective of someone who is a trans ally and a therapist who provides gender-affirming care, I wanted to write about this topic because I care deeply about it. However, there will always be natural limitations to my perspective even with my best efforts.
What is body grief?
Body grief is the sense of loss that comes with changes to your body that feel beyond your control. Chronic health issues and aging can bring new changes to your body, which can lead to a sense of loss over how your body previously looked and functioned. Perhaps you’re dealing with weight gain, and you worry that you won’t live up to the impossible beauty standards imposed by our society. If you’re trans or non-binary, there can be grief around certain aspects of your body not aligning with your gender. You might want to pursue medical transition but there might be barriers to accessing it. Perhaps you do have access to gender affirming options, but there are still aspects of your body that you can’t change. You might be thinking about voice feminization lessons, but don’t have the time to work on it as much as you’d like. If you’re trans masculine, you might be dealing with weight changes from starting testosterone therapy. Maybe you want to heal from disordered eating but feel like recovery conflicts with your gender goals. Your body grief might be more intense having to navigate a world that is oppressive and hostile to who you are.
From feeling unseen to feeling like a target
The systemic barriers that our society has in place might cause you to feel both invisible and heavily scrutinized. Transphobic policies are targeting bodies at their core from control over bathroom use to insurance coverage for gender-affirming care. Society’s attempt to control and silence trans people has manifested in violence and medical gatekeeping. The lack of inclusive language in paperwork at the doctor’s office places the burden on trans people to educate their providers. Bathrooms continue to be a talking point in politics and name change is costly and requires many administrative hurdles to overcome. Some trans people constantly feel vigilant about who is in their surroundings to feel safe, causing them to live in a constant state of stress.
When Gender Transition Brings Up Complex Feelings
While gender transition can bring you closer to your true self, there can be some unexpected grief that comes up around your body. You might miss aspects of your pre-transition body or compare yourself to thin, younger trans people. Transition can alleviate gender dysphoria, but it may not fully eradicate it as some aspects of the body cannot be changed. There can be grief around lack of representation in the media, especially for BIPOC trans people in larger bodies. You may find that societal standards hit you even harder because there is this pressure to justify your gender all of the time.
Grieving Societal Pressures and Anti-Trans Narratives
I want our society to be better for trans people in so many ways. While I’m cis, I sit alongside trans loved ones and clients as they are navigating their own grief. There can be a sense of mourning over the way we have been conditioned to feel about our bodies and yearning for a world that feels safe to exist as who we are. How would we feel about ourselves if society were supportive to gender expansiveness? I imagine there could still be complicated body feelings, but there wouldn’t be this extra layer putting so much pressure on everyone to fit in.
Recognizing the Impact of Cisnormative Expectations
Sometimes body grief can relate to wanting to pass as cisgender in society. The pressure to pass may relate to your gender goals and a way to feel safer as you navigate public spaces. The desire to pass can sometimes lead to feelings of disappointment over body changes that are not accessible. Binary gender standards can impact your self-worth and undermine the joy you experience in your gender. Acknowledging the impact that cisnormative expectations have on your body image can help you separate them from your true self. Instead of not feeling good enough, you can direct some anger towards these systems while also validating that it feels hard. Seeing a misalignment between your values and transphobic narratives can be another way to feel less controlled by them. While other peoples’ expectations will always be there, they don’t have to dictate how you live your life.
Body Grief as a Form of Self-Compassion
I like the concept of body grief because it validates the real struggles that you might have about your body. Body grief isn’t trying to change your feelings nor is it forcing you to love your body. It basically says it’s okay to not feel great about your body, while helping you come to a place of acceptance. It aligns with aspects of body neutrality which can make it feel more accessible. Giving yourself space to feel your emotions around your body may not change how it looks or functions, but it can bring you closer to a sense of peace. Books like This is Body Grief by Jayne Mattingly can be a great resource to understand body grief, especially for queer and trans people.
Ways to Process Body Grief
As an art therapist, I can’t help but recommend creative outlets like writing or drawing to process these complex feelings. Creativity is a way to go deep in your feelings while also finding a space to release them. Activities like playing music, listening to music, dancing and singing all release emotional (and physical) energy. Being in community with other trans people will help you feel less alone with your grief. It can look like talking to one trusted friend or going to an event to do something fun. Sometimes engaging in body appreciation reflection can be helpful where the focus is on the ways your body shows up for you. There are a lot of journal prompts that can help you explore body appreciation. Dr. Sand Chang’s All Parts Welcome is an IFS workbook for queer and trans individuals. Chang’s book can help you explore different aspects of your identity through parts work. They even have a chapter on how it all relates to the body.
When Gender Identity Therapy Can Help
Body grief can be intense, and therapy can be a space to sort through these complicated feelings in a safe space. A gender-affirming therapist who specializes in body image therapy can create a non-judgmental space where you can be honest about your feelings related to your body. I incorporate art therapy and IFS to help you tap into your own creativity and connect to your emotions in a deeper way. I love using IFS to help people identify their own inner critic and the self-beliefs that may have come from oppressive systems. IFS and art therapy can give form to these self-beliefs by externalizing them so we can get some space from them. It can help you move away from the thought, “what is wrong with my body?” to “I’m having a hard body image day.”
As a queer cis therapist, I’ll never know what it feels like to walk in your shoes, but I do my best to remain open to your unique story and remain aware of the common struggles you may face. I maintain ongoing awareness of how my identities may impact the work we do and always remain open to exploring that if it feels right for you.
While therapy can’t erase body grief, it can help you learn to live alongside it and find ways to live life with more self-acceptance. If you’re looking for affirming support around body grief, I’d love to connect and see if we’re a good fit. You can reach out by scheduling a 15-minute phone or video call.
