Erica Kitzman interviews Devin Pinkston, MA, NCC, LPC Gender & Mental Health Therapist
EK: Hi Devin, and thank you so much for agreeing to this interview. I appreciate your care for, and advocacy on behalf of, people whom others often treat poorly. How did you become interested in gender therapy?
DP: I became a gender therapist after involving myself first in LGBTQ+ counseling during my internship when I was still in graduate school. During that time I was an intern in Indiana at an office where they held an LGTBQ+ support group each week. I thoroughly enjoyed my time in that group and saw a lot of myself in others. I also identify as bisexual and have many family members and friends who are a part of the queer community, so getting involved in counseling for this specific community was important to me on many levels.
EK: You're a gender therapist. Before I met you I'd never heard of gender therapy. Is this a new area of psychology?
DP: I don’t know the exact history of gender therapy, but it is a new field in psychology and counseling. Currently there are no specific national or state certifications or requirements for someone to call themselves a gender therapist. There is a certification that can be obtained through WPATH (World Professional Association of Transgender Health) that certifies you as a knowledgeable provider in all things trans related. It is still not required with any national licensure. I am not certified with WPATH as of yet, as their certification process is long and requires continuing education credits. However, to be considered a true gender therapist you must be competent in the unique challenges transgender individuals face as well as understand your state laws about transgender health, local LGBTQ resources and providers, and WPATH standards of care.
EK: If you could tell the world three things about gender therapy, what would they be?
DP: Acceptance, Safety, Compassion.
EK: Are differently gendered people mentally ill?
DP: No they are not. And to clarify, gender and sexual orientation issues were removed from the World Health Organization as mental disorders in early spring of 2019. They were re-classified as sexual health issues instead to reduce the stigma. People who are differently gendered can still be diagnosed with other mental health concerns though just like any cis gendered person.
EK: What are some of the unique challenges faced by transgender people?
DP: Shopping for clothing in public spaces, correcting others when they misgender by name or pronouns, looking into the mirror at themselves every day, and even when dressed or expressing themselves the way they want there can still be this persistent feeling of discomfort which stems from societal judgement about how a person should look and appear. Those are just some of the main challenges.
EK: What is it about looking in the mirror that causes problems?
DP: They’re seeing features and aspects of themselves that don’t align internally. A mirror reflects breast or facial hair development, rounded or sharp features, musculature, etc. which are sometimes at odds with what they wish to see. A mirror reflects reality, and a mirror reminds a person. When we aren’t looking in a mirror we forget how we look. Some people prefer to shower in the dark and avoid mirrors completely.
EK: How is this different from mirror distress experienced by cisgender people?
DP: When cis people look in the mirror, we see what we expect. Just imagine if every time you looked in the mirror and someone else looked back.
EK: Is it similar to the dysphoria that a burn victim might feel?
DP: That’s a good question. I’m not sure I can speak to that really. I think it would depend upon what kind of burn a person had, how identified the person is to their original look, and which areas were affected by the burn.
EK: Dysphoria was recategorized as a sexual health category, so it’s not a mental illness?
DP: Correct, gender dysphoria is not a mental illness. It is categorized as a clinical diagnosis so that people can get medical care.
EK: Do your patients come to you for the same kinds of problems that other therapists treat? Or do you only deal with gender issues?
DP: Yes, I don’t just see people for gender therapy or LGBTQ+ issues. I also see people for depression, anxiety, couples issues, intimacy/sex counseling, trauma and other life issues.
EK: Several years ago, through a niece’s marriage, I became related to a young transgender woman. I remember being concerned that I would do/say something to hurt her feelings. How would you have advised me?
DP: Typically when parents or family members come into my office and they want to help their family member, I first ask them what their base knowledge about the queer community is. If there is limited knowledge we start with basic information building-what certain terms mean, allowing them to ask questions they feel aren’t “politically correct” but aren’t sure how to phrase, providing local resources if necessary, and informational websites.
EK: Luckily, One Colorado offered a transgender education symposium in my town that same year which I attended with another family member. How important are educational events for a community and how often would you like to see these events take place.
DP: Community educational events are very important! If it’s something that’s open to the public it also gives people an ‘excuse’ to attend without the same amount of fear. Community events also help highlight that the topic are excellent for helping people recognize that they’re not alone.
EK: Is your patient base experiencing more or less stress given the transgender ban in the US military?
DP: From conversations happening within my office and within the queer community here in the area, the military ban is definitely troublesome and heartbreaking for many. For those I’ve talked to it reflects our country’s continued rejection of their gender identity as valid. It reflects our country’s lack of acknowledgement that they are valid human beings. We’ve not had any major community wide conversations about the topic-just a few here and there who’ve shared their thoughts about the ban-it’s not welcomed news.
EK: How do you think Colorado's recent ban on “conversion therapy” HB19-1129 affect LGBTQ youth?
DP: I believe this measure will help teens in particular feel a greater sense of comfort in knowing that they can’t just be sent away to be ‘fixed'. It won’t take away uncomfortable conversations with family or friends, and won’t stop rejection from happening. But it does protect them from practitioners who might seek to harm them by ‘converting’ their gender or sexual orientation.
EK: Do you expect to see more homeless LGBTQ+ youth as a result of the ban?
DP: That I’m not certain of. I don’t have specific statistics on whether families who were seeking conversion therapy were more likely to keep their children at home if they attended such a practice.
EK: What are some of the benefits and/or drawbacks to being an LGBTQ+ person in rural America?
DP: Benefits are when you live in an area that’s more rural, there’s not a lot of attention on the queer community at large - so it’s easier to just blend it. There are some protective factors as well as drawbacks, because you're hidden. One big drawback is that when there’s not a huge visible community it’s sometimes difficult to know who to reach out to.
EK: How much pressure is there on trans people to be advocates when they don’t want to be trans advocates.
DP: I don’t think there's a lot of pressure to be an advocate, but there might be some pressure to act as an informal mentor to trans peers. Just to be able to offer and receive emotional support and understanding.
EK: Do you experience pushback from your peers in regard to gender work? If so, what kinds of things do you hear most often?
DP: I don’t feel like I get any direct pushback from colleagues. Usually I receive more interested inquiries about what being a gender therapist entails. Occasionally I get people from the community at large that like to voice their objections when I’m tabling at events. The objections are typically mild mannered. The biggest issue I run into though are medical providers who say they don’t work with transgender individuals. There needs to be more training for medical professionals before they can prescribe HRT to anyone. When I encounter pushback from medical offices, I never know if their offices are telling me their providers don’t have the training or if they are biased.
EK: How can communities and organizations best encourage medical providers to work with transgender people?
DP: That’s a good question because it’s one I struggle with as a mental health provider. I think it starts with introducing yourself or organization to the medical provider which can be done in person or over the phone. If over the phone, I would recommend asking that office if they are interested in obtaining any additional materials that you can mail or bring by physically. I think it will also take other medical providers as well stepping up to say we’ve taken this step, here’s how it’s beneficial, and here’s how you can help services this population as well.
EK: Medical providers are so busy, especially in underfunded rural areas. Are there specific trainings or curricula that medical providers can take online?
DP: Not specifically that I know of. Sometimes medical and mental health providers can take courses for continuing education. Part of the problem with medical licensure is that the CEUs in workshops is that the training doesn’t cross over between mental health and medical health. Another thing is that the time is limited for medical & mental health providers and travel from rural areas is difficult for time constraints. It’s about cost, overall interest, and whether it will apply to their patient base. Cultural experiences make a difference as well. Everyone has a different biases. But as mental health or medical professionals, we need to know when we can treat someone well and when we can’t.
EK: What do you feel are the biggest misconceptions about gender diversity?
DP: That being transgender or nonbinary is a phase. Everyone thought that about being gay and lesbian too. According to the American Psychological Association, the American Medical Association, numerous counseling organizations and of course WPATH - which is founded on research from international medical and mental health communities. Being trans or nonbinary is not a phase. The only instances I’ve encountered where someone has come into my office thinking they were transgender and really weren’t involved some sort of previous trauma that was unaddressed. In these cases, typically those individuals are operating from a place of protection-i.e. different gender equates to less opportunity for victimization. That’s part of the reason why counseling can be important in the referral process before someone moves forward with HRT or permanent surgeries. Teasing out other comorbid mental health concerns is essential in some instances.
EK: I’ve heard about people who transition only to feel they’ve made a mistake. Can you speak to de-transitioning?
DP: De-transitioning can happen for a variety of reasons that are usually unique to that person. For some it’s the financial burden of keeping up with the cost of hormones or surgeries. Others it can be pressure from family, friends or your community. If you’re not feeling welcomed by anyone in your life then it makes it harder to continue down a path that is perceived as socially unacceptable. De-transitioning can also happen if you aren’t satisfied with the results of the social or medical transition. Other factors can include other mental health related diagnoses that weren’t addressed prior to or during the transition such as certain types of sexual or emotional trauma. Taking transitional steps too fast and not fully analyzing whether you would be satisfied with others calling you by another name or pronouns, or even permanent medical changes can result in a desire to de-transition.
EK: You and your partner are the co-leaders of a rural Colorado PFLAG group. Why did you choose PFLAG?
DP: We choose PFLAG because it was an existing national non-profit and fairly easy to set up as many chapters already existed in Colorado. When you’ve got a base to work from it’s a lot easier than starting up a new non-profit. At least that was our experience!
EK: What has been surprising about PFLAG so far?
DP: The surprising aspect unfortunately about PFLAG GJ is that there are only a few individuals who have expressed interest in stepping up to take over, or help assist in the organization of running groups or taking on some responsibility. It can be a big commitment and challenging for people to dedicate time to, but these are the same individuals who also report a need for the group to continue.
EK: If you could change the world with a magic wand, what would you change? Why?
DP: I would change people’s ability to always approach new situations, experiences, people, lifestyles, etc from an open and balanced perspective. If people are willing to learn and truly understand why someone feels the way they do, or discover what makes them tick I think we can get somewhere. My first thought was to erase all types of hate but I then wondered what would we really learn from that? I think if people were ALWAYS on default to ask questions to understand and learn in a balanced way then they wouldn’t create laws, policies, programs, or start conversations that were discriminatory towards any one group.
EK: Are differently gendered people bullied more than the general population?
DP: Oh yea! There are a ton of statistics that show many LGBTQ+ teens suffer from discrimination and bullying in grade school and high school. Especially in this area I hear a lot about bullying in high schools where LGBTQ+ teens have been taunted verbally, berated online, and some even physically assaulted. And yet the parents of the kids who are bullying these teens and sometimes even administrative staff at the schools don’t always appear to be doing anything to step in. I feel overall disappointed in the education system in Western Colorado when it comes to helping LGBTQ+ kids. Some schools are really trying so I give them credit but others are not and they need to step up!
EK: Do you feel that American society is hyper-concerned with transgender people in general?
DP: Yes and no. Yes because some people feel that queer folks and other minorities are problematic in shifting focus onto ‘unnecessary topics.’ Meaning they’re tired of hearing about problems they don’t believe exist because they’ve not experienced them personally. Or they believe the topics are very overblown and over addressed. And no because in some areas of American culture, and globally, nobody is even recognizing that trans people exist and thus are ignoring the need to reform certain policies and laws that affect this group.
EK: Are attitudes changing for the continued good health of trans people? Or, are things getting worse with media?
DP: Yes I believe they are changing for the better! We are hearing and seeing more positive information about transgender people and what they need medically, socially, and support wise people are starting to wake up. The internet and social media has its draw backs but some of its benefits are that it can help disseminate a lot of information quickly and globally. Compared to even 20 years ago there are more medical, mental health, and support groups for trans and all queer people today!
EK: With Anti-trans feminists on one side and the trans-ban in the US military on the other, it seems to me that trans people are being assaulted from multiple directions. What do you think about this?
DP: I believe this is true. Discrimination like this isn’t unique for the trans community or even just the LGBTQ+ community at large. All minority groups have faced this in some form or fashion. What trans individuals are going through is definitely felt across minority groups - we stand in recognized solidarity! Some minority people have their own differing opinions on suffering based on history or personal experience though. But addressing the anti-trans feminists directly, a lot of extreme feminists in general have never been friendly even to less radical feminists. And the right-wing, just like the left or moderates have their own ideas about what’s a hot button issue to discuss and be mad about. My hope is that trans individuals continue to focus on all of the existing and growing support out there, not the hate.
EK: Is gender therapy uniquely American?
DP: No, gender therapy is international as WPATH is an international standard of care. However, gender therapy may look different depending on each different country’s laws and policies and might even be called by different names.
EK: What are the biggest challenges faced by intersex folks in your experience?
PD: I think it depends upon whether the person was gender assigned at birth or a younger person might be dealing with feeling different than their peers. The trend is changing away from physician assigned sex/gender and is standards of care now lean more to the individual’s personal choice.
EK: If a parent of an LGBTQ+ child reads this and wonders how to find support, what resources do you suggest?
DP: They can contact me if they are in Colorado, or if they are from out of the area - a person must find a therapist who is licenced in their USA state. Go to the .org sites because they are typically nonprofits and are more likely to have resources that aren’t sketchy. I’d look into PFLAG national, genderspectrum.org because it has sections for parents, teachers, clergy, etc and gives resources, statistics as well. YouTube can be a good place if you look specifically for LGBTQ+ informational videos. People can also look for LGBTQ+ support groups because they often hold resources for people who are seeking answers. For instance, PFLAG GJ keeps a list of local providers.
EK: What is the your clinical perspective on children taking hormone therapy? I just follow WPATH standards. If they’re not of puberty age there’ s no need to do anything medically. If a person s a teenager, it’s up to the referral physician and the standard age is between 14-18. This is where the physicians step in to the transition conversation in looking for medical risks and factors for each individual. Parental consent in Colorado a person under 18 can’t self-direct medical care, yet laws are different across the USA and globally.
EK: I’ve met several people of faith who were shunned by their faith communities for gender and sexuality reasons. Are there churches or other faith organizations where they can be full members?
DP: Yes. PFLAG keeps a list of open and affirming faith organizations. If a person feels comfortable they can ask questions of the other congregants. Ask how they feel about LGBTQ+ people participating in services, groups, and other faith community.
EK: Do you have any last words for our readers?
DP: There are people out there who are supportive, whether you know them or not. You see people every day who fight for rights, access to needs, even if it’s not available in the specific location to where a reader is now. There are advocates and we care about each other, even if it’s just online and you can’t trust your friends or family, there are people who want to show us love and empathy and encourage us to help us grow.
EK: Thank you for your wise words, your advocacy, and your willingness to speak to me for the GCAS Review.
DP: You’re welcome!