Therapists and Transcare: An Interview with Zach Hebert, LPC, NCC, PhD

One of the greatest pleasures I have in life are the friendships I've made along the way in my journey to becoming a therapist. For the most part, Counselor Education graduate programs tend to be small in size to ensure optimal quality of it's participants. From that comes the opportunity to learn and grow with a cohort of folks who are aligned in values and eager to change the world together. One such friendship is with my dear colleague, Zachariah Hebert. Zach is an LPC, NCC and recent PhD earner. I decided to interview him about one of his many passions--serving the trans community. Check out the interview below.

On Personal Practice:

What drew you to working with the trans community in therapy?

Professionally, when I started practicing in 2016, there weren’t really any trans-competent gender-affirming providers in the Acadiana area. Since this was prior to telehealth mental health services really being commonplace, I started working on achieving that competency through seminars, trainings, and listening to the lived experiences of other trans folx until, after close to a hundred hours of that, I felt I was prepared to start the work.

On a more personal level, as someone who grew up within queer spaces, and saw the difficulties faced by so many of my friends and family, made and born, especially in the Deep South. One of the core tenets of my personal philosophy is that, if someone is suffering, and you can help, you probably should, so I did.

Can you describe a particularly rewarding experience you've had working with a trans client?

There have been a lot of them. While I can’t go into much detail, every time I hear from a client that they feel safe in my sessions, it helps, as that’s what I shoot for, first and foremost. Some of my clients have gone on to be first trans folx to do this or that in the state or fields they’re in, and that’s my favorite part of the job, watching people go from struggling to flourishing.

Have you encountered any challenges or specific areas of concern in your work with the trans community? How did you navigate them?

The work itself is often difficult, but never burdensome, if that makes sense? When we choose to go into this line of work, we sort of accept that we’ll be going into some pretty dark places with folx, to try and help them come out of them. That, we sign up for. The hard part, for me, is the social cost. Since I started doing this, both the therapy and the advocacy work, I’ve gotten threats of violence, death, and damnation, always anonymously, of course. While I try to let them roll off me, and even wear them as badges of honor, I’d be lying if I said they didn’t worry me sometimes in the middle the night, less for myself than for those close to me. On the upshot, it’s a great excuse to minimize my social media presence, so there’s that.

What resources or training would you recommend for therapists aiming to become more competent in serving the trans community?

This is such an important question! There are so many good-hearted folx out there who want to do the work, and being gender-affirming and nonjudgmental is definitely the first step, but it’s not the only one, and that includes folx who are trans themselves, because one of the most insidious pitfalls in providing therapy on anything is assuming that our lived experiences are the same as our clients’. They can give us insight, definitely, but everyone’s experiences are unique, and need to be approached that way.

As far as training goes, there’s going to need to be a lot of it. The WPATH (World Professional Association for Transgender Health) standards of care were just updated to version 8, and they’re a great place to start. Lots of continuing education, especially from trans voices, is vital before even considering starting to offer services, and that includes learning the social, psychological, physiological, and medical aspects of transitioning, and recognizing that everyone’s transition looks different.

On Client Needs and Experiences:

In your experience, what are some of the most common mental health concerns or challenges faced by trans clients?

The research available consistently shows that trans folx are significantly more likely to experience every sort of negative mental health outcome, starting from a very young age, including the most dire, like self-harm and suicidal ideations. Gender dysphoria can lead to, or exacerbate, pretty much all of them, especially for those who are raised and are still living in cultures and systems that don’t recognize their identities, or, worse, outwardly refute them.

A lot of my work goes into helping people to find safe spaces within their worlds, which alleviates a lot of the pressures that GD can put on them, which means lessening anxiety, depression, and self-harm, amongst other behaviors with which they might be struggling, such as body dysmorphia or disordered eating, which have a high comorbidity with GD.

How can therapists best support trans clients through the coming-out process, both personally and socially?

On a personal level, the first and most important step is working with the client to create a safe space. That collaboration is important, because often the client doesn’t know what a safe space feels like, coming into therapy, so we work together to figure it out, then make it so. The process of doing so, in itself, is often helpful in building a sense of safety. The therapist, too, has a responsibility for being educated enough to not have to constantly ask basic questions about trans issues (though we all need to ask things, here and there).

Socially, we need to be advocates both in our personal lives and professional ones. A mentor of mine used to tell me that we don’t have to save the world to save a world, which is to say, we can always be working towards helping others by making change, even if we feel powerless to make broad, sweeping change. It all helps, and it all adds up.

What are some strategies you've found helpful in addressing internalized transphobia or gender dysphoria in your clients?

A lot of this is understanding where the whispers are coming from, the voices in the backs of our minds that tell us all the painful, harmful stuff that pulls us down every day. An exercise I often do with my clients is sitting with them while they really listen to those internalized messages and tell me whose voice(s) they really sound like. Often, we hear them so often that they start to sound like us, but they aren’t, not really. They’re the voices of parents, friends, society, that we’ve made our own. Once we understand to whom they actually belong, we can start to disentangle ourselves from them, make them something outside ourselves, rather than an assumed part of who we are.

How can therapists effectively collaborate with other healthcare professionals (e.g., endocrinologists, surgeons) to provide holistic care for trans clients?

This is so important! As I said before, we need to make sure that we know all the parts of the transition process that may come up. We don’t need to be surgeons or med managers or anything, but we absolutely need to know what to watch out for, and the ways that those sorts of things can affect our clients as they progress. We’re often the first to notice behavioral or mood changes, since they see us more often than their doctors. Same goes for having a mental list of community resources, including other therapists we trust. Pay attention to negative things you hear from clients about providers, and do the due diligence. Contact them, address those issues, and make sure things are safe for our clients there, not just with the doctors themselves, but with the support staff, too.

On Broader Context:

Most likely the largest issue is the erosion of trans rights, such as access to gender-affirming care and the right to establish their gender in the eyes of the law through correcting birth records and various forms of identification to reflect their true gender identities. We have an obligation to represent our clients’ best interests through advocacy as experts, which includes not only speaking up when anti-trans policies are brought up, but also staying abreast of the most current research in order to refute the plethora of misinformation that floods things like social media.

How can therapy spaces be made more inclusive and affirming for trans clients?

Small things matter. Putting up stickers, flags, whatever ways you have to show clients that you support them, even when they aren’t around, and aren’t afraid nor ashamed to do so openly. Making certain that support staff and colleagues at your workplace also value and take part in creating safe spaces, even when trans clients don’t seem to be present. Also, making sure not to have potentially triggering things, like religious symbols which may be sources of trauma, on open display can help them to feel safer.

Interested in delving into gender identity stuff with Zach? Check out his Psychology Today Profile here.