Archive of ‘LGBTQ’ category

This Pathology is Not All Yours… And Why Therapy Must Consider The Cultural Milieu

Psychotherapeutic training generally includes something called Universality as a healing technique. It stems from Irvin Yalom’s germinal Therapeutic Factors for facilitating group therapy. It basically means that when humans get to hear and witness another human facing something similar to their own experience, this communality engenders a sense of validation and fosters healing. Universality, with its relational delivery, inherently addresses the isolation any human can feel amidst a problem that had felt singular.

Normalizing Responses to Societal Issues

As a trauma-informed and relational therapist who specializes in climate change grief and disaster trauma; this is of interest to me for several reasons. A dominant one is that grief and anxiety created by several ongoing collective traumas are hard to separate from their myriad effects on a single person’s psyche, which at times is simply responding to these threats, pressures, and perils. Living within a colonial, imperialistic, and capitalistic society under threat of both climate change and continual pandemic pressures is not a cakewalk. Even that sentence stresses me out! The waters we swim in matter. Our collective ills contaminate human psyches and can show up as pain, depression, anxiety, panic, and the like. Our collective diseases become individuals’ problems.

And yet, as universality would have it, a clinician understanding these ills—as best they can from the purview of the client—is paramount to good treatment. Coping strategies alone are not sufficient, normalizing the client’s response to the collective deficiencies is part of alleviation of these pressures. Normalizing in this way may look like: “yeah, this is not, or should not be, normal.” This is a bit of disclosure from the therapist– a human to a human, both part of the same culture admitting where things stand.

I don’t think I am going out on a limb to note that our culture is currently struggling. As I write this, in Texas, transgender citizens’ rights are on the line. Gender-affirming care is slated to become criminalized, at times targeting trans children’s parents with threats of abuse. Recently, trans adults were added to the list with SB1029, which targets insurance companies and providers. Abortion is banned, though it is a medical intervention that can be lifesaving. To make matters worse, bounty laws that enforce this are creating an environment that is truculent and dangerously paternalistic. Books are being banned, and educators censored. A new Don’t-Say-Gay-esque bill was proposed just last week, modeled after Florida’s, which threatens an outright book ban around anything mentioning LGBTQ+, as well as censoring classroom discussions around the same. And the effects and human impacts of a climate changed are palpable and ever-increasing–in our area, we are recenrtly off the heels of another freeze. All of this on top of year three of the pandemic and its longstanding disruptions on learning, isolation, mental health, and physical health.

When Diagnostics Are Not Enough

And listen, I am not against diagnosing one’s mental health issues. Diagnostics as a part of comprehensive therapeutic treatment can be incredibly beneficial. They can certainly aid in devising and guiding successful treatment within the therapeutic consulting room. For the client who has been struggling with symptoms; a diagnosis can provide relief, an explanation, and a framework to describe their internal state or external behavior to themselves, family, classmates, work colleagues, and friends. Diagnostics on the whole can open up lines of communication within a treatment team, creating access to intervention avenues at the school level, or equally, funnel information to a psychiatrist who can better medicate. A correct diagnosis can create ease within a family system to remove the label of Identified Patient (IP) from a child’s role and help the system see their child or sibling from a more educated and supportive perspective. 

So- we can diagnose the person inside of the room however, we must also pay mind to the collective upheavals, distresses, and systemic issues that contextualize this individual. The medical equivalent might be something like this: we have a town next to a factory that is seeping toxic waste into the town’s water supply–a large and suspicious portion of the town comes down with a respiratory disease. Diagnostics alone would create a closed loop within the local medical system, with continuous siloed individual diagnoses reporting the disease created by this substance. AND/OR; the water supply could be addressed, and toxin mitigated. This is made more complex when we consider mental health as things tend to be created by many factors– and it can be tricky to suss out the causes, and the collective fixes. But complexifying our solutions, and as collectively as possible, is exactly the medicine called for in this era.

Psychologist James Hillman said (and of note, before the internet took hold):

“Of course I am in mourning for the land and water and my fellow beings. If this were not felt, I would be so defended and so in denial, so anesthetized, I would be insane. Yet this condition of mourning and grieving going on in my soul, this level of continuous sadness is a reflection of what is going on in the world and becomes internalized and called “depression”, a state altogether in me ─ my serotonin levels, my personal history, my problem…”

(Hillman, 1996)

Trauma-Informed Care as a Path Toward Healing

I know I am outting my politics, but alas—my last two blogs have been about porn and fairy tales so that cat is already out of the bag. Let’s take the example of gun violence. I see teens and work often with parents with young children. Both demographics are widely impacted by the nations’ lack of legislation on guns and are moreover the compensatorily-devised adaptation techniques that infiltrate our learning institutions instead of real action. If a teen client comes in saying; “I have had [X many] years of Active Shooter Drills at school and I am experiencing nightmares.” Yes, we can work to shift the nightmares, ameliorate the residual fear and treat the existence of such symptoms. But resounding data is against these drills and particular practices within. Why would I simply normalize them? 

A study quoted by Everytown bleakly reports:

“Active shooter drills in schools are associated with increases in depression (39%), stress and anxiety (42%), and physiological health problems (23%) overall, including children from as young as five years old up to high schoolers, their parents, and teachers. Concerns over death increased by 22 percent, with words like blood, pain, clinics, and pills becoming a consistent feature of social media posts in school communities in the 90 days after a school drill.”

Similarly, if a parent comes in citing concern their little one is going to be soon introduced to this practice at their new school, it would be wholly inauthentic of me to ignore not just the upset this future event is inciting but to not also see this concern within the structure of the collective climate. 

I speak here from a position of activism, allyship, and a desire to move forward as clinicians with eyes open, and as collectively aware as possible. No matter the source, symptoms and their manifestations are treatable. Therapy can provide meaning-making, the healing relationships can be sturdy-ing, and its structure and techniques can actively reify the resilience, connectivity, and vibrancy of the Self. If you love data, therapy has been shown in many forms to change the brain’s structure, namely in the frontal and temporal cortex, which enables more integration, processing capacity, and regulation of neural symptoms. When under the care of a trauma-focused and trained practitioner; trauma can be reprocessed to repair mental injuries from not only the initial trauma(s) but also any newer experiences that have been neuropsychologically linked up with the traumatic experience. EMDR, for example, uses bilateral stimulation as an adaptive information processing technique to reprocess and restore improperly stored, fragmented memories that can otherwise create interruptive and discontented states. The de-fragmentation and integration it engenders can be deeply impactful.

Therapy is helpful, and it is more helpful when it considers itself as a tool within a structure, that keeps in mind the structure’s influence on the clients it is aiming to help. I would be doing a disservice to clients to ignore the wider lens, and I hope that in and of itself is a helping technique. 



I am not telling you to do or not do anything, but here is a list of books that have been banned in Texas.

Other clinicians

Dr. Jennifer Mullan’s Decolonizing Therapy model provides trainings for Politicizing your Practice

Supporting Your Child with their Sexual Development

Watching life happen through your child’s eyes and teaching them about the world can feel exciting and fun. However, it can also feel overwhelming or even scary at times, especially when it comes to helping them navigate their sexual development. As parents, we move into our responsibility of teaching our children about the world and how to navigate challenges, but when it comes to sexuality, it can feel uncomfortable. If sexual development is one of the most important and wide-ranging parts of life, why do many of us fear navigating it with our children?  

Perhaps it was never openly discussed in your family, so it feels more comfortable to uphold the secretive attitudes around it. According to Dr. Jane Nelsen, author of Positive Discipline, this can lead to misunderstandings and possible shaming. For example, she discussed that many parents don’t have enough knowledge about human behaviors and child development whereas developmentally appropriate behaviors may be viewed as misbehavior.  Based on your developmental journey, you may have some of your own challenges with sex, making it more terrifying to talk about it with your kids. You may even have some deep-rooted thoughts of sex being shameful or dirty, so you’re left wondering: how can I navigate this with my kids in a positive way without creating shame and guilt? 

The Sexual Development Process

It is important to note that a child’s sexual development is so much more than sex. Their development bores out of the attachment relationship they had with their caregivers beginning at birth, connecting a physical association with being loved and intimate. As a child develops, they are constantly interpreting messages and learning social norms and appropriate expectations, shaping their actions, attitudes, feelings, interactions and behaviors. 

Since learning during these formative years sets the stage for your child’s adult sexuality and their relationships to others, it is vital that parents understand normative, sexual behaviors within their child’s developmental process to avoid creating shame around healthy, age-appropriate behaviors. In turn, more knowledge may bring healing and comfort to your past experiences and positive attitudes into your child’s process. This will support your child with learning healthy actions, attitudes, feelings, interactions and behaviors in confidence and safety within their bodies.

Healthy Childhood Sexual Development

Stage of DevelopmentCommon BehaviorsEncouraging Healthy Development
Infancy (Ages 0-2)•Natural to explore and have curiosity about their body, including genitals, “Who I am in relation to this body attached to me?”.
•Sensory is the highest form of information gathering: touching their genitals, including masturbation, in public and in private
•No inhibitions around nudity
•Attachment and positive physical association with being loved and intimacy
•Teach correct names of body parts, such as penis and vagina
•Explain basic information about the differences between male and female anatomy
•Help children begin to understand how to interact respectfully with peers of the same age
•Provide very simple answers to questions about the body and bodily functions
Early Childhood (Ages 2-5)•Occasional masturbation as a soothing behavior rather than for sexual pleasure. It may occur publicly or privately.
•Consensual and playful exploration with children of the same age. This could include “playing house” or “playing doctor”.
•May ask questions about sexuality or reproduction, such as, “Where do babies come from?”
•May show curiosity in regard to adult bodies (e.g., wanting to go into the bathroom with parents, touching women’s breasts, etc.)
•Continued lack of inhibition around nudity. May take-off their diaper or clothes off
•Uses slang terms for body parts and bodily functions
•Provide basic information about reproduction (e.g., babies grow in theuterus of a woman)
•Encourage a basic understanding of privacy and when things areappropriate and inappropriate
•Explain the difference between wanted and unwanted touch. For example, a hug that is welcome and positive versus one that isunwelcome and uncomfortable.
•Teach children about boundaries. Let children know that their body belongs to them and that they can say no to unwanted touch.
Middle childhood (Ages 5-8)•Continued use of slang words, “potty humor” or jokes to describe body parts and functions
•Deeper understanding of gender roles. May act in a more “gendered” manner as expected behaviors and norms associated with gender are learned (e.g., girls may want to wear dresses).
•Sex play or activities that explore sexuality and bodies may occur with same- and opposite-sex friends
•Masturbation. Some children may touch their genitals for the purpose of pleasure. This happens more often privately rather than in public.
•Promote a solid understanding of gender and how children experience their gender identity. Children who identify as transgender or gender non-conforming will experience this also, but can face confusion and may need increased support from adults.
•Explain the basics of human reproduction, including the role of vaginal intercourse.
•Talk about the physical changes that will occur during puberty.
•Explain that there are different sexual orientations such as heterosexual, homosexual, and bisexual.
•Teach that masturbation is something that occurs in private.
•Educate on personal rights (e.g., “your body belongs to you”) and responsibilities (e.g., treat boys and girls equally) related to sexuality.
Late childhood(Ages 9-12)•As puberty begins an increased need for privacy and independence is often expressed.
•Interest in relationships. May want to have a girlfriend or boyfriend.
•May express curiosity about adult bodies. This could involve the child trying to see people naked or undressing or involve looking for media (such as TV, movies, websites, and magazines) with sexual content.
•As social norms around masturbation become clearer. Masturbation will likely occur in private.
•Provide ongoing information about the physical aspects of puberty and changes in their body.
•Educate children on the social and emotional aspects of puberty. Help to normalize the new emotions and needs that they may be experiencing.
•Provide age-appropriate sexuality information and basic information about sexual behaviors and sexually transmitted infections, etc.
•Encourage critical thinking and build the skills to differentiate fact from fiction in media images and representations of sexuality.
•Support them in understanding they have both rights and responsibilities in their friendships and relationships. Encourage characteristics of healthy friendships and relationships.
•Support their emerging voice as they assert personal boundaries, setting the stage for empowerment and letting them try roles out.
Adolescence(Ages 13- 18)•Puberty brings rapid physical growth and body changes, which can create body image issues. This is truefor most adolescents, but especially for transgender youth.
• Increased interest in being seen as physically and sexually attractive.
•Hormonally and biological experience: getting used to a maturing body and new feelings, including an emerging sex drive and feelings of love or desire. This can be exciting and stressful for youth of all orientations
•Increased sense of modesty or shyness and need for privacy.
•Concern about feelings/behaviors being “normal.”
•Development of personal identity and independence: “Who am I?” Trying out different clothes, friends, and interests to find their identity.
•Separation form childhood with a desire for parents to be less involved.
•Peers are most influential and peer group socializing is very important as it provides opportunity for youth of all genders to interact. What am I going to tolerate? What am I interested in? How do I have a voice?
•Provide age-appropriate sexuality information on such topics as consent, reproduction, healthy relationships, sexual orientation & gender identity, boundaries, body image, and pregnancy prevention, and sexually transmitted infections.
•Provide empathy within their experience: it is an uncontrollable process as their body changes and the new emotions and needs that they may be experiencing.
•Support adolescents in understanding they have both rights and responsibilities in their relationships. Modeling characteristics of healthy relationships. Intervening and providing guidance when characteristics of unhealthy relationships and/or sexual violence occur.
•Help build critical-thinking skills to separate fact from fiction in media, such as TV, music, video games, pornography, and other depictions of sexuality.
•Create space to build connection and trust so they have an opportunity to share experiences and emotions. Start an open and honest dialogue, ask questions, listen to understand and connect with emotion rather than offering advice. “”I can see how that can feel frustrating… tell me more””.
•Encourage independence while setting clear boundaries.

Although other normative behaviors are worth noting, this chart can be used to support you with understanding some of your child’s typical exploration behaviors. It may still leave you wondering if some of your child’s behaviors are appropriate or healthy, but since every child’s developmental process is specific to their growth process, it can be challenging to distinguish. 

Being that exploration and curiosity tend to be a common theme throughout the developmental process, looking at the motivation behind your child’s behavior is important: Are they spontaneously exploring? Is it mutual and non-coercive when it involves other children? Do they respond to your correction after the behavior is done? Does it involve more advanced sexual behaviors such as intercourse or oral sex? If this leaves you with concerns or questions, the  Association for the Treatment of Sexual Abusers (ATSA) can provide more, detailed information related to appropriate and inappropriate sexual behaviors. In addition, seeking advice from a professional who can support you is also available.  

As a therapist supporting individuals through their unique journeys, I have found this topic very close to my heart. If you personally have any experiences that are creating unhealthy emotions, thoughts, or sensations and would like support with reprogramming, I would love to connect with you. As Terry Real, an internationally recognized family therapist, once said, “Family dysfunction travels like wildfire from generation to generation until one brave soul turns around to face the flames. That person brings peace to generations who came before them and spares the generations to come.” Healing yourself may be exactly what your child needs. 


Association for the Treatment of Sexual Abusers: Report of the Task Force on Children with Sexual Behavior Problems (2006)

National Center on the Sexual Behavior Of Youth (2023)

National Sexual Violence Resource Center (2013)

 National Sexual Violence Resource Center (2014)

Picture Books as Therapy

Understanding complex emotions and life events is difficult for anyone, but especially for children. When they don’t have the proper tools to express their inner turmoil and process their surroundings, this can often lead to frustrating interactions with parents and caregivers. One tool to give your child is seeing big emotions and hard situations played out in a book.

Books are a great way to help children understand their feelings, learn about differences, and begin to understand the world around them. This can start as early as toddlerhood with picture books! An extra bonus to picture books is the visual representation of emotions, interactions, and experiences. These can be jumping off points for all kinds of conversations with your little ones. Not only that, but it removes your little one from having to be the one with the heavy feelings or thoughts. Instead, by focusing on the stories of the character, you can discuss these feelings and thoughts without your child feeling put on the spot.

With that in mind, here are eight suggestions for picture books that can help engage your little one in some of life’s biggest questions:

Big Bear Was Not the Same

By Joanna Rowland

(Beaming Books, 2021)

Joanna Rowland is a fantastic author whose books tackle real-life issues. Big Bear was Not the Same discusses posttraumatic stress disorder and the effects that trauma can have on individuals who experience it and those close to them. In addition to Big Bear was Not the Same, her other books focus on tough topics such as grief, friendship when times are tough, and hope.

Ruby Finds a Worry

By Tom Percival

(2018, Bloomsbury)

Tom Percival is another picture book author that takes big feelings and makes them relatable to children. In Ruby Finds a Worry, Ruby experiences anxiety and thinks she is the only child with this issue. Eventually she realizes everyone gets Worries and the best way to deal with them is not to ignore them, but talk about them. Not only will the story interest your little readers, but the art depictions of the Worry are fun and engaging. Tom has many other books focusing on social emotional learning in his Big Bright Feelings series, including Perfectly Norman, Ravi’s Roar, and Meesha Makes Friends.

My Shadow is Pink

By Scott Stuart

(Larrikin House, 2021)

This was one of my favorite picture books of 2021 (and apparently one of my daughter’s also, since she made it read it 3 times on the drive home from the bookstore alone)! A young boy who loves pink and dresses and “things that aren’t for boys” struggles to be himself when he doesn’t fit in with his family and friends. Stuart’s beautiful illustrations and lyrical prose open the door for inclusivity, diversity, self love, and acceptance. This book gives children the permission to “be themselves, even when it’s uncomfortable.”

The Princess and the Fog

By Anthony Lloyd Jones

(Hachette, 2015)

The princess has everything she ever needs to make her happy until one day a fog settles over her and she can’t seem to feel happy anymore. The Princess and the Fog provides a fun, relatable look at childhood depression. An included guide in the back matter helps parents dig deeper on the topic. With realistic explanations of depression symptoms, Jones does a beautiful job of helping open up a conversation and foster understanding.

Don’t Hug Doug

By Carrie Finison

(Penguin Random House, 2021)

Bodily autonomy and consent are tricky topics to discuss with kids, but important nonetheless. Don’t Hug Doug approaches bodily autonomy in a way kids can relate to– with the concept of hugs. Doug doesn’t like hugs, but his friends and family often insist on hugging him! This book encourages children to ask before touching someone and to voice their own desires about how they are touched. Instead of a hug, why not a high five?

It Will Be Okay

By Lisa Katzenberger

(Sourcebooks Explore, 2021)

Katzenberger creates a kid friendly approach to anxiety through her story about Giraffe and Zebra. When going about his usual routine Giraffe experiences something that makes him so worried and anxious he just wants to hide. Zebra’s empathy and friendship help him overcome his anxiety and get back to enjoying his day. Katzenberger includes excellent educational back matter that can help parents and teachers engage deeper with the topic of anxiety. 

The Struggle Bus

By Julie Koon

(Kind World Publishing, 2022)

Each of us have experienced days where we felt like we were on the “struggle bus”. Nothing is going our way, we can’t seem to make things work out, and we have no idea how we’re going to get things done. In her book, Koon takes this to the next level by presenting children with images of an actual school bus as “the struggle bus”. Her lovely rhyme walks children through times of frustration, hardship, and ultimately perseverance. 

The Breaking News

By Sarah Lynne Reul

(Roaring Brook Press, 2018)

This year especially has seen lots of heartbreaking and stressful things in the news. From war, to pandemic, to school shootings, children may have been exposed to or have seen their caregivers’ reactions to media coverage of difficult situations. Sarah Lynne Reul tackles this in “The Breaking News” and helps show children and adults alike that while they may not be able to do BIG things to combat these issues, even small things can make a big difference. 

Each of these books are excellent ways to not only dig deeper into big topics with your children, but to encourage their love of reading and their imagination. 

For more resources on handling tough topics with kids, or to look into therapeutic interventions for yourself, your child, or family email [email protected].

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