Interview between Speaker 1 (Meg) and Speaker 2 (AC Goldberg)
Episode 55: Culturally Responsive Therapy – A Moral Imperative with AC Goldberg
[Introductory note]
Hey, it’s Meg. Wanna hear something hopeful for the OT and SLP fields? Hundreds of y’all have enrolled in our upcoming Neurodiversity Summits. And I’m excited about this because our neurodivergent clients deserve to have therapists who are committed to learning about strengths-based practice, and listening to the Autistic community. And you, as a therapist, deserve to have a community of like-minded therapists supporting you on your journey to practicing therapy in a way that truly aligns with your values. I’ll tell you a little bit about the Summit in case you’re not in yet. We have two Summits coming up — the SLP Continuing Education Summit, which is registered for ASHA CEU’s, takes place in October of 2022. And the OT Summit, which is registered for AOTA CEU’s, is in January of 2023. There are a limited number of early bird tickets for each. At the time of this recording, the SLP Summit early bird tickets are nearly gone. The Summits are going to cover topics like autistic learning styles, disability justice, AAC, gestalt language processing, regulation and interoception, emergent literacy, and more. Each talk is designed to really impact the work you do, filling your toolbox with strengths-based ideas, boosting your confidence that you are truly engaging in best practice, and, we hope, renewing your enthusiasm for your work. You can find all the details at learnplaythrive.com/summit. We hope to see you and all of your colleagues there.
[Introductory music]
Welcome to the Two Sides of the Spectrum Podcast. A place where we explore research, amplify autistic voices, and change the way we think about autism in life, and in our professional therapy practices. I’m Meg Proctor from learnplaythrive.com.
Meg:
Before we get started, a quick note on language. On this podcast, you’ll hear me and many of my guests use identity-affirming language. That means we say ‘autistic person’ rather than ‘person with autism’. What we’re hearing from the majority of autistic adults is that autism is a part of their identity that they don’t need to be separated from. Autism is not a disease, it’s a different way of thinking and learning. Join me in embracing the word ‘autistic’ to help reduce the stigma.
Welcome to Episode 55 with AC Goldberg. This conversation is the most important, relevant, and accessible conversation we can be having right now about how we can truly support our autistic clients given their complex identities. This topic is 100% relevant to the work you are doing, so please keep listening. It can be so tempting to make the choice to learn about neurodiversity but ignore the importance of other categories of people’s identities and experience like race, gender identity, and class. But in this episode, AC highlights for us how when we choose not to actively do our work around cultural responsiveness, this creates ruptures between us and our clients that may be invisible to us. This can be the difference between us providing useful therapy or creating more trauma for our multiple-marginalized clients. This is a big topic, it’s important, and AC brings it right down to the level of our actual therapy sessions.
I’ll tell you a little bit about our guest. AC Goldberg is a PhD level SLP who is intersex and transgender. He has 18 years of experience as a school clinician and he runs a continuing education platform and consulting business called The Credit Institute. He also runs the social media platform, Transplaining. AC has wonderful transformative continuing education courses that can also be used for graduate credit that he teaches alongside an impressive and diverse panel of other instructors. We’ll talk about it more in the episode and I’ll link to it in the show notes, but make sure you check that out. Here is the conversation with AC Goldberg.
Hi, AC! Welcome to the podcast.
AC:
Thanks for having me.
Meg:
I am thrilled to have you here, and I want to start by diving into your own story. Can you share with us a little bit about your personal and professional journey that led you to this point?
AC:
Well, when I first became an SLP, I didn’t realize how much my gender would actually factor into my work. As, you know, both a student and a clinician, I never really thought of that as something that I would have to either compartmentalize or, you know, fully embrace in order to actually be myself in the workplace. And I can kind of encapsulate when that all came together for me in one moment, which was when I started my CF on my first day. I showed up in a sweater vest onesie. It had sleeves like sewn to an actual sweater vest — it wasn’t really an actual sweater vest — and a tie that went into a little hole in the front. And for the listeners who can’t see me gesturing, I’m putting a tie down the middle of my neck. But I showed up for the first day of my CF wearing those clothes. And my supervisor who hadn’t met me previously and had only seen my legal name on paperwork told me I couldn’t come in dressed in drag. And that was the moment when I realized that I either had to fully embrace my trans identity and be a trans SLP, or I had to be closeted in order to actually get work in our field. And very much unfortunately, that is still the case. It’s even harder for me to find work now that I am more well-known than it ever has been before. And it’s disheartening, because we are a field of healthcare providers, and we serve transgender people, whether you’re providing, you know, services directly related to gender or not, you’re still going to serve trans people; trans people are everywhere.
So, you know, it’s disheartening that there is so much gatekeeping around employment, around services around education, that have to do with gender-affirming services, or just gender in general. It was a rocky road. I’ve got to say, my early career was really difficult. And then, I sort of hit a stride in a school SLP role, and now I’m too physically disabled to continue doing that type of work. And it’s been really hard for me to launch into different types of employment. What I have done is started my own continuing education platform, which is The Credit Institute, which is devoted to intersectional cultural responsiveness. I also have a consulting agency called Transplaining where I go and I teach about how to provide culturally responsive services to trans people. And, you know, it’s been very difficult to be sort of a visible, trans leader in the field. And at the same time, when I look back on what I’m most proud of, it’s the moments that I was being my full self. It’s not the moments where I got a job because I was hiding who I was, or, you know, I was able to access the space because I didn’t show up as myself. It’s the moments where I was able to push back and be my full self.
Meg:
Your story is obviously hard to hear because of the level of bigotry and discrimination that you faced, and face. And it’s also really exciting to hear how you’ve forged a path to address the problem that you identified personally, politically; deeply, deeply ingrained in our work, in our culture, in everything that we do. I also really appreciate your point that the things you’re the most proud of are things that might have been challenging. They might not have been, but you said the moments that you were authentic, not the moments that you were maybe masking, or people pleasing, or avoiding conflict. And I want to just reiterate that because a lot of listeners are really struggling with, “What do I do? How do I hold these values and not get in trouble at my work?” And I hear a little bit of a personal challenge there of when we look back at the work we’ve done, the moments we’re gonna be proud of, or the moments that we were a little bit brave or very brave, and acted in a way that’s aligned and authentic for who we are.
AC:
It’s true. I mean, it’s a lot. And those are — those are the times when, you know, it’s when I was true to myself, are the things that I can reflect back on and say, “That was great,” as opposed to things like, you know, getting really great evaluation or having a really great interaction, like a positive interaction with someone at work. You know, it really is more about being myself and not having to hide any of it.
Meg:
That message is really aligned for what we want to be supporting our clients to do as well, right, to be their authentic selves even when it’s hard. Yeah. I want to dive in a little bit more to what you’re doing at Transplaining and The Credit Institute. Can you walk us through what your mission is, and what the work you’re doing there is?
AC:
So, The Credit Institute is — and hopefully it will be a non-profit at some point in the next year, but that’s taking me a long time to manage that application. It’s a labor of love. The Credit Institute is dedicated to intersectional cultural responsiveness. The courses are like a billion CEUs, you know, 73.5 hours.
Meg:
Oh, my gosh. I’m gonna pause here real quick. So, you said ‘intersectional cultural responsiveness’. We talked about intersectionality over and over on the podcast, but let’s just pause and tell us what that means before you dive in deeper.
AC:
So, cultural responsiveness is a practice where you’re embracing understanding and taking the perspective of someone else, and you’re in an ongoing way, engaging in education about other people and other perspectives. And that is not solely about one specific subgroup of people, and that’s what makes it intersectional. It’s learning about the intersections of race, neuro type, socio-economic background, even just dialect, not to mention gender, gender expression. There are so many different nuances to our identities that we have to consider about ourselves when we think about our own biases, and how those might impact our interactions with our patients, clients, students, et cetera.
But there’s also the tenets of person-centered care, which is at the core of ethics for SLP’s, OT’s, and I’m sure a lot of other service providers as well. And you can’t truly deliver person-centered care unless you’re dedicated to understanding the other person as a whole, not just as, you know, an autistic child, or as a black person who stutters. I know that people who listen to this are probably people who provide services to autistic people. But understanding that there are many facets to an autistic person’s identity, that they aren’t just ‘Somebody who is autistic’. It’s not just their neuro type; they also have a race, they also have a culture, they also have a background, they have a gender, or maybe they don’t. And it’s very important for people to holistically consider the other person in the room and all of those perspectives in order to deliver the highest quality of care, because if you accidentally make someone uncomfortable, it’s really hard to repair that clinical relationship. I’ve been on the other end of a lot of very insensitive clinical conversations as a trans person. And I can tell you that I go back to those providers because there aren’t any others. I don’t go back because I want to, you know.
It’s important to know that sometimes those types of breakdowns are not really able to be repaired. However, if you approach things from a culturally responsive lens, they’re less likely to happen. And you’re more likely to be able to have the repair in the moment and understand and respond to the other person, when you notice that you’ve said something that’s upset them or you haven’t been sensitive to one of their needs. You’re more likely to be able to restore that relationship immediately than you are to have an actual breakdown in communication. And if you aren’t having a breakdown in communication, you’ll be able to understand how to work it out from a reflective lens that doesn’t put you in a position where you feel defensive about what you’ve said or how you’ve done something, because you’ve engaged in learning about other populations that has taught you that, you know, people from this culture don’t eat these foods or the, you know, things like that, that we just — you can’t know everything about everyone and I understand that. But the courses that I teach embrace and embody the sort of, we’re always learning about other people. And we try and learn about as many topics as possible from as many angles as possible so that we can truly embody that person-centered care when we are with other people.
Because, you know, as a provider, you don’t want to be someone’s negative experience. I always like to talk about Yelp reviews. You don’t want to be someone’s negative experience. You don’t want to be the, you know, you don’t want the bad Yelp review. And a lot of those negative clinical experiences, they’re really traumatizing. And I know that your listeners know that. But they aren’t just traumatizing from one angle. They’re traumatizing from any angle that they happen. And it’s really important to learn about how to navigate your own biases, what microaggressions are, how to interact with people, how to repair those communication breakdowns, and kind of how to move forward when those things happen in your sessions and also how to confront your own biases so that maybe they happen less often.
Meg:
I really appreciate how you describe this as a process. I feel like most of our listeners are here because they understand that the work that we need to do to understand the perspective of our autistic clients, it is real, and it doesn’t happen without actually putting in the time and listening. But I pointed this out before, when we have episodes on intersectionality in almost any capacity, they get fewer listens. And I think that’s interesting that people maybe have a harder time confronting these other biases, or making them important, or acknowledging that they’re relevant to the work that we’re doing. And when you describe it, you talk about reducing the impact of our biases, or being able to repair ruptures. It’s not even this endpoint of being culturally competent because we did the thing. It’s engaging in the process of it.
AC:
It’s engaging in the process. I know I’m so excited. Rachel is on her way over.
Meg:
So, AC lives pretty much in the same town as our frequent podcast guest and course, instructor, Rachel Dorsey. And apparently, they’re gonna hang out, which sounds really fun.
AC:
I’m super excited. Sorry, I got distracted. You know, I think it’s really important because there is no end point to culturally responsive care. There’s no way to kind of say like, “Oh, I’ve done it.” There’s only a way to acknowledge and recognize when you need more work or to lean in when someone’s trying to tell you something that you’ve either done that’s been insensitive, or that you maybe aren’t understanding from their perspective. I do think a lot of people think that intersectionality doesn’t apply because they need to know how to do a task, they want to be floor time certified, they want — I mean, those are all wonderful certifications that I’m not saying anything — I wouldn’t say anything negative about that. But people, they want to know how to do a thing. And what they don’t realize is that your clinical services will be less effective if you are accidentally racist to the person in front of you. It’s just a fact.
You know, health care disparities, the only way that we’re going to resolve any of that is starting with the one-to-one interaction. I mean, so many disparities happen as a result of those one-to-one interactions that go awry. And, you know, the only way we’re ever going to do anything about that is if everyone leans in and learns. And I have a tremendous amount of privilege. You know, it’s funny I say that, you know, with kind of no current full-time job coming to you from my basement, but I have a tremendous amount of privilege in that I’m white. I’m not visible without disclosure. Like, as a trans person, I have to tell you that I’m trans for you to know. And, you know, that’s one of those things, you know, people use the term ‘passing’, that’s not a word that I use because I’m not trying to be anything else; really loaded construct and a loaded word. But prior to being someone who could sort of be cis-assumed, cisgender is a word that means non-transgender, so that there’s not a dichotomy that’s transgender and normal person, or a transgender and regular. It’s transgender and cisgender. Cisgender — I’m cis-assumed most of the time just because of how I look, which, you know, is kind of silly.
But the reality is that as a white cis-assumed male-presenting person, I experience the world very differently than I did when I was female-presenting, and very differently than I did when I was someone who looked sort of visibly queer. And I have become very sensitive to the experiences of people who are ‘other’ based on how they look, you know, whether that has to do with like, body size, race, and just different types of bodies. I mean, you know, people have things like, you know, born without an arm. I’ve become very sensitive to understanding what it’s like to navigate the world as someone who looks different. And it’s really important that everyone sort of lean in, and take a minute to think about what that’s like from the perspective of the person who’s in front of them, and from sort of their own lived experience. I live in this privileged bubble where like, I do pass as a white man, and I don’t use the term ‘pass’ very often, you know, kind of when I’m out and about. And that brings with it a tremendous amount of privilege, because it just does. And I know what it’s like not to have that. And the world is very different. People treat me very differently. And then, when they know I’m trans, they treat me the same way that they always have, which is with less sensitivity than they should.
Meg:
Your emphasis on this one-on-one perspective-taking, the one-on-one interaction between providers and clients, it’s not random, right. There are systemic disparities, obviously. And my understanding is that the research really reflects what you’re saying that black people, indigenous people, people of color, transgender people are treated differently by their providers and that has a profound impact on their health outcomes.
AC:
Yes.
Meg:
That’s statistically very, very real. And we’re involved in that.
AC:
As service providers, you are. Everyone who’s a service provider is involved in that. Someone is far less likely to follow your recommendations for like a diet or any sort of like home activity if you don’t come at them from a culturally sensitive lens. Someone is less likely to follow up with you, if you’ve been micro aggressive toward them in any way that. Someone is less likely to even kind of invest in your relationship, which, you know, rapport building is like the cornerstone of like trust and consent, and progress within the therapeutic relationship, right. You don’t have rapport; you struggle to make progress with someone. And you can’t develop a rapport with someone who’s being transphobic towards you, or racist towards you; you just can’t. You can mask and develop a fake rapport, which is something that a lot of us have learned how to do, you know. I’ve dealt with a lot of, like I said, incompetent providers. And in order to get what I need, which is just through the session, through the, you know, to get the prescription, to get the shoulder surgery. I’m not talking about trans-related things. I’m talking about just, you know, like sports medicine, physical therapy, surgeries.
I have a physical disability, which is something that I don’t know if I disclosed, I have Ehlers Danlos Syndrome. I also have degeneration of my spine. I use mobility aids, and I’ve seen a lot of different doctors. And as I was getting diagnosed, actually, every single provider that I saw attributed my physical symptoms to my gender, or sent me for a psychiatric evaluation, and I have been experiencing pain related to this disability since I was a young child. And everyone looked at me and only could see my gender, and was like, “Well, you need a psychological evaluation.” I’d be like, “But you know what, like, how come my shoulder keeps coming out of the socket?” or, you know, like, “How is my gender related to my ACL tear in my knee?” And I’ve had to ask those types of questions. But getting through those interactions is so difficult. It’s so much more work. If providers were universally trained, then people like me would have better outcomes, you know. People would have better outcomes in general if providers were universally trained, and were mandated to engage in culturally responsive practices, not just, you know, a` one/two-hour webinar every three years. But like, an actual, ongoing conversation with people who are different from them.
Meg:
I absolutely agree. I mean, your story of being medically gaslighted isn’t outside of the scope of common. And I really appreciate you helping us tie that to what it looks like in our fields. Because I think that this often happens invisibly, right? If I’m working with somebody and there’s a disconnect because I’m making insensitive comments related to class, or race, or whatever it is, it is likely that they’re not going to tell me that because of this power differential intersection. It is likely that at the end of the session, I’m going to say, “Okay, between now and next week, maybe you could work on these three things. How does that sound? Okay, great.” And then when they come back, I’m going to be really confused about why nothing that we practiced in our session carried over into the home. And I’m going to start to build a story about the parent, about the family. This is a really common scenario that’s happening, and the provider doesn’t even know
AC:
And it reinforces their own bias. So, what happens is, you know, you see a client who — I’m going to choose sort of like something random. Like, let’s say you see a client and you assume that they are from like a low socio-economic background. That seems like an easy enough thing to make assumptions about, right. So, you see a client, you assume they’re from a low socio-economic background. And therefore, you make various assumptions about like, parent education, about the availability of adults to be able to help with a certain task, you know. You make assumptions about — you build a story in your head about like whether or not someone’s going to be able to carry something through just based on an assumption about their socio-economic status. Imagine the stories that we build in our heads around race that we don’t even know that we’re building because we haven’t done the work to confront our own biases.
And, you know, I’m going to give you an example of something that I confronted in myself that I realized was unbelievably insensitive of me. And it has nothing to do with clinical stuff and I think that that’s actually going to be impactful. So, I have a physical disability, as I disclosed, and I have a hard time going grocery shopping without getting heckled — “You’re taking a spot from a disabled person. You’re young and healthy. Don’t use your grandpa’s placard.” I mean, all these things are being yelled to me. And my children are like, “My dad is disabled!” And I’m like, oh, my gosh. Like, let’s just ignore these people. And the reason why people say that to me is because I get out of a car, my body to them doesn’t look like a disabled body, even though I can barely walk or stand and, you know, like, I can’t even go into an in-person job because of it. But I don’t need mobility aids to get the 12-feet from my car to the cart. And the cart is what I need in the grocery store. The carts are fantastic mobility aids, and then they get heavier and it like actually is easier. And there’s like a sweet spot with the weight of the cart. But I hope that some disabled listeners are saying like, “Oh, yes, there is! There totally is.” Like, once you get a couple of cans in there, it’s fantastic.
So, I get heckled a lot locally, mostly by white women, about taking a spot from a disabled person. And, you know, this has led me to do things like go grocery shopping in the middle of the night, go, you know, like all of these things just to avoid this situation. And what I started doing — I live in a really diverse urban area, I live in Cambridge, Massachusetts — I started going to a supermarket that was a little further away in a predominantly black neighborhood because — and I had been there previously, it’s the same type of supermarket that we have locally, which is like a discount supermarket, but it’s a little bit larger. And I started going there because I was like, well, nobody bothers me here. And it took me until that horrendous mass shooting in Buffalo to realize that the reason why nobody heckles me there is because they’re scared of me there. And that was a tremendous moment of, I am someone who is really engaged in this learning. And I was making people feel unsafe. And it’s painful for me to talk about that. Because I never want anyone to feel unsafe in my presence, because I would never harm anyone. It’s painful for me to think about the fact that by virtue of me going to the supermarket, like people were scared. But, you know, why would a white person go grocery shopping in a predominantly black neighborhood? You know, I was just there because I didn’t want to get heckled. Like, I can handle the white ladies in the parking lot. I don’t want to make anyone feel unsafe.
The type of unlearning that I have been doing is really crucial. But the fact that I still have sort of like, hit-by-a-truck moments like that really show you that no matter how much learning you can be doing, there are always things, behaviors that you engage in, that you won’t know are problematic until all of a sudden you realize they are. And it takes the amount that I’ve engaged in order to understand why things like that are problematic, you know, and it’s really important that everyone understand that by virtue of saying insensitive things, you might actually be making someone feel unsafe. You might be triggering trauma in someone. And you really might be creating a situation where that power differential, which I always in my sessions, I strive to make that as even as possible, you know. You might be widening that to such an extreme with actions that you don’t even understand, like me in that supermarket. I didn’t understand until that mass shooting that that was inappropriate, and that people were so nice to me there because they were scared of me. And, you know, if I were someone who was super concerned about my image, like, that would be embarrassing for me, but I’m not embarrassed to be learning in front of people. And that’s what I do over at The Credit Institute. I take all of the classes, you know, I don’t kind of like put myself in a silo. It’s a group discussion. It’s really amazing learning content, and I engage in the learning with everyone and it’s really impactful. It leads me to really impactful conclusions.
Meg:
Yeah, this is — this story is poignant, because I think one of the ways people distance themselves from the need to do their own work around intersectionality in every way is by putting all of the importance on their thoughts. Like, “I am not bigoted. I don’t have negative thoughts about these people.”
AC:
Oh, everyone says that. “I’m not racist.”
Meg:
“I’m not racist,” right. And it’s like, okay, we’re able to say, “Oh, I actually cannot do right by my autistic clients unless I do a lot of listening, and learning, and unlearning. That I am probably do no harm if I don’t examine my biases.”
AC:
Absolutely.
Meg:
And we need to be saying that in every category, that we probably are doing harm if we haven’t taken the time to examine and continually re-examine, and to listen. AC, I want to circle back towards the end to the work you do at The Credit Institute because it’s so important, but I want to keep diving in to what’s happening now around diversity and inclusion training, and what shifts you’d like to see, because I know this is some of the work that you’ve done with universities. Can you talk a little bit about that?
AC:
So, right now, there’s, for speech language pathologists, there’s two accreditation standards that diversity, equity, and inclusion have to be sort of baked into the curriculum. And universities, I’ve been coming on board with some of them and helping them with their DEIJ initiatives, which I, you know, I love doing that. Because, well, usually what happens is an institution has one non-white professor and like, one or two non-white students, and that is the whole DEIJ committee. And they are responsible for, you know, donating their labor, to, you know, everyone and teaching basically everything that someone might need to know about cultural responsiveness to people who are actively not treating them well. And that’s problematic, and that’s happening in your workplaces, too, if you aren’t aware of it, you know. It’s people from minoritized populations. Like, of course, you know, we want to be on DEIJ committees, and that’s important, and it’s very hard to educate people who are actively mistreating you.
So, what I love about my work is I get to come in as an outsider and make things better for the people on the inside. So, I like to go into a place, I’ll kind of make sure that I have, you know, a seat at a table, a Zoom table, with a director and the diversity chair. We have a conversation, then I’d like to talk to the diversity chair a little bit about what’s actually going on there. And then, we come up with a plan for getting their department educated. And I’ve got a lot of people I collaborate with, you know. I can’t do all of the teaching in this. I’ve got a lot of people who I collaborate with who can talk about their lived experiences from lots of different angles, you know, not just, you know, I can talk about physical disability, and gender, and neurotype, but I can’t ever know what it’s like to be non-white, I can’t ever know what it’s like to be a non-native English speaker. I, you know, I don’t know what it’s like to be an immigrant. All of those things. And it’s, you know, what I like to do is bring other people in, and we sort of team consult and come up with a way for places to actually foster a sense of belonging that doesn’t feel like it’s being forced.
I can’t tell you how bad it feels to be like the ‘diverse’ person. And I’m putting air quotes around the word ‘diverse’, because everyone is diverse. I hate — the term ‘diversity’ is misused so much because people think it only applies to ‘other’. It’s funny because it has started to be a term I dislike because people don’t use it properly, but to be the, quote, ‘diverse’ person, and have people expect you to educate them on everything, it’s very hard. So, I’ve been going into universities, clinics, hospitals, schools, and taking that on. I have trained something like 3000 different institutions in gender-inclusive practices, intersectionality, I touch on gender-affirming practices, as well as anti-racist, anti-bias work for which I have the appropriate contributors come along with me. Because it’s — those aren’t my things to teach, you know, I can’t facilitate a course on anti-black racism, but I sure can bring someone with me who can. And that sort of consulting has been really exciting for me.
I have also been going and giving a lot of talks about gender-inclusive practices. And the intersection of gender and neurotype is something really important and poignant for your listeners, because autistic people are far more likely to express a gender variance. And let’s break that down for a minute. So, autistic people and people with ADHD — which I have ADHD, and I am allistic — the intersection there is that people who have ADHD or who are autistic are 7 to 10 times more likely to express gender variance. Why? Well, let’s think about it. Gender is a social construct. Autistic people don’t really buy into social constructs that don’t serve them, right. So, you’ve got a lot of people who are like, “You know what, this doesn’t apply to me and I don’t have the intrinsic social pressure to accept it. And, you know, I don’t have the desire to express it to please someone else.” And, you know, when you think about gender, really, all it is, is a performance. You know, your gender is something that you do feel on the inside, but your expression of your gender, it’s a performance, you know. It’s not — and obviously, everyone performs their gender differently, right? You know, I don’t do a whole lot to perform my gender, you know. But some people do. Some people go to extremes and do their hair and do their makeup; some people just, you know, kind of wake up and walk out the door in what they’re wearing, and that’s how they express their gender. Everyone has different ways of expressing their gender. If you don’t feel the pressing need to fit into a construct, then you’re less likely to do it. And autistic people definitely don’t feel that pressing need as much as allistic people do, you know. The sort of social pressure to conform is really, really there for all of us. But we know that people who don’t buy into social constructs are less likely to perform them.
So, it’s really important, when we talk about the intersection of autism and gender, that we think about the fact that if you’re working with autistic kids, they are more likely to express that they’re trans. They’re more likely to be trans. And they’re more likely to feel comfortable with the fact that they’re trans because the sort of outside notion of ‘gender has to be this way’ isn’t something that they’ve internalized. And that can come up in your clinical sessions, and it’s important to be prepared for that. A kid can literally look at you and say, “I’m not a girl.” And you have to know that number one, your reaction in that moment, you’re either going to affirm that person, or you’re going to become a part of a traumatic experience for them. And, you know, that can go either way and it’s a very quick interaction. And if you brush it off, the person notices. That’s not something that you can just brush off and be like, “Oh…,” like, people know that you’re avoiding that topic. If someone says to you something like, “I’m not a girl,” you need to know how to respond to that, you know. And you would respond by saying, like, “Oh, thank you for telling me that. Am I calling you the right name?” And then if your client knows what pronouns are, then you can say, you know, “What are your pronouns?” and then get that information from that person. Most importantly, I would say the first follow up thing to say would be like, “Oh, thank you for telling me,” like, take it as a correction. And then, you know, am I calling you the right name? Am I calling you the right pronoun? Who can I call you that name and pronoun with? Do you want me to call you that in front of your teacher, your mom, your grandparents, your brother, your, you know, that sort of thing? Or is that just something that you only want me to know?
You need to know how to handle that conversation. And it happens, it’s like a nanosecond. And that moment can either be the first time someone has ever successfully self-advocated about their gender, or it can be another sort of layer of trauma added to their gender trauma, which, you know, people are always trying to tell kids, you know, you’re this, you’re that, you know, especially autistic kids. I mean, the level of ableism in our fields is unbelievable, what people think that autistic people don’t know. I mean, autistic people know themselves just fine. And I think it’s really important that people don’t question that information when it comes from an autistic person. I think there’s a lot of — I know where I am. I know I’m with you. And I know that this is a podcast listened to by people who have been — who are very sensitive to the needs of autistic folks. But there is sometimes a level of questioning because there’s even a level of questioning for allistic and neurotypical people, you know. Like, are you sure about your gender? Do you really know what that means? Like, yes. If someone is telling you that, don’t question it. No matter their neuro type, don’t question it. Just the immediate, like, “Thank you for telling me. Am I calling you the right name?” and then move on with your therapy session in a way that feels positive. And you know that the person feels like, “Oh, now you’re calling me the right name.” We’re like, you know, now you know I’m not a girl, or whatever it was that was happening. And we can keep playing together, or we can keep doing this writing activity, whatever it is that you’re doing. Knowing how to react in those moments is really important.
Meg:
I appreciate that you’re taking this small moment and you’re helping us see how much bigger it is. And like you said, we could miss it. But I just want to rename this. I want to linger here for a second before we move forward, that there’s this moment that if we’re not ready for it, and we haven’t done our work around our biases, and we’re not paying attention, it might make us uncomfortable, we might kind of try to fast forward through it because we don’t know what to do. We might respond in a fake or inauthentic way because we haven’t processed our own thoughts and feelings about gender. But what you said is this moment could be the first time the child successfully self-advocates for their gender, or it could be another layer of trauma that we are creating. So, that moment is a moment that they are finding out from us if we accept and make space for who they really are, or if they need to hide from us too. And then, the rest of your relationship goes from there. And this is so easy to miss. I just really think that we all need to take a second to absorb that, and plan for that, and be ready for that in so many ways.
AC:
There are other ways to plan for it as well. This is a lot of consulting that I do wraps into these moments in classrooms, and clinics, and hospitals, in universities everywhere, how to respond when things like that come up, or how to make sure that you’re actually doing things from a sensitive perspective in the first place. Like, how to teach pronouns. SLP’s get really caught up in that, right? You know, “how do I teach the singular ‘they’? Who left their water bottle right here?” We use it all the time when we’re talking about someone who’s unknown. So, why is it so hard when suddenly we know someone who uses that pronoun? And, you know, people think, well, it’s confusing, you know, the way I teach pronouns, I get out a pink box and a blue box. And I say, well, that’s just a coding activity. You’re not teaching pronouns, you know. A pronoun is a word that you use in place of a name. It is really in place of a construct. But if we focus on teaching kids that pronouns are connected to a person’s name, it’s actually even better for people with aphasia. I know you’ve got speech language pathologists who listen to this. So, let’s think about this for a second. People with aphasia have a horrible time with pronouns. Why? Because you have to leave your language center. Sorry, Meg, what are your pronouns?
Meg:
She/her.
AC:
Okay. I have to leave — I have to leave my language center if I’m trying to talk about Meg using a pronoun. I have to think, “Meg = woman. What is the sort of appropriate —” like, I’ve left my language center to map her to a concept that doesn’t have to do with language necessarily, to retrieve a pronoun, when I could just ask, or I could just, I could just know what people’s pronouns are. So, when we teach kids pronouns, I love to teach them that you need to know someone’s pronouns, you can’t just assume them. If you feel like you have to make an assumption, it’s best to just use the person’s name or say something like, you know, “That student with the purple hat,” instead of ‘him’, because you don’t know. So, the way that I teach children pronouns is mapping them to a name, to a person, and talking about people you know, and what their words are, and what their — well, I’ll use words for really young kids, and then start to use the word pronouns at around five years old, because kids who are around five years old can learn the word pronoun. They can, and starting to map a name goes with the pronoun, you know.
AC’s pronouns are he/him, Meg’s pronouns are she/her. Ari’s pronouns are they/them — I’m using an imaginary person in my head right now — Ari’s pronouns are they/them. Okay, let’s talk about them. So, Ari lives on the moon, and they keep moon plants. And that’s, you know, just their day job. And Meg has this incredible platform where she really does a great job delivering continuing education to lots of different service providers. And AC, he also is a service provider and continuing educator. And just talking about how people’s names and pronouns go together, and how to substitute out a name and a pronoun with actual examples of real people and not just like ‘the boy’, ‘he’, ‘the girl’, ‘she’, because then the person, they, I mean, we have to think about the humanity first, right. And not sort of putting people into boxes and saying, you know, “This is the space you fit. You have to get into this —” you know, maybe you’re a square peg, “You’ve got to get into this round hole. This is the box where you fit.”
When we think about someone holistically, and what their needs are, and we have them in front of us, if we’re teaching them sort of a language concept that is based in a construct that doesn’t fit them, number one, they’re going to feel uncomfortable about it. Number two, they’re going to start to have gender trauma related to your language sessions, because they’re going to be sitting there doing a pronoun coding activity that makes them uncomfortable. Number three, they’re going to feel like they can’t share with you that they don’t fall into that construct, which that isn’t necessarily a rift in a relationship, but it’s a place where like you realize, you know, you can’t kind of go any further in the trust ladder with someone when you know that there’s a place you have to stop with how much of your personhood you share with them. Essentially, the way that we approach those types of activities, they show someone how much they can trust us because if you’re really centering people, and the language that we use when we describe people, and the language we use when we describe ‘a boy’ — I don’t know.
I mean, it’s my own practices. I’m a humanist. And, you know, I think it’s really important that everything be sort of brought back to exactly what I started talking about, which is person-centered care. And I feel like it’s really important that everyone understand that all of these angles of understanding how to respond to someone either coming out to you or correcting you with regard to their name or gender, and also understanding how to teach pronouns, and also understanding how to just have representation within your materials that helps them see, you know, helps the kids see themselves, all of these things are so important, and they’re really important and vital to your relationship. And that is vital to the outcome of your therapy. I make a lot of hand gestures, and I realize that those are a moot point during podcast interviews.
Meg:
Oh, you know, I also realized that I should have my pronouns next to my name on Zoom, I’ve updated it before, but I think I’m in a different account. I really appreciate how you bring us back there to this isn’t just about our work aligning with our values. It’s also about the experience of our clients, and how the work that we do around diversity, inclusion, intersectionality is going to impact the experience of our clients, the relationship that we are or are not able to build with them, and whether we’re having a positive impact on their life, their self-concept, their growth, or whether we’re creating more trauma. I love learning from you and I love how you are able to tie this in concretely to the work that we do. So, before we wrap up, tell us a little bit more about how you do what you do at The Credit Institute, what you have to offer, and where we can find you online?
AC:
You can find me online at @Transplaining on Instagram and also @CreditsInstitute on Instagram. At Credit’s Institute this fall, we have an intersectional cultural responsiveness course, one that is self-paced that is for 6.2 ASHA CEU’s, one that is live that’s for 7.35 ASHA CEU’s. The live one has three optional graduate credits if you’re someone who works in a school and you get credit, you get to change salary lanes if you’re working on that. So, we’re accredited through Fitchburg State, which allows us to give people graduate credits. It also enables students to take the class and then transfer the credit to whatever program they’re in. I’m also offering something called the Trans Voice Elective, which is really exciting. That one is almost all asynchronous. It’s seven asynchronous webinars; I’ve only recorded three of them so far, but it will be live next week. And it’s seven asynchronous webinars. And then, there’s one live five-hour day and that one is for 5.15 ASHA CEU’s because it involves reading a book. And it also comes with two optional for-purchase graduate credits if you’re someone who works in a public school who wants to change your salary lien. And the purpose of that was so that graduate student clinicians could take the course. So, the Trans Voice Elective, sort of everything you never learned in graduate school about delivering culturally responsive, like, awesome voice services from a trans person. You know, that’s an exciting, exciting offering that I’m bringing to people. But really, the intersectional cultural responsiveness courses are what I — those are where I really learned because I’m not the instructor there, I’m a learner with everyone else. I facilitate conversations, sure, but I’m a learner in this space just as much as everyone else is. So, there isn’t sort of a power differential between the instructor and the students, you know, I’m in there with everyone. And, you know, I would love for you all to join me.
There’s financial accommodations that can be made for any courses. I have tiered pricing for everything. And if that still doesn’t work out, then I just accept e-mails of like, “Hey, I can’t afford this,” and I’m able to generate coupons pretty easily. Also, I am available to come and consult. And I think that that’s something that most places need and don’t have going on. I mean, they think that everything’s great. And then I go to fill out an intake form, and it asks me, you know, 19 different times if I’m married, and what my — I went to the orthodontist the other day and it asked ‘Gender assigned at birth’. And I said to the orthodontist, what would you knowing that I was assigned female at birth 43 years ago do for you in this appointment? You know, there’s a lot of places that just need an overlook of their intake forms and procedures. There are a lot of spaces that require training. There are a lot of places that people just, you know, you don’t know what you don’t know. And it’s really important to engage in this work because trans people — especially trans people — of any race and neurotypes are especially vulnerable to suicide and self-harm, because of these systemic failures. I love the fact that I get to go places via Zoom and help people better understand how to have better clinical interactions, because I have pretty much only ever experienced negative clinical interactions. And so, I love being able to get there ahead of people so that I like to think of it as creating a situation that I would have wanted someone to create for me, making people feel more confident when they interact with a trans person. That’s what I want to do.
Meg:
I love this so much. The work you do is unlike almost anything else out there in terms of — especially in terms of continuing education courses for therapists. I wish it were a prerequisite for, I don’t know, existing in the world. But it’s certainly something all of us should be pursuing. I’ll link to all of your work and your social media in the show notes. Thank you so much for your work and your time today on the podcast.
AC:
Thank you so much for having me.
[Ending music]
Thanks for listening to the Two Sides of the Spectrum podcast. Visit learnplaythrive.com/podcast for show notes, a transcript of the episode, and more. And if you learned something today, please share the episode with a friend or post it on your social media pages. Join me next time, where we will keep diving deep into autism.
