In Memoriam

5. Consider becoming an advocate for the TGD community.

It is now up to us, the clinicians and providers to take up the mantle of gender affirming care alongside the TGD community who have dared to defy the gender binary and claim an identity that is their own. ❖

References

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American

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Barry Kardos, PhD NJPA member 6 years

Transgender Health Care: Integrating CBT working with a Transgender Client

Peter Economou, PhD

Transgender History

As the 50th anniversary of the riots at Stonewall in New York was celebrated in 2019, it is fair to say that, while society has made strides in lesbian, gay, bisexual, transgender, queer (LGBTQ) rights, challenges still remain. This paper will present a brief history of the transgender literature in psychology, address issues in the health care of transgender individuals, and illustrate the integration of LGBTQ-sensitive treatment along with evidence-based practices. First, we will take a quick look at the transformation of transgender research.

A review of the transgender literature found that American psychology journals began writing about “transsexualism” in 1954 when physician, Harry Benjamin, published Transsexualism and Transvestism as Psychosomatic and Somatopsychic Syndromes in the American Journal of Psychotherapy, 25 years after the term transvestism was first introduced1. Early conclusions about transgender individuals2 were not entirely based on fact and were speculative. For example, although he is seen as the father of transgender research, Benjamin (1954) made significant assumptions in his early writings including: 1. “most transvestites would be horrified at the idea of being operated” (p. 22), 2. “homosexual inclinations always exist in the transsexualist…” (p. 221), and 3. Hypothesized that “psychological conditioning, infantile trauma, childhood fixations, or an arrested emotional development” yielded a transgender identity (p. 222). He did, however, reference that therapy could not cure transsexualism highlighting that these individuals “require psychiatric help, reinforced by hormone treatment and, in some cases, by surgery” (Benjamin, 1954, p. 230). He concluded that there were many causes of transsexualism, acknowledged the intersection between environment, biology, and psychological conditioning, and stated there were no cures, although he claimed efficacy with hormone treatment (Benjamin, 1954).

In the middle of the 20th century, American psychology researchers were attempting to understand the LGBTQ experience, and there was an apparent struggle between pathologizing and normalizing behaviors labeled as LGBTQ (Benjamin, 1953; Freud & Brill, 1910; Thompson, 1947). Thompson (1947) wrote about the sociocultural pressures of being LGBTQ and acknowledged the fluidity of gender and sexuality as we know it today, just as Kinsey was just about to highlight. Kinsey and his colleagues were nuanced and provocative when they described sexuality on a spectrum in the 1940s, introducing a new paradigm to society. Kinsey, Pomeryoy, and Martin (1948) concluded that more than one-third of males had a male-male sexual encounter between adolescence and old age. They also described independence between sexuality and gender identity that was mostly unclear in the early psychology research (Kinsey, Pomeroy, Martin & Gebhard, 1953). There was a tug-of-war between the pathologizing and normalizing of LGBTQ identities, but ultimately researchers were attempting to understand the LGBTQ identities, just as we still are currently researching.

Still today, the LGBTQ community is often misunderstood and perhaps understudied. In 2017, Wanta and Unger conducted a meta-analysis and found that it took several decades for psychologists to research and publish on transgender health whereby the most significant contributions occurred into the 21st century, some 40 years since Benjamin. Their findings showed that mental health publications related to the transgender community accounted for 11% of all LGBTQ-related publications and this included a review of more than 2400 peer-reviewed articles (Wanta & Unger, 2017). They also noted that there was an apparent shift from identifying transgender individuals as having a mental health disorder to a variation of normal. These accounts from 1900 to 2017 illustrate the shift that occurred within the LGBTQ literature, and it was not until early in the 21st century where the scientific method shift occurred, and the emphasis was placed on evidencebased practices within health care systems.

Health care and the LGBTQ experience

Nearly half of transgender individuals surveyed in 2015 reported their health care providers lacked provider knowledge (James, Herman, Rankin, et al., 2016), and a recent study found nearly 80% of first year medical students expressed implicit bias towards LGBTQ patients and 50% of those medical students endorsed explicit bias towards LGBTQ people (Sabin, Riskind, & Nosek, 2015). Discrimination in the health care context is pervasive for transgender people. In 2015, 33% of respondents to the US Transgender Survey, who had seen a health care provider in the past year, reported at least one negative experience with a health care provider related to their transgender status; 25% reported having issues with insurance coverage because they were transgender. Lack of access to highquality and non-discriminatory care or insurance coverage is a particular concern for this population because transgender people also disproportionately experience negative health outcomes. In the same study, 40% of respondents reported a lifetime suicide attempt, 29% reported illicit drug use in the past month, and 1.4% were living with HIV (as compared to 0.3% of the general US population).

These statistics highlight the need for services for the transgender community, and services that are culturally sensitive. In 2018, the first text book related to the overall health care needs of transgender individuals was published by psychiatrist, Eric Yarbrough (See Yarbrough, 2018), providing the first comprehensive look at the unique health care needs of the transgender community. Psychologists must be mindful of interventions that support this community in an effort to engage transgender clients and improve their overall well-being.

Integration of CBT and LGBTQSensitive Therapies

A meta-analysis that compared the efficacy of Cognitive and Behavioral Therapy (CBT) for multiple disorders with other

forms of psychotherapy that reviewed 26 studies and 1,981 clients, found that CBT outperformed other psychotherapies in the treatment of multiple disorders (Tolin, 2010). Tolin (2010) suggested that the results of this meta-analysis indicate that CBT should be considered as a first-line choice of treatment, particularly with respect to anxiety disorders, along with other disorders, indicating that CBT should be implemented for the treatment of diagnoses including symptoms of anxiety. The challenge for psychologists is understanding how issues of diversity interact with manualized and evidencebased practices, such as protocols within CBT. I will highlight this through the presentation of a brief case study3 .

The case of Kay. Kay is a 20-somethingyear-old assigned female at birth, who knew that the breasts and vagina were not aligned with gender identity from early childhood. Both parents noted that Kay would request stereotypical toys for males, was labeled as a tomboy, and asked questions pertaining to why he had breasts and a vagina beginning at least age 3-4-years-old. Kay is White and Catholic, has one sister, and was raised by both parents reared in a middle- class White area. Kay described dysfunction within the family structure whereby his parents would argue often and loudly, and he would catch his father speaking with other women and commanding sexual acts over the computer or phone. Kay had a very close and loving relationship with his mother, who would bring Kay to session, and a distant relationship with his father due to the aforementioned (i.e., he would judge and resent his father for the sexual actions witnessed). His sister was stable with a fulltime job, got married during treatment, and had a child.

Presenting problems included social phobia that was preventing Kay from securing work, from socializing beyond social media, and from learning skills for daily living such as grocery shopping. There was also agoraphobia evidenced by avoidance and intense fear of attending events outside the home, even when it was determined he would not have to interact with anyone (generalized anxiety disorder was also considered). Kay reported that his gender fluctuated between male and nonbinary. He presented with rigid thought processes and began hoarding. While the main presenting problem was the gender dysphoria, these phobias and anxiety symptoms were preventing Kay from presenting his actual gender to others and society, and had to be addressed while also targeting the gender dysphoria.

Having an open discussion about pronouns and names was helpful to build rapport, as were assessments of gender identity (e.g., Utrecht Gender Dysphoria Scale and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults), basic CBT psychoeducation such as cognitive distortions, behavioral chain analysis of Kay’s avoidance, and ultimately some values work attempting to address his ambivalence for eliminating his social phobia. While progress was relatively slow, Kay eventually would go to the store with his sister, felt most comfortable going out with his mom (i.e., he would even go to the movies with her, which for a transgender client is anxiety-provoking because of the public bathroom situation), and even applied for a few jobs. Kay would walk outside as a part of exposure practice, speak with someone at the store to ask a question, and would use the bathroom in our office as practice of using the male restroom.

One year into treatment, suddenly his mother died. Kay had been doing quite well and that included decreasing to monthly sessions (for the first 10 months sessions were weekly), regular employment, socializing with some childhood friends at least bi-monthly, decreased hoarding, and he had even babysat his nephew. The sudden death of his mother shocked him, but he presented as resilient. Kay described feeling sad, but he was also determined to persevere and accomplish more. In fact, one of his hoarding behaviors was related to money that in this case might be a strength since he had reported that his father was not responsible with money citing that his father had spent a lot of the life insurance policy.

While treatment assessed gender dysphoria, and this included psychoeducation about the fluidity of gender, the behavioral interventions were essential to overcoming the phobias and his moderate to severe symptoms of anxiety. These are two very discreet principles, but they were intertwined. That is, Kay could not practice living in his gender identity since he was phobic of public spaces and feared interacting with other people. The CBT interventions desensitized him to the social phobia and the hierarchy that was developed between him and clinician proved to make social settings tolerable. He reported decreases in anxiety symptoms when leaving the house, he was able to purge items that he was hoarding (e.g., cardboard boxes was a big one), and he used social media as a practice tool to conversation starters out in public face-to-face.

In terms of his gender identity, the commencement of hormone replacement therapy4 (HRT) almost immediately decreased the gender dysphoria and provided space for us to explore his gender identity that remained fluid between male and nonbinary. The initiation of HRT illustrates how CBT and gender identity, although discreet, were linked. When Kay had to call the endocrinologist’s office, he was nervous and avoided it for a few weeks. So, we conceptualized that as an exposure practice, and we made the call during session after modeling and role playing the call the previous week. This allowed him to gain confidence in these social interactions and the significant decrease in gender dysphoria positively reinforced this exposure making calls to surgeons two years later much more accessible. Kay also decided to change his name from his given name to one that was more gender-neutral. In terms of surgeries, we discussed surgical options and he completed a thorough review including consultations with a few surgeons. He was confident, and discussed with family, that top surgery5 was essential, but remained unsure about bottom surgery6. These decisions were made from my objective understanding of transgender processes, using several pro/con lists, gender dysphoria scales, a few family sessions (even 2 sessions with his sister), and with consultation with other professionals.

At the conclusion of treatment, Kay had worked to improve the relationship with his father and that included the practice of acceptance regarding the nature of their relationship and his father’s sexual behaviors, expressed healing over the loss of his mother, was a regular in the life of his nephew and sister’s growing family, was working full time and saving money, had a driver’s license and was mostly independent, and continued to explore surgery options for the transition. Termination was mutually agreed upon with the understanding that Kay would need additional support in the future as he decided surgical procedures. This would include the formality of letters

of support, but also the psychological shifts that often occur as a transgender client begins the transition anatomically.

Conclusion

Kay could not have been treated in my office alone. The unique treatment needs for transgender clients were enhanced by integrating my work and utilizing interdisciplinary networks such as endocrinologists, psychiatrists, social workers, and surgeons. It was imperative that these other practitioners be versed in the current transgender practices that was a challenge in and of itself and is geographically determined. As healthcare has dictated the need for evidence-based practices and psychological science has emphasized the importance of multicultural competence, it is incumbent upon psychologists to practice within these domains. This does not suggest invalidation of other psychotherapies, rather, working in teams to address symptoms associated with interventions based on empirical data.

There is still the need for enhanced treatment protocols for the transgender community, and 50 years after the Stonewall riots, this marginalized group is still in need of the advocacy efforts from various groups, such as psychologists, to ensure the healthcare practices are efficacious, culturally sensitive, and based on empirical research. ❖

Benjamin, H. (1954). Transexualism and

Transvestism as Psychosomatic and

Somatopsychic Syndromes. American Journal of Psychotherapy, 8. P. 218-230. Freud, S. & Brill, A. (1910). Three contributions to the sexual theory. Journal of

Nervous and Mental Disease. Grant, J. M., Mottet, L. A., and Tanis, J. (Oct. 2010). National Transgender Discrimination

Survey Report on Health and Health Care.

Retrieved from (Oct. 2010). James, S. E., Herman, J. L., Rankin, S., Keisling,

M., Mottet, L., & Anafi, M. (2016). The

Report of the 2015 US Transgender Survey.

Washington, DC: National Center for

Transgender Equality. Kinsey, A., Pomeryoy, W. & Martin, C. (1948).

Sexual behavior in the human male.

Philadelphia: W.B. Saunders Co. Kinsey, A. Pomeroy, W., Martin, C. & Gebhard (1953). Sexual behavior in the human female. W.B. Saunders, p. 680. Obedin-Maliver J, Goldsmith ES, Stewart L, et al. Lesbian, Gay, Bisexual, and Transgender–

Related Content in Undergraduate Medical

Education. JAMA.2011;306(9):971-977. doi: 10.1001/jama.2011.1255. Sabin, J.A., Riskind, R.G., & Nosek, B.A., (2015). Health Care Providers’ Implicit and

Explicit Attitudes Toward Lesbian Women and Gay Men. American Journal of Public

Health. 105(9):1831-41. doi: 10.2105/

AJPH.2015.302631. Thompson, C. (1947). Changing concepts of homosexuality in psychoanalysis. Journal of

Psychiatry. 10, 183-189. Tolin, D.F. (2010). Is cognitive-behavioral therapy more effective than other therapies?

A meta-analytic review. Clinical Psychology

Review. 30(6):710-20. doi: 10.1016/j.cpr. 2010.05.003. Wanta, J.W., & Unger, C.A. (2017). Review of the Transgender Literature: Where Do We

Go from Here? Transgender Health. 2(1): 119–128. doi: 10.1089/trgh.2017.0004 Yarbrough, E. (2018). Transgender mental health.

Arlington, VA: American Psychiatric Association Publishing.

Footnotes

1See Hirschfeld, 1925 2Labeled as transvestites or transsexuals in the earliest writings 3Note that consent was given to present this case using a pseudonym, and this section of this article was taken from another article under review for publication elsewhere. I edited it slightly and present just an abbreviated version of the comprehensive case study. 4Referral to endocrinologist was made within 6 months of treatment, in consultation with Kay and his parents, as was to a psychiatrist who attempted 2-3 SSRIs over the next 6 months, but ultimately decided that HRT and behavioral interventions were most effective so they stopped the SSRI prescription. 5Subcutaneous Mastectomy 6Vaginoplasty, phalloplasty, or metoidioplasty

Convergence of Legal Rights with the Educational and Psychological Well-Being of Transgender Students in New Jersey

Jodi Argentino, Esq.

Abstract

The school setting for transgender students is a critical environment to be considered for not only students’ academic development, but also their emotional and social well-being. Instances of bullying, discrimination, and non-gender-affirming or exclusionary behaviors and policies are known to have detrimental effects on the all-around wellbeing of transgender students.

Investigating laws and policies to determine whether they are sufficiently protecting the rights of all students regardless of gender identity, and providing appropriate trainings for professionals working with students are paramount steps in creating an environment of support and affirmation for transgender students.

Convergence of Legal Rights with the Educational and Psychological WellBeing of Transgender Students in New Jersey

Educators and those working in a school setting often ask: what does the law allow me to do, or what does the law require me to do when it comes to transgender students? What issues specifically or disproportionately impact transgender students in an elementary or

secondary school setting? Are there areas in which a mental health professional’s ethical obligation might be at odds with a school or legal policy? Are the laws that govern students in schools developmentally appropriate, or do they negatively impact educational and psychological well-being of transgender students?

Research tells us that 60% of students who identify as transgender or queer have been bullied in school because of gender expression (Day, 2019). Moreover, this toxic environment not only has an extremely negative emotional toll on students, but has a detrimental influence on academics (Day, 2019). Overall, transgender youth have far less academically successful educa-tion experiences than cisgender peers (Day, 2019). Contrarily, when an inclusive and supportive environment exists at school with learned policies and procedures, this causes the opportunity for more stable emotional wellbeing and academic success for all students, not just LGBTQ students (Day, 2019). Some Sexual Orientation and Gender Identity (SOGI) policies that are helpful in schools include personnel trainings on cultural competency and appropriate handling of harassing or inappropriate situations, having Gay-Straight Alliances (GSA) and/or other diverse clubs and school-sponsored groups, identification of safe spaces where, and individuals from whom youth can access support, and inclusive curriculum (Day, 2019).

Unfortunately, while many schools have supports for LGB youth, they are lacking in specific trainings and supports for transgender students that are different supports than those for LGB youth given that the trainings and supports must be regarding gender identity and expression, not just sexual orientation. Transgender students face significant additional challenges with how their schools handle discrimination and harassment associated with their gender identity and expression (Day, 2019). However, partnerships between school counselors and students (and families subject to privacy considerations), can be essential to positive experiences for transgender students (Beck, 2019).

Title IX of the Education Amendments of 1972 34 CFR 106 et seq. was created to eliminate discrimination in education based upon sex (Overview of Title IX, 2015). Title IX of the Education Amendments of 1972, 20 U.S.C. § 1861, provides that “No person in the United States shall, on the basis of sex, be excluded from participation in, denied the benefits of, or be subjected to discrimination under any education program or activity receiving Federal financial assistance.” The United States Department of Justice states that the “principal objective of Title IX is to avoid the use of federal money to support sex discrimination in education programs and to provide individual citizens effective protection against those practices” (Overview of Title IX, 2015).

Federal Laws create a “floor” of fundamental rights, not a “ceiling.” A state or locality can provide more rights than those provided by federal law, but the statement or locality cannot provide less protection (Miller & Wright, 2008). The type of protections offered by way of Title IX include rights such freedom from discrimination in housing, sports, and “any academic, extracurricular, research, occupational training, or other education program or activity operated by a recipient which receives Federal financial assistance” (Overview of Title IX, 2015). These protections have been used to protect LGBTQ people with the concept that “on the basis of sex” includes the sex of one’s partner, as well as one’s own gender identity and expression.1 However, because federal law is a baseline as discussed above, New Jersey can and does provide enhanced protections for LGBTQ people that will continue to protect New Jersey residents even if, at any point, the Supreme Court of the United States determines that Title IX does not protect LGBTQ people (Miller & Wright, 2008).

The New Jersey Law Against Discrimination (LAD) enhances the protections under Title IX and includes that persons in New Jersey cannot be discriminated against because of sexual orientation or gender identity or expression in places of public accommodation. New Jersey’s protections under the LAD well expand the federal floor and include protections based upon: race, creed, color, national origin, nationality, ancestry, sex, pregnancy, breastfeeding, sexual orientation, gender identity or expression, disability, familial status, marital status, domestic partnership/civil union status, liability for military service, and in some cases atypical hereditary cellular or blood trait, genetic information, and age (NJ

LAD).

In an effort to help students be protected from discrimination and to help schools treat their students with respect and support, in Fall 2018, the Commissioner of New Jersey Department of Education issued the publication: Transgender Student Guidance for School Districts (Transgender Student Guidance for School Districts, n.d.). The Commissioner of Education was required to develop this guidance pursuant to statute, N.J.S.A. 18A:36-41 that was signed into law on July 21, 2017. This guidance policy is necessary because of the significant challenges faced by transgender students (2015 US Transgender Survey, 2016). Students are often denied their basic human needs such as affirmation of identity, appropriate name, and ability to use a restroom associated with their gender identity (2015 US Transgender Survey, 2016). Further, while there is a plethora of research that shows that extracurricular involvement supports students’ developmental needs, transgender students may be excluded from involvement, such as in athletics programs. Exclusion from such opportunities prevents transgender students from having the advantage of those development experiences that cisgender students may access (2015 National School Climate Survey, 2016).

New Jersey State Interscholastic Athletic Association developed a transgender athlete policy in late 2017. While brief, this is a poignant policy that ensures that transgender students are permitted to participate in the sport “gendered” to associated with their gender identity. The policy allows that a trans student may choose to participate in the sports team that conforms to their gender identity or their sex assigned at birth at their election, but cannot thereafter, participate in another team that confirms to their sex assigned at birth (New Jersey Interscholastic Athletic Association Transgender Policy, 2017). This policy, thus, allows the transgender student, along with the cisgender student, to participate in activities valuable to their development and growth.

Coming out and/or social transitioning at school is something that exposes a transgender student to bullying, peer criticism, differential treatment by educators, and family acceptance issues, all of which contribute to the student’s mental health and emotional well-being (2015 National School Climate Survey, 2016). New Jersey has anti-bullying laws that were enacted

in 2011. The Anti-Bullying Bill of Rights Act provides that if a student is being targeted because of their actual or perceived gender identity or expression, it could be considered harassment, intimidation or bullying (N.J.S.A. § 18A:37-14). The Act requires every school board to develop their own policy that conforms with the requirements set forth in the Act and it must be reviewed and revised annually with the school’s designated Anti-Bullying Specialist (New and Amended Harassment, Intimidation and Bullying Laws, n.d.). The New Jersey Department of Education released (revised as of April 2011) a model policy which is available at <http:// www. state.nj.us/education/parents/bully.htm>. This guide provides not only a model policy, but references, books, and resources for policy development, assessment, prevention, and intervention.

Students’ “coming out,” a term of art meaning that they are revealing their transgender status, comes with an entire breadth of complications and considerations. Some students may come out at school, but not at home due to fear of unsupportive parents. These students may fear their parents finding out, but are fully comfortable being true to themselves at school because of a supportive school and peer environment. Other students may come out at home, but may not have socially transitioned at school and, therefore, may be suffering from dysphoric feelings while trying to progress academically. Yet other students may have socially transitioned in younger years, but are not out to their peers or educators about their transgender status, hoping to just blend in with others sharing their gender identity without revealing their sex assigned at birth or prior name, often known as a “dead name.” Federal and New Jersey laws help protect the privacy of families and students in all three of these scenarios, as well as many others.

The Family Educational Rights and Privacy Act (FERPA) is a federal law that protects the privacy of student records and, as with Title IX mentioned above, applies to all schools that receive federal funding through the US Department of Education. Therefore, disclosure of a student’s birth name, fact that they are transgender, and/or any other personally identifiable or medical information cannot be made without consent. This includes disclosure by personnel to other school personnel unless the disclosure is “related to a legitimate educational interest” (FERPA, 2018). Thus, a student can reveal their transgender status to a teacher, principal, nurse, guidance counselor, etc. and ask the personnel to use a chosen name and gender identity, but the student can also expect, under privacy laws, that their educators will keep their transgender identity, name, expression, etc. private from others. This does mean that the school must also keep the student’s transgender status from the student’s parents/family unless the student has consented otherwise (FERPA, 2018).

FERPA also allows for students to formally amend their school records if the records are “inaccurate, misleading, or in violation of the student’s rights of privacy.” Thus, transgender students are able to change their original school records to reflect their name and gender marker to match their gender identity and expression. If a student is under 18 years of age, this ability is shifted to the student’s parents/ guardian (FERPA, 2018). The argument is that if you can change your name and/or gender marker on other identity documents (such as a passport, state issued identification, or birth certificate) but not your school records, then the school records are, in fact, “false or misleading.” Moreover, if the school record reflects the wrong gender identity, then, again, the school record is “false.” In the case of Powell v. Schriver, a 1999 case generating in New York, but heard in the 2nd Circuit District Court, the Federal Circuit Court determined that it is “beyond a doubt” that someone’s transgender status is “excruciatingly private and intimate” (Powell v. Schriver, 1999).

Despite what appears to be backwards motion in transgender rights from a national perspective, the State of New Jersey continues to move forward in efforts to protect transgender individuals, particularly students, and to ensure that transgender students receive all the benefits, developmental, and educational experiences that cisgender students receive. In 2018, the State of New Jersey’s Transgender Equality Task Force was established “to assess the legal and societal barriers to transgender equality and provide recommendations to the governor and the legislature on how to ensure equality and improve the lives of transgender people” (NJ Transgender Equality Task Force, n.d.). Further, in early 2019, education-related laws were passed to ensure that middle and high school curriculum includes the historical contributions of disabled and LGBT persons.

It is important for transgender students to see themselves reflected in their staff, their lessons, their heroes, and to feel the support of their school and peers. Research associated with relationalcultural identity development show that supportive environments with peers and role models that reflect students’ own identities is necessary for positive minority youth development. This is especially true for LGBTQ youth, who have a pervasive environment of heterosexism and transphobia that create the necessity to overcome negative messages even more than for cisgender students (Singh, 2019). This can be accomplished through the implementation and follow through of the policies and programs such as GSA groups, appropriate academic and athletic policies, diverse staffing in schools, and educated staff and, particularly, experienced and trained mental health professionals in the school system and accessible and relatable to the students.

The guidance provided through the New Jersey Board of Education gives schools and educators the ability to provide these resources and supportive environments to transgender students (Transgender Guidance, 2018). The guidance encourages open (but confidential) communication between educators and students. Students’ assertions as to gender identity should be accepted and respected without the need for parental consultation. There is no need for legal or medical supports for the student’s assertions as to name or gender marker. The guidance confirms that even if there is a disagreement with a parent as to formal academic records that they have the authority over pursuant to FERPA, the student’s assertions should be respected and used in school. The guidance also provides that staff should receive appropriate trainings and that all activities, functions, and lessons within the school must recognize and be respectful of all gender identities and expressions (Transgender Guidance, 2018).

Unfortunately, while this affirming and supportive guidance exists pursuant to New Jersey statute, not all school districts have updated their policy to conform

with the guidance documents. Further, even those districts that have developed appropriate policies on paper, they may not have arranged for the trainings so as to appropriately effectuate the constructs therein. This is problematic because, often without a negative intention, schools perpetuate cis-normative structure that is the assumed expectation that the gender identity and expression of all individuals is that of their sex assigned at birth (Lewis, 2019). Trusted teachers and school counselors are poised to be important protective adults in transgender students’ lives at critical stages of development when acceptance, support, and affirmation is essential (Lewis, 2019). ❖

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About the Authors:

Jodi Argentino is an owner and the managing partner of Argentino Family Law & Child Advocacy, LLC, where her practice focuses on work involving LGBTQ families and children, non-nuclear family structures, families with special needs, and complex parentage situations. Jo is also qualified by the State of NJ as a Family Law Mediator, is a Parent Coordinator and Guardian ad Litem, and is currently completing her Master’s in Child and Adolescent Developmental Psychology. Jodi was the 2017-18 chair of the NJSBA LGBT Rights Section, is a member of the NJSBA Family Law Section and the Section’s Executive Committee, the Association of Family and Conciliation Courts, and is an appointed member of the NJSBA CLE Advisory Committee. Jodi was also featured on Inside NJ’s LGBT Powerlist, was a recipient of the National LGBT Bar Association’s 40 Under 40 award, and co-authored a chapter in Oxford University Press’ LGBT Divorce and Relationship Dissolution.

Celeste Fiore is an owner and partner of Argentino Family Law and Child Advocacy, where their practice includes family law, school law, special education, and anti-bullying work, civil rights litigation, and legal assistance for the transgender and non-binary identified community. Celeste is a long-time LGBTQ educator and activist and presents regularly on LGBTQ cultural competency and legal issues specific to the LGBTQ community. Celeste serves as a trustee of the NJSBA and is a past-chair of the LGBT Rights Section of the NJSBA. Celeste was also featured on Inside NJ’s LGBT Powerlist, was a recipient of the National LGBT Bar Association’s 40 Under 40 award, wrote an article on LGBTQ cultural competency for the ABA’s Solo and Small Firms publication GPSolo, and co-authored a chapter in Oxford University Press’ LGBT Divorce and Relationship Dissolution.