Take the Last Bite

We take a bite out of queer and trans affirming healthcare with Asher Wickell (they/he) a family and marriage therapist based in Wichita, Kansas. We get philosophical in our exploration of what healing looks like in the face of perpetual harm, how the pandemic has unearthed realizations about the flaws in our healthcare systems, and what a future of affirming care could look like when the current system becomes obsolete.

Show Notes

We take a bite out of queer and trans affirming healthcare with Asher Wickell (they/he) a family & marriage therapist based in Wichita, KS. We get philosophical in our exploration of what healing looks like in the face of perpetual harm, how the pandemic has unearthed realizations about the flaws in our healthcare systems, and what a future of affirming care could look like when the current system becomes obsolete. 

Additional resources & references from this episode: 

For questions, comments or feedback about this episode: lastbite@sgdinstitute.org 

Find us on Twitter, Facebook and Instagram or at sgdinstitute.org 

To support this podcast and the Institute, visit sgdinstitute.org/giving

Host: R.B. Brooks, they/them, director of programs for the Midwest Institute for Sexuality & Gender Diversity 

Cover art: Adrienne McCormick


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Creators & Guests

Host
R.B. Brooks
Director of Programs, Midwest Institute for Sexuality and Gender Diversity
Producer
Justin Drwencke
Executive Director, Midwest Institute for Sexuality and Gender Diversity

What is Take the Last Bite?

Take the Last Bite is a direct counter to the Midwest Nice mentality— highlighting advocacy & activism by queer/trans communities in the Midwest region. Each episode unearths the often disregarded and unacknowledged contributions of queer & trans folks to social change through interviews, casual conversations and reflections on Midwest queer time, space, and place.

For questions, comments and feedback: lastbite@sgdinstitute.org

To support this podcast and the Institute, please visit sgdinstitute.org/giving

Host: R.B. Brooks, they/them, director of programs for the Midwest Institute for Sexuality & Gender Diversity

Cover Art: Adrienne McCormick

RB
Hey hi hello ya’ll this is RB and welcome back for season 2 episode 6 of Take the Last Bite, a show where we take Midwest Nice put it on a stick, roll it in batter, and deep-fry it so that we can take a big juicy bite into the ways in which Midwest queer and trans communities make meaning out of our experiences.

On today’s episode, we get philosophical about the queer capacity for collective and community care and what powers we have in preparing for the wheels to completely fall off our current healthcare system.

While it’s not news to queer and trans people (or any oppressed group of people) that we are not served, affirmed, or considered by the medical industrial complex, in many ways the pandemic has revealed the depths of it’s inadequecies on an even larger scale. I believe a major shift is inevitable because now it's not just folks who have been battling with underwhelming healthcare for decades up to this point who are angry and activated. We now have the average, unattuned, unaffected person from before the pandemic who has now been made acutely aware of the failings of our healthcare systems. And like most major life events, whether it's examples like the large-scale protests from the summer of 2020 or the now on going pandemic, we will likely see people engage more deeply and find their political home to participate in social change work. We also know that plenty of people will go back to their ignorant bliss and move on.

In many ways it's hard to blame them– at least as individuals– because there are so many forces to encourage (i.e. force us) to adopt a historical amnesia and get back to business as usual. We are in a forced post-pandemic state of mind and it is going to require a certain level of conscious and intentional vigilance to ensure that we do not lose our opportunity to extract lessons from this moment and take action where it's needed.

And as I reflect on the conversation that you'll be hearing today between myself and a decades-long healthcare practitioner I'm reminded of so many incredible teachings that I want to uplift in this moment to further frame this episode and that I believe are necessary for us to dig deep into to take greater control over the futurity of our health and healing.

I'm first reminded of journalist Naomi Klein's writings about the aftermaths of various disasters such as hurricanes, coups or terrorist attacks. In her book The Shock Doctrine: The Rise of Disaster Capitalism, she describes the concept of the shock doctrine as the tactic of using the public's disorientation following a collective shock– such as, oh idk, a global health pandemic– to push through radical pro-corporate measures. In other words Klein has extensively documented the ways in which government, corporate, and private interests conspire together to bank off of disasters and monopolize the resources that people need for their survival after being devastated by that disaster.

From Klein, I readily jump to Dean Spade’s writings on Mutual Aid, which offers guidance on how people can come together in light (and spite) of government processes that do not serve our material needs, especially in times of crises. And I would weave that together with the takeaways from a recent podcast episode from the Emergent Strategy Ideation Institute– because my mind is always thinking about how emergent strategy interplays with everything– where adrienne maree brown chatted with Spenta Kandawalla about the nonlinearity of healing, how Western-medicine will not relinquish its reign and make room for the legitimisation of ancient medicinal practices and how the suppression and rejection of those practices by medical industrial complex cost us some potentially vital treatment options in the onset of COVID.

And that podcast conversation made so many points of connection to a book I recently finished (and will hopefully be finishing a review of for our website soon) called The Care We Dream Of by Zena Sharman, and I want to relay a direct paragraph from one of her essays called “The System is Not Broken, It’s Working As Designed” which– is a statement we could make about damn near any system– but in this case Zena is talking about healthcare systems so she goes on to say:

“Health systems have a way of fading into the background that can give them a taken-for-granted quality. This isn’t because we always trust the system will be there for us when we need it: rather, it’s because many of us have internalized the idea that the way the health system operates is somehow normal or natural. It’s just the way things are.

Many people live, suffer, and sometimes die inside the harms and violence of ‘it’s just the way things are.’ This taken-for-grantedness can also limit our ability to imagine what kinds of change might be necessary or desirable to create a health system capable of meeting LGBTQ+ people’s needs. To change a system, we need to be able to perceive it.”

I wanna emphasize that last part again– “to change a system, we need to be able to perceive it.” Now I interpret that two-fold: on one hand, the need to perceive and conceive of these systems as real, by not just looking left and right, pointing fingers and placing blame on individual people, but also looking up and down and understanding the foundations and the overtones that create our current conditions. And on the other hand, taking cues from our predecessors, harvesting what was planted for us, and planting more seeds that can nourish those after us.

This combination of writings, this syllabus I’ve essentially verbalized for ya’ll, showcases just how many barriers exist to our ability to tap into our power of cognition, to imagine, to dream, to envision something different. And it also proves to us that we are magicians, skilled shape-shifters and radical imaginaries. All the references and some bonus materials will be linked in the show notes so I highly recommend digging into that content and fueling your own imagination around how to perceive the next big change.

Today’s episode is all about pie-in-the-sky dreaming as I chat with a long-time friend and mentor who shares my love of external processing and building off of each other’s big ideas. I’m thrilled to share this chat with y'all and hope it serves as motivation for your own deep reflections on care-work and healing.

With that, take a deep breath, center yourself and settle in for this episode of Take the Last Bite.

[INTRO MUSIC PLAYING]

Y'all we cannot do this. We cannot be these stereotypical Midwesterners. Please eat the rest of this food.

We just have these conversations every day with people like this is exhausting. I don't want to do this anymore.

Why can't we be in space with hundreds of other queer and trans folks and having these necessary conversations?

I don't know who you are, but we're going to talk by the potatoes for five minutes

Because aesthetic is the only thing keeping my dysphoria at bay. I'm broke all the time, but I look amazing.

Definitely going to talk about Midwest Nice and if that's as real as it wants to think it is.

Midwest nice is white aggression. That's what it is.

[END MUSIC]

R.B.
So let's start off with you telling folks who you are. What should we know about you? Why are you here, besides me wanting to see your face? [LAUGHS]

ASHER
So my name is Asher Wickell. I am a marriage and family family therapist in Wichita, Kansas. I use they/them and he/him pronouns pretty interchangeably, in fact. Ideally, it would just be 50% of each all the time. But I feel like the only way to make that happen is to actively advocate for they/them pronouns in every queer space you enter and then just let everybody else use he and him. And that comes out to about the right proportions for me because I have built this queer bubble around myself that is honestly one of the best side effects of being in business for yourself.

R.B.
[LAUGHS]
Lovely.

ASHER
We were counting on our fingers. I've been therapist-ing for the better part of a decade at this point. With a license slightly longer than that if we want to count my student therapy days and really entered this field primarily from a place of having done a lot of queer advocacy, activism, leadership development, which is sort of just what it means to be queer or trans in the Midwest, if you like. It kind of comes with it. I loved that, and I love doing that in kind of like, group centered ways. But one of the things that I felt like I kept experiencing and I know I'm not alone in this experience is things were getting better external to us with the usual two steps forward, one step back dynamic that that entails. But we would see policy get better. We would see laws and regulations and so forth change for the better. But a whole lot of the queer and trans folks around me were still really suffering and struggling and overwhelmed by both past and still ongoing experiences relating to identity. So at some point I started looking at that and I was like, I really kind of want to do something about that thing that feels more direct and that hopefully allows more people in our community to live well in this world that we keep trying to make better.

R.B.
So that is definitely the direction we're going to go with this conversation is just talking about therapy, but kind of getting philosophical about it because you and I kind of resonated on that frequency of big picture conceptual/contextual. And I'm really excited to do that. And so we're just going to dive right into a pretty big question that we're going to kind of break down into some pieces throughout this chat–

ASHER
Perfect.

R.B.
– it was inspired by a podcast that I had listened to that I'm going to share with you, but it's an episode from Code Switch, and the title of that was Can Therapy Fix Racism or Cure Racism? Something to that avail. Right. And in the conversation for that episode, they had highlighted the fact that there's a huge influx of people after the summer of 2020 in light of the protests in the aftermath of George Floyd’s murder, who had suddenly decided they wanted to seek out therapy. And the episode then goes on to interview some folks of color who were kind of grappling and navigating with all the complexities that come with being a marginalized person, finding a therapist, building a good relationship with a therapist, et cetera. And we'll get into some of that later for sure. But one of the questions posed in the framing of that particular Code Switch episode was this kind of big bite question that we want to tuck into. And it was, how useful is therapy for exploring experiences around identity? And then I would add, right, harm caused by systemic oppression?

ASHER
Such a good question. Like, such a huge question.

R.B.
[LAUGHS]
Yeah, huge.

ASHER
Honestly, I feel like the most straightforward answer that I have to that question is it depends on the therapist. And I know that in some ways does an end run around some of the deeper pieces of like, okay, so if you've got a decent therapist who can actually handle their shit about this, what can that do? But I do think it's actually important as a starting point. I think a lot of the time there's this idea of, you know, all therapists are well intentioned, which that's not actually true of any large group of people. But more therapists are well intentioned than not. But I think when it comes to dynamics around privilege and oppression and around identity, well intentioned isn't actually good enough. It's not going to cut it to find the person who wants to be nice to you even though you're queer. And unfortunately, that's still a thing. I get people referred to me regularly who are not doing work about being queer or trans at all. They're doing work about like, depression, but have realized at some point that they're gay or bi or ace and mention it to their therapist. And then the therapist throws their hands up and says, well, I have no idea how to help you. Let me send you to a specialist.

R.B.
Ugh.

ASHER
And it's like it does depend. You got a therapist who's like, at least above that bar. But I think one of the other things I always think of around this is something that our mutual friend Dr. Jon Paul Higgins has said a couple of times in my hearing about a great first therapy session interview question for your prospective therapist is to ask them to define intersectionality for you.

R.B.
Oh.

ASHER
Right? And you can learn a whole lot from that answer.

R.B.
Mhmm.

ASHER
But I think there's a piece beyond even someone's grasp on theory. Right? Like somebody can be basically well intentioned, not actively exclusionary toward you or experiences and identities and impressions that you hold and sort of get the theory. And it can still be really difficult for somebody to integrate all of those pieces.

R.B.
Mhmm.

ASHER
And so I think that part of the question starts to come up is “what does it mean to do that work”? Because, of course, I don't think therapy on its own can solve racism at the level of one individual going to one therapist is just going to fix this whole thing. But I also think there starts to be this necessary exploration around what does it mean to heal from something and to find ways of living better in the context of something that is still ongoing.

R.B.
Hmm.

ASHER
Because that really is one thing to go to therapy for something that happened to you and has harmed you. But now it's over. It's something different, and I think takes a different level of a lot of things: creativity, openness in terms of how do you define wellness or progress or recovery? And also I think that requires a lot from the therapist in terms of how able are they to tolerate their own awareness of, they're not going to be able to fix this for you. I can get to a place where I've done my work around my trauma that has to do with trans-antagonism. I've done the work that I need to relative to, like, transition related care and trans antagonizing bullshit is going to keep happening. I was in Topeka last week. I got invited by a dear friend of mine who is also now the first trans legislator in the state of Kansas to see our governor sign a proclamation about trans day of visibility, and less than a week later was typing up written testimony about yet another trans antagonizing bill that's coming up around excluding trans kids from sports. So, you know, it's not going to stop. And if it's not going to stop for me, as somebody who is white, educated, working in a professional job, holds a relatively high degree of privilege in my context, it's sure not going to stop for a lot of other trans people who don't have access to the same kinds of resources that I do. So those are some of my first non-answers to your question.

R.B.
[LAUGHS}
For sure. We're not going to completely unearth an answer to that question. And I don't believe the Code Switch episode sought to do that necessarily either. But it's this really important framing, I think, around what can we expect from a tool, right, such as therapy in a broader toolkit, or in this case, giant multi layered tool box of things that ideally are going to move us collectively toward healing, toward undoing intergenerational trauma, toward, you know, upending the things that cause that perpetual harm that you're talking about, right. If we exist in this perpetual state of knowing, that, okay, today, circa March 2022, there's a variety of anti-trans fuckery that's taking place at this very moment. We know that if we were also to hop on a call again in April 2022, there's going to be a different slew of things that are not the same things right now. Right?

ASHER
Right.

R.B.
So when we live in this perpetual state of knowing that something is going to be triggering or frustrating or just a minimum annoying, something that we're going to roll our eyes at, right? Like at the bare minimum, what does it mean to seek out healing or support or coping around the things that hit us at that level of identity or hit us at the level of oppression? And I don't know what that looks like. Right. But I think that what we do know, too, is that there's a lot of reasons, especially queer and trans people don't go to therapy. And so we currently are at a place where we're barely convincing our fam to go to any kind of therapy, let alone thinking past what does it mean to have a health care system that isn't completely botched-

ASHER
Right.

R.B.
- but affirming and enjoyable and supportive and committed to understanding people on a holistic level? So, I know we're not going to answer that question, but I think that this almost offers an open question around a whole different flavor of trauma informed as a principle in any kind of healing or health practice. And so I'm curious for you, right? Like, in holding all of that big messy complexity of everything that you just said and everything I just said, how do we engage queer and trans folks or invite queer trans folks into therapy that is truly affirming when we know that there's so much to untangle that isn't necessarily going to get hit on solely through therapy?

Asher
I think my first response is we need more queer and trans therapists, partly because there are things that can be uniquely helpful about doing therapy with somebody who shares a particular experience or a particular kind of oppression with you. But I don't think it's just that. I mean, given the community that I live in and the size of the community I live in, I have never had access to a trans therapist. It is vanishingly unlikely that I ever will. I know all of the trans people in my city. Maybe if somebody becomes a therapist elsewhere and then moves here, but even then I'm going to be referring a lot of clients to them. So probably not right.

R.B.
Right.

ASHER
But I think the other place that it has an impact is the more queer and trans people that are doing this work, the more our voices start to be meaningfully heard by other professionals. There is an enormous difference between what somebody who is seeking to be an ally is going to hear and process and take in from somebody who can say, as a professional, like, look, I have the same training you have, I have the same knowledge that you have, and I need you to hear how this shows up for people like me. And I think that's true across all marginalized and minorized entities. Like, we need more therapists of whichever identity we're talking about. But I also think part of it starts to be about, on the side of mental health professionals, a lot of it is about listening very carefully to what are the things that have made therapy so inaccessible and so unsafe. And I know you and I were kicking back and forth some of the things we're all mindful of around both a lot of the gatekeeping bullshit for trans folks and a lot of the ways that queer and trans people are pressured or coerced into therapy, the long history of reparative therapies that are thankfully, finally, at least coming under a decent amount of pressure in most places but have not gone away by any means. Because I don't think it's enough to just say, oh, well, I'm not doing that and then not doing it and leave it there. I think there are a lot of ways that doing really direct and explicit engagement around well, for example, when I think about gatekeeping hormones. Right.

R.B.
Mhmm.

ASHER
Speaking of reasons we need more trans therapists, like the number of cistherapists who think of themselves as allies and who get like real, real antsy about telling any of their clients that you can access informed consent hormones locally because there's this sense of, well, but then you might not stay in therapy and clearly you need therapy in order to embark on this whatever. Okay. One of the things that I do to make therapy safer, more accessible, et cetera, for trans folks is if you're coming to me because you need a hormone letter, I'm happy to work with you, and I'll write you a letter if you want it. But the other thing I'm going to do is let you know all of the informed consent clinics locally.

R.B.
Right.

ASHER
And I think it's that kind of work around, ‘how do I make it as clear as possible and as true as possible that this really is your choice?’ Like, I'm here, I want to help. I'm happy to have you here, but I'm not going to coerce or compel your participation because that's what a lot of that stuff comes down to. I think it's just we have been forced into mental health settings that are often actively harmful. And at the very least, a lot of the time that are holding hostage necessary medical care. And I think everything we can do to make it more voluntary and more clear that this is voluntary, everything we can do to increase agency and choice is the most important piece of that to me.

R.B.
Yeah. I mean, just knowing what I've gleaned from talking to you and then our previous guest in this season about your going to a therapist being about a relationship. If that relationship is not based on a desire to be in that relationship, then it is not by definition, consensual. And when we have trans people, especially, being mandated into these relationships where it becomes very transactional because they need something based on these old school ways of accessing other types of treatment, then none of it is safe and none of it is appropriate. And so then if we're trying to play with this big question you and I are talking about today around therapy being a tool amongst many for addressing harms caused by oppression based on a marginalized identity, right? That is not at all what that tool can look like because it's causing additional harm. Right.

ASHER
Right.

R.B.
And so then we're stuck in this we're stuck in this other paradox of wanting to be in a place where we're wanting to encourage queer and trans people to seek out affirming therapy. But there's not clear pathways. It's a guessing game. It's labor that we shouldn't have to do already, especially if we're struggling, which we often are. And then it's again, a paradox to say if you need support addressing the impacts of systemic oppression, i.e. transphobia, cis-sexism, homophobia. Right. Like, whatever. But therapy is a site of causing harm along those lines. It feels like talking out of both sides of our mouth, even though we also just want people to get quality care.

ASHER
Yeah.

R.B.
And we're stuck.

ASHER
And I think there’s this other complicating piece. I think it has always been there. We just haven't always had meaningful alternatives. But I think of it as like the safe zone effect. Right. So you get this thing going where people have a sense either of good people are queer and trans affirming. And I want to be a good person. So I should put out there that I'm queer and trans affirming, even if I have no idea what that means or how it needs to show up in therapy or I don't know, in my documentation, in my training of my receptionist, in my bathroom signage, or in some instances, I think truly it's just a marketing strategy. But I know these people need therapists and they don't have many to choose from. So, yeah, it's not even a thing where we can just universally trust if somebody's got that in their marketing materials that they have any idea what they're doing.

R.B.
Because there's no threshold, right? Not that I want to create additional barriers for folks to do this work, because there's already a lot of work that has to be done academically, like licensure all these things. But it takes nothing like right now, there's literally nothing for there to be some kind of quality control from the vantage point of a trans person seeking a therapist. Right. Which may or may not even be about their transness -

ASHER
Right.

R.B.
- is another piece of it too. That they can just slap that label -

ASHER
Yeah, but also I want a safe place to be while I’m sitting in your waiting room.

R.B.
It's not that hard, right? Yes. It literally requires nothing besides typing it into your bio.

ASHER
There is an idea in most codes of ethics of you're not supposed to practice beyond your scope of competence. But it is, unfortunately, it sometimes gets used as an excuse of like, well, I don't know how to treat queer and trans people. And so the problem is not that I need to learn that. It's just I can't treat queer and trans people, I guess. And yeah, I think sometimes on the other end there are an awful lot of issues and dynamics where it's just not taken seriously enough. And part of what I think it circles back to with all of this is the idea of - this is a topic I can nerd out on a lot as a therapist - but the idea of informed consent, that is not just a document that you sign at your first therapy session. Part of the point of informed consent is it should be ongoing. There should be this continuous evolving conversation around maybe I’m a straight cyst therapist and I'm not really experienced with transplants, which Incidentally, I actually haven't asked my therapist about her gender or sexuality, but I think she's straight and cis. I know that as far as I'm aware, I'm the only trans person she had worked with at the time we started working with her. So it's not even that is a rule out. But being upfront about that is important. There are differences between what I can expect from somebody who has minimal experience around trans identity and all the things that entails versus if somebody comes to my practice I in fact, know all of the people providing informed consent hormones in town.

R.B.
Mhmm.

ASHER
I can give useful referrals as far as different surgical options. I know that trans bucket is the thing that exists, so there's a lot of stuff like that that I think is just background knowledge that can be very important to have and important for your clients to know if you don't have. But yeah, I also think about things like, is my therapist going to notice stuff to do with background access? What does the intake paperwork look like? Do they have a health record system where the receptionist is going to end up dead naming me every time I come in because there's nowhere visible to put my actual name? There are competencies that if you haven't intentionally thought them out and you are not queer and or trans, you're not going to know just because you're well intentioned or you want to be a good straight cis person.

R.B.
No. And then at that point I feel like it heightens the likelihood of making bigger messes.

ASHER
So much of my work as a therapist serving trans clients ends up being like different kinds of just risk management and harm reduction because it's tremendously dangerous. First of all, I mean, you talk about all of the impact that hormones have on somebody's body, but also you talk about like, even if somebody's not accessing transition related medical intervention, even if it's just I am going to the doctor's office and getting dead named. Getting misgendered. Like the impact of that on people's mental health and emotional well being is tremendous, and we have vast amounts of data backing that up if all of our lived experiences queer and trans people weren't sufficient. When I first started hormones in Wichita, there was one place you could go. And then that guy moved to the East Coast and nobody in his practice would work with trans people. Thankfully, I had a friend at the other place that had started to see trans people, so I was able to get in there quickly when I learned that my doctor had moved away and there was no way to get a new prescription. But part of what can make it so challenging is there's not always a straightforward recommendation of “here is the best or the right thing to do.” I'm in a place now where if I couldn't find a good enough doctor here, I'd drive to Kansas City and realistically, there are a couple of interventions for which I probably will. I did have top surgery.

R.B.
Well, and for folks who don't know anything about Kansas, because I'm not one of those people. How far is Kansas City from where you are?

ASHER
3 hours away.

R.B.
Yeah, 3 hours. If you want to get to a bigger city that's going to have more options, Kansas City is going to be about the closest. That's not something I could have always done in the last few years of my life. I certainly couldn't have when this doctor moved away. And it's not something most people can afford to do. Right? People have jobs and work schedules and limited budgets and don't want to always be driving 3 hours away for a new prescription.

R.B.
I'm imagining too queer and trans folks navigating their relationship with a therapist, being conditioned to be selective about what they're talking about, what they're bringing up in that discussion. If we're so accustomed to not knowing if we're going to say something that's going to prompt a visceral reaction or an indication that something might be wrong with us or an indication that we need to be medicated, right, like all those really tumultuous things that we're accustomed to from the forms of oppression we experience? How does not bringing up certain thoughts or experiences impact the ability for you as a therapist to address what they need or help them work towards the goals that you establish?

ASHERThe thing that I tend to see, I think the most around that is the staggering numbers of people and young people, people who are teenagers now have absorbed sometimes information from other trans people's experiences. It's like, here's the timeline I was on, here's what it was, and the person reading this experience doesn't realize that that was like four versions ago of the standards of care, but also people get it from doctors and therapists. I have had people referred to me by folks in the community where they're trans specializing therapist, like legit was telling them they were going to have to do things like a year long real life experience before they were allowed to start hormones. Yeah. Okay, so you haven't read this since like 1992. Cool. It impacts people's ability to access care. It impacts people's sense of like, if I want medical interventions is that even something I can have? Like the number of people who, it's been months or sometimes years in therapy before someone finally says, oh no, actually when I say I don't want to start hormones, what I mean is I do want to start hormones, but I think I would have to wait for two years and go through this whole process and there's nobody's going to want to work with me. And I'm like, I can send you to a clinic where they will write you a script in like you'll be in and out with a prescription inside of a week. People don't know that. And it hasn't even occurred to them to question because often they have heard from somebody speaking authoritatively, oh, no, that's not how this works. So I think it has a lot of implications around people's ability to access even just the kinds of care they actually want to need.

R.B.
Mhmm.

ASHER
I also think it has a major impact around the aspects of people's lives that they end up often masking. And I think it's particularly true for people who are nonbinary, especially folks who are nonbinary and want to access some level of medical transition. It's also very, more common than I would have expected it to be, for trans folks to work overtime to mask queer sexuality. So the thing about if I am FTM, then I have to be like the macho-est man who wants to date all of the femme ladies and vice versa. It does sometimes hit me on this level of like, whose therapy office do you think you're in? Like did you look around the waiting room at all? But also, I mean, more seriously, what hits me about that is if it hits that hard in my office, imagine if you are walking back from being misgendered by the receptionist and there's not a safe bathroom to use and your therapist has never been aware of meeting another trans person and there wasn't a box on the intake paperwork that included your gender. Like, if people can't talk about it with me, how much more is getting masked or just totally ignored and not addressed outside of my office? And mental health is the other place because people are so frightened of- it's reached a point where I just kind of give people a disclaimer when they start therapy with me about like, look, if you need a letter, first of all, you probably don't. Second of all, just so we're clear, the fact that you're like, depressed or anxious or on meds or have trauma is not going to make me say, I can't write you a letter. No, because it was I had enough experiences over time of people not talking about histories of trauma and abuse because thought that would prevent them from accessing care or make me think that they weren't really trans or weren't really queer.

R.B.
Ugh.

ASHER
Collectively as medical and mental health systems we really have trained queer and trans folks. That all of us have to silo off our care. And we need to really sort of like, protect and hand hold the professionals who are allowing us to access care and not let them see anything that might be like upsetting or overwhelming or distracting or misleading. And at that point, frankly, the client is the one doing the therapy.

R.B.
[LAUGHS]

ASHER
That's not serving them at all at that point.

R.B.
It's so frustrating.

ASHER
Yeah.

R.B.
What is the landscape looks like right from your vantage point of someone who's been in his practice for nearly a decade, who does this work in Kansas from your geographical standpoint, from your practicing standpoint, what has shifted? What has changed? What is happening, circa, the beginning of this pandemic tack onto that also the emergence of additional protesting in light of specific instances of police brutality and racial injustice, namely George Floyd's murder in the summer of 2020. What's been going on?

ASHER
A lot. And really I could just leave it at a lot and that would pretty well capture it. It's interesting because when I try to count back about when did things take this hard left? Because it's always been some amount overwhelming, right? Like, when I first entered practice, I was the only openly trans therapist locally. I encountered like, one other person who was stealth and I don't know if they were talking at all about being trans, but like kind of quietly introduced themselves to me at one point. But I was it as far as people that anyone knew and could refer to. But then there was kind of this gradual like a few more openly queer folks and trans folks centered practice. And so it's still busy but not like, completely overwhelming. And there's no one for me to refer to. But then we hit 2016 and Donald Trump getting elected. And the figure that I heard quoted from a lot of my friends working in crisis, which tracked pretty closely with me, was that their calls had roughly tripled. And that was pretty accurate for me. The number of people I had calling asking to start therapy just about tripled at that point, and then COVID started and it just about tripled again. And then as we've had these other things that have happened over time, particularly around George Floyd's murder, also when Trump was in office, it was just some new atrocity multiple times a day where it's just everyone is hitting that tipping point for context. Pre-COVID, pre-Trump had a pretty full practice and it was typical for me in a normal week to get maybe one to three people calling asking if they could start therapy. I had a day a few weeks back when I had twelve people in one day call to ask if they could start therapy with me. So that's been a thing. I think the other thing that really has been shaping it, certainly in my experience as a therapist, but I think also for clients has been some of the shifts around telehealth and the extent to which that's available and I think can be a really useful tool. And also some of the ways I think that it has been sometimes oversold or like the things that are really not therapy are being presented as therapy. And then we get into this really weird harm reduction place again, where it's like, when is something better than nothing?

R.B.
Hmm.

ASHER
And when is this something that you're getting actually not what you've been promised or sometimes actually harmful? What I hear from clients, increasingly the longer it goes on, is that it's incredibly difficult to get in to see any kind of mental health professional, let alone to actually deliberately choose somebody that’s like, “I think this person will do good, skilled, competent, knowledgeable work for me.”

R.B.
That's the piece that was a huge motivation for me to want to bring, at this point, multiple queer and trans therapists into conversation for the show. And something I wanted to point out in this conversation as well is that for certain and for justifiable reasons, we, the collective we, the societal we, have been paying a lot of attention and the media has drawn a lot of attention to the overwhelmed hospitals and how that creates impacts for folks who may have other health needs besides going to the ER or the ICU for COVID concerns. Right. And that's an important point to make. But what I don't think I've personally seen nearly as covered by the media or in conversation is all of the other legs of health, including in this case, therapy, that have also been in many ways burdened by the impacts of this global health pandemic. Okay, right. There could theoretically be something to be said about how it's probably a good thing that folks are now seeking out therapy because either a) maybe coping mechanisms or practices you already had are now not of use to you during the pandemic. You can't travel, you can't see people, your routine has been offended all these reasons and b) right? Maybe you were someone who was avoiding therapy and this was the last straw and you're like, okay, I give, I got it like a pandemic is what it took. That's fine. I see you. I affirm that. But the other point you made was that if suddenly the books of therapists the nation over are so strained and you're getting twelve calls a day for folks looking to start a therapy that's going to impact folks' ability to shop around and look for someone who's going to be a proper fit, who's going to be affirming, who's going to offer them the care that they need. And also, it just sounds really fucking exhausting for you.

ASHER
Absolutely. It's partly the thing about the uptick in referrals, which has been huge. But then, of course, simultaneously we have this really abrupt shift from pre-pandemic, I knew almost nobody who was providing telehealth. I was and I knew a few other queer and trans people who were because you get the people out in rural Kansas who don't want to drive 5 hours to come to a weekly therapy session. But there was honestly a lot of resistance to it. There was a lot of discourse in therapy circles around, oh, well, I don't know if telehealth is even really ethical at all. And amazing how fast some of those folks did a 180 as soon as they realized that was their whole practice. But it was. So we have this abrupt shift from everybody's working in person to everybody's working online, which as anybody working online can vouch for, also meant the Internet was just kind of broken for like three or four months at least in flyover country it was. And then on top of that, you've got everything is closed, right? So when state agencies are closed, that means Department of Children and Families, Child Protective Services, we're still making reports, but no one who's doing anything with them. It means schools are suddenly closed. Kids don't have access to their friends. They can't go to a GSA meeting. It means the Behavioral Science Regulatory Board was closed. So all the newly graduated therapists that would usually be getting licensed just got stuck sitting there waiting. Insurance companies were closed or working remotely. So all of our payments got slowed down and have stayed slowed down because of course they have. And then you've got people, meanwhile, who are like losing jobs, suddenly don't have insurance who still need to be in therapy. So it was just all of the systems that we ordinarily collaborate with vanished.

R.B.
Heard.

ASHER
All of the things we depend on in terms of money to keep the door open, licenses so that we're allowed to practice, start - the wheels are coming off. There are a bunch of therapists who frankly, like, we're not trained on telehealth, and you can get training on telehealth. Nobody teaches you that in grad school.

R.B.
Bet they do now.

ASHER
Certainly they sure do. Absolutely they do. They learned. You're suddenly having to pick up this entire range of other skill sets and somehow try to account for all the kinds of support people don't have. As your number of referrals has gone through the roof, even under the best of circumstances, a lot of the time you're going to have some limited choices around how much do you pay for therapy, how good of a fit is the therapist, and how long are you stuck waiting to get in to see somebody?

R.B.
It feels kind of daunting. I feel like I would say from my vantage point as someone who's in higher education, the ways in which my field is moving, and I imagine many fields are moving, is that we're just trying to force feed this post-pandemic state of mind onto people when that's not the reality. And then what I would say as just like a socially justice minded person, is that there's a lot of things that I think the floor is going to fall out from underneath a lot of, like, status quo structures. I think just like all the institutions of medicine and education and law enforcement and government, folks are fed up, folks are tired, folks are naming things. Right. And recent work is not new. But there's a very particular sharpness, I think, to the critique that folks have in this moment. And so what I'm thinking about in relation again to this big pie in the sky conceptual question we wanted to tackle at the beginning of the chat about therapy as a tool, therapy as a means of exploring identity or problematic issues related to identity, is that what as queer and trans people who are very skilled at being creative and having to carve out spaces on our own and alternatives to the status quo, what can you envision as this landscape continues to shift, that offers folks more in the way of tools either beyond therapy or in addition to therapy, that aid folks in grappling with all of the inherent impacts, either as an individual or within our communities, from systemic oppression, from climate change, from racial injustice? Right. How do we start - not start- but how do we manifest from this moment that we're learning through this pandemic how to keep each other healthy and how to start continue striving towards healing when the structural components of therapy - clearly is a very small question - when what you're naming about the structural components of therapy are getting rocked, like really kind of getting shook right now, it doesn't sound sustainable, is why I'm asking.

ASHER
Absolutely not. The wheels are coming off for everybody, and I'm excited because I think there's a lot of long overdue change coming in a lot of sectors, and it's the Lord of the Rings thing, right? Like, nobody wants to live in exciting times. We want to live right after the exciting times when it's like, all kind of settled and we all have access to at least more of what we need. And it's not so overwhelming and unpredictable and chaotic. But I think a lot of what I see happening that I am the most excited and hopeful about and also that I try to keep plugging into on my own behalf, just stay afloat is it feels like in the hard stop that happened right at the beginning of the pandemic, and that forced a lot of people to slow down, even if it was in ways that impacted our own survival day to day functioning, is that it feels like we have collectively reached a place of being a little more possibility informed and a little more organism informed. And what I mean by that is I think there was this real intensity pre-pandemic around this is impossible. I can't keep doing it. I have to keep doing it. And I think we hit the pandemic. And for a lot of people, that was the moment where they're like, I can't it doesn't matter if I have to. I cannot keep doing this and we can't keep doing this. And I think when I talk about that idea of being organism informed, that's a piece of it, right? It's like we do, in fact, inhabit these bodies that require a certain amount from us in the way of rest and food and care. And I think for a very long time, well, forever. We've had a lot of pressure around this sort of imagined separation between this electrified meat that I inhabit and me floating in the ether somewhere away from them. And it's like, no, those are the same. Like, if you don't put in food and rest and a reasonable degree of care and like faces and humans that are responsive to you, it is going to quit working. It's just gonna, no matter how much anybody wants to lecture or shame you or be disappointed about it individually or systemically. And I think we are beginning to come to terms with that in a more real way than I've seen happen ever. I kid you not like the thing that has been helping me the most the last few weeks has been I am just, like, doing my own exposure therapy around the idea of I am going to disappoint people and holding that statement and letting it unspool in my body however it needs to, doing the whole urge surfing, watching how distressing it is, waiting for it to ease off thing. And I think that it's not going to be that specific thing for everybody. When I think about how do we get through this to whatever better thing is hopefully going to come together on the other side, I do think a lot of it has to be about coming to terms with we're not going to be perfect, we're not going to do everything, we're not going to save everybody. We can't and we've been set up so that we can’t. If we run really hard and never stop, the outcome is not going to be that we do more good. It's going to be that we burn ourselves out and then we can't do any good.

R.B.
What that brings up for me right is what other possibilities? What other things? If the pace of life were to be more attuned to what is reasonable for a human being, what else do you think we should be doing right? What would be a way in which the things you believe are some of the most valuable that you offer through your therapy practice that you would like to see manifest into additional ways in which folks receive the messages, the care, the support that therapy hopes to provide? Knowing that, like we said, the wheels are falling off and who knows how long this model is going to last, right?

ASHER
I think with really big picture questions. And when we're trying to imagine, okay, if we undo this whole garbage fire and just make something better, what would it be? What are the basic things that we do? What are the basic things that we need? And I think a lot of it at least once you're past talking about the very most basic survival stuff is we're either like trying to manage distress, trying to manage anxiety, trying to tie that stuff up, lock it away where it's not going to bother us too much, or we're seeking connection and sometimes connection with ourselves, sometimes with other people, with our communities. That's it. Those are the two big human things. And so I think in some ways it's a hard question to answer because it depends so much on what are those places of connection that are the most important to an individual person. But I do think that's what a lot of it comes down to. I think a lot of it is the more that we're able to operate from a place of I'm reaching toward the things and the people and the life that I want versus I'm just like fending off all of this horrible bullshit. I think that's what starts to shift things. And I think honestly, when therapy itself even is doing the most around helping with big picture stuff, I think that's how it does it. It's really about if you could make it emotional about this, if you could have the life that you wanted, what would that be? Even if we can't get you all the way there, how do you get like 2% of the way closer so that then maybe you can reach the next 2%? I think there are ways that part of what's exciting about some of what's happening now is it feels less like just this push and pull between the things that feed me versus all the stuff that's in the way of that and more like there are new things happening. There's this way that we started finding new ways of connecting and new ways of being present. And I think that's an important piece of it. It's like, how are we building new possibilities? How are we creating ways of doing this that we hadn't even thought of so far? Connection and community. That's my answer to what do you do if you can't see a therapist and also if your therapist is any good, they're going to lean on you to do that stuff anyway.

R.B.
I think those are two things that queer and trans people are incredibly good at anyway, right. Because we've had too, we've had the practice of chosen family, the practice of leaning into folks with comparable identities and having to make meaning out of cis-het normative spaces to be like, can I be here? Is there a place for me here? Right. Like that all feels very standard, but I think that that's a promising principle thinking how do we go from this moment to the next? How do we go from this crisis to the next? Because even if it's not a pandemic, right? Like as we talked earlier, the monotony of the minutiae of daily life. A marginalized person is a perpetual state of crisis. It's a perpetual state of panic or frustration or inconvenience or bureaucracy. And it's what we know very well. So I am also hoping that from the past three Marches, if it's not exactly three years, but this is the third March in a row now that we're still contending with the realities and the impact of a pandemic. And it's not going away. But what doesn't have to happen is we don't have to pretend that we're going to springboard back to any semblance of what existed before March of 2020 and do something different, because I think folks ideally have gotten a taste of what it means for life to slow down and what you want to do when you can't go anywhere and you can't see other people and you don't have to go to work in the same way that you did. The veil came down.

ASHER
And I think there's also something in the mix of all of that around. I think a lot of the time when we talk about connection, we talk about community. It's this kind of sanitized, I mean, like, sure, I'm going to go to the club, but I'm going to be put together and my boyfriend is going to be put together and we're going to be there looking like we have our lives together and we're not going to talk about any of the hard stuff. And then people are going to go to their jobs, they're going to go to their advocacy spaces, they're going to go to their religious and cultural spaces and all of those places. We're going to act like we're fine and everything is fine. It can get so performative so easily. And I think sometimes with good intentions, sometimes it's just I know all the other queer people are drowning and I don't want to dump my shit on them. But I think one of the things that has shifted just because it couldn't not has been there's been so much for so long, we've started talking in more real ways. And I think that's important. Like, when you talk about what is it that lets you thrive in the context of one crisis after another, it's not that the emergencies stop. I mean, I hope we get to a place where there are less of them, but they're always going to be crises. And even if they weren't shaped by oppression, there would still be crises. Most of my therapist crises have not been primarily about the fact that I'm queer and trans, although they've been compounded by that, all of the therapists are having them. But what we can do is let our bodies and brains do what they need to finish having a stress response. And a major piece of that, if you're looking at the whole course of human evolutionary history, what happens is not that you're, like, sitting locked up in your house panicking about Donald opening his mouth on the TV again. You're getting chased by a literal physical predator, and maybe you fight it off, or maybe you run away, or maybe you play dead, and then it leaves you alone, and then you run away, and then you run back home to your people and you're all happy together that you didn't die of the lion that was chasing you. And you get to have that physical experience of, like, all right, this was overwhelming. It was terrible. I'm super keyed up about it. And then it ends, and that end and connecting with other humans or connecting with your safe space, it doesn't mean you're never going to get chased by another predator. It just means this one is over and everything can relax. And our being able to have that experience is hugely important. And I think it's one of those places we're having community that's real and where we don't have to fake like we're all fine and nothing has been chasing us and trying to murder us.

R.B.
Essentially, there needs to be greater gaps between oh, no shit moments intermixed with moments of this is great. I'm cozy, I'm safe. Everything is good, because there's been a whole lot of revolving door oh, shit moments -

ASHER
So much.

R.B.
- with a smattering of everything's great, everything's fine. Well, Sam, in the fashion of your concession that you're going to disappoint people, we did not effectively come up with the textbook answer for how useful is therapy for exploring experiences around identity and harm caused by oppression. But I think we did a really good job thinking conceptually, big picture. And there's a possibility orientation around how we can start to pick into that question, because I think it's very important when our communities are so negatively impacted by health care structures in general, but in this case, therapy what else? Is there anything else that you feel like is really vital to share, name, and express for folks who have stuck it out with us for this conversation about affirming therapy, about health care structures, about wheels falling off of those structures, and all the infinite wisdom that you have provided so far.

ASHER
I think the only thing that I would add, I don't even know if it's really an addition, but that I would sum up in brief terms is to say that I think when it comes to all of the therapy things, I truthfully think that the most important thing is to keep going. And I'm saying that in this moment with the awareness that may just be keep calling therapists until somebody actually gets back in touch with you and know that many of us will but are running slower than usual because we're getting a lot more calls than usual. But I think it holds true when it comes to how do you get the most use out of therapy once you're in it? I think it holds true when it comes to the really big picture stuff around. How are we going to make this better? I don't know exactly yet, but most of how we figure it out as we keep going. That's what I say to my therapy clients, too. Often I can't actually tell you exactly how you'll get better. We've got months or years of that ahead of us, but we'll find out amazing.

R.B.
Well, it's been a treat to have this conversation with you. I appreciate all of the insight you've provided and all of your willingness to engage in this big idea headspace around such a complex topic.

ASHER
Thanks for letting me nerd out about it for a while. Usually I just have to do this talking to myself doing laps around the office at the end of the night, so it's great.

R.B.
Happy to interrupt that pattern. [LAUGHS]

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R.B.
Our inbox is open for all of your insight, feedback, questions, boycotts, memes and other forms of written correspondence. You can contact us at lastbite@sgdinstitute.org. This podcast is made possible by the labor and commitment of the Midwest Institute for Sexuality and Gender Diversity staff. Particular shout out to Justin, Andy and Nick for all of your support with editing, promotion and production. Our amazing and queer as fuck cover art was designed by Adrienne McCormick.

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