Laura Scarrone Bonhomme : Gender-Affirming Therapy, Systemic Bias & the Wonder of Queerness

On this episode, Caroline and Dr. Avgi Saketopoulou are joined by clinical psychologist Laura Scarrone Bonhomme as they meet at the intersection of psychoanalysis, gender, and liberation. This episode Dr. Laura Scarrone Bonhomme brings her perspective as a clinician working in the UK, sharing how both personal and professional experiences have shaped her approach to affirming care amidst rising political backlash.

The episode explores the limitations of diagnostic systems like the DSM and the impact of social norms on therapeutic models. Dr. Laura highlights how transnormativity, fertility access, and systemic bias affect both patients and practitioners, while Dr. Avgi stresses the importance of not collapsing gender exploration into pathology. Her book been awarded the 2025 Distinguished Book Award by The American Psychological Association’s Division 44 .

The episode emphasizes the value of radical listening, community care, and the courage to question entrenched narratives, whether in psychology, media, or public policy. Dr. Laura and Dr. Avgi underscore the urgency of creating spaces where trans and non-binary lives are affirmed, not analyzed out of existence.

“Dr. Laura Scarrone Bonhomme is a Consultant Clinical Psychologist and global leader in gender-affirming mental health care. With over a decade of experience across the UK, Spain, and Chile, she’s supported hundreds of trans, non-binary, and LGBTQ+ clients through therapy, research, and clinical supervision. A chartered member of the British Psychological Society, she’s also the co-founder of Affirm, a global training platform equipping clinicians to provide inclusive, trauma-informed care. Dr. Scarrone Bonhomme is the author of Gender Affirming Therapy: A Guide to What Trans and Non-Binary Clients Can Teach Us and a regular voice in international media and conferences, challenging bias in mental health systems and advancing care rooted in dignity, self-determination, and liberation.”

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Episode Transcript

(00:00):
Well, hi everyone. Welcome back to the Trans
Narrative Podcast. I'm Caroline, and today I'm
joined with Doctor Avi Sakatapulu.
Oh my God. Hi, welcome back.
Hi, thank you for welcoming me back.
Welcome to the Trans Narrative podcast.
My name is Aviya Sakatapulu. I'm a psychoanalyst working in
New York City and an academic, and I'm a queer identified

(00:22):
person. It's very good to be here.
I want to welcome Laura Scarone Bono for an amazing conversation
that I look forward to having with all three of us today.
Yes, absolutely. Thank you so much.
And before we get started, Laura, welcome to the show.

(00:42):
It's so good to have you. Thank you for being here.
Thank you so much for having me.I've been really looking forward
to it and and it's always great to have talks with other people
who are also queer identify and who who you know, whose goal is
to work for the betterment of ofthe situation of the
communities, which now more thanever is very much needed, isn't

(01:05):
it? Wow.
Absolutely. So before we get started, I'd
like to read a little bit about Laura Scaroni.
But no. Laura is a consultant, clinical
psychologist, international educator and Co founder of a
firm E training platform advancing trans affirming
practices and psychological care.
With over a decade of clinical experience across Spain, Chile

(01:29):
and the UK, she has supported more than 600 transgender and
non binary individuals and theirfamilies.
A charted member of the British Psychological Society, she is
listed on the BPS Gender Diversity Specialist registered,
and serves on editorial and organizational boards including
Counseling Psychology Review, WPA, or W Path, and BAGIS.

(01:53):
Her groundbreaking book, Gender Affirming Therapy, a Guide to
what transgender and non Binary clients can teach us, challenges
diagnostic models that pathologize trans experiences
and advocates for a radically listing, reflexive and rational
model of care. She's devoted to reshaping the
field through a liberatory created in the colonial clinical

(02:15):
praxis. Oh my God, it's so good to have
you here. What an introduction.
Wow, I I'm not sure I recognize myself in on that.
So beautiful. Well, Laura, I'm very excited

(02:37):
for this conversation with you and perhaps, perhaps we can get
started with you saying a littlebit about yourself and also
situate us a little bit in what's happening legally, what
the what the landscape looks like right now in the UK, which
is one of the places where you work.
So we have so, so many things have been happening so quickly
and legislations and rules are changing so fast.

(02:59):
Perhaps it will give us like thekind of like the foundation for
like where we're starting from in our conversation.
Absolutely. So in terms of my own
background, I'm originally from Spain of South American parents
or you know, we're just a bunch of immigrants everywhere coming
and going. And like 12 years ago or so, I

(03:22):
moved to the UK and that's whereI started my work at the general
Identity Clinic, which is one ofthe largest national clinics.
And it was interesting because Ihad never met a trans person
that I knew of at the time. Obviously now in hindsight, I
look and I'm like, OK, I can seewhy, why you would be here, but

(03:44):
I had never met anyone that was trans.
So I came into the field with a lot of magical ideas and, you
know, influences from the media,influences from what culture and
other people say. And so it was a big and very,
very positive shock to be there and start to meet different
people and to learn from their experiences.

(04:05):
And that's kind of like what's inspired me to, to continue to
be in the field because there's so much to do, there's so much
to learn. It's constantly evolving.
Even then the medical, you know,care that we provide or the
things that I did 10 years ago have, you know, maybe not much
in common with how I approach care at the moment.
And so it's it's an amazing way to see people transition and to

(04:29):
oneself, you know, also transition.
We have meant to learn, learn how to approach it differently.
Obviously, the UK is not the most welcoming of places at the
moment. And there's been a ruling to
really find a word to being a woman means.
And this is rather challenging because, first of all, it's not

(04:49):
a representation of what the thevast majority of the population
believe, you know. Will you, will you tell us what
that redefinition has been and what the what the ruling has
been? For those who don't, we're not
aware of it. So the the court ruling, so it
had been approached by a group of radical feminists who were
trying to be exclusionary of trans rights and they want, they

(05:13):
wanted exclusive access to whatever being a woman means in
their eyes. And they had tried in some
smaller courts and this was not possible.
And when it reached the High Court, that is when it's been
now approved like a week and something ago.
And so over the past week, everyone is really concerned.
There are some guidelines now the state that actually in terms

(05:37):
of single sex bases now trans people are not necessarily
included. So a lot of a lot of people from
organizations, from gyms, from pubs, from all of it, they're
being forced to take a position.So you either have a gender
neutral space that is clearly accessible for anyone who is
trans or, or you state that in this space, trans people are

(06:02):
welcome. And so once again, you see how,
you know, in the 1800s, women didn't have access to public
toilets, you know, and this was used as a tool to be able to
grant freedom to women because you cannot go further from your
house, like for more than two hours, because you will need to
use the lavatory. And so now it's again, this,

(06:23):
this process of freedom that it was granted to women, they use
in this, this feminist, so-called feminist to take away
from trans people. And so it's very concerning.
It's it's very sad to see. And even some of my, my ongoing
therapy patients are now like looking at I'm going to move

(06:44):
countries because I'm no longer welcome here.
And I think that probably you guys in the US are, are starting
to see a very similar narrative.So.
Before we get really into the depths of that, I really want to
know about you and your background and your growing up.
Take us back to what it was likegrowing up and staying and your

(07:09):
journey to your own reclamation of gender and your journey and
how how you got here today. So take us back there.
Tell us, tell us what that was like.
Tell us about you. I feel like I'm in a therapy
session now. I'm not being imposing.

(07:29):
Well, I grew up in the late 80s in Spain and I was raised by my
mom because my dad is used to be, you know, he's retired a
captain of ships. So it was just my mom and I and
all my family was in South America and I went to an old
girls school. So my whole life was, you know,
ruled by women and nuns, you know, as the authority in my

(07:52):
life. So a lot of like Catholic, you
know, ideals in terms of what you're allowed and not allowed
to do. And a lot of you need to be, you
need to be a proper girl and youneed to sit in this way or you
shouldn't use your sexuality in order to call attention of other
people and so on. And I guess it was a bit of a
struggle for me because I was, Iwas always a bit of a tomboy.

(08:16):
And, you know, I would try and, and as I become a gender
therapist, I look back and I, I resonate so much with so many of
my patients stories. Like, I would also run away and
ask to get my, my back shaved, you know, my, the back of my
head shaved. And my mom would lose her shit
because I did that. And I would seek to present more

(08:37):
masculine and I would be discouraged from doing so.
So I, I definitely have that experience of having had my
gender police from a younger age.
And I think that as many people come into puberty and learn more
into femininity and, you know, as a way of assessing my body
and as a way of getting boys attentions and, and, and I think

(09:01):
it's later in my life as I come into the gender field that I
sort of dare again to, you know,present in a bit more queer
fashion and, you know, and to cut my hair short again and to
do all of these things that I was denied as a child.
So I think it would be rather, Iwould be rather obtuse if I

(09:24):
would take all these people intotheir own gender journeys and I
wouldn't look at my own, you know, and, and so it's been so
enriching to to grow with it andto see.
So I continue to identify as a CIS head, but I see everything
now as much more flexible. And, you know, who knows, maybe
the rules in the future, maybe it doesn't.

(09:45):
But it feels good to be among a community that is so accepting
and supporting and provides the same freedom that it asks for
you. Know doctor Ravi and I and and
doctor we talked so much about how gender in in coming to terms
of who you are. It's not exclusive just to trans

(10:05):
people to to you know to non binary gender is for everyone
and especially considering trauma induces could induce a
part of that that understanding.And So what were there any
moments in your early life that may have planted seeds for your
later work? Any specific moments that stand
out in your life? I think that, and I've talked

(10:31):
about it in other interviews, but both my parents have
struggled with their own mental health, you know, and I think
that as a child, I grew up beingthat parental figure for them at
times, you know, that would be arole that would be exchanged and
swapped. And so I think I was always
aware of other people's emotional needs and I was aware

(10:53):
of how to to try and control andsuit my own to be able to be
supportive of other people. And so I think that that those
experiences of having parents who struggle and who try their
best, but at times maybe they weren't able to fulfill all the
needs I had. And that would be the story of,
you know, every parent, I'd imagine that really paved the

(11:15):
way for me to lay to seek a, a job as a psychologist.
If I may jump in here for a moment, like I really appreciate
this, the sets of questions, Caroline, and your willingness
to talk about them, Laura, because so often we are told or
LED to believe in our field. And I'll speak as a mental
health practitioner for a momentthat while we need to examine

(11:38):
our past and to have a sense of where we're coming from, that
should then be separated out from our work, from our
interventions, from our thinking.
Especially if our experiences have to do earlier on in life
with non normative gender or with non normative sexuality or
even with mental illness. That is something that we're

(11:59):
supposed to resolve and leave out of it because it could be
seen as unduly affecting our opinions or our stances.
And I appreciate, Caroline, you asking these questions because
they show the rootedness of our work in the kinds of experiences
that you're describing or of having had your gender policed.

(12:22):
And like gives us perhaps a pathway to understanding why
somebody, even as they're identifying as his, his head
might have a capacity to tune into sorts of experiences that
menaces people do not think about or do not tune into.
And I think that it's really important to have a space.
To. To not dissociate our own

(12:44):
histories from how we're theorizing.
Absolutely. And you know, and during the
last W PATH conference in Lisbon, which was last
September, we created this presentation that I'm rather
proud about it because it was like I, I felt it was very nice.
So we cannot focus on as a clinician, what is your
intersectional, your intersectional identity and what

(13:07):
is the role that that has in your ability to work with trans
people? And you know, sort of
acknowledging we, you know, we are working really hard to
challenge those unconscious biases.
We are now getting better about talking about unconscious
racism, you know, and it's no different when it comes to
transphobia or to thinking, you know, should we work with people

(13:27):
under the assumption as of an informed consent model or are we
policing people's genders and ability to access gender
affirming care? And so one of the questions that
we put for this group of hundreds of clinicians all up
from the world to answer was around has the agenda been
police and Hubai? And it was like 70% yes.

(13:49):
And, and most people from the family, you know, from the
mothers actually came as like the most prominent ones, which I
think is, is very interesting that moments would be at the
core of this is how you need to behave, you know.

(14:09):
So how did your identity, you know your your experience with
with your gender in your expressions?
How did that play into your clinical training and early
career? Did it create fiction or did it
help clarify some things? I'm reframe the question.
I'm not sure I'm following her. Let's get again, please.

(14:31):
So, so you know, you would you, you know, we had touched on how
you know, in, in, in, in so muchof our works that we're supposed
to separate our, our growing up and, and our journey to
ourselves with our clinical work.
But how did that, you know, how did your journey with coming to
understand your queerness? How did that interact with your
clinical training in your early career?

(14:53):
Did it create fiction? Did it create clarity?
What was that like? So I think that starting in the
field was illuminating in the sense that I wasn't sure what I
was going to do right. And so I guess that I, I, I
thought, I don't know, is this gender work, particularly with

(15:15):
transforming people? Is this going to be like a
makeover? Would I provide advice on, you
know, what should be your choice, your choices in fashion
or where like, I sort of like, you know, a sisterhood role of
like, look, this is how, how youcan do your makeup or how, you
know, so I came with all of these ideas of what am I meant
to do? And, you know, they're not so

(15:36):
far from reality in the sense that people would come into the
session and say, I'm, I'm makinga different choice as to how I'm
presenting myself today. What do you think?
You know, so people ask you directly and here is when you
sort of have to really re evaluate what am I here for?
You know, and am IA fashion iconto Italy, what to do with your
clothes or you know what, what is my role?

(15:57):
And so I think it's really helping me be a bit more humble
in the sense of saying this is not my role.
You know, this is about how do you feel in this clothes,
whether I like them or no, it doesn't matter, I'm not going to
wear them. You know, this is about you and
how all the people receiving you.
And you know, is it a firm in who you are?

(16:18):
And, and I think the other big challenge that I encounter, and
again, it's it's always good transferring people because
feminine to get so much more police, right.
When we come to the moments I do, I do the endorsements.
When people in the UK want to access hormones or surgery, they
would have to come through psychological evaluation with
myself or with another psychologist or psychiatrist to

(16:40):
be able to get that OK from a medical professional.
And so there are all these questions about when is the
right time to start hormones. And you find people who say I
cannot go out presenting feminine if I don't feel I have
the backing of these hormones inmy body, if I don't feel
confident enough in myself. There's the counter argument of

(17:01):
are you over relying on those hormones?
When in reality, the hormones are not going to get you dressed
and they're not going to get youout and have these difficult
conversations with your family, you know.
And so when asking people to be a little bit brave and to
express themselves a little bit more, again, we come to the
point that is very hard of wheredo you draw the line?
And how much do you guide a person to say, Oh no, yes, you

(17:24):
definitely need to wear a dress.You definitely need to have had
this experience to be consideredsuitable.
You know, so there is all that sort of historical policing that
I leave, I find myself enacting to some degree and really
questioning, you know, what is right, what is right for the
person, what is right from the clinical perspective, what is

(17:46):
right from a legal perspective. Because being in this field,
you, you carry so many hats, youknow, and responsibilities.
And so I think that's that's howis it starting to show in
different parts of my job. So would you be able to say a
little bit about like what? So when you started training and
started encountering like your own exposure to different

(18:07):
theories, to different ways of being with people in the
consulting room, excuse me, what?
What did you find to be the gapsin the field?
Like what what? Where did you find the limits of
what what you were being taught could help you in working with
orienting yourself towards transcare?
So this is part of what I why I wrote the Co wrote the book and

(18:31):
why I, I started the affirm withMichael Beatty is because in my
training in Spain, my whole training was delivery in Spain.
I got nothing, no, nothing whatsoever.
There was one mention that beinggay used to be in this DSM and
that was all. But nobody ever talked about
trans people. Nobody ever talk about

(18:53):
relationship diversity, about polyamory, about nothing of
these things. And so it's so sad.
It's so sad and it's so square that that, you know, even even
my own training. So particularly in Spain,
there's a big emphasis on cognitive behavioural therapy

(19:14):
and there's this idea of psychology as an extension of
medicine, which to some degree Ilove because I love medicine and
that's why I ended. And I feel like gender that
allows me to explore and pursue the sort of more medical side of
things. But it's really, you know, mind
and body and that's it. And so it was really lacking and

(19:35):
coming to the UK and starting towork in places like the
Tavistock that has such an amazing tradition and
psychoanalysis and a psychodynamic theory.
And, you know, it really opened my eyes to how to view people
more holistically. And but everything I've learned

(19:56):
within, you know, queer communities, I've learned from
my patients. So you know.
I, I, I encountered books, I read a few books in the process,
but even those were so clinical and so tough to swallow.
You know, I, I so much yearned for an approach like Irving

(20:18):
Yelong in this field, you know, and that to me was a great
inspiration when I was writing the book because I felt it was
pointless not to put myself in it.
You know, I, I needed to make a little bit of a reflection and I
really Michael who, who Co wroteone of the chapters and who also
has been an amazing help becausehe is native speaker and he he

(20:41):
has beautiful English skills. But he says I encourage him to
be self reflective. Now.
I force him to, to put a little bit of himself in the book.
You know, I felt to say it's a fair ask given that we ask our
patients to be so vulnerable, you know, for us to do a little
bit of it. Has your, has your clinical

(21:01):
experience in a way been unfolding in a, in a like a Co
creation of like your sense of identity within yourself?
Because, you know, growing up inSpain, you really have no
language to understand queerness.
Because, you know, our identities seem to have been
stripped through something. I think growing, growing up in
Spain, I did have an awareness of, of queerness.

(21:24):
And, you know, there was always,you know, my mom always had lots
of gay friends and that was, they were very open with me
about it, you know. And so there was a sense of, you
know, normalcy and, you know, just go and spend time with my
mum friend who had a library. And to me was like, wow, I could

(21:45):
go and, like, pick all the booksand tidy the math.
And so I had a blast that I never had a negative experience
with a gay person. But to me, it was interesting
that it was so, like, hush, hush, you know, don't say
anything about this. It's something kind of not OK.
And, you know, travelling to South America to see the rest of
my family, you do see tremendously homophobic

(22:08):
experiences and, and, and that'svery sad.
And that was something that for some reason, I always found
myself challenging and, you know, battling against different
people like, but why are you so adamant that this is wrong and
why people cannot live with how they want, you know?
And, and so I think that that connection was always there.
And I've never been able to explain it, but, you know,

(22:30):
there's a great sense of queerness within me in terms of
how how much of part of the community I feel and how much
I've ended up immersing myself. And the way in which my identity
has evolved is that I think a great, I've acquired a greatest
sense of freedom, you know, which may come with age, but
it's also as well to see so manypeople having the courage to

(22:55):
pursue what makes them happy in spite of worrying about shame,
worrying about abandonment, worrying about discrimination
nowadays, you know, but when yousee that people have no choice,
you know, it's not, it's not something I'm doing 'cause it's,
it's in fashion. And it kind of gives you courage
as well to pursue whatever it isthat makes you feel good.

(23:19):
And Carolyn, I love your second question about the DSM because
to I'll give you, I'll give you a Segway answer to that.
But I'm part of agenda specialist WhatsApp group.
And yesterday someone was sayingsomething along the lines of one
of my trans stations is in the at the moment in the process of

(23:42):
obtaining A diagnosis for autism.
But they are concerned, what is this diagnosis going to mean for
them? You know, and this is not the
first time I hear this. So I had someone else a few
months ago as well saying I knowI'm autistic.
Like I've read the the sort of the criteria, lots of my friends
and you're divergent. But I do worry that if I get the

(24:04):
diagnosis that's going to be used against me, that's going to
go on some form of register thatis going to label me as
disabled. And as much as I might be
struggling in some ways, you know, socially or with certain
sensory issues, as much as, you know, I know myself, I am afraid
of the consequences. And I think that that is the

(24:26):
problem with the DSM. You know, we're looking at a
pathologizing model for understanding human experience
and behaviour. And so it is useful, you know,
in that we have a common language, it is useful in it
that integral ISIS. But there's also, I'm not sure
if I'm allowed to use this word for it, but I feel like there's
also a lobbying of the kind of conditions that get included,

(24:49):
right? And if you are a a academic and
you're fascinated by this part of psychology, well, you just
create your little lobby to makesure that it ends up showing up
in the DSM, right? So yeah, it's, it's not
representative of all human experience.
It's just a way of understandingit, and in a very narrow way.

(25:12):
It's a It's a very interesting commentary you're making because
I was seeing recently that thereare questions about whether
people who are diagnosed as autistic, whether or rather
sorry, it starts in the oppositedirection, whether people should
be screened for autism before being allowed to transition.

(25:36):
Because the assumption is that if you're autistic, then you
can't also be trans. You're just disillusioned.
You've disillusioned yourself asbeing, you've illusioned
yourself as being trans. So part of what you're saying
also, I think it also puts an interesting pressure on the
affirmative consent model, whichhas been offered as an
alternative to gatekeeping because a consent model is also

(25:59):
an ablest model like it. It raises questions about who
can consent, which brings up questions of age, questions of
mental health diagnosis, as if somebody who is who also has a
mental illness cannot also be trans, as if these are mutually
exclusionary or the one explainsthe other.
So I was wondering if you can say a little bit about that and

(26:21):
also to to loop it back to something that Caroline asks,
like the question of how coloniality or like lineage gets
left out of models that are beatthat are based on DSM.
For example, you talk in your book about coming out, coming
out as, as we know as kind of like, I would love to hear more

(26:44):
about this one from you has kindof like a it's a cultural
framework, right? So I'd love to hear you speak
about this too, together. Yeah, absolutely.
Yes. And the book I sort of like I, I
was reflecting off this thing ofcoming out because I, I don't

(27:05):
remember where I I heard it or read it, but someone was
challenging this notion as I wassaying, it's not coming out.
Just letting in, you know, we'renot coming out anywhere.
We're just letting on in into something that we've been
experiencing that we haven't yetspoken about openly, right.
And, and this, this having to disclose, hey, I'm different in

(27:26):
some way. Why, why do we do that?
Do you know why, why we forced to do or say that?
You know, and, and in the book, I'm sort of reflecting at the
time when I wrote it, there was like this trend on social media
of straight kids coming out to their parents as a straight.
And obviously their parents are kind of panicking at the start
because it's like, my goodness, my God is my child is going to

(27:49):
be queer in some way. And it's like, no, no, there's
no issue. It's just, you know, this is who
I am. And so, yeah, we sort of expect
everyone to fall within that range of normal, which is the
most absurd of notions, right. And, and, and so I think that,

(28:10):
yeah, the DSM once more, like Caroline was saying and like you
were saying, it just sort of reinforces this idea of a wide
colonial, this head, you know, normative in every way person
that if they have any of these experience, this is it.
You know, and I think something that really made me challenge as

(28:31):
well, what I think about different conditions, right?
For a long while I worked as well with people who are
suffering with schizophrenia or psychotic illnesses, right?
And you read in the paper, someone has schizophrenia and
you imagine the worst, right? You imagine aggressive
tendencies. You imagine like a person who is
a danger to themselves and to others.

(28:52):
But a lot of the work that I didwith this population was around
talking to these voices, you know, or relating to these
voices and what they are and where they come from.
And you know what, what relationship to their own trauma
they have, right? And how how there was just a way
of trying to heal, trying to merge the parts of themselves

(29:14):
that were split right and divided.
So yeah, we we did. We need a different way aside
from the DSM to help people understand themselves in that.
Context. Would you say a little bit about
the Affirm project that you've been working?
Yeah, excellent. So, yeah, so I got an approach

(29:37):
to to write the book, which I did with all my love because I
feel like, right. This is an amazing opportunity
to bring, like I said, that yellow approach, that reflective
approach to the work, but also because I've ended up
specializing in in this field when like I mentioned earlier, I
had never met a trans person. So if I can do it, anyone can do
it, you know, and it's not that complicated.

(30:02):
So I think that as much as people try to make the notions
of gender really, really complexat the end of the day, and like
you sort of hinted at, it's a little bit about what makes you
feel good and why and what can you do to affirm your experience
and to feel good about yourself.Do you want to wear this?
You want to wear black? You do whatever you like, you
know, with your body. It's yours to to use and to

(30:24):
nurture. And, and, and I realized that
there wasn't much out there on that line.
And so we wrote the book, We Co created it with many community
members. So we interviewed parents of
trans people who are part of theorganization Families Together
London. We interviewed people who had
the transition, people who were religious as well as trans, you

(30:49):
know, and thinking about their old experience of of God and
deity and faith and so on. And we felt like finally we had
something that it was Co createdwith the communities that it
wasn't. So this is the clinician and
this is my opinion. And that's the end of and when
we finish, I, I guess we felt a little bit like a empty nest.

(31:11):
And so we decided to to continuewith Michael to create a firm.
So with a firm with created a via edge of training courses
that we are prerecorded and we've also interviewed community
members for them so that their experience can be there.
And so we have from psychotherapeutic training
courses like how to support someone who is concerned about

(31:34):
being clogged constantly or how to work with people who struggle
with looking at themselves in the mirror, right.
And that that very common struggle for trans people to
just more general training for clinicians.
So we have like a 5 hour course for clinicians or a three hour
course for clinicians so that there is no excuse for any

(31:54):
healthcare professional when a trans person enters the room to
say, you know what, I might not be an expert, but I'm willing to
help and I know a little bit about this.
Caroline, did you want to say something?
I didn't want to interrupt you. No.
Well, I I did want to ask you a little bit more about kind of

(32:17):
like the way in which your book emphasizes like the wisdom of
trans and non binary people. And I was wondering if you might
be willing to share some examples of how your clients own
narratives are shaped, shape your understanding, or challenge
your understanding. That's like a like a picking a

(32:39):
seashell from the sea. It's a very broad question, I
guess. For example, in terms of
sexuality, they have really challenged, right, this sort of
this whole assumption that you can be gay or straight or maybe
if you're really out there you can be bi and that's it.

(33:01):
I've been working with non binary people and suddenly
realizing, oh, should this not aword to define, you know, who
you're attracted to? And suddenly we need to think
outside the box for this. And actually, if we were to
think in non gender terms, what is it that you like?
You know, and he said, is it that the person is particularly
intellectual? Is it that they're really good

(33:23):
at giving you massage? He said that you have a common
interest. They said that they have the
same religion, he said, you know, and so sort of
understanding sexuality is much,much broader than what is the
gender or the genitals of the person that you sleep with.
That has been big, big eye opening process for me,
particularly coming from, like Isaid, Catholic background where,

(33:46):
you know, you either have sex tohave children or you don't have
it at all. So that has been very, very eye
opening. And I think lately as well,
this, my sort of understanding of euphoria is really evolving.
And I think that to start with, what I was told is that, you

(34:07):
know, this sort of trans normative narrative that you
need to hate your body in order to be trans, right?
You really, if you have a penis,you must hate and if you don't
have it, you must need it, you know, and it's, it's looking at
people and see how their understanding of the
relationship with your, their body evolves, right?
And how people so intelligently use humor.

(34:31):
So there was this young trans girl like, I don't know, 17
years old, and she was like, I call my Penelope.
And Penelope comes with me everywhere.
And it's like, you know, being able to make light.
And it's like, I used to be really a point of being ashamed
of myself and feeling less of a woman.
And now, you know what it does the trick is this body part that

(34:51):
I have like an elbow, like a knee, like a foot.
So why am I looking at it in gender terms?
Why am I feeling ashamed of it? And it's like, absolutely.
And so I think I continue to sort of take these pieces of
wisdom from people that I meet and try to communicate it, you
know, sort of like pass the baton in that sense.
And, you know, I don't know whatwhat she did particularly that

(35:13):
it worked for her to be able to see her body with such a natural
way and to accept herself. But, you know, maybe something
you can too try. But I think it's really hard for
people to be reflexive in this field.
I think it's very hard for clinicians as much as you know,

(35:34):
for psychologist or psychotherapist, it might be a
little bit more part of our training that you have to have
that space. You have to have that.
The UK is a minimum of one hour a month where you sit with
someone else and you do your, asI, as I view it in, in Catholic
terms, you know, your confession, you know of the
things you maybe are doing wrong.
It's really hard as well becausemany people who are supervisors

(35:59):
might not know enough about queerness, right?
And, and suddenly you get this, this you carry the burden of
some of your patients. So for example, some of my
patients might be a bit indecisive as to whether do I
want to transition? Do I want to leave us this
gender? Do I want to tell all the
people, right? And when you bring that to

(36:21):
someone else, they might be quite like, oh, maybe, maybe
not, you know, or maybe. And so you sort of see how it's
really hard to have someone as well who would be who would have
looked at their own gender. Everyone has to do this
exercise. Everyone has to understand in
what way has gender as a construct shaped them in their
lives and their ability to express themselves.

(36:46):
And also I think in all the complicated dynamic is that in
many countries, and I don't know, for example, in Spain, I
know is, is is a thing rights activist groups and clinicians
are sort of like in combat with one and other, right?
And so that makes the works of clinician even more hard because

(37:09):
you cannot really accept actually, I think can be a
little bit transphobic here. And so part of the work that I'm
doing in conferences in those open spaces is to be very open,
the things that I notice in myself.
And so for example, I've noticedthat if a person is coming and
they want hormones of surgery and they are performing their
gender in a way that I understand it, it is a lot

(37:30):
easier, right? If you, if you meet a trans guy
who is tremendously masculine, you're like, oh, of course I see
it, right. Your insight is outside now.
So it's easier to understand andto believe.
And perhaps I will put less questions that if I'm working
with a woman who happens to be alot more masculine than the
average, you know, then it's when you really question who Are

(37:51):
you sure, you know? And only through saying, wow, I
don't think this is OK. Like what is going on inside of
me that this is happening, that I can sort of challenge myself
and that I can talk about it, you know, but I know that many
people don't don't go that far. They just think this is my
clinical judgement and I must follow it or I felt something
wrong. But I, I felt the wrong in the

(38:13):
judgement that I was doing. So I'm really, I'm really open
to changing. I'm really open to seeing how
this whole horrendous political situation is going to shift my
work. I worry that I might not longer
have the option to supporting people with hormones or surgery

(38:35):
because they might close that down, right?
They, they put in roadblocks forhealthcare, for transfuse.
And so it's a matter of upping up the dial and increasing the
age, right? And so in the cast review, they
were saying what 21 should be the age of consent for accessing
the source of treatments. 18 you're still developing.
And so they add more and more and more and I worry and, and

(38:58):
lots, lots more people are turning to self medication and
lots more people are coming for what we call a gender
recognition certificate. So this is the document in the
UK that allows you to change your birth certificate to either
female or male. We don't have a gender neutral
or sex neutral marker, but lots of people are coming because

(39:18):
they're looking hopefully for that protection.
And it manifests as well in in that many people when I ask
them, OK, have you thought aboutfertility?
And, you know, would you like tohave kids one day?
So many people say I will adopt and and I say I so much wish
that for you. But look at the news and do you

(39:39):
think this is going to be a possibility for you?
You know, it might not well be. And so again, trying to support
people to access fertility preservation becomes a point of
activism as well because you youface challenges from the NHS and
from GPS who do not want to be helpful.

(40:01):
And, and what you're saying makeme also think about kind of like
transnormativity and kind of like the ways in which even even
with fertility, fertility and kind of like the idea of
reproducing or having your own biological child is so valued in
our societies that it may be hard for people who, for whom
this is not a priority or for whom the communicate, who are

(40:25):
constantly met with the communication about how
preserving fertility is, is a, is a important when it may not
be important to them. Jules Gill Peterson has done
amazing work talking about kind of like linking these kinds of
discourses with abortion discourses and here in the
United States and how I think the the idea that the body

(40:48):
producing another kind of like an offspring perhaps and they a
new agent of the state, like another person that will
ostensibly get plugged into the machine of capitalism that like
that all of these systems are interconnected.
This is one of the reasons why talking about colonialism,

(41:09):
talking about other intersectionsystems that are not just about
individual psychology, but also about larger frameworks seems so
important. Because as we know, not not
every trans person wants is interested in preserving
fertility. But fertility has become such
the fighting point, especially when it comes to children.
It's become such a such a contested terrain over which

(41:34):
trans children's capacity to transition or access care is
being negotiated. So I appreciate you bringing
that up. The big challenge with trans
Healthcare is that the politics get into the clinical work,
right? Because so for example, I, I, I,

(41:56):
I met with this Russian patient and they were saying to me,
look, I believe in US myself since I was 18.
This person was already in their30s.
But I'm really sorry, I cannot give you any of the reports
because in Russia I could go andmy clinician could go up to 10
years in jail. If, you know, they, they were

(42:19):
found out to have been supporting a trans person.
And so the stakes are very high in that sense, right?
Making a mistake, supporting someone who later made the
transition, you might be found guilty for that decision or for
having facilitated that process,You know, and, and so it's hard.

(42:39):
I am lucky enough in that I have, you know, I have a loving
family and I have loving friendsand an amazing group of
professionals that I can lean into and sort of say, hey, what
do you think about this? And you know, it, it, it works
for me. But if you feel threatened, if
you are worried about your safety, about doing the right

(42:59):
thing, it's going to be so much harder to be honest with
yourself and, and, and see, you know, what's driving some of
your decisions. So let me so I I, I I, I I.
You're right that CRP must be radically listening.
And I think that really touches on especially what we're doing

(43:20):
here in this podcast and something I've really strive to
do, which is to hear the storiesof of people of gender not
conforming to celebrate gender diversity.
And it's really important for me, especially when I put that
in the bio, because gender diversity opens the door to

(43:41):
humanity to, to experience this and, and, and even this
conversation here is gender is gender diversity.
And, and you know, what does radically listening look like in
your field beyond what we've already talked about?
And and on top of that, how, howdo we build models of care that

(44:04):
don't just affirm our identitiesbut but support transformation
and becoming? I think that radically listening
looks like looking at the world with fresh eyes, you know,
looking at the world with the eyes of a child that is surprise

(44:28):
by new things. So that is curious by, you know,
what they see. And and I think that's the key
to it. You know, when we come with a
lot of preconceptions, it's harder to hear what the person
is saying to you saying that that that is at the core of
listening psychotherapeutically,but particularly in this field,

(44:51):
right, when a person might be non binary and have a very,
very, very specific understanding of what that means
for them, right, or how they present or how did evolve so the
sense of fluidity and so on. So I think that that would be
and the second one was how to build models that sorry, I've
got. Caroline, I'm here.

(45:15):
Sorry it's cut out. Yeah, yeah.
The second question was how to build models.
Maybe, maybe you might remember.Yeah.
I think kind of like how to encourage our how to be a model
for that for other clinicians iswhat I think Caroline was
asking. Yes, yeah.
So how do we build models, Sorry, the Internet cut out how

(45:36):
do we build models out of that up?
How do we build models of care that don't just affirm identity
but but support transformation? Well, that's a one $1 million
question, right? Oh, it's really hard because I

(45:59):
think it's an intention what is important, but you know, people
have some atrocities with good goodwill.
So I'm not sure if the intentionwould be enough.
I think, you know, for us what we, what we understood or what
we define as gender affirming therapy and particularly through

(46:19):
through affirm and through. So the work that we done in our
writing is 2 bids. And I think the first one is to
learn enough about the subject matter, right?
Like if you are working with a person who struggles with an
eating disorder, you go and readabout eating disorders and you
ask them, you know, what is that?
How does that translate to you personally, to your life, right?

(46:42):
You don't go into a session witha person who has an eating
disorder said, but what is anorexia?
Like people would go into a session with a trans person and
say dysphoria. What do you mean?
What's that right? And so I think that the same
level of education should be required to work with any
element of a person's identity, that cultural sensitivity, that

(47:03):
gender sensitivity, that or all of that should be part of our
core training. And the second one, like we've
been talking about is reflexivity.
Look at yourself. How does it feel like for you?
What, how, what is your own experience of your own gender
identity? What is your experience of
eating? And you know, how, how does it
impact everyday? And I guess it something that I

(47:24):
do regularly is that those questions I ask my patients, I
also try and ask myself. We were we were talking parts of
that realization of, you know, this transformativity around do
you need to hate your body? You need to feel in a particular
way towards your body and so on.Once I asked myself, how do I

(47:45):
feel about my genitals? I was like, what a weird
question. I talked to myself, I don't
care. Like, I don't know, they're
there, right? And so.
But once I was able to turn 10 mirror towards myself, I
realized, OK, yeah, I can. I can understand now how people
feel in this process or how, youknow, impose and you can feel to

(48:06):
have these questions. So.
Yeah. Can I jump in to ask a quick
question? I'm really interested in your
insight around this because there are like everything that
you are speaking about in which I totally agree with.
Also presumes A clinician who isinterested or curious or is well
meaning but perhaps unaware or uneducated or is missing some

(48:28):
things. But as as we know, there's also
some clinicians in the field whoare kind of like trans
antagonistic. There's a hostility to
difference, a kind of deep anxiety about trans experience
that makes them recoil and makesthem be more inclined to look at

(48:49):
trans people with suspicion. So I was wondering what your
experience, insights, thoughts might be about these clinicians
who I think are coming from a different place than the kind of
like what we might assume is most people who are kind of
unaware but perhaps open or willing to learn.

(49:09):
Yeah, yeah, absolutely. I think that it's very important
that we check our position, right.
We may have gone to university, we may have thousands of hours
of clinical experience, but how much do we really know?

(49:29):
How much do we really know aboutthe world?
How much, you know, even if we think about how do we measure
pain, right? If I pinch you or you pinch me,
how do we know that we're feeling the same thing, that
this is a shared experience? We can try and tell you, OK, it
was a three out of 10 in intensity or it made me cry or I
have redness in my skin. But there's so many elements of

(49:51):
human experience that we're justinferring and trying to
translate into words and, and attimes meaningless scales, you
know, that are not truly representative of science
because there's certain things that you we cannot measure just
yet. We might someday, but not now.
And so I think that we need to be humble in our approach.
You know, I, I too was somewhat skeptic towards some things that

(50:16):
I've seen in the field. I too couldn't understand why
some people wouldn't want to have their nipples.
What is this about? Is this trauma?
Is this what's going on with this?
Right. And so you, you question, you
worry, you think, do I need to put some barriers to this?
Do I need to ask them to complete six more sessions of
therapy to make sure they're sure of it?
Or is it I that I'm not understanding what's going on

(50:39):
for them? And so I think that a little bit
of humbleness would be appropriate.
You might be a doctor. You don't have all the answers,
you know. And when you don't have the
answers, you shut up and you listen to the person that is in
front of you and you hope they might be able to give you the
answers or they might allow you to guide them to a point where
you both so that I may be able to find some answers.

(51:03):
So you know, this, this your answer there kind of ties into a
little bit, you know, because I think this is really fascinating
and I'm sorry to all my friends who've heard me talk about this
nonstop for the last month. So I'm going to talk about it.
But I but I think it's really interesting because we, you
know, we've been emphasizing dialogue reflection and these

(51:24):
narrative resonance within, you know, our therapeutic language
making. And, and so I'm interested in
how you approach the emergence of AI technology and how does,
how does your work challenge or expand what we consider therapy

(51:46):
and how my tools like AI play a rule, a role in that
redefinition. Well, I, I I'm in a special
situation because my my husband is a doctor in physics and he
specializes in in AI inside get.Out of here.
You're kidding. Me, we are in an open

(52:09):
relationship with ChatGPT in ourhome, You know, it's like.
Me too. Her name is Sage.
She remember herself, she her pronouns I.
Thought it was spinning. So for my personal life, is is
is quite important. It certainly feels like so
useful to have all the world's information summarized in a way

(52:32):
that you can make sense of it aslong as you're prompted
adequately. And like, you will know
Caroline, the training's for that, right?
That's cute. My writings to it, you know,
I've I've shared with it in my life in in so many deep layered
ways that it's in ways that there like there was there's not
enough time in the world to go through all of that.
I've gone through with with another human because it's so
time consuming. You send a lot in 10 seconds

(52:55):
later. Like, it's incredible.
I, I do want to kind of like logic concern about this.
And I know, I know that both of you use AI, but I, I want to
raise a couple of different things for our discussion.
One of which is that AI is terrible for the environment.
It is completely destructive in terms of kind of like the amount

(53:18):
of water that it uses for these like mega farms of processing
information. So the question is like how to
use it ethically and the ways inwhich it then can like feeding
it information also trains it for projects that are not
necessarily in the long term going to benefit minorities.
So I'm just thinking about what you're saying, Caroline, and
what you're saying, Laura, that you are in kind of like

(53:39):
polyamorous relationships, a guyas somebody who is actually
quite worried about these things.
I'm I'm curious, I just wanted to we don't have to spend a lot
I. Like this, this is very
important. I really value your your
response to that because I thinkit's very important to have
these kind of conversations whenit comes to this emerging
technology. I mean, I mean, like you said,

(54:01):
Caroline, like we've been sayingfrom the, the thing that I see
is it can really, really work for a portion of the population,
right? I think for people who might not
have that, you know, people who might have tried going through
many different therapies that nobody really got them or who
might be in an isolated area whomight not have access to someone

(54:23):
asking them a question, right. You can kind of try and prompted
to to help you ask questions to yourself that someone else
would. So it's a tool and like
anything, it can be useful harm or it can be useful your
benefit. I think that for a lot of
people, if you're thinking about, you know, the
psychotherapy said use of AIA, lot of people will need that

(54:45):
human connection and will need to see a person, even though it
might be through soon or you know, in the same room, it is
part of the someone else can accept it.
So why not? Can I not upset myself, right.
And so it becomes instruments instrumental to that, but it can
work and it can evolve. And I think I, I really love

(55:07):
that idea. Currently.
You can train it for the, for the good and, you know, create a
new, a new being almost that that would support it.
Also, it's important to say you can use it with a temporary bit,
right? You can click on temporary and
you're not training the models with what you're asking.
And so that's that's also an option I've.

(55:28):
I've come to really understand my gender without identity.
And I think that the work that Doctor V and Doctor Antellegrini
have done has really done so much to elevate our
conversations and really allow for a liberatory experience.
And then what we're doing, whichis what you're doing.

(55:50):
And I, I'd like to know, you know, a little bit, you know, I
know that you may not be as familiar with, with this work,
but you know, how do we hold space for gender as both a
deeply felt truth and fluid experience and also a
constructed experience? I the two times you've said that

(56:20):
this thing that you've been ableto understand yourself just as
Caroline, right? Sort of like just share this is
who I am and like, you know, my identity requires just one name
and so on. I, I keep thinking that about
this, so many, many transfer many people that I talk that I
with that I that are exploring the general identity.
They tell me I don't know if I'mfluid because there are days

(56:42):
where I feel very firm and I will dress and I enjoy it and I
might go out or not, but at all the days where I'm like nothing
and I'm not doing it. And I guess those are my
masculine days because, you know, the, the base that we're
starting with is more masculine.And again, I sort of turned the
question back to myself and I'm like, how many days do I wake up

(57:04):
in the morning and can I be bothered to make up on, you
know, and am I masculine those days?
Or am I just being not necessarily having to perform
any gender, not necessarily having to prove anything to
anyone, right. And, you know, and if I was to
look at the patterns that you'reexperiencing in your gender, in
the way that you express yourself, and we were to ask
your female sisy and the female partner about them, they're

(57:27):
like, they might say something similar, right?
Like I'm just being me. I'm wearing sweatpants today.
I'm like, you know, what do you want me to do?
Do you want me to dance? They shouldn't prove that I am
who I am. And so I guess that it might be
a beautiful sign of evolution that that formativity you can
leave behind and you don't feel the need to split yourself into

(57:47):
so many parts. To explain, actually once a
month I would like to wear high heels and the rest I don't.
You know what? What do you hope clinicians and
clients and allies take away from the work that you've been
doing? Just chill, Just chill and look

(58:07):
at the person that you have in front of you and have a chat
with them and ask them how is itgoing and what are they feeling
and why. You know, like there's no
difference in the trans work than with seized people or
straight people. There's nothing different.
It's a person sitting in front of you.
So, you know, remove those mental barriers to to prevent

(58:29):
you from treating them as such. You know, forget, forget about
the doctor or patient. You know, obviously keep, keep
confidentiality, keep, keep all those rules that are useful for
the work. But there's no need to
overcomplicate this. Yes, like my, my last question

(58:51):
would be also thinking towards like the sorts of clinicians who
are struggling or trying to findtheir way into working in the
ways that you're describing. I mean, in some ways, I guess
you're talking about the, the clinician's own transition from
working in one way to another. And here I'm using a term by
Nicola Sebzonas. So I'm wondering like what would

(59:12):
you say, perhaps you can speak from your own experience or what
you've seen in other colleagues,what has has been the most, the
biggest obstacle in making that transition for the clinician?
I think that it goes back to that intersectionality, right?
And what are the parts of yourself that you consider to be

(59:34):
salient that are that conflict with with gender diversity,
right. If your particular religious
beliefs prevent you from believing that this is how God
would make a person, then you'regoing to really struggle because
you're going to be questioning them.
Is my pastor wrong? Where are my parents from
telling me this? So, you know, So what do you
need to reject from your own experience to be able to allow

(59:57):
to let trans people in? And so I guess that that that
same reflexivity and honesty at some point might reach a point
where you just think maybe I'm not the right person to work
with queer people. You know, maybe my specific
beliefs, maybe my, my, you know,my hell belief in binary genders

(01:00:20):
and how they manifest prevents me from doing this work.
And I guess that they that's you, that's also OK.
But treat people with humanity, treat people with respect and be
open about it, right? I might not be right for working
with a very specific population or condition and that's fine.

(01:00:41):
So but I guess that for those who do not have those strong Rd.
clocks to supporting trans communities, it is your duty to
work on that, right? You wouldn't be turning a
person. I don't know person from China
way because you know what? I don't know enough about China

(01:01:02):
book darling. Like it's fine.
You can read a book and you can work with your patient and you
can ask them to to be open and to accompany them.
My goodness, I, I really enjoyedthis time today.
This has been such a treat, sucha pleasure.
I I really, you know, I always love it when Doctor V comes and

(01:01:24):
you know, I really enjoy your presence and I really enjoy
being here with you today after Laura.
This has been such a treat, suchan honor.
I really thank you so much. And audience, thank you for
being here as always showing up every week and being here with
us is a beautiful is a beautifulthing.
And if you like to participate and be on the show, please,

(01:01:45):
that's Doctor Laura Skarani. Anam had had reached out to us
via e-mail at [e-mail].
That's [e-mail].
Please reach out to us and we will have you on the show,
please. And this has been, this has been

(01:02:07):
truly such a treat. Doctor video.
Any final thoughts, comments, oranything you'd like to say
before we go? Yeah, I just, I just want to say
express my appreciation for the podcast, for the work that
you're doing, for how how both open but also kind you are,
Caroline, in thinking with clinicians and thinking with
people who are coming from different angles and trying to

(01:02:30):
weave together these conversations.
I think that's very important and very delighted to have met
you, Laura, and to have heard about your work and to know that
there are clinicians everywhere who work towards the flourishing
of trans life. Thank you so much for for having
me. And yeah, it's been, it's been a
blast. We'll be happy to come back

(01:02:51):
anytime. Oh, I would love, I would
absolutely love that an audience.
If you'd like to learn more about after Laura's work, you
can find their book gender affirming therapy, a guide to a
transgender and non binary clients can teach us.
This has been this has been wonderful.
Thank you all for being here. And before we go after Laura, as

(01:03:14):
we depart and and carry on throughout our week, what what
gives you hope and what message would you like to leave with us
to carry on for our week? It gives me hope.

(01:03:35):
This sentence gives me hope whenI look at the world now, when I
think about, excuse my French, how fucked up it is in so many
ways. I think about this sentence that
I heard in a show which says thebest revenge is to be happy.