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Background

A university setting is like no other; it is a microcosm of society, acted out within the confines of (in this case) an inner-city campus in the north-west of England. Students come from a mixture of backgrounds, abilities, cultures, religions, genders and sexualities. Annually time-bound to three semesters in which hierarchies, roles and interactions develop and statuses struggle to prevail, the diverse community comes together to connect, engage in learning and develop unique identities.

The population of predominantly young adults thrown together and away from home for the first time, creates a heady mix of excitement and anticipation, but with this come challenges to mental health, often associated with acceptance from peers and identity development. There is no group this applies to more than trans* students (we use the asterisked term trans* to include transgender, transsexual, non-binary, gender fluid, trans-feminine, trans-masculine and anyone who sees themselves not fitting the binary roles of societal norms of masculine and feminine).^1,2

The trans* community has an increased risk of mental health issues as a result of individual and group emotional, psychological and physical trauma rooted in social stigma, marginalisation, rejection, exclusion from health and social care services and verbal and physical assault.^1–4 Within our university, as in modern society as a whole, this marginalisation is being tackled head on with increased inclusion and visibility for trans* people.

There is a great deal of misunderstanding and ignorance around terminology associated with the trans* community. However, this article is not an educational piece on language or the issues of cisgendered toilets – that is for the reader to research. Rather, these are our reflections about the drive to create inclusion and visibility for the trans* community in the university setting through a trans* support group.⁵ To quote Kate O’Donnell – a Manchester-based performer, activist and Artistic Director of TransCreative.uk – ‘…it’s not trans people’s job to sort out transphobia, in the same way it’s not a person of colour’s job to sort out racism. It’s everyone’s job. Asking minorities to sort things out for the majority is a big ask!’⁶

I dislike the idea that trans* inclusion is a strategy demonstrating to educational boards that the university is meeting its required diversity target – trans* people are real people with real struggles, facing greater challenges than some of us will ever know; they are, and have always been, an important part of society, quietly contributing to a wealth of culture and history, and their experiences need to be heard and validated.⁷ Now is the time trans* people are stepping up; fuelled by increased human rights and government legislation, a more positive trans* media presence and a shift in society’s awareness of gender diversity. This combines to create a vibrant, more colourful, world, and as trans* allies, we need to support this movement.⁸

We do not want this piece to focus on trans* mental health statistics and vulnerabilities. Instead, this article celebrates the coming together and sharing of support that trans* people engaged in through the university’s trans* support group. It also contains our reflections on facilitating that group.

Our background

Having worked clinically in a one-to-one setting with numerous trans* students, we were struck by individuals’ frequent lack of connection to other trans*-identified people and the lack of positive trans*-supportive spaces.⁹ This lack of resourcing seems very often to result in isolation and invisibility. The LGBTQ+ community may not be as inclusive and accepting as people imagine. People of colour, people with disabilities, heavier people – in fact, anyone who does not conform to acceptable cultural normative aesthetics and behaviours can be judged, rejected and isolated by the very community in which they seek safety.¹⁰ University LGBTQ+ societies may not be sufficient to meet the needs of trans* students. Considering these factors, we decided to set up a support group solely for trans* students within the university, with the aims of helping them to connect with one another and share experiences in order to feel accepted, included and heard.

Aims

Within a university it can be difficult to engage with similar people who may be in different buildings, on other courses or who are just less able to engage in societies such as the LGBTQ+ society, for a whole plethora of reasons, including social anxiety, fear of judgment or discrimination.

The aim of the group was to create space for an immediate connection and recognition of solidarity within the university’s trans* community, offering a source of support and a space for exchange of experiences and ideas on how to manage challenging situations.¹¹ We hoped that each group member would bring a unique perspective arising from differing stages of emotional and physical transitioning identity development (in whatever way ‘transitioning’ was being experienced by them). The weekly sessions would run for 90 minutes, over a six-week period.

We hoped that the group would engage individuals who might not want to access individual therapy or who might need something other than individual support from a cisgender therapist who – as much as they might empathise and strive to create a safe and inclusive space – might not fully understand the subtle nuances of the trans* journey.⁸ The group offered those who might be waiting for counselling, or just finishing their counselling sessions, the opportunity to engage in more immediate or continued support with individuals they could relate and connect to, on a deeper experiential level.

Recruitment of group members

The counselling service displayed adverts throughout the university through computer screensavers and message boards, as well as group emails distributed to all those who were registered with the trans* forum database (the trans* forum is a quarterly meeting of former and present trans* students, diversity and inclusion staff, healthcare professionals, student union officers and external services). We asked people to spread the word about the group or to forward the email to anyone they thought would be interested in attending. The students’ union used social media to promote the group, and it was also promoted through the university wellbeing service. Individuals were asked to respond to a generic wellbeing address to register their interest and in return we sent them details of the location where the group would be held.

Prior to the group

We studied and reflected on the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counselling’s (ALGBTIC) Competencies for Counselling LGBQQIA Individuals¹² as an ethical framework for this population, along with Ïã¸ÛÁùºÏ²Ê¾«×¼×ÊÁÏ’s Ethical Framework.¹³ One author of this article, NSC, has a special interest in LGBTQ+ therapy, development and issues, and has engaged in the ‘Pink Therapy’ accreditation process¹⁴. We also use personal reflection and supervision to explore our own ideas of gender and sexuality in order to be aware of how these can influence and impact the therapeutic alliance.

Before facilitating the group, we discussed our own identities as Caucasian, cisgendered professionals supporting the trans* community and considered how this might influence group dynamics. Even though one author identifies as a gay male (NSC), neither author has the experience of being a trans* person, and we wanted to ensure participants took the lead in the group by supporting one another and being the ‘experts’ on their own experience. Even though the challenges each member faces may be similar, their lived experiences will ultimately be very different.²

We were open and transparent about the participants being the experts in the room and that it was a peer-support group, rather than a therapy group. This reduced anxiety for the group, knowing that as facilitators, we were not expecting anything from participants, or analysing responses to engage participants the way we would in a one-to-one session.^1,2,11 Both authors have experience dealing with high-risk clients and safeguarding issues and were up to date with university policies and procedures should any participants have presented in a highly distressed state or have become distressed during the group.

Prior to the group starting, we asked those who wanted to participate to email us confirming their attendance and to send their preferred name and gender pronouns. We wanted to gather pronouns and preferred names to help us create the respect and dignity participants deserved during their time attending the group. Each week, when email reminders were sent out, participants were able to change their name or pronouns with no judgment or questions. This allowed for experimentation of gender with no conditions attached, giving participants a space where they could be comfortable with who they were at that point in time.

During sessions

Having an open group with a ‘drop-in’ style attendance could have disrupted the dynamics developing in the sessions and ultimately damaged the interactions and trust which had gradually been created. Therefore, we decided the sessions would be run as a closed group. With fewer than 12 confirmed participants and owing to the potentially sensitive and vulnerable nature of issues discussed, the closed group protected the structure and integrity of the group and its members.

It was important for us as facilitators to monitor our own influence on the group, and to ensure that we avoided leading discussions in any way to satisfy our own curiosity. In the same way as it is not our aim for this article to educate the reader on appropriate language to use when working with trans* clients, it was not the role of trans* group members to educate us on terminology relating to their experiences. We had no right to tell participants how they experienced being part of this minority group and we refrained from offering any understanding of their experience, based in theory or academic research.

The possibility of power being manipulated in any therapeutic relationships is a constant reality, if not appropriately managed. As professionals, we can often be elevated or revered by clients as fonts of all knowledge, who can fix any problem; I am sure we have all experienced this idealisation to some degree. We aimed to keep our professional egos in check by debriefing with each other after each session and thinking about the level and quality of our contributions during each session. We questioned whether our contributions adhered to our aim of keeping the group autonomous and participant led. Having cis-male and cis-female facilitators brought balance to the group and meant we could challenge and question each other throughout the process.

In the initial session, we emphasised our role of allowing the group to lead the conversation. We had no aim for the group other than to create a safe and supportive space in which participants could open up and be themselves – something we were very aware they might not be able to do outside of the sessions. The initial session involved developing the working agreement, which was a live and adjustable document that participants could add to and amend as and when they saw fit throughout the process. It was displayed to everyone for the duration of all sessions. Some of the key aspects of the agreement were confidentiality (with standard caveats applied, such as our response to any disclosure of risk to self or others), respect and the space to be heard.

These elements were clearly very important for the group – some participants spoke about not being granted these qualities in their daily lives, either currently or in the past – and these qualities of confidentiality, respect and non-judgment are present in both the ALGBTIC competencies and Ïã¸ÛÁùºÏ²Ê¾«×¼×ÊÁÏ’s Ethical Framework.^12,13

As facilitators, it was important to make the group accessible to all participants, especially quieter individuals who wanted to be heard and have their feelings validated, while simultaneously managing the more extrovert members of the group. As with all groups, this equilibrium can be difficult to manage as it is only natural for some individuals to take up more psychological space than others. This can result in quieter participants becoming withdrawn and at risk of not continuing with the group. Groups can be difficult to navigate for facilitators and attendees as sessions may descend into members minimising others’ experience or using humour and anecdotes as a defence against disclosing personal emotional pain.

Emerging themes

While overt and covert transphobia is a stressful and challenging reality for trans* people, it was the casual, ignorant, intentional and unintentional comments from cisgendered people that were often discussed in the group. From misgendering people, dead-naming individuals (the act of using old names/asking a person what they used to be called, prior to transition) or enquiring about their sex lives and which toilets they used¹⁵ – transphobia is an extremely common and daily occurrence for many trans* people. The group expressed mixed frustration and resignation about being seen as educators to people who were misinformed or ignorant about trans* issues.

Some felt happy to take on that role, while others were tired of repeating basic knowledge that was easily accessible to the majority of people. The literal sigh of exasperation group members made when talking about examples of ignorance among peers, tutors, counsellors, fellow students or twitter trolls highlighted how prevalent these issues are for trans* people’s experience.

The theme of the role of technology, particularly online and social media, was returned to in almost every session as it has such an impact on trans* lives. Those in the LGBTQ+ community have always been prolific users and at the forefront of communication through the internet.^16,18

Not only is this way of interacting somewhat safer, but it also offers a more extensive community with which to connect. This can be due to level of outness, location, safety or ability and confidence with which to engage with others.¹⁶ These interactions were not always positive, with examples of toxic disinhibited behaviour¹⁷ reinforcing participants’ feelings of victimisation and ostracism.

Participants talked of retreating to the relative safety of gaming avatars (personalised graphical depictions which represent the user through an online platform), which allowed them to create their own identity and present an image to the world that could be anything they wanted it to be. For trans* people who are exploring their identity, avatars can be a first step into the world – being seen and accepted in their preferred identity.¹⁸ Even though an avatar exists online, a multi-layered approach to identity occurs, where an individual creates both an on and offline persona while navigating both simultaneously. Members of the group discussed exploring these experiences while maintaining safety through varying degrees of interaction with other individuals across different media and in person.¹⁹

One of the biggest challenges in facilitating the group was encouraging introverted and shy participants to speak up and make themselves heard while simultaneously respecting their right to be their natural, introverted selves. We encouraged quiet participants to engage by addressing a number of participants at once, usually the half of the group away from where more vocal contributors were sitting, in order to ensure that we were not singling members out by asking one person to respond. We used open questioning to see if members had any responses or thoughts around what had been discussed, keeping summaries vague and open to interpretation and therefore accessible, to keep the discussion engaging. This reflection and encouragement kept us facilitating, rather than directing, and gave the group autonomy to express thoughts and opinions on topics they wanted to explore.

Unfortunately, due to the coronavirus outbreak, the university shut down and the sessions were disbanded, which had a major impact on the group. It was impossible to talk about anything else in our final session and it was important to reflect on how a global crisis feels for those often marginalised and victimised on a daily basis. As one participant questioned: why would they be scared of coronavirus? They were always on their guard when they left the house, trying to work out who might want to harm them. They commented that they could simply add COVID-19 to the list of things they needed to deal with now. This really highlighted for us how difficult it can be for trans* people to lead lives free from isolation, separation and hypervigilance. There can be a constant pattern of feeling anxiety in social situations, fearing harm and then retreating into the isolated safety of home.

Feedback and practicalities

The feedback we received from students regarding this group was generally positive. One participant commented that they valued the group and had spoken to their trans* friends in other universities who were not offered this kind of support. This comment encapsulated why the group was created. Trans* people are often grouped in with the LGB community, assuming that the lesbian, gay and bisexual experience is analogous to the trans* experience. The room in which the sessions were held was on the lower ground floor of the building, and participants found it hard to locate. They felt it was too out of the way, which reinforced their experiences of marginalisation. For future groups, the location of the room will be accessible, visible and more suitable, to make participants feel included and accepted in university life. Also in future groups, during the initial session we will discuss participants’ feelings around having two cisgender therapists facilitating the group, and adjust to feedback where possible.² We could also consider the benefits of disclosure about our own sexual orientation.

We noticed that universities often fail to recognise the need for specific trans* support. The creation of this group was a direct response to trans* students telling us that they frequently feel invisible and unsupported by a university counselling and wellbeing department. Starting university can be a particularly vulnerable time for trans* students, who may be leaving home or coming out for the first time. This group is a response to the need for peer support to help students with this transitional period.

Conclusion

This group felt like an important addition to the counselling and wellbeing model supporting student experience. Past groups have focused on psychoeducation and management of feelings to create emotional resilience in a structured and guided way. However, the trans* support group was different from anything we had done before; the group was theirs to shape and mould to meet individual needs. It didn’t belong to the facilitators and had no agenda.

As Johann Hari argues in his book, Lost Connections,²⁰ it is social isolation and disconnection from others, an all too common impact of modern life, that is at the core of conditions such as anxiety and depression. Our aim was to give participants a sense of empowerment to own a space and work together to shape it into a supportive and safe environment – to provide a means of connection for trans* students – individuals who can often feel isolated and on the fringes of society. For some in the group, connections were made which transcended the confines of the group and socialisation happened within other areas of the university.

While individual counselling can be an incredibly useful and life-changing experience for some, we would now like to expand our wellbeing service to ensure students can access a range of support to suit their needs. We plan to run the trans* student support group once a term so that trans* students who feel detached and alone have a space to bond with others who understand their experiences. We are also planning groups for other demographics which will focus on peer support and connection