Episode 53: Trans-Affirming Therapists [featuring Kieran McMonagle]

Show Notes

What does it mean to be a trans-affirming therapist? How do pronouns work? Why is it so important to get educated and support the queer and trans community as a therapist?

In this episode, I talk with Kieran McMonagle to answer these questions. He is an LMFT in California and Washington and the owner of Red Cape Therapy which teaches therapists how to support the queer and trans community by creating trans-affirming therapy practices.

More about Kieran:

Kieran McMonagle (he/him) is queering therapy—from supporting your transgender kid, supporting a couple to improve community, to doing parent coaching for when you just aren't sure what to do. He works with therapists and organizations to increase their capacity to support the queer community. He is an individual and relational therapist licensed in California and Washington. He began working in the mental health field with folks in 2009 and started practicing therapy in 2012. He works individually and relationally with teenagers and every age of adult. Many of Kieran’s clients are queer, transgender, gay, LGBTQIAAP+, and polyamorous or wanting to learn more about these communities.

Kieran's Website: redcapetherapy.com

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A Thanks to Our Sponsor!

I would also like to thank Diversion Center for sponsoring this episode.

If you are looking to tap into a cool niche that can take your private practice to 6 figures or more, check out my guy Derek Collins at courtmandatedtraining.com. He helps licensed therapists expand their practice by working with court-mandated clients. So if you are burned out, and tired of writing notes and dealing with insurance companies, I highly recommend that you check out what Derek has to offer.

He can show you how to get paid cash every day through court-mandated evaluations and classes like anger management, domestic violence, substance abuse, shoplifting and theft prevention, and more.

This niche could be the breakthrough that you have been looking for.

Go to courtmandatedtraining.com and watch the free webinar to get started.

Transcript

PATRICK CASALE: Hey everyone. If you are looking to tap into a cool new niche that you can take your private practice to six figures or more, check out my guide, Derek Collins at courtmandatedtraining.com. 

He helps licensed therapists expand their practices by working with court-mandated clients. So, if you are burnt out, tired of writing notes, dealing with insurance companies, I highly recommend that you check out what Derek has to offer. 

He can show you how to get paid cash every day through court-mandated evaluations and classes like anger management, domestic violence, substance use, shoplifting, theft prevention, and more. This niche can be a breakthrough that you have been looking for. Go to courtmandatedtraining.com and watch the free webinar to get started. Remember that is courtmandatedtraining.com

Hey, everyone, you are listening to another episode of the All Things Private Practice Podcast. I'm your host, Patrick Casale, joined today by a very good friend, Kieran McMonagle. He is a LMFT in California and Washington. For some reason, I always think he's in Oregon. But that is not true. And, you know, I still don't believe that state exists. But anyway, he is here to talk a little bit about his journey as a trans therapist and consultant, and what the industry gets wrong so very often. And I'm really looking forward to this conversation. Kieran and I have become friends. He came to Ireland to the retreat, Asheville, to the retreat, and I'm just really happy that you're here.

KIERAN McMONAGLE: Yeah. Well, thanks for having me. I'm happy to be here, too.

PATRICK CASALE: Yeah. So, tell us about kind of the journey. You know, you and I have talked about it privately. You've talked about it in some Facebook groups because you're a very active member of all therapist's Facebook groups like my friend Tara is. I think you both need, like, therapist Facebook group interventions. But, you know-

KIERAN McMONAGLE: I believe.

PATRICK CASALE: You're out in the world, and like really advocating, obviously, for the trans and queer communities, and trainer, consultant, therapist, entrepreneur, I just want you to talk to us about your experience, and your journey, and wherever you want to go with this. I want this to be your story and I don't want to have a lot of ability to dictate that. So, yeah, tell us how you've gotten to where you're at right now.

KIERAN McMONAGLE: Yeah, that's a good question. You know, I didn't become a therapist to work with the queer and trans community. This wasn't my goal or what I thought would happen. In fact, like, the whole career that I built for myself is like, completely, not anything that I would have imagined it being when I started therapy school. 

I started therapy school when I was young. I was, like, 23. And so, I've been doing this for a long time. And I started school, like, barely out as queer, not really understanding what trans even meant for myself, for other people, and so, like, really, my journey of being a therapist has also been my journey of like, gender exploration. 

So, when I work with folks who are like, "Well, I didn't learn about this in, you know, middle school." I'm like, "I didn't either." Like, I grew up pretty conservative Catholic. I got confirmed when I was like 20. And in an attempt to just try and figure out who I was and what my community was, and so, I always tell people, like, if I can learn about this, like, you can learn about this, and I had to learn about this, but it became a matter of life and death for me. So, what does it take for it to be that high stakes for other therapists? Yeah.

PATRICK CASALE: When you say that, you know, "This was a matter of life and death for me, and how can we make it more high stakes for therapists?" What do you think, you know, the common thread is here? It's just like, the type of mentality of like, if it doesn't really impact me on a day-to-day then it's just not as important.

KIERAN McMONAGLE: Yeah, I mean, I see gender-affirming care as suicide prevention, right? Like, if we look at the statistics around the increased probability of queer and trans youth, adults, people committing suicide, killing themselves, or being murdered, like, it's just astronomically higher than that of our cisgender heterosexual counterparts. 

And I think, like, looking at it from like a suicide prevention lens is super important because all therapists need to be able to work with suicide, all therapists need to be able to know how, like, the appropriate prevention looks like, and like, it starts earlier than people getting suicidal, it starts from when people come out, it starts from when people are just beginning to learn about themselves. 

And no, like, I had no idea that trans people existed really at all. I met a couple trans kids when I was younger, and I remember being, like, "This is something that is going to be part of my life and I don't know how." And I didn't know exactly what that meant for me at the time. You know, I've always definitely been like, I've always dated boys, right? So, part of like coming out, everyone's talking about their sexuality when I was younger, and I wasn't a lesbian, but I always like, kind of wanted to look like one. But I was like, in the boys, and that matchup was so difficult for me to understand. And it wasn't until I realized that, like, trans men exist and can be into men. And I was like, "Oh, gay, trans man, that's me." But it was, like, hard-

PATRICK CASALE: When did you realize that?

KIERAN McMONAGLE: When did I realize that? I mean, I had a little stint where I dated a couple of girls at the very beginning of grad school. And I remember just like, it just didn't feel in line with me. And like, the girls I dated always, like, looked like boys. So, I had this opportunity in my internship when I was, like, coming out as queer, started, like, cutting my hair short, and like dressing more [INDISCERNIBLE 00:05:57] for myself. 

And I, like, went through a really shitty breakup, for lack of a better word. And I was like, "I'm going to do whatever I want to do." Like, it was really one of the first times where I was like, "I'm just going to, like, listen to what I want to do, and I'm going to do it."

And so, I volunteered at the summer camp for trans kids. And that, like, youth have taught me everything I know about gender, like all of my career has really been, like, elevating voices of young people, learning about gender from them, learning about my own gender from them. And I kind of walked into this summer camp, and met all of these, like, trans adults, and was surrounded by people, and was like, "Oh, these are my people." People were, like, surprised that I wasn't already, like, out as trans and like, had been doing it for a while. I was just like, terrified, super vulnerable because I was the therapist at this camp. So, I felt like I was supposed to know everything. And really, I like, was in it and learning. Like, all of you, I just happened to be, like, in my own transition piece at the same time. 

So, really working at this summer camp, like, blew my mind, taught me more than I ever could have learned in grad school about working with queer and trans folks, taught me more about myself than I learned ever. It was really, like, mind-blowing, eye-opening, and a space where for the first time ever I was just like, listening to me, and letting that be true, and following that.

PATRICK CASALE: It sounds like that feels really freeing too to have had that experience and to finally, like, drop in and say, "Oh, this is kind of it for me. This is who I am."

KIERAN McMONAGLE: Absolutely. And that was like the beginning of the journey, right? And I always say that, like, my clientele picked me. So, at that summer camp, like, all these kids were like, "You need to be like a queer trans therapist." And I was like, one, terrified because like, I didn't learn anything about that in grad school. I knew about my own identity, but I was still learning, like, what that meant for me, like, I'm I non-binary? I'm I a trans man? What does that mean? 

You know, so I was really in this process of discovering more and more about myself. And then all these kids were coming to me were who were highly suicidal. And I actually got my first therapist job right after grad school to the bunch of the kids that I worked with, and to this amazing, like, queer trans dropping group called Be Glad. And the therapist who had run it for the last, like, 10 years was like, "I want you to come, like, I need more help. There's more queer and trans kids than I can have on my caseload." And so, I got this job. 

And I remember when I went to my first queer trans training, I was like, "Yes, they're going to teach me everything I need to know about working with queer and trans folks." And I left that training being like, "Oh, I know more, just because of my experience of being trans, just because of my experience of listening to young people and elevating their voices. And coming at it from like, how can I support you? What do you need? And learning and really just, like, sitting in that process with so many young people helped create, like, the path I'm on today, the way that I train and teach therapists, the way that I support young people. 

But again, it wasn't something that like, I came in with all of these ideas thinking I knew how the community needed to support it. Really, I came in with this nerdy being like I'm learning about myself and how do you all want to be supported.

PATRICK CASALE: That humility was probably really important to create connection and rapport with a group of kids who really feel unseen and just under-supported and stigmatized and discriminated against? So, being that advocate and being willing to learn, and being willing to be open to the experience, do you find yourself in those moments, like, making the mistakes and saying the wrong things, and then, having to learn from those experiences?

KIERAN McMONAGLE: Absolutely. I mean, I think we all as therapists make mistakes. I've made mistakes, I've caused harm. I think it's important that we acknowledge that because when we acknowledge that we hold that power and that we can make mistakes, that's the place that we get to learn from and that's the place we get to do better. 

And so, I'm constantly, like, sitting in session and working to do better. I was just in a session with two non-binary folks the other day and stopped using the word guys, and I paused, and I was like, "Hey, I'm noticing I'm using this word, how does that land?" And they was like, "We don't like it." And I was like, "Thank you." And so, then I was noticing shifting my language because it's the word I use all the time because they hang out with a bunch of dudes. And so, I, like, was just noticing and being like, in that uncomfort as the person who's really good at this, so like, if I am good at this, and I make mistakes, like, I expect everyone to. 

The whole point is that we're here to work and do better and acknowledge our mistakes. And then also seek consultation with people for the experience so that they can help guide you in a way to do better. 

So, like, you know, I don't expect people to be like, understand gender, and the complexity, and how that can look unless they've done this own work themselves. So, the first thing I do with therapists when I'm consulting with them, is they start to help break down, like, how do they know their gender? What was their gender exploration process look like? Because it's not something that was necessarily taught to me when I was growing up. And we all have a gender and sexuality, right? There's just dominant genders and dominant sexualities that we're taught are ours until we really look in and say, like, what is our gender? What is our sexuality? How do we know that? So, yeah.

PATRICK CASALE: And I think that you know, for a lot of people, therapists included, brings up a lot of discomfort because I think it's like, you and have talked about this, therapists' groups and people not being able to, like, own their shit and just admit that they were wrong and learn from it. I think that when we don't know about things, when we feel uncomfortable about things we tend to hold back and not try to learn, not try to be curious, because I think there's fearfulness of like, I'm going to say the wrong thing. I think there's fearfulness of I don't know enough about this, or I'm going to come across as like, ignorant or just something to that extent. Do you feel that way at all? Or do you see that at all? 

I see that a lot and it's not apples to apples, but like, the autistic community right now, right? Of like, even as someone who's an autistic therapist, I don't know all the language or all the neurodivergent and neurodiverse terms out there and I'm getting it wrong a lot. And people will correct me and I'm like, "Okay, that's a great learning experience because I didn't fucking know that." 

And like, you know, it's just one of those things that is strange to identify, but also, like, still not really know all of the ins and outs and innuendos too.

KIERAN McMONAGLE: Absolutely and it's a process, right? Like, there's no, like, I'm never going to get to a place where I get, like, some, like, queer badge of honor that I know. And, like, the whole community is constantly changing and constantly growing. And there's new definitions, and new words coming out, and new ways that people talk about themselves and their identity. 

And so, I think even the more that I'm in it, the more that I learn, and the more that I don't know, and I think, I mean, even just sitting here and acknowledging that, like, I came out in grad school, like, I have shame around that, because I think when people think about me, or look at me, they think about this kid that like must have come out when he was like 11 or 12. But like, no. My story is like, really having no light. And I grew up in like progressive Seattle, right? Really having no idea that this stuff could apply to me. 

PATRICK CASALE: So, when you're naming that and you're feeling that shamefulness almost as if, like, if I'm, you know, advocating, and training, and consulting, and looked at as this figure, are you feeling like, I don't have enough life experience yet to be looked at as this figure sometimes?

KIERAN McMONAGLE: Yeah, I mean, totally. I think that even with, like, getting invited onto podcasts and getting like asked to speak in place, like, one thing I would say is that, like, I don't speak for the whole queer community. Like, I might say something, and then, another trans dude, another non-binary person, someone else might look at me and be like, "No, that's not in line with me." And that's great. That's the part of the community, that's our intersectional identity, is like, I am like a white trans dude, I'm one of the only marginalized identities that the more I move into my identity, the more power I get, right? The more privilege I get. 

Like, through my marginalized identity I actually get more power and privilege. And that's been something to like, tussle with through myself. Like, I now occupy, like, a white man space. And so, like, what's that, like, for me as somebody that was not socialized that way to now take up that space? And how can I use that to help educate people, not just about queer trans life, but also, about like racism and how that exists?

PATRICK CASALE: Yeah, that's really beautifully put. And it's really a wonderful perspective on this kind of evolving experience for you. And I know that it hasn't been a pathway that hasn't been full of pain, and suffering, and struggle.

KIERAN McMONAGLE: Right. 

PATRICK CASALE: And, you know, I only want to go as deep as you want to go. But, you know, I know you and I have talked about this a little bit off the mic and off the camera. Do you want to talk about the experience of transitioning and surgery, and just experience within family system or friend groups?

KIERAN McMONAGLE: Totally, yeah. First, what I was thinking about was just like, the mental health component on like, what it feels like to grow up in an invalidating society. Like, our society teaches that gender looks a certain way and that's the box you have to put yourself in. And so, I kept finding myself trying to put myself into a box that just didn't fit. And with that, I found myself just, like, getting depressed, really high anxiety, and not really understanding, like, why or what it was coming from. 

And so, I talk a lot about how, like, I feel like, as a therapist, I'm supposed to be this, like, pedestal of mental health, I'm supposed to be in this, like, this thing that people… Like, I had a client once say something like, "Oh, I want a bracelet that says What Would Kieran Do?" And I was like, "You don't know and I don't know what I would do [INDISERNIBLE 00:16:08]." Because I'm not some pedestal of mental health. Like, I have my struggles. And it's not something that's like, "Oh, I have my struggle, and now I'm through it, and I'm, like, the therapist." 

Like, I had my struggles when I was a therapist. I was recovering from PTSD when I was a therapist. I've had suicidal thoughts as a therapist, right? I've also done my entire gender transition as a therapist. I actually took a break for about a year or two from doing direct client work and moved into more supervisory roles because of the amount of transphobia that was just being, like, shot at me by different clients and was so hard to sit with. I mean, in general, like, I tell kids, like, they'll get the power to choose their communities. Like, I've chosen the people that… like, the people who stuck around me are the people that really see me and affirm me. 

My coming out process looks different. And I feel like it looked different or weird because I didn't have the language, right? So, like, some people in my family were like, "Well, you didn't tell me that you were gay and you didn't tell me that you were trans?" And I was like, "I didn't know how to say it, I was just trying to figure it out." 

So, I'd bring like a different partner home, or I'd start looking a certain way, or, you know, but it was really, like, I definitely lost some relationships in there. And I'm always taking that stuff out. It was not an easy choice for me to medically transition. I think one of the common misconception is that, like, one, all trans people were medical transitioned. That's not true, but they're very many trans, and non-binary, and all kinds of gender folks out there that do not want to seek gender-affirming care. There's also a lot of cisgender folks that seek gender-affirming care. So, gender-affirming care is also just not for trans people except there's barriers for trans people. And there's no barriers for cis people. That's a different story. 

So, it was a hard decision for me to start testosterone and to get top surgery. I felt like that there was a loss, like, that there was a protection that my chest gave me, that was hard for me to let go of. I'm really afraid of [INDISCERNIBLE 00:18:12]. It took years for me to even get tattoos, right? Even though I wanted them. Like, this idea of like, permanent, was really hard for me. And actually, like, in a way had me feeling my own mortality and at the same time, interspersed with this is like, I also have epilepsy. So, I was getting diagnosed with epilepsy throughout this process. So, I mean, it's kind of a funny story. 

But the night before I had top surgery, I had a seizure, my first seizure ever in front of the doctor who was about to give me top surgery, and he was such an affirming doctor, that him and the anesthesiologist worked super hard to find a neurologist that I could see the morning before top surgery so I could actually get top surgery, to make sure that my brain was going to be okay when I got [INDISCERNIBLE 00:18:57]. I mean, that's the definition of affirming care, right? That's access, that's trans-affirming, that's gender-affirming, and like creating access for folks. The only question, specifically, I can kind of keep going but…

PATRICK CASALE: No, I want you to keep going but it sounds like having that doctor in your corner probably at least makes things a little bit more comforting or at least, like, okay I think it's going all right even though this is really fucking scary and really fucking overwhelming. And-

KIERAN McMONAGLE: Yeah, 

PATRICK CASALE: Yeah, yeah, but keep going with where this is going because I think this is bright.

KIERAN McMONAGLE: Yeah, so, I got top surgery and like, you know, I was really scared that moment when I woke up and I was, like, going to be different, and like, well how is that going to feel in my body? What would that feel like? Like, part of me always wanted a flat chest but part of me also felt that my larger chest was a protection, like, literally space to cover my heart. 

And the idea of taking that off and showing the world who I was felt so fucking vulnerable, that it was like this visceral scared reaction. I think it's something we need highlight because like, clients might come in to your, like, therapy sessions, and might be talking about the complexity in that and that's okay. That doesn't mean that they're not trans or they don't want gender-affirming stuff. But there is a fear in there. And that's okay. And that might not be true for everyone. And it was true for me.

PATRICK CASALE Sure, I imagined there was a major grief process with that, too, of just, you know, anytime we have surgery, but more importantly, when we're having a major surgery, where we're kind of shifting in terms of how we're going to move through the world, I have to imagine there was a ton of grief.

KIERAN McMONAGLE: One thing, yes. When I talk to trans folks about surgery, in general, like, let's take gender-affirming surgery aside, in general, surgery is trauma. Like, you've had surgery. They go into your body, and they're cutting things open, and that in and of itself is trauma, right. So, it's not just gender-affirming, that's trauma. Like, surgery is trauma. So, I think that's something just to name and I say that to my clients. 

And there's also things like post-surgery depression that are not about gender, but they're just about things that happen when we have surgery. So, all of that on top of going into a place and like, having something happen that was going to be how I occupy the world was scary. And there was a huge like, like, I had my own grief, and like, grief and euphoria at the same time, which was like an interesting dialect to hold. And letting that be true for me and alive with me still. Like, I'm still sitting with like, what it's like to integrate all of these. I mean, so many of us are working on this, but how do we integrate all these parts of our identity? And how do each of those parts take care of each other? Right?

And like, now, this is how I show up and show my gender in the world. And for me, it's aligned, right? For the, I mean, it's not only for the first time, something ongoing for a bunch of years, but I feel more aligned and like, connection with myself. 

And the other piece that really added in to this is like having my gender experience, but then, also, having my sexuality experience. And so, like, I'm a gay dude, I occupy lots of gay man spaces, and there is all kinds of transphobia in the gay man world. But I found, like, a really good group of trans guys who are all gay, and moved down to California, just to kind of like, be in a community where this was supported, and loved, and normal, and okay. And I think that was probably, like, aside from being on testosterone, aside from top surgery, and like, being accepted into, like, a gay leather kink community was much more affirming than anything else I'd ever experienced.

PATRICK CASALE It's nice to hear that for you to be able to find that landing spot and to feel like safe in that space, too. Especially, navigating, like you said, even discrimination in the gay community and so much transphobia that exists still to this fucking day, right? And we all know this as therapists, but we see a lot in the therapist community too, which is unfortunate. 

But it's really lovely to hear like, "Okay, this has been a traumatic experience. I'm still questioning a lot about what's going on. I finally find people who I can be myself around, and I can feel acceptance around." And I imagine that had to feel like safety and security to some degree as well.

KIERAN McMONAGLE: Yeah, I mean, there's still, so like now, I'm very out as trans. Like, I think most people know that I'm trans. But it's also not the first thing that I say about myself when I meet people. So, now, at times, I just look like a short white gay dude. And so, I hear things that people wouldn't say around trans people, right? And sometimes I challenge them, and sometimes I send my partner in to challenge them when it's not something I have space to do, which is interesting, because, you know, finding, like, a silly story would be like, having an associate guy attracted to me, and then, in another beat, they're talking about hating genitalia although they may or may not have, right? And maybe I'm like, "Well, you were just hitting on me like two seconds ago, bro? And they're like, "Shit." Right?

And like, challenging people's ideas just by existing and just by being, I think, it's just interesting to be able to kind of, like, see so much and have a different critique that other people might not have because of how they're socialized.

PATRICK CASALE Yeah, like subtle challenge too to make someone, like, really question you know, their actions in the moment and have to reconsider, like, "Oh, shit. Like, yeah, this doesn't even add up if I really thought about it logically?" Right? Like, and-

KIERAN McMONAGLE: Yeah, absolutely. 

PATRICK CASALE: It seems like it's going to be, you know, ongoing, advocacy and challenging in a lot of spaces. And I'm wondering how you really take care of yourself, and your energy, and just, like, protect yourself when that is a big part of your value system and who you are and how you show up in the world?

KIERAN McMONAGLE: Absolutely. I think this speaks also to just, like, therapists who have some kind of marginalized or some kind of identity that they work with their clients all the time who have a similar shared identity or experience. So, this has shifted a lot throughout my career too. Like, when I was just coming out as trans and people were not making an assumption I was trans and I was getting misgendered all the time where people were not using my affirmed names or pronouns, that was so much more exhausting, and draining, and just what… I mean, I worked with therapists, so they were the ones misgendering me all the time, was much more exhausting, and sitting with the clients who were experiencing that same transphobia was so much more exhausting. 

Now, when I go out into the world, I don't experience that same transphobia all the time, because people don't necessarily assume or know that I'm trans and I still cheer it. 

How do I take care of myself? I mean, in general, I think COVID has shifted a lot. It shifted a lot of big stuff for me. One of the biggest things was realizing that, like, having a smaller community and a smaller group felt really good for me and where I'm at in my life. So, I stick to people that affirm me, I set really strong boundaries. 

I love my mother dearly. And she still at times struggles to gender me properly. She goes through phases. And recently she's been on misgendering me phase, and I just had to be like, "Mom, like, you have to stop. People are confused around you." 

And so, you know, just setting strong boundaries, showing up with the people that really care about me and see me. I see clients and do consultations three days a week. So, four days I'm doing a lot of creative stuff, I'm writing, I'm all over therapists' Facebook group because I love networking, I love meeting people. I mean, that's how [INDISCERNIBLE 00:27:07] this a lot. 

But I firmly believe that people grow and learn in relationship to people, we grow in relationship, we heal in relationships. So, part of why I'm so connected to therapist is because I want all therapists to be gender-affirming. I believe that all therapists need to do this work because we don't know who's trans, we don't know who's coming out. Like, it might be like a little baby trans on your caseload, and you don't know. And so, you might have this four or five-year relationship with a client, and then, they come out. And although I think it's important and awesome and wonderful for trans folks to work with other trans folks, I also believe that there's just not enough trans therapists in the world to support all the trans people. And even if they were, this whole license in state can only see clients in state, there's states out there that so many trans people move away from when we become adults. 

And so, there might not be as many trans therapists in Texas. That doesn't mean there's not as many trans, like, young people, trans adults, people coming out, people exploring this. So, it's so imperative that all therapists are able to support trans folks in their process. 

So, taking care of myself also is part of why I'm a consultant, and part of why I'm like coaching, part of why I teach because I can see about 15 people a week. That is like my limit when I'm working full-time. And so, part of what I do is I like to see all of the therapists that I've supported, right? So, like, for every therapist that I teach, they have a caseload of, hopefully, 15, but sometimes bigger clients. And so, I feel like I have a larger impact when I'm teaching the therapy world on how to support queer and trans folks in the intersections of our identities. And that fills me more than just sitting with clients. 

PATRICK CASALE: I love that because it's such a good perspective on that ripple effect, right? Of like, this trickles down. If I help these therapists they help 15 people, they help 15 people, you know, and it really starts to grow. And therapists can do so much damage if they haven't done the work even-

KIERAN McMONAGLE: Absolutely.

PATRICK CASALE: Even if it's sometimes unintentional, it's still damaging and you're talking about suicidality before you're talking about major depression, and depressive episodes, and trauma, therapists can do a really shitty job of being affirming in all sorts of marginalized spaces and intersectionality. And we definitely need to do better. And it's great that you know people like Kieran exist out in the world who are trying to do that work and it's okay to make these mistakes. It's about learning from them. 

And, you know, if you're just sitting there biting your tongue because you don't want to say the wrong thing or show up the wrong way, I don't think that's useful, and I don't think that serves anyone, and it's really important to be able to take that criticism and not take it personally just learn from it, and grow, and know that if you don't know, you don't know, and you have to do the learning, you have to do the education around it. 

And I see that being a rampant problem in the therapy world, not just for, you know, queer and trans folks, but just all sorts of identity, right? And we see it a lot. And it's still mind blowing to me, but maybe it shouldn't be, you know, and at the end of it-

KIERAN McMONAGLE: And I think-

PATRICK CASALE: Go ahead, I'm sorry.

KIERAN McMONAGLE: Oh, I was just going to say one thing I like to tell people a lot is like, if what I'm saying makes you uncomfortable, where if I'm making you uncomfortable, that's awesome, and that's perfect because we grow from a place of discomfort, we learn from a place of discomfort. Being comfortable is a privilege. People with marginalized identities do not get to experience comfort if they're having trauma come at them all the time through oppression, and so, great, let's get uncomfortable together.

PATRICK CASALE: Yeah, absolutely. That's well said. And we teach our clients this all the time, right? Like, you don't grow in places of comfort, you have to get uncomfortable. And then, it's really hard for us to sometimes practice what we preach in this profession, which is… And so, that's a struggle for sure. So, do the work, do the education. Like, learn from experiences from people who are actually speaking about it, who have those identities, who have that lived experience, I think it's really important. And to really start doing trainings. Like, start really immersing yourself in these experiences because grad school doesn't teach us this shit. Like, grad school, we get one cultural diversity class, and everything and anything is like, built into three hours a week for one month, or whatever the case may be. And that's just not sufficient. You know, it's not sufficient to learn about gender, and sexuality, and all of the struggles of people in the world. Like, it's just not sufficient. And it's not enough. And we need to be learning all the time and growing all the time. 

KIERAN McMONAGLE: Yeah, absolutely. I mean, I think we didn't even have a class on gender. We had a class called human sexuality, where we kind of talked about gender. But like I said many times, sexuality and gender are totally different.

PATRICK CASALE: Right, I know you and I have talked about this, but that is something that gets… there's a misconception and misunderstanding pretty constantly about gender and sexuality. Would you agree?

KIERAN McMONAGLE: Oh, yeah, I totally think so. I think, especially, when you're like a cisgender person that hasn't really, like, taken a deep dive into what gender means for you, and how you tell you're a woman, how you tell you're a man, what that means for you, how you experience it, how you show the world it? What are the things that give you gender euphoria? What are the ways you feel affirmed in your gender? Like, all of those things can happen whether you're cis or trans. 

But if you haven't taken that deep dive, I think that people kind of look like LGBTQ, queer. Oh, that's all under that umbrella. That's gender and sexuality. When really, no, that's just the way we talk about it. And in our community, we have to take a deep dive in it because for many of us, it's a matter of life or death [INDISCERNIBLE 00:32:55] by everyone to take their own deep dive. Like, how do you know what your sexuality is? Like, how do you explain sexual attraction? Yeah.

PATRICK CASALE: It's good advice. And my advice too would be to take trainings from people who are offering them such as Kieran, like, you're presenting at a conference in a couple of weeks, right? And-

KIERAN McMONAGLE: Yeah.

PATRICK CASALE: Tell us about that conference real quick because I think it's really important and I'm really proud of you for being a part of that.

KIERAN McMONAGLE: This is an exciting conference that's been put on by a therapist named Van. And it's the Do Something Identity (ies) Conference, and the entire conference, top, bottom, side to side, all this is completely done by people who have non-cisgender identities. So, trans folks, trans folks who may or may not identify as non-binary and non-binary folks are all putting together this, like, different conferences, some of it's clinical, some of it's not. They're all about like what it means to be, you know, non-binary, trans, and non-cisgender.

PATRICK CASALE: It's going to be a really wonderful offering. And, you know, I know you do consultation, too, for practices and for therapists in general. I know you're going to be doing one for my group practice, really excited for that. And I think it's just got to be consistent and constant. It can't just be a one-and-done, you know, when we're trying to learn and we're trying to grow and we're trying to be more affirming. It's really about putting this stuff into practice. It's really about doing the work and not just showing up as an ally without, actually, you know, doing the deeper dive and getting uncomfortable. 

KIERAN McMONAGLE: Yeah, I always say in the beginning of my change, like, this is the beginning of your journey to becoming a trans-affirming therapist. You know, what the journey looks like really is starting out with some trainings, but then doing ongoing consultation as you're working with trans folks, and bringing, like, these clients to a trans therapist and really talking through, like, what am I missing? What am I seeing? What am I doing a good job at? I have a whole, like, family therapy model I've created on how to work with queer and trans kids. And a lot of it focuses on parent coaching because we see clients for 15 minutes a week. They are in their family, and they're in their system, the rest of that. 

So, yes, surely can happen with me, but a lot of what I'm doing is teaching parents, therapists, everyone, how to create an affirming environment so that the kid can grow up and know that their identity is okay, know that how they experience themselves is valid, know that, like, they don't have to put themselves in some box. And if they want to, that's awesome. They can also do that.

PATRICK CASALE: That's beautiful, and talk about, you know, active suicide prevention, right? Like, that's the way to do it. Those kids need to be in affirming homes, and in affirming relationships. And, you know, the parents are so pivotal, and I'm glad that you're offering that service. 

And like you said, if we don't have enough trans therapists out in the world, or in the country, we need to have trans-affirming therapists, and that's really important. I live in the southeast. It's not exactly the safest place for a lot of different populations of people. So, I have a lot of privilege, I don't ever walk through the street thinking about anything like that, and my wife as a black woman does. And it's just important, like, even when she's looking for a black therapist, and there's, like, three in the area, that's problematic. So, we just need really, really, really need the therapist to be doing the work. And really, really, you know, it can't just be a one-and-done, it has to be an ongoing process throughout the rest of your career. 

Anything you want to add any, any last moments, or you know, any offerings, or thoughts, or feelings about anything that we've talked about, especially, for the therapist community who is mainly listening to this podcast?

KIERAN McMONAGLE: Yeah, I mean, I think we've said this a lot and ongoing consultation with therapists who have lived experience when working with any marginalized identity is huge and important. I think that making sure that you're continuing to do your own work, so questioning how you experienced these things for yourself can help kind of open up your experience of gender and sexuality for other folks. This isn't about just working with queer and trans folks, this is also about how we talk about identity development for all people, and instituting these things into your practice, that it's not like, "Oh, this person kind of looks queer so now I need to make sure to ask their pronouns." Like, how is this, like, in the, like, the system of your practice? How is this there for all people so that when… you know, like little things, like, all the time, people are like, "Well, what are your preferred pronouns?"

And preferred, it's a microaggression, right? It's just what are your pronouns? We wouldn't look at somebody and be like, "Oh, I wonder what their preferred pronouns are." Like, not a preference, they're just pronouns. Similar things with like the word name. Like, I just got a simple practice survey about how we should handle preferred names. And I was just like, "Just put name, and then, legal names, and if they match, cool, and if they don't, cool." Because people use different names for different reasons, whether they're trans or not. And so again, putting in those words, like preference, like, no, this is who we are and this is how I'm showing the world who I am.

PATRICK CASALE: I love that. And that's a great, great way to end this conversation. And I just want to say that it's been really wonderful connecting with you. You know, if I never took the BART from San Francisco to Oakland, we probably wouldn't be sitting here. And I think that I'm really glad that we did that and have remained friends. And I really am excited to see where your journey takes you because I know you've got a lot of cool things in the works. 

Speaking about a lot of cool things in the works, tell them where they can find you because people need to be hiring you. You need to be doing the coaching and consulting that you're developing and creating.

KIERAN McMONAGLE: So, I'm developing a bunch of coaching and consulting things. I'm doing training. So, I want to work with group practices. I want to work with individual therapists. If you have a small group of therapists, friends, or a consult group that you already have, you can invite me in and I can help you guys with some consultation there. You can create your own groups. I'm going to be doing a consultation group around working with trans folks, so that'll be coming out probably in the fall. And I'll want folks signing up for that. 

I also have a group that I'm always continuing to try and create around for trans clinicians working with trans folks, and then, I'm available for individual consultation as well. I really want to get out there and kind of help and do training. I do trainings and speak at conferences. I've also worked, like, in the school system with different independent schools coming out and doing a lot of parent coaching. So, if you have parent groups, I'm happy to come and do parent coaching around that. And just really trying to figure out how I can help everyone make all of their practices trans and gender-affirming. 

Even if you don't think you have any trans clients that are coming to your practice currently, that's okay. I am available to help kind of show you how to make a place feel safer for a trans person to come to so you can have trans clients because they're out there and they need services.

PATRICK CASALE: Yeah, lots of wonderful, wonderful services. One important thing [CROSSTALK 00:40:18].

KIERAN McMONAGLE: Oh, I'm sorry my websites.

PATRICK CASALE: Yeah, that.

KIERAN McMONAGLE: My website's redcapetherapy.com and it's not because I think I'm a superhero. It's based off of a poem by A. Gibson, where they say, "I've never met a heavy heart that was in a phone booth with a red cape." And so…

PATRICK CASALE: Love it. And that will be in the show notes too for everyone so that you can find Kieran's information and reach out, do some hiring, get some coaching, get some consultation, get some training. It was really great to have you on and I hope it wasn't as overwhelming as we talked about. 

KIERAN McMONAGLE: [INDISCERNIBLE 00:40:52] thank you. 

PATRICK CASALE: And for everyone listening new episodes of the All Things Private Practice Podcast come out every Sunday morning. You can find it on every major platform that you listen to podcasts. Like, download, subscribe, and share. And we will see you next week. Doubt yourself, do it anyway.