Clinical Intersections: Becoming Visible

by Aybala Öztürk, LCSW

     As therapists and as social workers, we are trained to observe, welcome into treatment, and analyze our clients’ whole presentation, including the movements and comfort level in their own bodies.  We are tasked with paying attention to their affect, bodily movements, and posture in an effort to theorize about our clients’ psyches. We use our study of the body as a way into the mind. We are constantly asking ourselves questions like: Is this client comfortable? What’s going on beneath the surface? Alternatively, the concept of the therapist’s body is rarely brought into clinical discussions, supervisory spaces, and educational training. When the topic does arise, we are taught how to take up less - in fact, the least - space in treatment.

     The first time I talked to a supervisor about the concept of acknowledging my body and identities as a therapist in sessions with clients, my then-supervisor discouraged it. As someone who was "out" in my personal life and presented as visibly queer, I had asked her, “What if my clients ask me if I am queer?” As a white, heterosexual ciswoman, her response seemed to come from a place of unacknowledged privilege and excessive simplicity. She answered, “We tell them that we are here to discuss them, not us.” The lack of nuance in her response translated to a complete erasure of my experiences as a therapist with marginalized and invisibilized identities. While she may have had the consistent privilege of clients accurately assuming her identities, I rarely did.

     As a biracial, nonbinary, queer person, my identities are often ambiguous to those around me. In other words, I am not easy to “read.” In navigating the world, I am more often than not experienced as confusing. Over the past several years, I have learned that I, and I alone, must welcome my body into my work, and even demand its (and therefore my own) existence. Furthermore, I have realized that my ability to provide treatment to clients relies on the existence of my body, and therefore my complete social location, "in the room." If I am not visible in the therapy space, how can I expect my clients’ bodies to feel seen and welcome, and one day, perhaps feel safe? If my body does not belong, how can my clients’ bodies belong? These are the questions that run through my mind and informed my clinical thinking.

     I recently had the privilege of having top surgery, which required me to take off three weeks from work. I thought for months leading up to the procedure about what to tell my clients and co-workers about this time that my body required to heal. Fortunately, I currently work at an agency that is openly queer and trans-affirming, which undoubtedly made the conversations I was contemplating easier. I decided to tell all of my clients the truth: that I would be taking time off to get a medically necessary surgery that affirmed my gender identity.

     In sharing with my clients that I would be seeking top surgery, I not only expressed a future body that I needed, but also indicated, without putting words to it, a long discomfort with the one I inhabited then: the body that had been sharing space with them. This exchange alone has created an opportunity to explore a deeper connection, a strengthening of the clinical bond, as well as ruptures that occurred as a result of my body’s entrance into the treatment relationship. All of this was and continues to be deeply relevant and necessary for the therapeutic relationships that I engage in.

     The world works to discourage the existence, well-being, and safety of people who hold marginalized identities. Many of my clients are queer, non-cisgender, people of color. We often share the experience of being erased and invisibilized. We are also, sometimes, subject to hyper-visibility when others experience fear, or find it useful or "interesting" to consume our experiences. If the therapeutic relationship is to allow for the healing of traumas, a safe/safer space must be created to allow for healing around the specific traumas of invisibility and hyper-visibility. I believe that a safer space can only exist once we honor, welcome, and make visible our own bodies, so that we may model and encourage the existence of all of the identities and layers of our clients.

     I brought my body into treatment with my clients and did so with forethought and awareness of both shared and unshared identities. While I believe that this could be beneficial to other therapists and their clients, I also want to acknowledge how unsafe this may be for those who do not exist in spaces that work to affirm and hold their identities. In previous workspaces, I would not have been safe enough to bring many parts of me into the agency, let alone into the treatment. Those of us with power and privilege must start making changes within the field of social work, changes that take steps to dismantle the systems that both oppress and erase those with marginalized identities - this is one step. Leaders and those with social privilege must honor and hold space for therapists who hold marginalized identities. Honoring and holding space could help to normalize the naming of both visible and invisible identities, and allow therapists who hold marginalized identities to take up the space they need to feel safe/safer both in and out of the treatment relationship.

     I had the privilege of having gender affirming surgery while working in an environment that not only respects, but also celebrates, this step for me. In disclosing this part of my journey to my clients, I made a conscious decision to enter the therapeutic relationship authentically - with the discomfort of surgery, the anxiety of sharing my body, and the potential that my body and my identities would be rejected.

     I am hopeful that social workers might continue to have broader conversations about the presence of the therapist’s body in treatment and how this can be done ethically and to benefit the therapeutic relationship. Despite this issue being more deserving of discussion than a blog post, I am hopeful that we all could (therapists and non-therapists alike) benefit from contemplating how we bring our bodies and identities into our work.

Aybala Warner Öztürk, LCSW (pronouns they/them/theirs), lives and works in Philadelphia, PA. They graduated from Bryn Mawr College, earning both a bachelor's degree in psychology, and a master's degree in social work. Aybala sees clients at Walnut Psychotherapy Center and in private practice. They strive to provide therapy from a trauma-informed, identity-affirming, and social justice lens, working primarily with the LGBTQ population.