We are only beginning to understand gender. Is it inborn or learned? Can it be chosen―or even changed? Does it have to be one or the other? These questions may seem abstract―but for parents whose children live outside of gender “norms,” they are very real.

No two children who bend the “rules” of gender do so in quite the same way. Felicia threw away her frilly dresses at age three. Sam hid his interest in dolls and “girl things” until high school―when he finally confided his desire to become Sammi. And seven-year-old Maggie, who sports a boys’ basketball uniform and a long blond braid, identifies as “a boy in the front, and a girl in the back.” But all gender-nonconforming children have one thing in common―they need support to thrive in a society that still subscribes to a binary system of gender.

Dr. Diane Ehrensaft, a clinical and developmental psychologist, has worked with children like Felicia, Sam, and Maggie for over 30 years. In Gender Born, Gender Made, she offers parents, clinicians, and educators guidance on both the philosophical dilemmas and the practical, daily concerns of working with children who don’t fit a “typical” gender mold. She debunks outmoded approaches to gender nonconformity that may actually do children harm. And she offers a new framework for helping each child become his or her own unique, most gender-authentic person.

Join us this month for a conversation with Dr. Ehrensaft. At the University of California–San Francisco, she is the cofounder and director of mental health at the Child and Adolescent Gender Center, an associate professor of pediatrics, and an attending psychologist at the Benioff Children’s Hospital Child and Adolescent Gender Clinic. Her work with—and advocacy for—gender creative children has been widely covered, including by The New York Times, the Huffington Post, and NPR. She has been featured on the Los Angeles Times online, Wired online, and has appeared on Anderson, The Oprah Winfrey Show, and The Today Show.

Robert Frashure: Thank you so much for joining us, Dr. Ehrensaft!

Dr. Ehrensaft: It is great to be here, Robert, and to speak with you.

Robert Frashure: My first question has to do with the incredible pace at which gender expression and terminology has been evolving, and the continual challenge for psychology and other health disciplines to keep up!

What is your perception of  how the field of psychology has evolved to incorporate developments in gender, in particular the field of contemporary psychodynamic theory. Do you feel like it is evolving well to include LGBT folks, or do the ghosts of its past still stain the discipline?

Dr. Ehrensaft: I definitely think the field is evolving itself. So I think we could also say it just splits as well, such that indeed there is a trope of traditional, conservative, psychoanalytic literature and practice, which is ill-influenced and thus created harm for, certainly, starting around the understanding of homosexuality as a disease to be treated. And I actually think that, over these past years, the psychoanalytic community has come around, around understanding gay and lesbian lives in a very different way. But they have yet to come around to that gender, many of them who came around, around sexuality. So I think gender trails behind and that that’s the next ones here.

But then, also, I think there’s some psychoanalytic thinkers like Tim Dean absolutely in the forefront. He’s using special analytic tools to understand gender. I think they really have promoted the notion of the multiplicity of gender, the notion of the, kind of, the gender as a social construct but not just a social construct, and the, you know, kind of the inter-relationship between the self and society around what is gender. So I have felt those in theory but, also in terms of the practice tools, the psychoanalysis has been incredibly helpful to me in working with gender non-conforming, transgender children and adolescents. So that I would…some of the things I learned in my training about how to do therapy.

Actually, you know, it’s simple in some ways and it was absolutely needed, like listen to the patient.

If you listen close enough, you know, if you listen to the patient, you’ll learn something from them, and particularly around their gender. Eventually together within the relationship, you’ll figure it out. But it’s their story to be told, not your disease to fix, no.

Robert Frashure: What kinds of training were most important to your thinking about gender development in children and young adults?

Dr. Ehrensaft: I was trained analytically, so this has been a major influence in my writing. But I also had family therapy training as well and I’m a developmental psychologist which, I think, around my gender work, has been critical being a development psychologist, to understand how gender unfolds and that, you know, that it’s different for different age groups, and that having to rework.

One of the things that’s absolutely wrong were the traditional theories of gender, gender development. They’re just wrong, including the fact that, according to the psychoanalytics original theory, that by age six it’s all wrapped up and you know your gender, you know it’s not changeable, and you’re heterosexual if you want to be healthy. And we know, that’s just wrong.

Robert Frashure: Why did you choose to title your book “gender creative?” I am curious how this term “gender creative” is distinct from other terms or descriptions you might see used when talking about gender non-normative children, such as “genderqueer” or “gender fluid?”

Dr. Ehrensaft: As I began writing the book, I borrowed from psychoanalyst D.W. Winnicott and his theory of “true self, false self, individual creativity” in constructing my own paradigm of gender creativity.

I changed it to this true gender self, the false gender self, and gender creativity. And, from gender creativity came the gender creative child, which is a gender creative person which is a person who takes the core of their choosing in their self [inaudible 00:11:57] together. Gender self, that is one’s own creative, unique possessions, actually. So that’s where I got the gender creative self.

I took his terms and adapted them to fit into gender development. So I basically changed it to this true gender self, the false gender self, and gender creativity. And, from gender creativity came the gender creative child, which is a gender creative person which is a person who takes the core of their choosing in their self concept together. Gender self, that is one’s own creative, unique possessions, actually. So that’s where I got the gender creative self.

Robert Frashure: How was the response to the “gender creative” terminology you were developing when you first began to share it with colleagues? Was it popular, or did other gender professionals not take it seriously?

Dr. Ehrensaft: Well, it’s funny you ask! The irony is that I was gonna name the first book, “The Gender Creative Child”. But I went to a group, a consultation, because I was invited to present my work. This one is, like, the first meeting of transgender specialists, I mean, the first group that existed for many years in the Bay Area. So they asked me to come and talk about the book as I was writing it, and I did. And I was asking them to help me with titles because that’s where I was then, and I said one of the titles I was thinking of was “The Gender Creative Child”. And one of the people in the group who has also had been in the publishing world said, “You know, I don’t think that’s a good idea for the title because, when people see it, they’re gonna think that you are saying that people create their gender, and that’s not the message of your book.” So I said, “Duly noted,” and he said, “Look, put it as a chapter where you can explain it,” and then I’m like, “Okay,” so that’s what I did.

And who knew, that was the most popular term in the book! All of a sudden, everybody started talking about the gender creative child, there were workshops on the gender creative child.

Robert Frashure: And is that how you ended up calling the second book the “gender creative” child?

Dr. Ehrensaft: So when it came around to the next book, I said to my publisher, “You know what? This one I want it named…I want to call this one “The Gender Creative Child”,” because I learned from writing the last one that it would work. So that’s how it came to be. That’s the story of the gender creative child. That’s exactly right. When it came around to the next book, I said to my publisher, “You know what? This one I want it named…I want to call this one “The Gender Creative Child”,” because I learned from writing the last one that it would work. So that’s how it came to be. That’s the story of the gender creative child.

Robert Frashure: I like how the term captures the fluidity and movement of how young adults change and play with their gender identity.

Las summer, I worked at an LGBT summer camp here in Los Angeles. I noticed while working at the summer camp that youth had so many terms for describing their sexual and gender orientation that I had never even heard of! I was so impressed by their intelligence and resilience. Some identified as asexual, others as pansexual, some of gender queer, etc. Many of these terms didn’t even exist when I was in college, which was only ten years ago.

Another thing I noticed was how some of the kids from the first week would completely change their sexual or gender identity by the second week! They might go form asexual or omnisexual to pansexual and genderqueer in the span of ten days.

Dr. Ehrensaft: I see that in my practice as well, there is a real willingness and passion for exploration and not getting stuck in labels imposed imposed by the majority culture.

Robert Frashure: Exactly, I learned so much from being there and listening to the words they used to express their experiences. My question is, is it hard for parents and professionals working with these children to keep up with the developing terminology?

Dr. Ehrensaft: It’s a great question, and I would say that the fluidity of the category is also matched by the fluidity of the young people in choosing new ones and not being boxed into any particular ones. But, you know, I do think you’re absolutely right. There are so many changes going on and the pace goes fast, and what was the politically correct term yesterday is now offensive or obsolete. If, you know, you wait a little while, you find out you’re out of sync with what it should be.

Even the word ‘transgender’, there are so many youths who say, “I hate that word because I didn’t trans to anything. It was other people who had to understand who I was, but I’ve always been a,” whatever it is, or other,” and it was for others to get used to it.

Robert Frashure: Do you feel as though the explosion of social media during the last five to ten years has also accelerated the pace of how quickly gender terminology has developed?

Dr. Ehrensaft: Yes, I do believe that this is certainly part of the story. You know, like, kids don’t hang out talking on the phone. They text each other or they Snapchat or whatever, Instagram or whatever they’re gonna do. But I do think there’s an important thing there that the internet and that kind of connection among youths has made an incredible difference.

And having access to social media sites can make a huge difference in small towns as well, where finding people is much easier when there are social networking sites to connect.

Robert Frashure: I totally agree, and I observed how important social media sites like instagram are to the youth who came to this LGBT summer camp! Many of them found out about this camp through instagram.

One concern I had with the LGBT summer camp was how there was so much panic and anxiety among the kids who came to the camp. Some of this seemed connected to going up in front of the campers and telling your story, which can be a very intense experience. I wascurious what your thoughts are on how to make an LGBT summer camp experience successful?

Dr. Ehrensaft: I’ve seen this happen, too. One concern I always have is that there’s an assumption that everybody wants to tell their story and it’s empowering: and it’s not necessarily so. The the most important thing is to create safe spaces, not make it even more stressful for them. I believe that to assume that everybody is in a place to be a public speaker about a very personal and, perhaps, a painful part of themselves is asking way too much. Especially when the kids are pre-teens or teenagers, than can be a lot to ask. To make public speaking an expectation of participation, I think that’s just fraught with the possibility of panic attack.

Robert Frashure: I agree with you. Many of the kids who come to the LGBT summer camp have gone through abuse and bullying and had suicide attempts. It seems unreasonable to expect them to get up in front of a crowd and speak openly about something so difficult which could take someone many years to understand!

Dr. Ehrensaft: Definitely, there are a few camps that are models for how to do this I believe. Camp Aranu’tiq, for example, was set up as a camp for transgender and gender non-conforming kids. It is a wonderful camp that blends supportive therapeutic environments with fun, since mental health professionals designed the camp. I think that makes a big difference.

Another thing I would mention is the distinction between gender identity and sexual orientation. When you’re gay, for example, you are usually able to make decisions as to how out there with it or not you would like to be. And that’s somewhat true with gender, but I think that a lot of people who are gender expansive, gender creative, and transgender who don’t feel comfortable or safe in the world.

Part of this lack of safety comes from feeling that, at any moment, something bad can come their way. Unfortunately, this is seen all to often with the kind of harassment that people get in the streets which is really around the gender presentation.  Gay bashing is sometimes based on seeing two men or two women walking down the street together. But much more often, it has to do with the violation of those ingrained gender expectations and a backlash against it. So I believe that much of the anxiety and panic with gender non-conforming youth has to do with not feeling safe, especially when their gender is an essential aspect of who they are and its not something that can be turned on or off.

Robert Frashure: Well, we need to stop for now but I really want to thank you for stopping by and speaking with us. I look forward to speaking with you more for the second half of our interview together.

Dr. Ehrensaft: It has been a pleasure, Robert. I appreciate your thoughtful and important questions, I am thrilled that my book has impacted you and inspired you to get out there and make a difference.