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Terminology

Understanding core concepts around biological sex, sexual orientation, and gender is central to supporting rainbow people. We don’t define every important term here, but we do provide a few basic definitions to help with reading this resource.

Sexual Orientation

In its most simple definition, sexual orientation refers to who a person is attracted to (physically, romantically, emotionally, and spiritually). Knowing someone’s sexual orientation doesn’t mean you know everything about their attractions and behaviours – everyone is different.  

It can be helpful to think of sexual orientation as being on a continuum. Some people’s sexual orientation stays the same throughout their lives, while for others it may change and go back and forth along the continuum. Some people don’t experience any sexual and/or romantic attraction, so might not place themselves on this continuum at all (we talk more about this further on in the resource).

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Gender Identity, Expression and Fluidity

Gender is an aspect of who we are, how we describe ourselves, and how we express ourselves. For some people, their gender is the same throughout their life. For others gender is fluid, meaning it changes over time. Some people don’t identify with any genders, and some people are questioning their gender. Gender expression is about how we present ourselves to the rest of the world – for example, our haircuts and the clothes we wear

Pronouns

Pronouns are words used to refer to other people, as a substitute for their name. Commonly used pronouns are she/her/hers, he/him/his, and they/them/their, though there are many others. Use of they/them/their to refer to one person is grammatically correct. In te reo Māori, the third person pronoun is ‘ia’, and is used to refer to people of all genders.

Common Terms

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Transgender (trans) and gender diverse are umbrella terms for people whose gender is different from their assigned sex at birth. Cisgender (cis) is a term for people whose gender is the same as their assigned sex at birth. Agender is a term used for people who do not identify with any gender.

Nonbinary genders do not fit the man/woman gender binary. Like the term transgender, nonbinary can be an umbrella term. People under this umbrella may also describe themselves using one or more of a wide variety of terms (like genderqueer or genderfluid) or may simply use ‘nonbinary’ or ‘nb’.

Intersex/Variations in Sex Characteristics

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Biological sex is a label used to describe our physical bodies. Although most people are assigned male or female at birth, our sex characteristics (sexual anatomy, reproductive organs, hormonal patterns and/or chromosomal patterns) can be arranged in a multitude of different ways.

‘Intersex’ or ‘variations in sex characteristics’ are terms used when someone’s sex characteristics are more diverse than the typical definitions of male and female. Intersex people use different terms to describe themselves, and it is estimated that up to 1.7% of the global population are born intersex, or have a variation in sex characteristics.

Gender and Sexual Orientation among Intersex People

There is huge diversity among intersex people in terms of gender. Many intersex people identify as male or female, others are nonbinary, others identify their gender as intersex, and others use some combination of these terms. There is also diversity in the way intersex people identify and express their sexual orientation.

Diagnoses

While some people may never know that they are intersex, many intersex people are diagnosed with an intersex variation, and that diagnosis could take place at many points throughout their life. There are over 40 intersex variations. Having a diagnosis is important for many intersex people, but there is a move away from seeing intersex as a disorder or something to be fixed. Instead, there is a shift toward embracing variations in sex characteristics as part of human diversity.

Top Terminology Tips

Use the same terms that a client uses to describe themselves. Rainbow people frequently have their identities undermined and questioned in their daily lives, and mental health settings have the potential to be validating and healing environments where clients can explore and freely be themselves.

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  • There are no rules or criteria for using any identity label (e.g. transgender, bisexual, queer) – the important thing is that the term feels right for the person using it.

  • If a client uses a term you’re not familiar with, you can stop and check in on what the term means for them. Having some background knowledge of terminology is helpful however, as it can be frustrating for clients to spend time educating mental health professionals about language and terminology.

  • Be mindful that people often use different identity labels in different situations or with different people, or they might use a label for simplicity. For example, someone might describe themselves as ‘queer’ among friends, but use the term  ‘bisexual’ at work.

  • Lots of mental health professionals worry about getting terminology wrong, especially if it’s unfamiliar. Remember that everyone makes mistakes – if you do, just apologise and move on.

Our linguistic choices are crucial, particularly as minorities. That’s kind of how we relate to the world, by choosing certain words to describe us, our behaviours, our histories, whatever.

It’s really important to honour pronouns and names - if I call myself transgender don’t call me a transsexual.

Our word choices are deliberate and I don’t like seeing other people mess with those
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Historical Context

Takatāpui and Pasifika Rainbow Identities

Pre-colonisation, sex, sexuality, and gender diversity was accepted and valued throughout Pacific cultures, including in te ao Māori (the Māori world), with takatāpui (Māori of diverse gender identities and sexualities) claiming their identity through whakapapa, or genealogy. The colonisation of the various islands in the Pacific by European settlers disrupted this, bringing Victorian and Christian attitudes to gender roles, morality and sexuality. Colonisation throughout the Pacific also brought British laws that denied the basic human rights of rainbow people.

Colonial Law

Under British law, sexual relations between men were criminalised and came with harsh punishments. Sex between women has never been criminalised in New Zealand, though women who engaged in ‘inappropriate sexual practices’ could be sent to government institutions or committed for psychiatric treatment. The 1970s saw the birth of the modern gay and lesbian rights movement in New Zealand, with the formation of Gay Liberation groups. Significant law reform followed, including the decriminalisation of homosexuality in 1986 and the introduction of marriage equality in 2013.

Trans and Intersex Histories

For most of New Zealand’s post-colonial history, there has been widespread silence about the social and legal status of trans and intersex people. Trans people weren’t able to legally change their sex until 1995, and have experienced discrimination in housing, work, and public life. Trans people have also struggled to access essential healthcare services. Intersex people have faced a lack of recognition of their existence and needs, and for the last half-century, medical interventions have been performed in New Zealand on intersex babies, meaning they have no opportunity to consent.

Contemporary Context

Despite legislative gains for rainbow rights in New Zealand and increasing societal acceptance, rainbow people continue to experience widespread stigma and discrimination. Sometimes this is explicit, including verbal, physical, and sexual assault and harassment. At other times, it is more subtle.

Coming Out – or Staying In!

Due to widespread assumptions that everyone is straight, cisgender, and not intersex, rainbow people are often expected to ‘come out’ about their identity in a way others are not.

Misconceptions and Assumptions

Rainbow people also face common misconceptions or assumptions that their identities are a phase, a choice, or not valid, and that everyone fits neatly within the gender binary.

Healthcare

For some rainbow people, homophobia, transphobia, and/or intersex discrimination is part of daily life and has profound negative impacts on their health and wellbeing. Other rainbow people are affirmed and validated by those around them, and many people’s experience is somewhere in between these two ends of the spectrum. It is key to keep this diversity of experience in mind when working with rainbow clients.

 
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”Our gender expression changes the way that we’re treated in society.

I experienced a lot of prejudice in my previous workspace, and I lost my job inevitably because of it. I would go out and people would question my gender everywhere I went, you can’t escape it, it’s everywhere”
 
 

Intersections of Identity

Intersectionality is a framework we can use to understand the ways in which sexual orientation, gender, and biological sex intersect with a person’s other important identities.

Intersectionality states that oppressions based on different social categories (e.g. sexual orientation, gender, ethnicity, disability, education, age, and class) are interlinked, and cannot be addressed separately from one another. Holding more than one identity means that the effects of oppression are compounded – the negative impacts of these oppressions on a group or an individual are amplified when experienced together.

While sex, sexuality, and gender diverse clients are all exposed to potential discrimination based on their rainbow identities, they are impacted by other forms of discrimination in different ways. Many of our clients may face multiple, overlapping oppressions, so discussing structures like colonisation, racism, ableism, sexism, and classism is just as important as exploring homophobia, transphobia, and intersex discrimination.

 
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Rainbow Identities and Mental Health

History of Rainbow Identities in Mental Health

Rainbow identities were historically pathologised in the field of mental health; homosexuality was included in the Diagnostic and Statistical Manual of Mental Disorders (the DSM) in various forms until 1987, and gender diversity carried a ‘disorder’ label until 2013. Gender dysphoria (the distress associated with the disconnection between one’s body and sense of self) is still in the DSM as of 2019 (this is called ‘gender incongruence’ in the International Classification of Diseases-11). Many people have called for it to be removed, but others are concerned that this would threaten gender diverse people’s access to healthcare and support services.

Because of this pathologising history, many rainbow people feel mistrust towards the field of mental health care and are often hypervigilant to signs of pathologisation in mental health settings.

Minority Stress

High rates of mental health difficulties among rainbow people are now understood using the minority stress model. Put simply, the model states that the external world affects the internal world – societal stigma and discrimination create a hostile and stressful environment for sex, sexuality, and gender diverse people. This stress, in turn, increases the risk for mental health problems. The minority stress model is supported by a large body of research, which suggests that in order to address the high rates of mental health problems among rainbow people, we need to intervene at two levels – at the societal level, to reduce stigma and discrimination, and at the individual level, to support sex, sexuality, and gender diverse people as they face stress and adversity.

 
 

Common Topics of Discussion in Therapy

Rainbow People and Intimate Relationships

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It’s important to remember that not all clients are in relationships, have been in relationships, or want to be in relationships. A person’s experience with relationships might not seem to correspond to their sexual orientation (for example, a person who identifies as bisexual might not have had relationships or sexual experiences with more than one gender). This doesn’t mean that their identity can be questioned by anyone but themselves. Another consideration is that New Zealand’s rainbow communities are small and interconnected, which can complicate intimate relationships and friendships.

Coping with Societal Stigma and Discrimination

As mentioned earlier in this resource, there are widespread misconceptions that societal stigma and discrimination towards rainbow people ended with legal reforms like marriage equality. Subtle forms of discrimination (sometimes called microaggressions, e.g. unkind jokes, comments, and looks) can be especially hard to pinpoint and challenge but can build up and cause significant distress. Rainbow clients may want to talk through experiences of discrimination, or worries about discrimination, in mental health support settings.  

Sharing about Identity

The process of understanding one’s own identity and sharing aspects of identity with others is often called ‘coming out’ or ‘disclosure’. This can be a difficult process, especially if someone is worried that those around them won’t be accepting. Sharing about identity can also be freeing, allowing someone to live in a way true to who they are.

Some important things to know about coming out:

  • Coming out is not a one-time thing. Many rainbow people come out on a daily basis, or many times in a single day.

  • People might be out to different extents in different parts of their life. For example, someone might tell their family and friends that they’re nonbinary, but not be out as nonbinary at work.

  • The concept of coming out doesn’t make sense to everyone. For many people, not sharing about their rainbow identity doesn’t make them ‘closeted’ - it’s just a personal choice.

  • Rainbow people don’t need to be out to everyone they know in order to be happy. Some people might choose not to come out to others because they feel their identity is personal information, not relevant to their relationship with that person, or because it might not be safe. Often, choosing whether to share about identity involves balancing these different considerations.

  • If someone comes out to you, you can thank them for trusting you with that. You can also support clients by providing space and time, and by acting as an affirming sounding board during this process.

When talking about coming out, mental health professionals should go at the client’s pace and not idealise coming out as an end goal for the client in terms of improving their mental health and wellbeing.

Children and Parenting

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Some rainbow clients might want to talk about parenting and children with their mental health professional. Some people feel intense grief if they are not able to ‘traditionally’ conceive a child with their partner, and others worry that it will be difficult to have children through methods like adoption, surrogacy, or IVF. Rainbow parents are also faced with misconceptions that their children will be somehow harmed by their parents’ identities, even though research has proven otherwise. Parents may also access mental health care to ask how they can best support their rainbow children.

Internalised Negative Attitudes

Some rainbow people internalise negative societal attitudes about sex, sexuality, and gender diversity, and feel shame and loathing about their own identity. Those with internalised negative attitudes may reject their identity, or want to change it. Here, it’s important that mental health professionals maintain their affirmative stance and support the client to explore where their negative attitudes might have come from.

Gender-Affirming Healthcare

Gender-affirming healthcare is any healthcare that affirms or validates someone’s gender, including transition-related services (e.g. hormone therapy, laser hair removal, and surgeries), as well as therapy that supports people through the process of transition.

Gender diverse clients in need of gender-affirming healthcare often require a letter of referral from a mental health professional before they can access the care they need. Not all mental health professionals are able to provide this referral, so will sometimes need to direct the client to someone who can. Mental health professionals can also support clients who are figuring out what kind of healthcare they need. You’ll find more information about gender-affirming healthcare on page 39.

 
 

Accessing Mental Health Support as a Rainbow Person

Many rainbow people talk about positive experiences with professionals who they feel take them seriously, are respectful, and create a safe space in which they can talk freely about what’s going on for them.

On the flip side, many rainbow people talk about how hard it is to access support, with long wait times and little support available. They also note that mental health professionals often lack basic knowledge about sex, sexuality, and gender diversity, or do not consider the impact of societal stigma on their clients’ mental health. Many rainbow people have to educate their mental health professionals in order to move forward in therapy.

 
I had a really wonderful counsellor who was tremendous and a great help through my transition. She helped me through some really tough things
 
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I hate the experience of like, I don’t know how much you know about this, and I’m going to have to explain it to you, and I’m going to have to answer your weird questions, as though like you’re like an acquaintance I’ve just met and not the person who’s giving me care
 
I’m happy to talk about my mental health stuff, and the nitty gritty of that, but when it comes to the queer stuff, I guard it a bit more carefully. It’s still kind of ‘can I actually share this here, how much can I share, what am I being judged on’ cause even if they’re a counsellor they’ve still got opinions about it, whether they can share them or not
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Experiences of societal discrimination and negative experiences in health settings were common among participants of our research:

  • 45% had experienced discrimination outside health settings based on their sex, sexuality, and/or gender

  • 22% had previously had a negative experience with a health professional

  • 36% had heard stories of other rainbow people having negative experiences in mental health settings

Many rainbow people worry that mental health professionals will be discriminatory or will respond with surprise and discomfort when they tell them about their sex, sexual orientation, or gender.

For mental health professionals, this means it’s our job to earn the trust of our clients and show them that we are aware of the impacts of homophobia, biphobia, transphobia, and intersex discrimination. We talk more about this in the next section.