Patients & Providers: Obligation to Ethics

Mere’s education to become a Gender Specialist, Social Worker, and clinical researcher was intertwined with their own path to discovering their trans non-binary identity. This is part 1 of 3 posts from Mere during which you will get to know them and their identity, the role of social workers in trans health, and learn about the work they are doing at at the UCSF Child and Adolescent Gender Center in the first NIH sponsored research project studying long term medical and mental health outcomes for trans youth.

Identity and Obligation to Ethics

by Mere Abrams


When I began my training as a clinical social worker, I already knew I wanted to work with the trans community. I was excited about the skills I would learn that would allow me to support people who were questioning, pursuing, or exploring some aspect of gender.

I should also mention that while in my social work program, I was also deep in my own process of questioning my gender. At that time I was presenting as a binder-wearing, masculine female and had a history of discomfort around the roles and characteristics society prescribed to me based on my sex assigned at birth. I wasn’t yet out as trans non-binary to myself or anyone else.

Photo by Daniel Watson on Unsplash

Due to the intensity of my program, I didn’t feel as if I had the emotional capacity to do school work and “self” work simultaneously, so I did my best to put my need to masculinize aside for a while. Despite these efforts, I was still distracted by dysphoria and the desire to pursue a more masculine appearance. When frustrated by my inability to make progress towards actualizing my gender, I thought to myself “but I’m going to learn information about how to help others who are in the process of questioning their gender, which will inevitably help me help myself through this process.” I put a lot of faith in the fact that my social work program would prepare me both as a social worker and potential client/patient who was seeking trans affirming care.

It wasn’t until my last year of the program that I was able to take a class focused on working with LGBTQ populations. I remember spending one, maybe two sessions addressing “the T” by inviting a transgender man and his partner to come in to talk about their experience. While having this person in our class was helpful and validating of my personal feelings and experiences as closeted non binary trans person, it didn’t provide me with any practical resources or information about how to guide or support someone who was exploring gender identity and/or pursuing medical transition/alignment. Social transition versus medical transition wasn’t discussed at all. Nonbinary identities were not even mentioned. We may have discussed gender identity, but only as a general term to help clients understand this aspect of self.

Overwhelmed with the stress of being a graduate student and my own gender wonderings, I didn’t have it in me to advocate for more in-depth learning on the subject. I just wanted to graduate. As it came time to start looking for a job, I held on to my dream of being in a professional role where I could work with and support trans youth and their families.

When I started looking for opportunities, I immediately realized two things: 1) There weren’t very many options out there, and 2) I still didn’t have the knowledge or information I needed to actualize and pursue my own trans non binary gender. I obviously didn’t have enough training and education in this area to adequately help others who were looking to do the same. The training and knowledge I gained about mental health diagnoses, clinical interviewing, and psychodynamic theory was great and would form my work with trans clients, but it wasn’t enough. I knew it wasn’t enough because these approaches weren’t enough to answer the questions I had about how to get top surgery and come out to my family as trans. A social worker that would listen and validate my experience wasn’t going to get me where I wanted to be. I wanted someone who would be able to provide practical information and share experiences from those who had already been down that road.

While my fellow classmates went on to pursue clinical jobs doing individual, group, and school-based social work/therapy, I took the road less traveled and opted for a position with a non-profit called Gender Spectrum

Gender Spectrum is a national non-profit organization with a mission of creating gender sensitive and inclusive environments for all children and teens. Gender Spectrum provides psychosocial support, education, resources, and training to trans youth, their families, and youth-serving institutions and organizations. This is where I got the large majority of my gender literacy, gender education, and gender training that I use in my current clinical work with trans young adults and youth. This is also where I gained the information I needed to better understand and pursue my own gender. Neither social work school nor gender therapy did that for me.

As a trans nonbinary social worker with the privilege of supporting trans and nonbinary young adults, youth and their families, I am acutely aware that a large portion of the mental health system trans folks are asked to engage with in order to access gender-affirming medical care is not trained in gender. Due to this lack of training, many professionals are not able to offer the services trans folks are most frequently seeking, such as an assessment for letters of support to access medical care, assistance with legal gender marker and name changes, psychoeducation and resources about gender, and simply talking to someone who can share experiences from those who have come before.

Social workers have an obligation to the core values of the National Association of Social Workers’ Code of Ethics. These values include service, social justice, dignity and worth of the person, importance of human relationships, integrity, and competence. Social workers and their affiliated professional programs should be considering each of these values as it applies to work with trans, nonbinary, and agender identified individuals. We must be reflective and honest about the fact that most of our training programs do not equip us with a competency in gender. And if our training programs do not appropriately prepare professionals in this area of specialty, then we should not be claiming a competence in this area until additional training and education is sought out. That is part of maintaining our integrity as people in this helping profession.

About Mere

Mere Abrams, MSW, ASW, is a Gender Specialist, educator, consultant and advocate in the San Francisco Bay Area. Mere currently has a private practice in Oakland, California, where Mere provides gender affirming counseling, consultation, coaching and advocacy to children, teens, and adults. Mere is also a clinical researcher at the UCSF Child and Adolescent Gender Center working on the first NIH sponsored research studying long term medical and mental health outcomes for trans youth. Mere serves on the Board of Engender, a non-profit organization with the mission of supporting gender diverse youth, their families and communities by strengthening self-determination through direct services and programming.

Follow @MereTheir on Instagram or Twitter, or reach out to them on their personal website.

Tell us in the comments!

The Patients & Providers series is an opportunity for us to learn from each other. We invite you to interact in the comments with questions, thoughts, and personal experiences.

What values can help guide your provider’s care?



2 thoughts on “Patients & Providers: Obligation to Ethics

  1. I wholeheartedly support a system that will help prepare our youth for a world that can be unfriendly toward the “different” kids. I was one of those kids. I often reflect on my experience and wonder how it might have been if I’d had the tools and support now emerging from the health care community. I am heartened to witness this emergence of care and compassion for our trans and nonbinary youth.
    Mere, thanks for your work, for your advocacy. In your studies and as you grow your experience in this field, don’t forget about us oldsters. I’m guessing I’m not the only one coming into our own late in life.

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