People

As an officer in the Kentucky Army National Guard, Jacob Eleazer was "Ma'am" to his soldiers but "Jake" to his family and friends. Four years ago, he listened to the "foghorn going off in the back of my head" and came out as a transgender man.

While his loved ones were supportive, the military was not. Soon after he came out to his commander, he received separation orders. "It was frustrating how quickly things changed," he says. "The military treated me like I was psychotic."

Eleazer's separation was eventually rescinded, but this was only the beginning of a protracted legal battle. The experience left him feeling humiliated—and spurred him to action. Eleazer became an outspoken advocate for lifting the transgender ban, as a member of SPART*A, a nonprofit group built by and for the LGBT military community.

Advocacy by SPART*A and others paid off. In June, U.S. Secretary of Defense Ashton Carter lifted the ban, stating, "Our mission is to defend this country, and we don't want barriers unrelated to a person's qualification to serve preventing us from recruiting or retaining the Soldier, Sailor, Airman or Marine who can best accomplish the mission."

The Monitor asked Eleazer—who is now a captain in the Army National Guard and finishing his doctoral degree in counseling psychology at the University of Louisville—about his advocacy, his research on transgender issues and what psychologists can do to better support the transgender community.

How did you work to lift the ban?

We created a covert network through SPART*A—it started with a secret online group of about eight people that now includes over 500 actively serving transgender military personnel. Once we got organized, we realized there are a lot us out there. Transgender people are more than twice as likely to serve in the military as the rest of the population, meaning the Department of Defense is likely the largest employer of trans people.

We leveraged our collective training and experience to develop a strategy for ending the ban. The "don't ask, don't tell" repeal movement gave us a leg up because we had seasoned allies and movement leaders on our team. We engaged media to amplify trans service members' incredibly powerful stories. [To see an Emmy-nominated op-doc in The New York Times, go to www.nytimes.com and search for "Transgender, at War and in Love."]

However, our most impactful work was getting transgender service members in the room with leaders in Congress, at the White House and at the Pentagon. We humanized the issue, sharing how the ban impacted our military service and our families. We were able to convince key decision-makers that policy change was both feasible and necessary.

You've done dissertation research on transgender issues as a fellow at the Palm Center, an independent research institute. What have you found?

My dissertation is a qualitative study of transgender service members' military service, trans identities and experiences of discrimination. One of the interesting things I learned was that many participants experienced everything internally—by virtue of the policy, they had to be closeted. So, when asked about discrimination, many responded, "I don't experience discrimination because I'm not out."

I also asked transgender service members about their experiences accessing care. Shockingly, several participants who were under investigation by the military stated that they were initially reported by their therapists. Military providers can break confidentiality for anything that might put the mission at risk. Since regulations considered transgender identity a disqualifying "paraphilia," it was arguably legal for military therapists to out their transgender clients, but was it ethical? It's complicated because if therapists, particularly those conducting fitness-for-duty assessments, failed to report a medically disqualifying condition, they put their own careers at risk.

What does that mean for transgender military clients?

We already know that stigma prevents many service members from seeking mental health care. We also know that suicide risk is high for transgender, military and veteran populations. What that means is that we have a community that is at great risk and reasonably afraid that seeking help would end their career.

What can psychologists do?

As a profession, we need to find ways to provide care in a system that is ill-equipped to address the needs of transgender clients. The biggest barrier is competence. It's one thing to be a trans-affirmative provider, but working with service members requires another layer of cultural awareness and competencies. You don't find many psychologists who have training and experiences in both areas. One service member reported that they see one therapist for combat trauma and another for transition-related care. Civilian and military therapists need to work on developing both competencies.

Meanwhile, the military health-care system is about to be inundated with transgender clients when psychologists are more practiced at discharging folks than treating them. So a lot of training will be needed across the system to ensure providers can offer the professional quality of care that our service members deserve.

What else would you like psychologists to know?

As the military undergoes its own transition, psychologists may need to take on a greater advocacy role in order to protect clients' privacy, access to care and physical safety. Without training or experience, psychologists may feel overwhelmed or confused about how they can help trans clients.

I would encourage military psychologists to be proactive in familiarizing themselves with available resources. For example, they can review the APA Guidelines for Psychological Practice with Transgender and Gender Nonconforming Adults (PDF, 461KB). They can seek consultation and attend trainings. They can reach out to advocacy organizations like SPART*A and the Transgender American Veterans Association. They can also engage with professional associations, such as APA Div. 44 (Society for the Psychological Study of Lesbian, Gay, Bisexual and Transgender Issues), the World Professional Association on Transgender Health and the Center of Excellence for Transgender Health. For civilian psychologists, APA Div. 19 (Society for Military Psychology) offers online trainings on military culture.

Unfortunately, the policy change did not erase decades of discrimination in military mental health. However, during my study, several service members revealed that finding a therapist they could trust saved their lives. Rebuilding trust with the trans community and trans clients may prove challenging—but these efforts remain crucial to providing professional care and can be a powerful step in building alliance with trans clients.

For direct links to the resources cited in this article, go to our digital edition at www.apa.org/monitor/digital.