Tim* (he/him) is a Veteran. As a young adult, he joined the military to both serve his country and strive for a better life. Tim is also transgender. He was assigned female at birth and grew up in an abusive household. During his service, transgender people were not permitted to serve openly in the military, so Tim hid his gender identity to serve. He deployed several times, sustained combat-related injuries, and survived military sexual trauma.
It was not until his discharge from the military that Tim began to openly identify and transition, enrolling in VA health care services and taking the first step towards healing. Tim took part in hormone therapy and other gender-affirming services provided by VA; but transitioning is not just physical transformation. He realized he had traumas and mental health challenges he needed to confront as well. Tim sought mental health treatment and was offered – and accepted – an innovative form of therapeutic writing called Trans-Affirmative Narrative Exposure Therapy (TA-NET) that was being developed and supported by the Veterans Health Administration (VHA) Innovators Network (iNET) Spark-Seed-Spread Innovation Investment Program.
TA-NET is a therapeutic approach for Transgender and Gender Diverse Veterans that puts emphasis on sharing personal narrative holistically. The program is not just focused on one trauma as most evidence-based treatments are, but on the entire life story, chronologically, across a Veteran’s lifespan. It focuses on how a lifetime of trauma impacts how a person views themselves and the world around them.
Through this process of therapeutic autobiographing, the intensity of Tim’s trauma-related symptoms substantially decreased. The ability to safely catalog and then unpack an entire lifespan of trauma, discrimination and shame in an affirmative, supportive environment over the course of these sessions has changed Tim’s life.
“I came into this not very hopeful. I buried my trauma,” said Tim. “But now the meaning is very different: I define my story.”
A Transition for VA
TA-NET is a fairly new concept at VA. In mid-2019, clinical practice guidelines didn’t exist to address the common experiences and complex traumas experienced by transgender Veterans. There was a critical need and Dr. Tiffany Lange of the Hampton VA Medical Center (VAMC) saw it regularly when working with the Veterans she served.
Dr. Lange grew up just outside of Toledo, Ohio, part of a large family that scattered across the Midwest. Like so many others, she has cousins and other family members who identify as LGBTQ+. At a very young age, she became uncomfortably aware of how the conversation shifted when that individual wasn’t in the room. As she grew older, Dr. Lange became a consistent voice of advocacy and support, fighting back against the negative commentary that she heard and that her LGBTQ+ family members experienced.
This drive for equity and advocacy ultimately led Dr. Lange to VA. As a licensed clinical psychologist and LGBTQ+ Veteran Program Manager at the Hampton VAMC, Dr. Lange works to embed LGBTQ+ affirmative care into clinical practice across VHA. There she began supporting LGBTQ+ Veterans, including launching PRIDE in All Who Served, a rapidly expanding program for LGBTQ+ Veterans. With TA-NET she hopes to build another key resource for for transgender Veterans and is once again finding support through the VHA Innovation Ecosystem (VHA IE) with a Seed Investment from iNET. Through this training and development support, Dr. Lange equips VHA clinical staff with the ability to deliver a validating and welcoming therapeutic space for VA’s many lesbian, gay, bisexual, transsexual, and queer/questioning (LGBTQ+) Veterans.
In addition to the work to expand access to TA-NET and programs like it, Dr. Lange is also working with her VA colleagues to advocate for another shift in narrative: the one that relates to what VA is and is not. “Over and over, I hear, ‘I cannot believe that there is any of this at VA,’” Dr. Lange said. “And I just want to shout from the rooftops that VA’s mission is to care for our Veterans. We are here to uplift and support the full spectrum of humanity that comes to our doors. Nobody needs to hide who they are. They served. They have more than earned the right to be here, and to receive knowledgeable and affirmative care.”
Support for All Who Served
There is an LGBTQ+ Veteran Care Coordinator (VCC) at every VA facility to help LGBTQ+ Veterans get the care they deserve. While programs may vary from facility to facility, VA health care includes, among other services:
- Primary care
- Hormone treatment
- Mental health and substance use treatment
- Treatment and prevention of sexually transmitted infections/PrEP
- Intimate partner violence reduction and treatment of aftereffects
- Heart health
- Cancer screening, prevention and treatment
- Gender affirming prosthetic devices and speech therapy
To learn more about support and VA services available for Veterans with lesbian, gay, bisexual, transgender, and related identities, visit https://www.patientcare.va.gov/LGBT or contact your local VA facility’s LGBTQ+ Veteran Care Coordinator.
Allison Amrhein is the director of operations for the VHA Innovators Network and communications lead for the VHA Innovation Ecosystem.