Transformational
Learning

SKILLED TRAINERS

By definition, transformation learning is challenging.  It requires a skilled trainer to facilitate the process of self-examination, change, and understanding that comes from challenging the dominant culture.

Because learners enter the training with biases and stereotypes, trainers probably have to overcome how the trainer is perceived in order to reach learners. Undermining stereotypes skillfully can establish the trainer as an expert who can be trusted to lead to the learner through the process.  This helps learners to know that the trainer is capable at maintaining safety and working through the difficult topics.

Sometimes, learners enter the room defensive. The dynamic about how people feel about the training can be influenced by how the training is marketed and how people are invited to attend the training. Most often, learners come into the room prepared to learn and ready to be engaged. Regardless of the learner’s attitude, the trainer only has control and responsibility over their own emotions. If the trainer does not have the right mindset when they enter the room, they cannot be grounded and will not be able to be present in the room. Here are some tools to for trainers to ground themselves, from an experienced trainer:

• Pay attention to the body’s needs: Are you breathing? Do you need to use the restroom before you get started?
• Do some mindfulness meditation to be in your body. Feel your feet on the floor, take your shoes off and press your feet into the floor.
• Take a breath, look around, look at people and let them look at you. Whatever label you want to call it, slow down and recognize your place in the firmament.
• Feel yourself and understand that you’re an integral part of what is going on.

We often hesitate to go to places that are softer, “to soften the soil and prepare it for seeds” and some trainers sometimes want to go into the room and prove how close they are to being a doctor. These reactions and impulses are based in the dominant culture’s need to assert value or supremacy or authority, and ultimately come from a place of insecurity and discomfort. The trainer is modeling how to handle discomfort and should usually refrain from acting on these impulses. The trainer is there precisely because their skills are different from, and needed by, the learners.

Trainers can support the learners in the process of challenging their biases. If a learner is exhibiting a negative attitude or behavior in a training, it can be helpful to first identify the attitude and behavior and get clarity on what the trainer thinks they heard or saw. Developing the skill to make an intelligent inquiry about what happened is essential. Our trainers recommend: Take a second for a breath. There is rarely a need to speak immediately into the space. Take a moment to settle and gain some power. Silence and thought can let the learner know the trainers are being thoughtful and intentional in their response. It is a moment to think about how to ask the question in the least confrontational manner. Most of the time, the goal is for the trainer to ask the question in a way that allows the learner to tell their best truth, as this facilitates growth. The trainer should try to give fewer words, actions, and indicators about what they expect to hear from the learners.

Because closely held religious beliefs are deeply engrained, it may be helpful to recommend further reading and research outside of the immediate context of the training environment. A publication by the Auburn Seminary, My Mind Was Changed, is a helpful, evidence-based resource for discussing LGBTQ people in the context of Christian religious communities. Our trainers recommend usually steering away from the issue of religion, unless that is the purpose of the training session. It may be helpful to avoid a potentially derailing conversation and say: “I recognize that this is difficult for a lot of people. I don’t have time to address it completely today. I think we can agree that our focus today is on our patients. If you are of the Christian faith, I found this book to be an excellent help in navigating these issues.”

Trainers should be quick to respond if someone asks an obvious homophobic and transphobic question. It needs to be addressed. The good trick is to say “I need to pause to think about your question a little bit.” And “This is a challenging question that I need to think about before I respond.” This gives the asker time to think about it and gives the trainer time to not react. Sometimes, reflecting their question back helps.

Another way to address negative attitudes and behaviors is to change them through exposure to LGBTQIA+ people. Storytelling, through videos, written text, or in-person sharing can humanize LGBTQIA+ people for learners. Increasing the visibility of LGBTQIA+ people can be an effective tool for changing attitudes. Often, when people have negative attitudes and behaviors it is based on fear and misunderstanding. Many people who harbor negative attitudes may not realize that they likely have LGBTQIA+ people close to them and so not understand that many LGBTQIA+ people share their values and live in their communities. Stories are also helpful for exposing learners to communities of queer people who are new to the learners’ experience.

EXPLORING CULTURE

Part of the trainer’s job when setting up the training is to assess the needs and find out some basics for where the learners are. This usually involves exploring the organizational culture and history. Visiting the site of the organization and meeting with leadership and staff can be helpful in a pre-assessment. The trainer can ask department leadership “What do you see as the most important thing for me to convey to your staff?” Answers will vary, but the process gives people the opportunity to identify what is not known, lets the leadership define what their goals are, and can identify an LGBTQIA+ champion to carry the torch on establishing an institutional commitment to LGBTQIA+ cultural competency.

If possible, do an online survey that collects data from learners ahead of time. This gives the trainer something to bring it into the room and talk about. It lets people realize that they are not the only person with questions and is another way for folks to learn from each other. For some people, seeing a filtered version of what they said may help them be more willing to talk about their journey.

Discussions of culture need to help people identify their own culture roots and where they come from so they can see how they relate to others. LGBTQIA+ cultural competency trainings try to help learners understand how privilege plays to benefit some to the detriment of others. Those who benefit from privilege can be described as belonging to the dominant culture. For trainers that are a part of the community in the room, tapping into your own sense of privilege is very important, as the trainer‘s example is a powerful teaching tool for learners.

For people who are members of the dominant culture, their ignorance of history and culture is a source of harm for members of subordinate groups. For example, many white people react with surprise to learning about the burning of Black Wall Street in white riots in Tulsa, OK. In contrast, Black people are surprised and hurt that this important piece of history is unknown to white people. Similarly, for LGBTQIA+ people who are out but not to those learners in the room, you can see them frozen by the lack of understanding and the casual harm of their colleagues.

Our identities are intersectional and people can have portions of their identity that are dominant, for example, a white, cisgender gay man is a member of dominant culture from the racial and gender lens and a member of the subordinated culture from a sexual or affectional orientation lens. For people who are members of the dominant culture, in whichever aspect or part of their identity in which they find themselves, if they want to be something other than just in the dominant culture, they have to stand in a place of vulnerability. Transformational learning requires presence and openness to accountability.

Trainers embody the values that we want to train. We model the behavior that we are seeking to promulgate. For an example from an antiracist trainer who warns: “Do not expect people to be nice when you step on them. They are giving you valuable feedback, even when they are not nice about it.” The learner, as a health care provider, needs to learn that feedback from their patients is a gift. It is part of their professional obligation to their patients and clients to take that feedback and learn from it.

It is particularly important for trainers to be able to speak to the history of racial subjugation and racialized violence in the United States. Exploring these events are an important part of discussing culture. Here are some recommended resources for learning about the impact of how discrimination in health care has impacted and marginalized communities and some resources on the resilience of those same communities.

• The 1619 Project – Episode 4 Bad Blood.
• Gentrification of the Mind: for the role of HIV/AIDS in gentrification
• TAGG Magazine: generally for health and queerness
• SWERVE Magazine: Also for queerness and Black communities and Black culture.
• “So you want to talk about race”- Ijeoma Olua, the chapter on privilege challenges people to explore the way that privilege affects their lives.

If it is safe and appropriate, some learners benefit from sharing their own stories of experiences of marginalization. Some trainers found that participants have wanted to share their stories as a LGBTQIA+ person or an experience where they acted as an ally. The other participants can benefit from the stories and experiences of their coworkers, friends, and co-learners.

There are also activities that allow for learners to explore the cultural differences and perspectives in the group. Following are two examples from the National LGBT Cancer Network curriculum:

LGBT Cancer Network Unit 1. An example of an Icebreaker, because it sets the stage for multiple identities, public and private identities, and starts people sharing their own experiences.

REFRAMING DISCOMFORT

One trainer prefers “brave spaces” to “safe spaces” to help learners approach their discomfort with curiosity. Here is a resource on the development of brave spaces. The brave space terminology reminds learners that they have to be willing to be vulnerable. This trainer uses accountability as a tool for vulnerability by spending time talking through the accountability that accompanies the words that we say. Setting up the expectation of accountability in the beginning can give people the opportunity to deconstruct their biases. It makes learners attentive to the delicate balance between learning and processing. By listening for the impact of their words, the learner recognizes that they may say words during the learning process that are hurtful. In this way the cultural competency training has a way to get at people’s hearts and create some empathy. Otherwise, people take their notes and try to learn the right words, but they have not internalized the way that their words can be harmful. It is more important that they learn how to not impose biases rather than learn to not have biases.

Holding people accountable for their words may require pausing for people to speak. One trainer uses very intentional questions that encourage people to reflect and tries not to speak at length without allowing for silence to give people silence to think and reflect. Silence can be a recognition from the trainer that people process in different ways. Sometimes people will not speak in the room, but they are engaging. It is important and helpful to create different opportunities for expressing what people are learning. For example, writing, or speaking in small groups, in pairs and in trios.

Trainers need to create opportunities to tap into the affective or emotional underpinnings of the cognitive processes. If someone comes in defensive about their gaps in knowledge, they will have barriers to learning. One trainer recommends using experiential exercises to allow the learner to explore their own lived experiences and their levels of self-awareness. For example, going over the dominant culture system of sex and gender, by asking learners to fill in the diagram for you. Ask “Who is missing? Who is displaced or uncaptured by the binary system?”

The vast majority of learners are very receptive in trainings. Very few are obviously rude and don’t want to be there. Trainers cannot do much about them and some may just stew during the training. Trainers can let them be. Some learners can be eager to participate, but have a lot to learn. For example, one trainer had a learner who asked “What does it mean to masculine?” This learner, a man, was so steeped in his own experiences that he did not have the skills to reflect on what the experiences meant. The trainer asked themself, “What do you do in the moment to help this man while still facilitating the session for the rest of the learners, who understand the issue?” In this instance, the trainer answered him with an example and then talked with him one-on-one later.

Sometimes, trainers can read the room and may be able to enlist the supporters in the room to address uncomfortable feelings. A trainer can open up a room and ask, “How are people feeling?” Someone may want to chime in. The trainer can say, “This material can be challenging for people, and I’m inviting you to talk about it.” This creates space for modeling vulnerability for people that are close to the power and privilege in the room. It is helpful to give people options to talk on the break, talk in the room, or talk over email afterward.

Brave spaces allow people to be challenged by the content. Our goal for this training is to help people be more knowledgeable about LGBTQIA+ folks and more aware of their feelings about LGBTQI people. One experienced trainer cautions that trainers “do not want to cast people in the role of perpetrator and victim.” This frame may encourage people to shut down. People, often white people, who see themselves as desiring to be good health care providers, do not necessarily want to expose themselves as perpetrators or beneficiaries of racism. Empathy, which is very much part of this practice, has to be embedded in the best practices around cultural competency. Learners are often in their heads. So, anything trainers can do to get learners into the heart space is going to help them by making them uncomfortable. It can be helpful to remind learners to reflect on discomfort. One trainer quotes, “All progress takes place outside of your comfort zone.” Naming that discomfort is information can help them learn from it.

Brave spaces sort of create an umbrella of safety for people to mess up, but it recognizes that messing up has consequences. If a provider does not know how to talk to a patient or client about their gender identity without thinking about what is happening in their pants, then the provider cannot ask a question without fear that their biases are coming to come through. The goal of cultural competency trainings is to learn how to ensure unconscious biases do not impact patient care. One trainer suggests this encouragement for learners, “Ask the question in the best, most sensitive way that you know, and then we can address your question. Ask your ignorant question! I will address your question’s language, and then we can address the content of your question.”

Trainers are often reluctant to make the participants uncomfortable. Transformational learning creates opportunities of escalating discomfort so that people can challenge themselves with increasing knowledge. One trainer recommends progressive cases: A single case vignette that spans the whole of the training. This allows the complexity to expand and challenge the learner to understand their biases and the gaps in their knowledge. This method figures out how to escalate the discomfort, but draws familiarity through the training as well.

SILENCE

Silence is critical in both in-person and virtual trainings. For in-person, it may take as few as five-seconds for silence to produce results, In virtual settings, it usually takes 15 seconds or more. In trainings with quiet groups, sometimes it takes a full minute of silence to allow people to speak.

Trainers should only ask a question when they want it to be answered. They can pause and allow respectful silence for people to process the question and think about how to answer. If a trainer gets nervous because the silence has lasted too long, they should wait. Someone else is feeling nervous about the silence, and the trainer can outlast them.

If a trainer is giving people individual work to do, for example, worksheets or journaling, and they have set a certain amount of time, trainers should encourage the participants to sit in silence during the activity.

GROUND RULES

starts with the ground rules, which are mutually agreed community norms. For shorter trainings, trainers usually prepare some suggested ground rules for convenience and safety.

Pending time, the group can develop their own norms. If a group is training together over the course of months, they can spend time and intention developing their own norms. The facilitator is still a part of the group and can still ask for norms for the group.

If there is not much time, trainers can look at the values of the organization to serve as the norms. Always ask for learners to agree to norms, by some motion or some sign. When they agree to ground rules, it is important for them to know that it is everyone’s responsibility to uphold the community norms. This is especially true of small group activities, where the trainer is not present and learners have to practice upholding community norms.

There is a risk of creating ground rules and then ignoring them right afterward. After making a list of ground rules, to avoid turning the activity into a performance, keep the rules visible and relevant.

The ground rules need to live in the trainer and be articulated at every moment from the trainer. One trainer expressed it in this way, “I do not expect people to be nice to each other, but I expect me to handle it. I do not expect people to ask questions in sensitive ways, but I expect myself to be able to handle it.” Whether or not the group was able to formally establish ground rules, the trainer must embody the ground rules in their speech and behavior. This is a central challenge of cultural competency rainings and one of the reasons why skilled and experienced trainers are necessary for successful trainings.

Here is a ground rule activity from the National LGBT Cancer Network curriculum.

The theory relies on tapping into potentially uncomfortable emotional responses when challenging a learner’s underlying assumptions and habitual ways of thinking, so that those assumptions can be explored critically. Emotional discomfort often manifests within one’s body and mind as a way of communicating lack of familiarity, which can be misinterpreted as danger or a threat. Trainers can help learners reframe uncomfortable emotional responses. The trainer can help learners to approach such responses with curiosity, instead of avoiding them as a form of self-protection.

It is generally most effective to use questions to stimulate reflection on a matter that many trainers and advocates take for granted but the learners may not. Transformational learning theory is flexible enough to allow for different degrees of experience for differently situated learners. Silence is almost always necessary in trainings to allow for self-reflection to encourage learners to become aware of some of their preconceptions and to feel less distance between themselves and the “other”, for example, the individual or family member.