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What to Look for in Gender-Affirming Therapy

I am not going to sugar-coat it: this is a tough time to identify as gender expansive in this country (it’s not a walk in the park in a lot of the rest of the world either, but that’s beyond the scope of this post). Laws are being proposed – and frighteningly many are being passed – that threaten the lives and basic human dignity of trans and nonbinary folks. Politicians and legislators are countermanding the very clear messaging from the medical and mental health community about the harm being done by this witch hunt. All of this on top of the fact that exploring our identities and becoming who we truly are can be challenging for anyone, and especially so when that identity has been marginalized and dismissed by our society since the proliferation of Western culture (watch the Netflix documentary Disclosureexecutive produced by Laverne Cox to, learn more about the history of gender expansive portrayals in media specifically – it’s really powerful and pretty grim).


Now, I know that I am biased here, but I truly believe that psychotherapy can help! Gender-affirming therapy can provide support around identity exploration, promote feelings of empowerment towards living an authentic life, and be a safe place to experiment with new ways of being. It can also be a place in which to work through very real fears about what it means to identify outside of the gender binary in the U.S. right now. But how do you know what to look for in a gender-affirming therapist?


There are so many mental health professionals out there trying to get your business. How does anyone even know where to begin – and what to look out for – in choosing the right person to trust with your gender journey?


Here are some things to consider if you are thinking about seeking therapy for support around gender identity or gender transition:


Above all, beware the false prophet. You would be shocked at how many emails I get on a regular basis from organizations that sound like they are gender-affirming on the surface, but when you read further, are really pushing a gender-binary/non-trans-affirming agenda. Many of these begin with compassionate language but are really amplifying the small numbers of people who de-transition or express regret about gender affirming procedures. Their goal is generally to convince the world (including the world of actual gender-affirming providers) that your truth isn’t really true. Run. Just run the other way!


Also be cautious of the generalist. This is not to say generalist therapists aren’t good at their jobs. Most good therapists start their training with a broad exposure to all sorts of mental health concerns, identities, and issues. They learn to treat the most common problems, and many of them to do this extremely well. Some therapists then specialize in a couple of areas they are truly passionate about, and with which they are really well suited to get great results. Others enjoy the generalist work and may continue in that vein. The difficulty with working with a generalist is that most of their caseload is likely to comprise the most common mental health problems: anxiety, depression, maybe some substance use, likely some trauma work. And while some of these concerns may resonate with you too, a generalist therapist is unlikely to have a ton of exposure to or experience with gender identity issues or transition-related concerns. So even if they are generally affirming, these therapists may not be able to provide the kind of specific support that would be the most helpful in your gender journey. On the flip side, a therapist who has gravitated towards gender identity work as an area of specialization is likely to have had a lot more exposure to the specific kinds of issues faced by trans and nonbinary clients, including the common emotional ups and downs of gender identity exploration, the challenges and celebrations of social transition, and the ins and outs of medical transition.


Look for someone who walks the walk. Okay, so this therapist says they are gender-affirming, and they seem to be specifically interested in gender issues. Do the policies and procedures of their practice back up this talk?

  • When you look at their paperwork, are there spaces for you to identify your pronouns, preferred name, and gender identity?

  • When you speak with them, do they ask your pronouns and honor your response?

  • Do they discuss with you how you want them to handle these issues in their case file, on other paperwork, or in any insurance billing you might be doing?

  • How do they respond if they misgender you accidentally?

  • If they have a physical office space, is there a gender-neutral restroom available?

  • Do any office staff also respect your name and pronouns?

These kinds of questions, although they may seem basic, can help you home in on how gender-affirming a therapist really is in practice.


Finally – fit is key. You can find the most experienced, most specialized, most knowledgeable therapist on the planet, but if you don’t feel comfortable with them, you won’t get much from therapy. Research has shown that the majority of change that clients experience in therapy is not attributable to any specific theoretical orientation or approach to therapy. Rather, the extent to which therapy is helpful is largely a function of fit – of the strength of the therapeutic relationship built between you and your therapist. The cool thing about that is that if you can find a therapist with whom you really feel like you can connect, that relationship can be the tool that helps you to make significant positive change in your life.  So, pay attention to the clues you get about who the therapist is – the language they use on their website or other profiles and bios, the way they speak with you during an introductory call, and the way you feel after the first session are all good indicators of what this relationship might feel like. If it doesn’t feel good, or doesn’t feel quite right, don’t be afraid to let them know you need to keep looking. And when you find someone that clicks – go for it!

Above all, you deserve a safe space to do the hard and important work of becoming who you are meant to be. A gender-affirming therapist will support you in living your truth, taking back your power, and allowing all of you to be seen and heard. Good luck!

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