Welcoming trans people into therapy – how can therapy help?

There are various terms pertinent to different aspects of gender, such as gender dysphoria, gender affirmation, non-binary and genderqueer.

Gender dysphoria can be considered mainly as a medical diagnosis describing a person who experiences an ongoing incongruence between their gender identity and their assigned sex. Gender affirmation refers to the process of transition for transsexual people. Non-binary is a term used to describe a gender identity, neither being male or female. Genderqueer, on the other hand, describes a gender identity which is neither male nor female.

There are many more terms to describe the welcome nuances of different experiences of gender, helping sensitise society away from polarised conceptions of gender and human experience

Currently, there will be different nuanced definitions of transgender and one attempt at defining transgender may be generally describing individuals whose gender identity, or their core/inner felt sense of being male, female and any other gender expression on the spectrum, does not align with the sex they were assigned at birth. The term ‘cisgender’ describes individuals whose gender identity matches with the sex they were assigned at birth.

The role of therapy in supporting the trans community  

Offering a non-judgemental, confidential and safe environment where marginalised and often isolated and potentially vulnerable people can start to feel comfortable to share openly about what is on their minds, seems paramount.

Establishing an immediate positive rapport and therapeutic relationship will help and maintaining this throughout the sessions, communicates consistency, reliability and ultimately trust. Sharing a written working agreement helps individuals, couples and families with gender factors in their lives to know where they stand in therapy and to have the framework as a reference if any queries arise.

A therapist working with gender issues may well veer away from using diagnostic language but rather explore openly such factors as identity, experiences and relationships to get to know the context and background of the current situation.

A therapist is in no position to attempt to change anyone’s mind about how they identify in relation to their gender and/or if this interweaves with sexual orientation. A therapist working with gender could provide information and support that may help better understand the situation and connect with core aspects of the self, if wanted by the individual seeking therapy.

It may be that on seeking therapy that a person feels distraught or stressed and may find all the information points overwhelming. I offer plenty of time for people to raise queries at any time of the therapy. When therapists offer a free consultation/introductory conversation, this allows the individual seeking therapy to gain a sense of whether they want to schedule an initial session and to go at their own pace as to how they feel after this more in-depth discussion.

It may be that the person would like to continue in therapy and I advocate for seeing how a few sessions feel, to ensure that no one feels obligated into anything, with autonomy and choice at the heart of the therapy process.    

How can therapy help?

Therapy can help trans people in many ways, including:

Exploring gender identity

Therapy can help people explore the complexities of gender identity and find their own expression and sense of self with this, which inevitably improves their quality of life in a plethora of ways, such as self-worth, romantic relationships, friendships to name a few. 

Building relationships

Additionally, therapy can help people build positive relationships with friends and family once the person’s identity has been understood, heard and clarified. It can be very helpful to look at current relationships in the person’s life, to assess their quality and how frequently contact is made and how. Thinking about past relationships can inform how present relationships are formed and managed and in relation to self-confidence and worth, alongside identifying any patterns of relationships, which may be helpful to explore.  

Working through trauma

Importantly, therapy can assist people to work through relationship issues and their trauma history. Being able to talk about past experiences with a professional, often for the first time can be greatly relieving and clarifying. Connected difficult feelings with traumatic experiences such as shame and guilt can be processed and cease to interfere as much in decisions that are made.   

Setting goals

People seeking therapy may have formulated or unformulated goals for the therapy, which can be discussed and established in the early sessions and reviewed. It may be that the person does not wish to set goals and this is also fine with me. The focus of the therapy is the person seeking help and their best interests are always at the heart of the therapy work together. 

Accessing medical care

In some instances, therapy can assist people to access necessary medical care, such as hormone therapy or gender-affirming surgeries. I am always willing to have such discussions and to write letters/reports as needed. 

Learning coping strategies

In therapy, it may be relevant to help people learn healthier coping strategies to manage trans-specific stress, such as discrimination, alienation, and transphobia. 

Feeling comfortable

It is very much hoped that therapy can help people feel more comfortable with how they express their gender identity and feel proud of who they are.

Considerations for therapists

Reflections for consideration when working with transgender individuals include:

Creating an affirming environment

Therapists need to be adept at creating an environment which is gender-affirming, trauma-informed, and one which provides sources of resiliency and empowerment. 

Being mindful of power dynamics

It is crucial that therapists be very mindful of power differentials and open up discussions about how gender is discussed, at the choice of the individual seeking therapeutic support. 

Reflecting on assumptions

Choice of language use always needs to be considered and reflected upon. Therapists need to reflect upon assumptions and different positions they and their clients might privilege concerning gender, sex, and gender identity. The therapists’ own social constructions need to be interrogated towards exceptional self-awareness of the impact on others of their verbal and non-verbal communications.  

Psycho-education

It can be enormously helpful to discuss offering psycho-education about gender diversity and to recommend reading or films, depicting different gender-diverse characters for further discussion in therapy, if the individual seeking therapy considers this approach fruitful.

In summary, with improved visibility and acceptance of gender diversity, it is perhaps easier for trans people to feel included and valued. I think that we have a long way to go before this is achieved at the level necessary.

I hope that this article communicates to trans people that they are warmly welcome to seek therapy with me, and for this to be an experience which moves gently forwards at their pace and expression of choices. It is hoped that people who identify as trans, feel that they have safe therapy places to turn to and share their experiences to lessen isolation, unhappiness and vulnerability and improve connectivity, wellness, fulfilment and a pride in who they are in the world.