Gender Affirming Psychotherapy

Gender Affirming Psychotherapy

Written By: Melanie Vause, MSW, LSW

Finding a therapist who is well-informed about gender, gender-affirming care, and the infinite varieties in gender experience and expression can be difficult. Progress has been made over the years in terms of education about and acceptance of transgender (trans) and gender non-conforming people. However, it can still be daunting to find a therapist who you can feel safe with being honest about your gender. And, even when you are able to find a therapist that you might feel safe with as a trans or gender non/conforming person, not knowing what to expect in therapy with a gender-affirming therapist may be scary. My hope through this blog post is to explain some of the things you may see in your work with a gender-affirming therapist, and share a little bit about the way that I practice as one of these therapists. 

What to Expect at the Beginning of Treatment

When you begin therapy, you will likely be asked to fill out what is often referred to as an “intake form”. Typically, in these forms, you are asked to share a little bit about yourself, what brings you to therapy, and other relevant information. (Of note: the specific questions included on these forms can vary between practices.) Sometimes, these forms ask you for the sex you were assigned at birth and/or what your current legal sex is, how you refer to your gender currently, and what pronouns you use. As a therapist who has worked with the queer and trans community for several years, there are various things that I prioritize at the beginning of treatment with my trans clients. 

First, if you filled out this intake form prior to your actual intake appointment, I will likely confirm this information with you by asking the pronouns that you use, as well as ask you to describe, in your own words, why you’re coming into therapy. I will likely share the pronouns that I use (which are she/they!) as well. I may also ask you if you have any other names that you like to be referred to as, whether they are related to your birth/legal name or not. I will never refer to you by your birth name (sometimes referred to as a dead name if you no longer use it) unless you request me to. One thing to note, however, is that if you are using your insurance benefits to help pay for sessions, it will be necessary to provide your legal name and sex in order for us to submit insurance claims. This is an unfortunate and unavoidable part of the process if your legal name and sex are not what you would like them to be, but know that this is one of the only times this would be a consideration. 

Throughout Treatment

When working with minors, I often collaborate with their parents to a certain extent to ensure that lessons and strategies learned in treatment are implemented outside of session at home, but I never share details of our sessions unless it becomes absolutely necessary. An example of this may be if the minor reports to me that they have been engaging in self-harm or are having active suicidal ideation. Of course, if it ever gets to a point where I feel this is necessary to communicate to the caregiver(s), I try my best to have a conversation about this with the minor before doing so. 

There are some things I keep in mind when working with minors who identify as trans/gender-nonconforming. One of the most important things is that I will have a conversation with the minor at the beginning of treatment to make sure I’m referring to the client how they would like to be referred to when I speak with their caregivers. This is especially important if the minor is not out to (i.e. hasn’t shared their trans identity with) their caregivers. Additionally, part of doing therapy with trans minors is providing education to caregivers about their child’s trans identity, how to support their trans child, and more, and I will always discuss this with the child beforehand to make sure I’m doing my best to have conversations with their caregivers that they are okay with. 

When working with clients who identify as trans, I sometimes support clients with identifying any gender-affirming care goals they may have. This may include things like hormone replacement therapy, gender-affirming surgeries, voice training and more. These interventions would require medical professional oversight, but I am happy to play a role in providing referrals and collaborating with providers throughout the process (with consent, of course). We may also talk about gender affirmation without medical intervention, such as exploring how clothing, body modification (such as piercings and tattoos), binding, tucking tools, and more may be incorporated into your life to express yourself and your experience of your gender. These conversations often include myself pulling from elements of Narrative Therapy and Solution-Focused Therapy as you discover more about yourself. I always approach these conversations with enthusiastic curiosity, supporting clients on their journeys to discover what makes them feel most at home in their bodies. 

When Looking for a Gender-Affirming Therapist

There are many things to keep in mind when you look for a gender-affirming therapist, and these can vary widely based on a person’s preferences. However, there are some things to keep in mind that a gender-affirming therapist will never do. One thing that a gender-affirming therapist will never do is force you to use your birth/dead name if you don’t want to. If I am aware of a trans client’s dead name, such as in cases where their chosen name is not their legal name, I do my best to ignore that information as much as possible and only use their chosen name unless otherwise specified by the client. (Again, it’s important to note that legal names do need to be used to file insurance claims.) Additionally, a gender-affirming therapist will never tell you that you need to change who you are, how you should express yourself, or how you should refer to yourself. Therapists, especially those who are trans themselves, may provide suggestions at times, such as potential ways to manage gender dysphoria. That being said, these suggestions should never be made in an attempt to tell you how you should experience your identity or express yourself, but rather to offer alternative options and resources. The process of discovering yourself can be a sensitive one, and it should be approached and discussed with care, acceptance, and support. 

Final Thoughts

Ultimately, it is up to each individual person to decide what is best for them and their goals when choosing a therapist. It sometimes takes people a few tries with more than one therapist to find the one that they feel comfortable with, and although this can be a frustrating process, know that it is not out of the ordinary. You deserve to work with a therapist that you connect with, who sees you for who you are, and who is committed to supporting you in working towards your goals. 

​If you are interested in counseling, call OakHeart at 630-570-0050 or 779-201-6440 or email us at [email protected]. We have counselors, psychologists, and social workers available to help you at one of our locations in North Aurora, IL, Sycamore, IL, and/or via Telehealth Online Therapy Services serving Kane County, DeKalb County, Dupage County, and beyond.