Being a Trans Affirmative Therapist

If you are a therapist, you may find that you work with a wide range of clients who vary in backgrounds, identities and lived experiences. With increased awareness and visibility of trans people, more trans people are seeking therapy to work through their issues. Many of the issues will relate directly to their gender identity. Therefore, it’s important to have a good level of understanding of trans people, the specific issues they have, and how you can work with all of that therapeutically.

Equally important is challenging your own thoughts and beliefs on trans people to ensure that you are providing an accessible, inclusive service in which you are fully trans affirmative.

Being trans affirmative is about more than saying you accept trans people or welcome them to your therapy practice. It’s about having that understanding of who they are and what they are going through. This stands you in good stead for successfully working with them.

If we look at some of the terminology relating to trans people, there are a range of identities that are commonly used:

Transgender –

Someone who does not identify with the gender they were born as. A transgender person may go through the process of transitioning so that their physical body matches how they feel as a person.

Transsexual –

This means someone who has transitioned from one gender to another. However, it’s seen as an outdated and medicalised term.

Genderfluid –

Someone who does not have a fixed gender. A genderfluid person may feel more male at some points, more female at other times, but could also feel a combination or both or neither. This depends on circumstance, the situation that person is in, and how they feel at that time.

Genderqueer –

This is essentially the same as genderfluid.

Non-binary –

Someone who is non-binary does not feel they are male or female. A non-binary person may feel more masculine or feminine, but likely identifies as gender neutral or not having a gender.

Trans –

This is an umbrella term for anyone who does not identify with their birth gender in some way. It includes all of the identities above, plus many more.

A trans person may use gender neutral pronouns. For example, someone who identifies as female may be referred to as she or her. A person who identifies as male may be referred to as he or him. A trans person may use the pronouns they and them. Not all trans people do, so it’s ok to ask which pronouns they would like you to use.

If we look at some of the issues that trans people face, research by Stonewall in 2017 showed that two in five trans people had experienced a hate crime or incident in the previous twelve months due to being trans. There is evidence to suggest that this is rising each year. Other research shows that:

• 48% of trans people don’t feel comfortable using public toilets through fear of discrimination or harassment.
• 34% of trans people have been discriminated against because of their gender identity when visiting a café, restaurant, bar or nightclub in the last year.
• 28% of trans people in a relationship in the last year have faced domestic abuse from a partner.
• 44% of trans people avoid certain streets because they don’t feel safe there as an LGBT person.
• 25% of trans people were discriminated against when looking for a house or flat to rent or buy in the last year.
• When accessing general healthcare services, 41% of trans people said healthcare staff lacked understanding of trans health needs.
• 36% of trans people in higher education have experienced negative comments or behaviour from staff in the last year
• 83% of young trans people have experienced name calling or verbal abuse.
• 60% of young trans people have experienced threats and intimidation.
• 35% of young trans people have experienced physical assault.
• 27% of young trans people have tried to commit suicide.
• 89% of young trans people have thought about suicide.
• 72% of young trans people have self-harmed at least once.

Sadly, anti-trans attitudes and behaviours remain prevalent. In 2018, a British trans woman was granted asylum in New Zealand because there is so much transphobia in the UK.

Further issues that trans people face are sexual assault and difficulties accessing health services. The process of transitioning, whereby a trans person attends therapy, takes hormones, lives as the gender they identity as, and has surgery, can be lengthy and traumatic.

All of those issues mean that trans people are often vulnerable and experience poor mental health; something which therapy can help with.

It’s true to say that trans people experience the same problems as many other people. They experience anxiety, depression, low confidence and self-esteem, as lots of other people do. However, with trans people it’s often due to one of the issues detailed in this blog.

Barriers for the trans community exist too. They may worry about whether their therapist will accept them for who they are. They may wonder if they’ll be able to express their gender identity in the therapy room. There will be thoughts about whether their therapist has prejudices and if that will impact on the therapy. Therapists are taught about being non-judgemental and congruent during their training, but the reality is that every single person will have a prejudice about something. We all do, whether we realise it or not. That’s just a fact of life. Nobody is perfect.

So, how can you become trans affirmative? By being willing to see trans clients you’ve already made a start. To progress with being truly trans affirmative it’s important to take the following steps:

1. Gain more knowledge and understanding about the trans community. This could be learning more about the different trans identities, including correct use of pronouns for trans or non-binary people (she/her, he/him, they/them). It could be learning more about the lived experiences of trans people and the issues specific to that community. Educating yourself is key, even if you think you have an awareness already, which leads me to the next point.
2. Enrol on some trans awareness training. This will help you to gain the knowledge and understanding required to be truly trans affirmative. It will provide you with an opportunity to engage with trans people and others who are seeking to become more trans aware. Taking part in such training is often an eye opener and can really make a difference to your awareness.
3. Once you have done all of that, look at the way you work and your surroundings to ensure it’s as trans friendly as possible. You could actively promote that you are trans affirmative on your website, social media pages and in literature. This sends a powerful message to the trans community that it’s safe to choose you as their therapist. At your place of work, you could make toilets gender neutral by putting a sign up saying it’s an accessible toilet that all are welcome to use. There are many ways of showing that you are trans affirmative and often the small things make the biggest difference.

Being trans affirmative is something that all therapists should be and by following the advice above it’s something that you can achieve.

With thanks to HS Ambassador Daniel Browne for providing this blog. You can find out more about Daniel and his work here.