Gender Affirming Care as a Therapist

By Paige Rocker, LPC Associate
Supervised by Jennifer Buffalo, LPC-S, LMFT

What first comes to mind when you hear “Gender affirming therapist?” What does it mean to you? I remember when I was in graduate school, and all I knew was that gender-affirming meant respecting your client for how they present themselves in session. Little did I know that gender-affirming care encompassed patient-centered care and treated individuals holistically, supporting them in aligning their outward physical traits with their gender identity. It sounds like a complex task for some, but this sounds like human decency to me. When a therapist affirms a client, it creates a sense of connectedness and it nurtures the therapeutic relationship.

Affirmation is the fundamental piece of the counseling relationship with the LGBTQIA (lesbian, gay, bisexual, trans, queer/questioning, intersex, ally) population.   LGBTQIA individuals face minority stressors and discrimination daily. Including their workplace, coming out process, or general wellness visits with their current physician. As someone who is a member of the LGBTQIA community, I can share that we never really stop “coming out”. As a Gender Affirming Therapist, it is first and foremost our duty and job to hold the client with a high level of respect and to work to understand them without judgment. Being a Gender Affirming Therapist is just the cherry on top. As a therapist, I am here to write about some topics about gender-affirming care, how they show up for me as a therapist, and provide insight on this topic.

Items for consideration when practicing gender-affirming care:

Affirming Language & Gender-Neutral Terms
When in session, it is imperative to avoid making assumptions about a client’s presenting gender and the gender of individuals they might interact with outside the session (partners, family members, friends, etc). This is the most important piece because of the perceived dominant culture’s gender binary (male/female) that is considered the “norm”. Shifting our vocabulary in session and out in the world to allow for a broader construct that includes a gender continuum is often a helpful framework for working with all folx who desire to explore gender identity.
Gender Neutral Terms you can use:

  • They/Them/Theirs- This is instead of using he/she until instructed by the client of their specific pronoun. Keep in mind you can always ASK for respective pronouns before or during the session.
  • Folx/Folks/Friends/People: This is commonly used instead of “you guys” or “you girls”; it creates a neutral stance when talking about particular gatherings. In Texas, we often say “y’all” as a gender-neutral bridge to refer to a group of folx.
  • Spouse/Partner: This is instead of the commonly used “boyfriend, girlfriend, fiancé, husband, or wife” dynamic.
  • Adolescent/Sibling: This is instead of the commonly used “daughter/son” or “brother/sister.”
  • Understand and watch out for “Microaggressions”

Microaggressions are indirect, subtle actions that can arise in any relationship and result in feelings of invalidation, discrimination, and can even humiliate individuals who are a part of a marginalized group, such as a racial or ethnic minority. When being a Gender Affirming Therapist, it is essential to remember that some may commit these microaggressions, knowingly or unknowingly. Microaggressions are often baked into cultural references or are taught to us unconsciously through the modeled behaviors or others.

Here are some examples of indirect or subtler microaggressions

  • “You look so good; I would never have thought you were nonbinary or trans.”
  • “Oh wow, changing pronouns must be so hard.”
  • “So, what’s your real name?’
  • “Oh no, you got a haircut; it was so long before.”
  • “You’re so in touch with your emotions; I wouldn’t have thought you were originally a male.”
  • “You’re lucky to experience being a man and a woman.”
  • “But what are you biologically?”

These Microaggressions can be harmful to the LGBTQIA+ and Trans communities. It is crucial as a therapist to be aware of these and always ASK before assuming.

Track, Confront and Repair Mistakes, Missteps or Errors

Peeps, we all make mistakes. As therapists, that’s a part of what makes us human. This is true of all therapists, whether or not they identify as a part of the LGBTQIA+. One example of an error a therapist can make is when pronouns are unknowingly misused or an incorrect name is used.  This will happen.  It is guaranteed that when working as a therapist, you will make mistakes.   When this happens, it is critical to acknowledge this mistake and to track how this mistake could potentially harm the client. This can make room for a repair and help the therapist to build a plan to prevent it from happening in the future. Seeking professional consultation or clinical supervision are key elements to being an ethical gender affirming clinician.

Lastly, I want to reiterate that you’re a human being who will make humor errors. Please do not allow these mistakes to have power over you. Acknowledge, take accountability, offer a repair and when that is all handled appropriately, give yourself permission to move on. If you do not move on, it can hinder the growth and treatment in session and make the client feel guilty or the need to take care of their therapist emotionally. Making amends as a therapist can feel uncomfortable, but we cannot expect our client to show up authentically if we are unable to ourselves.  If you’re still noticing that you’re stuck, seek additional consultation.

The best course of action is as follows:

– Acknowledge what you did
– Something like: “I am sorry I used the wrong pronouns.”
– Work to avoid defensiveness or justifications
– As a therapist, if you feel you have made a mistake, it is vital to model authenticity and address the client by name, and let them know  of  the mistake that has taken place.
– Seek consultation and create a plan for the future

You may find yourself wondering, what does a plan for moving forward entail?

Some items for consideration as you traverse the repair landscape:

  • Ask if the client is willing to correct you moving forward while assuring them that you are seeking additional professional support for this
  • Seek Supervision or Consultation
  • Make a note in their chart and prep before the session.
  • Slowdown in session.  Mistakes are more common when we are rushing
  • Practice outside of session
  • Utilize self-care leading up to the client’s session to ensure you are your best therapist self in session
  • Practice self-compassion.  We cannot learn when we feel shame so be gentle with yourself
  • Seek additional professional training if the problem persists

Gender-affirming care saves lives. It is a part of advocacy, professionalism, and support in the career of counseling. If you’re looking for a Gender Affirming Therapist, reach out today!  At Luminary Counseling, PLLC we believe that gender affirming care is a right and we are committed to supporting you on your journey! We offer FREE 30-minute consultations to ensure it is a safe, affirming and warm space for you to show up as yourself.

“Did something you read resonate for you? Reach out today to schedule a complimentary 30-minute consultation with one of our skilled and caring clinicians.”

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