Providing gender-affirming mental health care
Being transgender isn’t a mental health condition, but the trans community faces higher rates of mental health challenges than any other LGBTQ+ identity group. If you’re a mental health clinician or provider who works with questioning, trans, and/or nonbinary people, knowing how to affirm their gender is critical to providing quality support.
This article covers:
- Why gender exploration might be coming up more frequently in your work.
- What “trans-affirming mental health care” really means.
- How to affirm your questioning and trans clients.
If some of this language is unfamiliar to you, you can find bolded words defined in the Human Rights Campaign's Glossary of Terms.
As our society starts to unlearn the gender binary, more and more people are beginning to question their own gender identity. This is especially true of youth, as we see Gen Z leading the way in breaking down the United States’ traditional concept of gender.
According to a 2022 report, 1.6 million people ages 13+ identify as transgender in the U.S. Eighteen percent of those trans people are 13-17, despite their age group making up only 8% of the population. The number of people identifying as trans is likely to increase as social attitudes shift and more people gain the language and safety to express their true selves.
What is gender-affirming mental health care?
If you’re a mental health care provider, it’s crucial that you understand what gender-affirming care really is. Accepting and affirming someone’s gender identity aren’t the same thing: Acceptance is more about tolerating their identity, while affirming their gender requires a more active role.
As a clinician, it’s essential that you affirm the identities of the people you provide care for. Affirming someone’s gender identity means reflecting their gender back to them. Do this by showing them you see and honor their gender as an important and natural part of who they are. For example, don’t assume gender, and give your own pronouns when making introductions.
Gender-affirming therapy is a therapeutic model that emphasizes affirming a client’s gender identity. This includes supporting them in questioning the concept of their own gender and coping with related challenges.
According to the American Psychiatric Association, the main themes explored in gender-affirming therapy include:
- Trauma
- Shame
- Depression
- Self-harm
- Violence
- Sexuality
- Medical treatment
- Societal stigma
Keep in mind, you don’t need to overhaul your current approach to integrate best practices of gender-affirming therapy. Gender-affirming practices can – and should – exist everywhere.
How do I provide gender-affirming mental health care?
You can’t support a trans or questioning client if you don’t know the basics of LGBTQ+ identities and experiences. Here are some trusted resources to start with:
- Understanding Gender Identities
- Gender Dysphoria
- Understanding Transgender People: The Basics
- Understanding Nonbinary People: How to Be Respectful and Supportive
Trans rights, safety, and access to care vary significantly depending on the state where someone lives. You can learn more about how this correlates with mental health outcomes in the trans community through our interactive map.
Your internal records should reflect your client’s correct name and pronouns (you can separately note their legal name for billing purposes). Make sure you rethink sex/gender on any forms or documents and have a trans-inclusive non-discrimination policy.
- Check out the American Counseling Association’s Nondiscrimination Position Statement for guidance.
Until you know otherwise, use gender-neutral language – for example, they/them pronouns and “partner” instead of “boyfriend/girlfriend.” The goal is to create an environment where no one has to really “come out” because you aren’t holding any expectations of their gender or sexuality.
Another thing to keep in mind is that language is constantly evolving. It’s okay to ask for clarification if you don’t understand something. Even people within the trans community are hearing new terms all the time! Tell them you’ll also educate yourself, and follow through.
There are many ways to demonstrate that you are truly an ally. If possible, providing gender-neutral or private bathrooms is one of the essentials. Include your pronouns in your email signature and feature gender-diverse people in the materials in your waiting room or office. Take a look at decor as well: How can you demonstrate inclusivity and support? Think about incorporating Pride flags, affirming quotes, artwork, or books and magazines featuring LGBTQ+ folks.
Transness is part of your client’s identity – not all of it. Keep their gender in mind, but don’t assume it’s the focus of your work together. If a trans person is seeing you about work stress, they might not need or want to discuss their identity or transition. You can affirm them by simply using their correct name and pronouns and using gender-neutral language.
Trans people aren’t just trans – everyone has complex identities. Even if they sought you for support with their gender identity, you’ll learn about other experiences, relationships, and social factors that impact them. Facing everything that comes with being trans, in addition to racism, classism, ableism, sexism, etc., can be overwhelming. Support your clients in seeing those connections, how they impact their mental health, and developing coping strategies and supports.
If you’re regularly engaging with a number of people who are exploring their gender, you might slip up – most people do, even trans folks themselves! If you misgender or deadname someone, give a quick apology and correction as soon as you catch yourself. If they point it out, do the same. Unless they need to discuss, it’s critical not to give too much time to the mistake. A lengthy apology or dwelling on your error can lead to the client feeling guilty or like they need to comfort you. Put extra attention towards validating their identity afterward.
Examples:
"Hi Caleb, how are you doing? Oh, I'm sorry, Kayla! How are you, Kayla?"
"As her sis- sorry, as her sibling..."
"I just realized I used the wrong name for you in my email earlier - I'm so sorry about that! I'm going to [ACTION STEP, e.g. review and update name/info in all files], but let me know if there's another way I can support you. You are always welcome to correct me when I mess up!"
Diving into gender exploration with your clients can feel intimidating if you aren’t prepared. Expect things to change – language and concepts of gender will naturally evolve, and so might your client’s relationship with their gender. You can utilize Mental Health America’s free National Prevention and Screening Program tools to identify specific conditions your clients may be facing or help track their symptoms over time by visiting www.mhascreening.org.