The Trans Person’s Guide to Finding a Therapist
Even in the most basic situations, finding the right therapist can be a challenge. Every individual has unique experiences and goals as they enter into therapy, and therapist’s styles and personalities don’t always mesh. As a transgender woman myself, I have faced particular challenges in finding a therapist that was competent working with trans identity and gender issues. Now, as access to gender affirming healthcare is under threat and a slew of hostile federal policies are implemented, transgender people are facing tougher challenges and even more barriers to receiving care.
Therapy can be an important tool in building resiliency and improving mental health, and now more than ever, it’s critical that transgender people have options. Sadly, in my own experience, not every therapist is equipped to support transgender clients. But if you’re transgender and looking for a therapist, there are steps you can take to help ensure that your experience will be a positive one. There are also red flags to be aware of, both during your search and once you start therapy.
Red Flags: Prejudice, Ignorance, and Negative Bias
In my own journey with therapy, I’ve had some good, some questionable, and some downright horrible experiences with therapists. Even as trans issues are debated on the public stage, the truth is most people have a very limited understanding of what it means to be transgender. I once had a therapist early on express total shock that as a trans woman, I would want to continue my relationship with my partner, a woman. “You’re a trans woman, don’t you want to be with a man?” Having to explain the difference between my gender identity and my sexual orientation – much less my commitment to my longstanding relationship – was exhausting and ultimately not helpful to my own mental health.
Another therapist I was seeing for a few months had absolutely no idea about some of the basic experiences I was having around my identity. Even though she was well-meaning and supportive, I found myself having to spend time every session explaining the basics of transgender existence. She even joked once that she always learned so much from our sessions but ultimate I wasn’t getting much out of them. Sadly, it’s not uncommon for trans people to have to take on the burden of educating their care providers, but it’s not ideal.
My most negative experience with a therapist occurred early in my transition, as I was struggling to navigate some of the crucial steps in coming out, accepting my identity, and experiencing changes related to hormone replacement therapy. When I would bring up these topics, she seemed to freeze up or even act dismissive, and I started to dread my appointments. Ultimately, I stuck it out because I felt I really needed support to work through this period in my life. I could sense my therapist was becoming increasingly hostile however, especially as I described my fears around coming out at work and around how certain changes to my body made remaining closeted more difficult. After I shared these feelings, the therapist snapped back at me and asked me why I was even telling her any of this. I struggled to respond, but she continued saying that my experiences would never compare to a “real woman’s experiences” and she didn’t want to validate me any further. I ended our session early after that and canceled my remaining appointments, and kicked myself for not detecting her transphobia sooner. Sadly, these kinds of trans exclusionary attitudes aren’t unknown in the mental health field and are even present in therapists that list “LGBTQ+ issues” as a specialty in their bios.
If nothing else though, these experiences taught me to look for red flags in potential therapists. Ultimately, I discovered that it would be my own responsibility to make sure that the therapist I worked with would be qualified, knowledgeable, and free from negative or transphobic biases.
Finding a Trans Affirming Therapist
Finding a therapist can be a daunting task, especially as a transgender person. One helpful starting place could be asking for referrals from your doctor or the clinic where you receive medical care. Generally, these providers have been vetted and will hopefully have some understanding of transgender care. In my experience, however, these lists are often woefully outdated, or the therapists on them aren’t free to take on more clients. Asking friends or checking with appropriate social media networks can also be a great start, but not every trans person is lucky to be connected with those resources.
Your next bet would be to try an internet search. I spent a lot of time browsing profiles on Psychology Today or reading through individual websites, but it can be hard to narrow down your options. I would recommend looking for therapist that directly write that they have experience dealing with transgender people. If you can’t find that, then look more generally for therapists that write directly about working with LGBTQ+ people. I wouldn’t always trust someone who just lists “LGBTQ+” as a keyword among their list of specialties. My guess is that many therapists think generally that they would be fine working with LGBTQ+ people when they check that option, and in fact every therapist I’ve ever worked with had “LGBTQ+” listed generally in their profile. Instead, read through bios carefully and prioritize reaching out to therapists that write directly about working with clients with similar experiences to your own.
Identifying Therapy Goals and Questions for a Therapy Consultation
Before starting therapy, I would highly recommend writing out some goals for yourself. Maybe you want to address feelings around gender dysphoria, or around anxiety or depression more generally. Maybe you want to develop coping strategies for challenges you’re facing in life or your relationships. Whatever the case may be, writing out some goals will be very helpful and can serve as a starting point for getting the most out of therapy.
If you’ve identified a therapist that might be a good fit, you can reach out set up a consultation. Therapists themselves might need to ask a lot of questions during this consultation, but the meeting is also a crucial moment for you to figure out if the therapist will be a good fit. That means you should have questions of your own prepared.
My first recommendation is to ask if they have experience working with the issues you identified in your goals. I would also recommend asking if they have had any experience directly working with transgender people. You can ask if they’ve had any education around transgender or LGBTQ+ mental health topics. Therapists all receive training in mental health care and are required to pursue continuing education to maintain licenses, so an ideal therapist might have received additional training on LGBTQ+ topics.
Finally, I would also recommend asking if they have a personal experience with transgender folks or larger LGBTQ+ community. While many therapists are hesitant to reveal too much personal information, finding a therapist that is in community can be incredibly reassuring. To get the most out of therapy, you will need to feel comfortable opening up to this person, and it helps to know that they have an understanding and accepting perspective.
Don’t Be Afraid to Do What’s Best For You
Even after working to establish care, don’t be afraid to speak up for yourself or end the relationship if the fit isn’t right. With some of my previous therapists, I wish I had stopped seeing them sooner than I did, but my commitment to receiving therapy in general kept me going back, even when I didn’t want to. A good therapist can challenge you and help you work toward growth, but should never express bigotry or bias in their work with you.
