Navigating LGBTQ & Transgender Care: A Philadelphia Therapist's Guide
Finding affirming mental health support as an LGBTQ+ or transgender person shouldn't feel like searching for a needle in a haystack, but let's be honest—it often does. Maybe you've sat across from therapists who didn't quite get what it's like to navigate gender dysphoria while also struggling with body image. Or perhaps you've felt that familiar disappointment when a provider listed "LGBTQ+" as a specialty but couldn't actually speak to the nuanced experience of being queer, trans, or non-binary in Philadelphia.
As a queer-identified therapist who specializes in eating disorders and gender-affirming care, I understand these frustrations deeply. My work sits at the intersection of these identities because I've seen how they're often inseparable—how gender dysphoria can fuel disordered eating, how heteronormative recovery narratives can feel alienating to queer folks, and how finding yourself while healing your relationship with food requires a therapist who truly gets both journeys.
In this guide, I want to share what I've learned from years of working with LGBTQ+ individuals, transgender teens and adults, and partners navigating transition together. Whether you're exploring your gender identity, supporting a transitioning partner, or looking for eating disorder treatment that honors your queerness, my hope is that this offers clarity about what affirming care actually looks like.
Understanding What Makes LGBTQ & Transgender Care Different
When I first meet with clients, many share stories of past therapy experiences that missed the mark. They describe having to educate their therapist about basic LGBTQ+ terminology, feeling like their gender identity was treated as separate from their mental health concerns, or worse—facing subtle (or not-so-subtle) judgment about who they are.
The reality is that your identity isn't separate from your mental health. If you're a trans woman dealing with anxiety about your recent mammogram results and a family history of breast cancer, those fears are layered with questions about your body, your transition, and how medical providers will treat you. If you're a non-binary person in your thirties who struggles with perfectionism and people-pleasing, exploring why you care so much about others' opinions might involve unpacking gender expectations and societal pressure to conform.
The Weight of Navigating Healthcare as a Queer or Trans Person
I've heard countless stories from clients about being misgendered in waiting rooms, having their chosen name ignored on medical forms, or facing providers who clearly lacked basic cultural competency. These aren't minor inconveniences—they're experiences that create real barriers to getting care. When you've been hurt by the healthcare system before, walking into a new therapist's office takes courage.
What makes this even more complex is that many mental health struggles faced by LGBTQ+ folks are directly tied to discrimination, stigma, and the exhausting work of navigating a world that wasn't built with you in mind. Depression, anxiety, and trauma don't exist in a vacuum. They're often responses to very real external pressures—from family rejection to workplace discrimination to the daily microaggressions that accumulate over time.
Why Traditional Therapy Approaches Often Fall Short
Traditional eating disorder treatment, for example, tends to assume everyone's experience is the same. Recovery narratives often center cisgender, heterosexual women and completely miss how gender dysphoria can complicate someone's relationship with their body. When you're trans or non-binary, changing your body through medical transition is affirming and necessary. But distinguishing between healthy body changes and harmful eating disorder behaviors requires a therapist who understands both.
This is where my approach differs. I use relational and experiential modalities like Internal Family Systems, art therapy, and psychodynamic work rather than a strictly CBT approach. These methods create space to explore the deeper questions: What parts of you feel at war with each other? How does your inner critic connect to external messages about gender, bodies, and worth? What does authentic self-expression look like when you're healing from both gender dysphoria and disordered eating?
Finding a Therapist Who Actually Gets It
If you're reading this in Philadelphia, you might already know that while our city has a vibrant LGBTQ+ community, finding mental health providers with genuine expertise in both eating disorders and gender-affirming care can still be challenging. Here's what I encourage you to look for and what to ask.
Beyond the "LGBTQ+ Friendly" Label
Many therapists will list "LGBTQ+" as a specialty, but that doesn't always mean they have deep, lived understanding of the community. When you're vetting potential therapists, look for specifics. Do they mention working with transgender and gender-diverse individuals explicitly? Do they discuss experience with issues like gender dysphoria, social transition, supporting partners through transition, or the intersection of eating disorders and gender identity?
I'm transparent about my own connection to this work. I'm married to a trans woman, which is a personal motivator for me to show up fully for this community. I share this because it matters—it shapes how I understand the nuances of what partners go through, the complexities of medical transition, and the everyday joys and challenges of living authentically.
Questions to Ask During Your Search
Don't be afraid to be direct when reaching out to potential therapists. You might ask about their training in gender-affirming care, their familiarity with WPATH standards, or their experience working with clients who share your specific concerns. If you're looking for eating disorder treatment, ask how they approach body image work with trans and non-binary clients. Do they understand that changing your body through transition is different from changing it through restriction or compulsion?
In my practice, I offer a 20-minute free phone consultation specifically so we can talk through these questions before you commit to anything. I want you to get a sense of whether my approach resonates with you, whether you feel comfortable with me, and whether I have the specific expertise you're looking for. That first conversation is a chance for both of us to see if we're a good fit.
The Importance of Lived Experience and Community Connection
While clinical training matters, so does connection to the LGBTQ+ community. Therapists who are part of the community or who have close personal relationships with queer and trans folks often bring a different depth of understanding. I don't just see my clients during our weekly sessions—I'm engaged with the Philadelphia LGBTQ+ community, I understand the local resources available, and I stay current on both clinical research and the lived experiences shared within the community.
This also means I'm familiar with the specific challenges of living in Philadelphia as a queer or trans person. I know which healthcare systems in the city are more affirming, what social support looks like here, and how to navigate local resources for everything from support groups to legal advocacy.
Working Through Gender Dysphoria and Identity Exploration
Gender dysphoria—that deep discomfort when your gender identity doesn't align with the sex you were assigned at birth—can show up in so many different ways. For some people, it's an overwhelming, constant presence. For others, it comes in waves or is tied to specific situations, like being misgendered or seeing your body in the mirror.
In therapy, I create space for you to explore what gender means to you without any pressure to have it all figured out. Maybe you're questioning your identity for the first time in your thirties or forties. Maybe you've known you were trans since childhood but are only now considering transition. Or perhaps you're somewhere in between, exploring non-binary identities or what it means to exist outside traditional gender categories.
Creating Safety to Ask Hard Questions
The exploration process isn't always linear. You might have questions like: What if I transition and regret it? What if my family rejects me? How do I know if medical transition is right for me? What about my career, my relationship, my future?
These are valid, important questions, and I don't rush you through them. Using approaches like Internal Family Systems, we can explore the different parts of yourself that might have conflicting feelings—the part that knows who you are, the part that's terrified of losing people you love, the part that worries about making the "wrong" choice. This internal work helps you develop clarity and self-trust.
When Gender Dysphoria and Eating Disorders Intersect
For many trans and non-binary folks I work with, gender dysphoria and disordered eating are deeply intertwined. Maybe restricting food feels like a way to control your body when everything else feels out of control. Perhaps you've developed compulsive exercise habits trying to shape your body in ways that align with your gender identity. Or you might be using food restriction to suppress secondary sex characteristics you find distressing.
What makes this particularly complex is that some body changes are healthy and affirming—like chest binding for trans masculine folks or hormone therapy for trans women—while others are harmful and rooted in disordered eating. My role is to help you distinguish between the two. We work together to support your gender affirmation while also healing your relationship with food and your body. This isn't about telling you what to do with your body; it's about developing the internal clarity to make choices that truly serve your wellbeing.
Supporting Transgender Youth and Their Families
When a parent reaches out to me because their thirteen-year-old just came out as trans and wants to start hormone therapy, I often hear a mix of love, confusion, and fear in their voice. They want to support their child, but they're also processing their own emotions—grief for how they imagined their child's future, worry about discrimination and safety, questions about medical transition.
If you're a parent in this situation, I want you to know that your feelings are valid. Supporting your transgender child doesn't mean you can't also process your own experience. In fact, getting support for yourself—whether through individual therapy, parent support groups, or connecting with other families going through this—allows you to show up more fully for your kid.
Creating an Affirming Home Environment
The research is clear: transgender youth with supportive families have significantly better mental health outcomes. But what does "supportive" actually mean in practice? It starts with the basics—using your child's chosen name and pronouns consistently, even when it takes effort and practice. It means educating yourself about gender identity so your child doesn't have to be your teacher. It involves creating a home where their identity is celebrated, not questioned.
I work with parents to navigate these practical steps while also processing the emotional complexity of their child's transition. We might explore questions like: How do I talk to extended family about this? What do I say to the school? How do I handle my own grief while being supportive? How do I protect my child from discrimination while also giving them age-appropriate independence?
Navigating Social Transition and School Support
Social transition—changing names, pronouns, clothing, hairstyles—is a huge part of many young people's journeys. Schools play a critical role in this, and working with educators and administrators to create a safe, inclusive environment is essential. I help families develop plans for how to introduce new pronouns to classmates, what to do about bathrooms and sports teams, and how to address bullying or discrimination if it occurs.
For the young person themselves, therapy provides a space to process all the feelings that come with social transition. Excitement and relief often mix with anxiety about peer reactions or feeling different from friends. We work through these emotions using age-appropriate approaches, often incorporating art therapy or other creative methods that resonate with teens.
When Your Partner Transitions: A Journey You're On Together
If your partner is transitioning or has recently come out as transgender, you're navigating something profound—not just their journey, but your own. Maybe you're a thirty-six-year-old woman whose husband just came out as trans right after you got a positive pregnancy test. Or perhaps you're processing the end of your engagement after your partner came out as trans-femme. These moments bring up layers of emotion that deserve space and support.
I've seen how partners of transgender individuals are often expected to be endlessly supportive while their own feelings take a backseat. But here's the truth: you can deeply love and support your partner while also processing grief, confusion, or uncertainty about what their transition means for you and your relationship. Both things can be true simultaneously.
Processing Your Own Experience
In our work together, I help partners explore questions like: What does my partner's transition mean for my sexual orientation? How do I handle questions from family and friends? What if our physical intimacy changes in ways I'm not sure about? Am I allowed to feel sad about losing the person I thought I married, even while celebrating who they're becoming?
These aren't easy questions, and there are no one-size-fits-all answers. I use a psychodynamic approach to explore how your partner's transition might be bringing up deeper questions about your own identity, your desires, and your vision for the future. We create space for all your feelings—even the complicated, contradictory ones.
Navigating Intimacy and Relationship Shifts
Intimacy often shifts during transition. Hormone therapy can affect libido, physical responses, and how you both experience pleasure. What felt familiar in your sexual relationship might need to be reimagined entirely. This requires open, honest communication that can feel vulnerable and scary.
I help trans spouses and partners navigate these conversations. How do you express your needs while also honoring your partner's journey? What does it mean to redefine intimacy together? How do you stay connected emotionally even when physical intimacy is changing? These discussions happen at whatever pace feels right for you, with attention to maintaining respect and care for both partners.
Building Your Own Support Network
One of the most important things I emphasize with partners is that you need your own support system. This might mean connecting with other partners of trans individuals through support groups, finding LGBTQ+-affirming friends who understand what you're going through, or engaging in individual therapy separate from couples work.
Taking care of yourself isn't selfish—it's what allows you to be present and supportive in your relationship. In our sessions, we identify what support looks like for you specifically. Maybe it's weekly therapy, joining a peer support group, maintaining your own hobbies and friendships, or all of the above. Your wellbeing matters just as much as your partner's.
The Complex Relationship Between Eating Disorders and Gender Identity
Traditional eating disorder recovery narratives tend to assume everyone's experience fits a certain mold—usually centered on cisgender women and diet culture. But for trans and non-binary folks, the relationship between bodies, food, and identity is often far more layered.
I've worked with trans-feminine clients who developed restrictive eating patterns hoping to appear more "feminine," trans-masculine individuals who used food restriction to suppress menstruation or chest development, and non-binary folks whose eating disorders were tied to wanting a body that felt less gendered. In each case, the eating disorder served a purpose related to managing gender dysphoria, even if it was ultimately harmful.
Distinguishing Between Affirmation and Disorder
Here's where things get delicate: some body changes are affirming and healthy parts of gender transition, while others are rooted in eating disorder behaviors that cause real harm. Hormone therapy that leads to fat redistribution is different from restricting food to achieve an unhealthy weight. Chest binding as part of gender expression is different from compulsive exercise to the point of injury.
My role is to help you develop the internal clarity to tell the difference. We explore the motivations behind different behaviors, the impact they're having on your physical and mental health, and whether they're truly serving your authentic self or if they're coping mechanisms that need to be addressed differently.
A Recovery Approach That Honors Your Identity
Recovery from an eating disorder when you're also navigating gender identity requires an approach that honors both experiences. I don't use cookie-cutter treatment plans. Instead, I work with you to develop a recovery path that affirms your gender while also healing your relationship with food and your body.
This might involve art therapy to express complex feelings about your body that are hard to put into words. We might use Internal Family Systems to understand the different parts of you that have conflicting needs—the part that wants recovery, the part that's terrified of weight changes, the part that feels safest in control. Or we might explore through psychodynamic work how early experiences with your body and gender shaped your current relationship with food.
Throughout this process, I recognize that your body will change in various ways—through recovery, through transition if that's your path, through aging. My goal is to help you develop a compassionate relationship with your body through all these changes, honoring it as the home of your authentic self.
What to Expect When Working With Me
I know that reaching out for therapy can feel vulnerable, especially when you've had negative experiences with providers before or when you're dealing with sensitive issues around identity, eating, or relationships. I want to be transparent about what working together actually looks like.
Starting With a Free Consultation
I offer a 20-minute free phone consultation because I believe it's important for you to get a sense of who I am and how I work before committing to therapy. During this call, we'll talk about what's bringing you to therapy right now, what you're hoping to get out of it, and whether my approach feels like a good fit. This is also your chance to ask me anything—about my experience with specific issues, my therapeutic style, or practical questions about scheduling.
If we decide to move forward, I'll send you information to set up your client portal and complete intake paperwork before our first session. This gives me some background so we can use our time together efficiently.
The First Session and Beyond
In that first session, I want to understand your full story. What's happening in your life right now that led you to reach out? What are you hoping will change? What motivates you toward growth or healing? I'll ask questions about your history—your experiences with gender identity, any history of disordered eating, trauma you've experienced, and the support systems you have in place.
I'll also be transparent about my approach and what you can expect. I use modalities like art therapy, Internal Family Systems, psychodynamic therapy, and for clients with OCD, Exposure and Response Prevention. These aren't just techniques I apply generically—they're tools I adapt to your specific needs and experiences.
After the initial sessions, I meet with clients weekly for one-hour therapy sessions. We choose a designated day and time that becomes your regular slot, creating consistency and reliability in your week. Some clients choose to meet more frequently or for longer sessions, and we can adjust based on what serves your healing best.
Beyond the Therapy Room
Depending on what we're working on, I might send journal prompts between sessions to help you continue processing between our meetings. If we're doing Exposure and Response Prevention for OCD, there's weekly homework that involves monitoring obsessive thoughts and compulsions and practicing exposure exercises while resisting compulsions. This between-session work is collaborative—I'm not assigning homework for the sake of it, but rather supporting practices that deepen your growth.
Building Connection and Community in Philadelphia
While individual therapy is powerful, I also believe deeply in the importance of community. Being part of something larger than yourself—whether that's a support group, a creative community, or simply having friends who share aspects of your identity—can be profoundly healing.
Philadelphia has a vibrant LGBTQ+ community with resources ranging from the William Way LGBT Community Center to various support groups, social organizations, and advocacy groups. I often help clients connect with these resources as part of their broader support network.
For some clients, group therapy becomes an important part of their healing. There's something uniquely powerful about being witnessed by others who understand your experience, sharing your story in a supportive environment, and learning from others' journeys. Group work can complement individual therapy by providing additional perspectives and reducing the isolation that many LGBTQ+ folks experience.
The Power of Peer Support
Whether through formal support groups or informal community connections, peer support offers validation that's hard to find elsewhere. When you're going through something difficult—coming out, transitioning, recovering from an eating disorder, supporting a transitioning partner—being around others who truly get it can make all the difference.
I encourage clients to seek out these connections while also respecting that not everyone feels comfortable in group settings. Some people thrive with lots of social support, while others prefer more intimate, one-on-one connections. There's no right way to build community—it's about finding what feels authentic and supportive for you.
Moving Forward with Authenticity and Compassion
Whether you're exploring your gender identity, healing from an eating disorder, supporting a partner through transition, parenting a transgender teen, or navigating any combination of these experiences, I want you to know that affirming, knowledgeable support exists. You don't have to settle for therapists who don't quite get it or who make you feel like you have to explain yourself constantly.
My approach is grounded in the belief that you are the expert on your own experience. My role isn't to tell you who you are or what choices to make. Instead, I offer a safe, affirming space where you can explore the hard questions, process complex emotions, and develop the clarity and self-trust to live authentically.
As a queer-identified therapist with advanced training in both eating disorders and gender-affirming care, working at the intersection of these identities isn't just my specialty—it's deeply personal. I'm committed to creating a therapeutic relationship that honors all of who you are, recognizes the unique challenges you face, and supports you in building a life that feels genuinely yours.
If you're in Philadelphia and looking for therapy that truly understands the complexity of navigating LGBTQ+ identity, gender transition, eating disorder recovery, or any combination of these journeys, I invite you to reach out. You can book a free 20-minute phone consultation through my website to see if we might be a good fit. You deserve care that sees you fully and supports you exactly as you are.
Ruberti Counseling Services provides individual therapy and group therapy for LGBTQ+ individuals, transgender and gender-diverse people, queer and trans teens, and partners of transitioning individuals in Philadelphia, PA. Specialties include eating disorders, gender-affirming care, anxiety, trauma, and OCD using art therapy, Internal Family Systems, psychodynamic therapy, and Exposure and Response Prevention.