What steps can therapists take when treating all genders? 

As the debate around transgender rights in the United States grows more heated, an elevated need for psychological care in this population can be expected to follow.

Beyond respecting pronouns and names, what steps must be taken for therapists to create a safe landing space for clients of all genders?

A basic internet search will bring up preliminary suggestions, like asking for pronouns and gender identity on intake forms; including inclusive artwork or reading materials in the waiting room; integrating inclusive language on every website page; offering gender neutral or single-stall restrooms; and making sure staff is both welcoming and aware of micro-aggressive language, like commenting on appearance or treatment expectations.

Addyson Tucker, Psy.D., a genderqueer psychologist licensed in Rhode Island and Massachusetts, provides therapy for adults who are queer, trans, nonbinary, and “often at the intersections of identities that experience oppression, stigma, and marginalization.”

In addition, the therapist offers consultation, trainings and facilitation for mental health providers, and other professionals to better support these communities.

First, Tucker said, one must recognize the unique position of power between provider and a client who may have difficulty in feeling trust in a mental health or medical system that often dismisses or disparages the needs of trans or nonbinary people.

“It may or may not be about you,” Tucker said. “But, in a role of power, as a therapist, what you say holds a different weight, and that’s not always a good thing.”

For those looking to move beyond “Trans 101,” Tucker recommends a variety of next steps including seeking consultation, education on trans or nonbinary issues, and connections with these populations outside of the therapy room.

Take the time to learn about the appropriate, and constantly evolving, language and the specific issues a transgender or nonbinary person may face in a world that has historically been hostile. Be aware that being trans may not be the reason they are seeking therapy but also that it can affect everything that they experience.

“You can’t always separate trans-ness from what’s going on,” said Tucker. “For example, if you work with substance disorders, but you don’t consider whether the substance use would be alleviated if that person had gender-affirming hormone therapy, then you might be missing something really important.”

The modality recommended can depend entirely on the situation and the client.

“While some modalities are exactly what a client might be searching for, other approaches can cause harm if the therapist is not trans-informed,” said Tucker. “Different approaches provide a variety of benefits, so it truly depends on the needs of the client and the skills and training of the provider.”

It’s an intricate dance, of course, being open to learning while not expecting the client to be responsible for educating the professional, or not causing harm while offering compassionate, personalized care.

It is in understanding that some body-focused work can be harmful for someone experiencing body dysphoria, that re-framing distorted thinking needs to consider how those distortions can be protective, or that not everyone is ready to be open about their gender identity.

For some therapists, a fear of saying or doing the wrong thing can become an issue, pushing them to avoid working with trans clients or to over-apologize for missteps. If an error is made, apologize, work to do better, and move on, experts say. Then address any ongoing biases or feelings of shame with a colleague or in consultation.

Therapists can accept that they do not have all the answers but are open to learning. Grace with oneself goes a long way.

“I don’t know that all providers should be offering specialty care to trans people, but I do know that all providers deserve to feel like they can affirm a human,” said Tucker. “It is universal work. It helps us recognize the humanness in all of us being really diverse in the ways that our brains work and the ways that our bodies are.”