Gender Identity Issues in Therapy

What sort of gender identity issues might bring you into therapy? You might feel like your gender expression is different than what others around you have expected. You may feel like you were born the wrong sex/gender. You may identify as transgender or transsexual and want a therapist who already gets what that means. You might want to explore psychological and medical options for changing your sex/gender. Or you might want a place to talk about what it means to be gender non-conforming or variant in a culture that sees gender as only a binary (feminine women and masculine men).

Transgender (or sometimes shortened to Trans) is an umbrella term that can be used to refer to a continuum of identities that do not conform to the gender role expectations of their biological or assigned at birth sex.  Some children express themselves in ways that are traditionally masculine or feminine,  while others may be gender non-conforming (think of children who get labeled as tomboys or "sissies") or androgynous.  Most children (regardless of their gender expression) have a gender identity that corresponds with their assigned sex.  For transgender and significantly gender non-conforming children though,  conflict may arise when their sense of who they are doesn't correspond with their own body, or with the gender messages they receive from parents, caregivers, teachers and culture.  I do believe that it is the impact of stigma in a transphobic culture that often creates the problems that may bring transgender people to therapy.  I do not accept the view that gender variance is in itself pathological.

Transgender and gender variant people seek treatment for all the issues people in general do! Additional reasons for seeking therapy may include (but are not limited to):

1. Gender identity questioning: Some liken the process of questioning one's assigned at birth sex/gender to a coming out process of sorts. Where do you start? How do you understand yourself in terms of gender? Who will you tell and how? It may help to have professional support as you question what it means to you to feel gender variant or to experience your sex differently than others around you dictate.

2. Support regarding coping with the impact of societal stigma: therapy can provide a safe space to recover from damage done in the rest of the world. your therapist can also help link you to local support systems and transgender related resources.

3. Gender variance and trauma: Have you experienced job, housing or workplace discrimination due to your gender? Have you been bullied, harassed or physically harmed? Have you experienced abuse or rejection within your family? All of these are traumatic experiences. In addition, some studies suggest that as many as 1 in 2 transgender individuals have experienced some form of sexual assault. You deserve to get help healing from these experiences; a transgender and trauma informed therapist is optimal.

4. Transition planning and education: You may want to discuss, with an informed and understanding professional, how to transition with friends, family and/or in the workplace. You may want to seek information about transitioning options. These include information and support regarding legal steps such as a name change and medical steps such as cross-gender hormone therapy and sex reassignment surgery options. Some doctors require assessment and/or therapy by a qualified therapist prior to starting hormone treatment or surgical procedures. This puts the therapist is a gatekeeper role, a situation that can be uncomfortable for you. Some doctors operate from an informed consent model. My approach is to work with you to meet the requirements necessary for your transition goals. What counts is that you receive the support you need.

5. Post-transitioning issues: You may want to have support on an ongoing basis, as you get used to living in your new sex/gender.

6. Cross dressing issues: Is cross dressing related to your gender identity? Not everyone who cross dresses is transgender. Sorting this out and addressing the role cross dressing plays in your life is a reason some seek therapy.

7.  Significant other, partner and family therapy: Partners/families of transgender people may also seek therapy services for education and support. Parents of gender variant children need information and resources to guide them in supporting their children. You may want to utilize therapy to help you educate your family about your gender and transition plans. As a partner of someone undergoing transition, you may question what this will mean for the relationship or even your own identity.

8. Sexual orientation issues: Some people experiences changes in their sexual orientation upon transitioning. Some fear that they will. As a partner of a transgender person, you may wonder what it means about your own sexual orientation as your partner changes genders.

I have many years of experience with transgender issues and communities. I have walked with many clients through the process of questioning gender, coming out and choosing a transition path that works for them. I have worked with gender variant and gender non-conforming clients who have no wish to medically transition but want a place to address their lives and struggles without having to first educate a therapist. I have provided education and training to organizations and agencies regarding understanding transgender issues and becoming more trans-inclusive.

In addition to office visits, I believe in providing online therapy services because I am keenly aware that not every transgender or gender variant person lives in an area where they can easily access culturally competent therapy. You do not have to deal with these issues alone.