Therapy is never “one size fits all.” Just as every single person who comes in to see a therapist has their own unique experiences, ideas, and background, so should every therapy session. And this may come as a surprise, but so should every therapist. We are people too!
Therapists come with our own set of ideas, types of baggage, levels of education, and varieties of experience. But it is our job to create an inclusive, open, welcome, and safe space for everyone who comes through our door or joins our secure, encrypted, HIPAA-compliant, Fort-Knox-level-security video calls.
What is Affirming Therapy?
Affirming therapy goes beyond simply tolerating or even celebrating queer + trans identities and experiences. Affirming therapy centers these identities. To be affirming means we are consistently working to divest ourselves of holding cis-het-mainstream culture as the default, as the basis on which truth is measured, or as an aspiration for everyone.
Affirming therapists are able to help our clients with any issue that brings them to therapy. AND we are able to help our clients work through issues that queer + trans people specifically face, including homophobia, transphobia, heterosexism, cissexism, and more.
A major branch of affirming therapy is gender affirming therapy. Gender affirming therapy prioritizes the social, emotional, physical, and mental needs of people who are:
Exploring or questioning their gender
Experiencing gender dysphoria
Seeking gender-affirming interventions
No longer identifying with their assigned sex at birth
Gender affirming therapy is not meant to diagnose you, give treatment for questions, or assign you a gender. It is designed to support you, center your perspective, provide information, and help you better connect with yourself mentally, emotionally, socially, and physically.
So how do therapists create an affirming practice?
There are many different ways we can educate ourselves on affirmative therapy, from listening to people with lived experience (and compensating them adequately for their labor), to seeking formal training and education, to committing to mentoring from others in the field, to understanding queer communities through our art, media, and culture. There is always room for education and growth in a variety of ways. But there are also some key principles that therapists, can keep in mind while we create a safe and inclusive space of affirming therapy for our LGBTQ+ clients.
By the way, being part of a marginalized or oppressed community doesn’t automatically guarantee that we know what we’re doing. Just like being a therapist doesn’t guarantee it either. It’s everyone’s responsibility to engage in the deliberate practice of active allyship and affirming therapy.
The Key Principles of Affirming Therapy Practice for Queer + Trans Clients
Keep an Open Mind
Having an open mind is the beginning, not the end goal.
This means not making assumptions or premature conclusions, especially when we don’t realize we’re doing it. It is often the thing we think we’re really good at that actually needs attention.
It’s ok to ask our clients questions about what certain words or concepts mean for them. It’s GOOD to ask our client to educate us on their own experience. We need to do this in order to catch our assumptions and actually learn the truth about our client firsthand.
This is different from asking our client to educate us on concepts, or the experiences of people in their community in general. That’s why we have other resources (like the ones mentioned earlier) available to us.
Clients can only share their own stories. They don’t come to therapy to be an educator or activist. They come to therapy to be a client.
How to do this: Practice questioning the meaning rather than the definition of words and concepts. Instead of “What does that mean?” Try, “What does that mean for you?”
This goes not only for each person we serve but also the ideas and meanings within ourselves Notice places where our assumptions were wrong and pay closer attention to those.
Engage in Self-Examination
Humility is the name of the game. No matter how much lived experience, training, or knowledge we have, there is always more room to grow. We are human, remember? Even if we have done tons of research, we can’t personally know everyone’s experience. We’ll need to check our own biases or expectations.
How to do this: Remember those assumptions and personal narratives we figured out above? It’s our obligation as an affirming therapist to dissect those, learn where they come from, and actively work to challenge them.
Liberal allies often start with listing all the assumptions that we proudly challenge. However, we can’t challenge what we don’t realize is there. Non-defensive self-examination is mandatory and ongoing.
Bonus: Looking at ourselves in a constructive and open way will help us bring that energy to our clients as well.
Do Not Assume a Destination
As therapists, we often wield the double-edged sword of pattern-finding. It can be helpful to draw parallels between stories, even between different clients. But it can also work against us when we start picturing the destination too early on.
It can be really easy to assume the endgame of treatment if the journey seems similar. But even if we have past experience with many similar situations, we never know what may be different for that individual person. Building a container where each client can feel seen and heard, no matter their journey, means not coercing our client, even when well-intentioned.
A therapist’s responsibility is to hold our knowledge as foundational groundwork, but we have to let the client build the home that they live in.
How to do this: Remember those questions we agreed to start asking above? Actually listen to the answers. And let the client tell us where they want to go. Don’t feel that we need to be several yards ahead of our client at all times on the therapy journey - we can actually be alongside them, or even let them take the lead.
Prioritize Client Self-Determination
Regardless of what we may be able to see for our client as it’s happening, it is incredibly important to allow space for the client to take the time they need to get where they want to go. If we have a timeline, we have to set it aside for our client and their pace. It is their life and experiences they are sorting through, and that needs to be prioritized.
How to do this: Now that we’ve ensured that the client is deciding the destination, make sure they are also deciding the timeline, and the method of getting there. One way to catch this is to check if we’re getting frustrated or impatient- that’s usually our own shit that we need to work on!
By the way: It might sound like we’re “making the client do all the work,” but we are still guiding them with the knowledge, experience, and foresight that we have. We are able to gently point out times when clients might work against their own interest, engage in self-sabotage, let old patterns our outside messaging get in their way, etc. The key is to balance guidance with encouragement.
Challenge Gender Norms and Definitions
Each of us has our own stories of gender norms and identity. It can be SO easy to focus on our own experience of gender instead of what works best for the client. Separate our own experiences not only from their gender meanings but from the meaning assigned to them by others. We can help our clients by giving them the language to narrate their own experience of gender. We can build a protective space to help people externalize messages that have been passed on to them.
How to do this: One exercise I like to do with partners, parents, families, groups, or individuals, is have people list stereotypical gender norms. (Just go with it.) These lists start out really polite, but soon get very long and ridiculous.
And then I ask people to pick out the ones they identify with. Often there are VERY FEW that actually apply - to any of us. This goes for cis people, nonbinary people, trans people, and people somewhere in between. Challenging gender roles becomes easier when it becomes more specific.
Do Not Assume “Passing” is the Ultimate Goal
“Passing” refers to someone being perceived as their true gender, whether or not it was their gender assigned at birth. Sometimes cis-passing means being perceived as cisgender, whether or not someone is.
For some people, particularly some binary trans people, passing is very important, both personally and socially. It certainly affords privileges to avoid (while also reinforcing) cissexism.
But it’s by no means the ultimate goal for everyone. Many people embrace their transness, take pride in this aspect of their identity, and don’t wish to be (or be seen as) cisgender.
A therapist who treats trans identity AND the journey of transition (two separate things) as a “point A to point B” process will miss out on individual nuance and potentially harm their client. This ignores each of the principles discussed above.
How to do this: Do not assume passing is the ultimate goal and don’t treat therapy as a race to the finish line. Recognize that the finish line looks different for everyone. Our job isn’t to get our client to fit in with the world and feel “done” with their identity. Our job is to help our client find comfort and acceptance in the exploration.
The problem with “passing.”
Cis-passing continues to center cisgender identities. It makes cisgender the basis against which identities are measured, which reinforces both cissexism and transphobia. It puts people into boxes.
However, passing is also important and meaningful for many people.
For some, being put into those boxes feels like safety. But for others, it feels like a trap.
Be an advocate
If we want to create safety for trans and nonbinary communities, we also need to be cheerleaders and advocates for those spaces and clients whenever possible. Not just waiting for a trans person to become our client, or waiting until something personally affects us.
It is the responsibility of the affirming provider to be aware of barriers to resources, mindful of gatekeeping, and willing to advocate for our clients. (Actually, for the communities our clients belong to, even if they are not our clients. )
If we don’t know what obstacles these communities may be facing, we can’t fully understand how to serve, guide and create safety for them. Awareness is important. But so is doing something about it. When we support individual voices, we will be fighting for the collective voice of trans and nonbinary people everywhere.
How to do this: The world already centers binary cisgender experiences. If this is our own experience as a therapist, how would queer + trans clients know we are a safe person? We have to demonstrate it at as many opportunities as we can.
Code switching as an affirmative therapist means we may talk (and therefore think) one way with our trans + nonbinary clients and loved ones, but it becomes another way when we think they’re not around. This only harms and hinders both ourselves and our clients. How will people know we’re “one of the good ones” if we don’t consistently speak up about it and show up every time?
Being an Affirming Therapist isn’t a Part-Time Gig
There are many things to learn and be aware of when it comes to affirming therapy. And it can feel overwhelming. We will have blunders and fear being “cancelled.” But remember, this is a learning process and journey. We owe it to ourselves to take those risks and to accept hard lessons.
Affirming therapy is an incredibly important school of thought that explores safe ways for growth and learning- for both us and our clients. Everyone deserves to be heard, especially those whose identities are often ignored. Therapy will never be one size fits all, but this approach will allow us to create enough space of every size for more people.
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Prospect Therapy is a queer + trans affirming therapy practice based in Long Beach, CA, with a focus on mental health for first-generation, immigrant, and bicultural communities. We continue to provide online therapy for a variety of mental wellness and relationship concerns to clients throughout the state of California. Learn more about how we bring lived experience to our work with LGBTQ+ folks of all ages in our communities by requesting a consultation below.