How I work with trans clients
When trans people contact me for an initial consultation, they often want to know whether I’ve worked with other trans clients. It’s understandable; many have had poor experiences with other therapists or heard stories of how other trans people have been misunderstood in therapy. So I want to set out how I work with trans clients.
There is a lot of misunderstanding around what it means to be trans. Not only in the media, where the row over single-sex spaces has seen trans men in particular conflated with sexual predators; but also in the therapy room, where gender dysphoria may be seen as an unconscious reaction to childhood abuse, disability, past sexual experiences, etc. That approach pathologises being trans, positioning it as something to be fixed. It’s not.
My approach is to accept the trans person and their right to identify their own gender, and to listen to what it means for them to be trans.
For many, being trans is difficult in two main ways. The first is living with a body that doesn’t match the person’s gender identity and does things (menstruating, growing facial hair, etc) that feel really wrong. The second is living in a society where there is a lot of ignorance of, and prejudice towards, being trans. It can feel like every day is a battle on those two fronts.
However, a really important part of therapy with trans people is to remember that being trans is only one part of their life. They also have relationships, work, friends, family, health issues, etc. So the therapy isn’t all about gender dysphoria. We talk about whatever the client wants to talk about, and don’t put all their problems down to being trans.
That said, I am aware of how being trans interacts with all those other issues. Dealing with a health concern is so much harder, for example, if gender dysphoria makes getting undressed in front of others scary. Leaving a stressful job is a much harder decision when interviewing for a replacement job requires explaining your pronouns and anticipating prejudice.
When you have no choice but to deal with ignorance and prejudice every day, you find a way to cope. Sadly, for many people, that is to brush it off and bury the hurt and anger it causes. But those feelings are still there, and can cause problems if they are left buried. So part of my work with trans clients is to provide a safe space for them to talk, when they feel ready, about how painful it is to be misgendered, to receive verbal abuse, to be rejected, to have people ask intrusive questions about how they have sex, and so on.
I’m also aware of the process trans people have to go through to access treatment for gender dysphoria, and how gruelling it can be. Under the NHS, if a trans person wants surgery to bring their body more in line with their gender identity, they have to have socially transitioned for at least a year beforehand. This means living in line with their gender identity rather than their biological sex, without having access to the medical support that could make passing (being accepted as their gender) easier. That makes them particularly vulnerable to prejudice and abuse, which they may have to live with for years waiting for medical treatment. Waiting lists for gender identity clinics were notoriously long even before the pandemic.
There’s an assumption that all trans people want surgery (they don’t) and that once they have surgery, that’s the problem fixed. In the years leading up to surgery, it can be tempting for the trans person themselves to see the operation(s) as the silver bullet. In reality, while surgery may lessen gender dysphoria and make it easier to pass, it doesn’t change everything. The period after surgery, when the trans person comes to terms with that reality, can be very sad. It’s a time when therapy is really beneficial.
I welcome trans clients at any stage of their journey. Whether you are questioning your gender identity, considering transitioning, in the process of it or have been living as your true self for a long time, I would be happy to support you with anything that is troubling you.
If you have any questions, please contact me. And if you would like to book an initial consultation, you can do so here.