The importance of a trans-friendly therapist

Transgender people (also referred to as trans people) face high levels of marginalization and stigma within our society. Members of the lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) community are more likely to experience mental health challenges, so access to a safe, healing space for them to engage in therapy is important. 

Mental health concerns within the LGBTQIA+ community

It is important to note that being a member of the LGBTQIA+ community is not a mental health condition. However, LGBTQIA+ people may be more likely to experience mental health conditions, a fact likely explained by the minority stress theory. 

Minority stress is the high levels of stress experienced by members of minority groups due to the stigma they face from society as a whole. This can result in prejudice, discrimination, fewer economic and educational opportunities, poor social support, harassment, maltreatment, victimization, and lower socioeconomic status. Though minority stress theory has historically been associated with sexual minorities such as LGBTQIA+ people, it can also apply to racial or gender minorities, people with disabilities, or anyone who is part of a marginalized group. 

LGBTQIA+ people, including trans people, may be more likely to experience mental health conditions, not because of who they are but because of how society might treat them.

For example, transgender people report high instances of abuse, bullying, marginalization, stereotypical expectations, harassment, and violence. Trans and non-binary people are also more likely to experience poverty, homelessness, and related traumas and stressors, which in turn can increase the likelihood of developing mental health conditions. These mental health conditions may include:

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

• Mood disorders such as anxiety, depression, or bipolar disorder
• Substance use disorders
• Eating disorders such as anorexia or bulimia
• Self-harming behaviors such as cutting, burning, or engaging in other repetitive self-destructive behavior
• Post-traumatic stress disorder

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Members of the transgender community might live with gender dysphoria, which is the sense that one’s gender identity does not align with their biological sex. Gender dysphoria is not a mental health condition, but it can have mental health challenges associated with it. One study showed that people experiencing gender dysphoria were three to four times as likely to participate in self-harming behaviors.

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Aspects of LGBTQIA+ affirming therapy

You may be wondering how a trans-friendly therapist can help support a transgender client. It can be beneficial to understand exactly what LGBTQIA+ affirming therapy looks like and ways such therapy can make a difference for trans people.

LGBTQIA+ affirming therapy is a form of affirmative therapy, which means that it accepts the individual’s identity and is not meant to change any aspect of the person. Trans-affirming therapists often have specific training in mental health challenges commonly experienced by the transgender community. Thus, they can be competent care providers with the knowledge, tools, and skills needed to support trans people. 

These therapists may better understand how homophobia, transphobia, and heterosexism all intersect to affect transgender people’s daily lives and mental health. Their enhanced understanding of trans-related trauma (as well as the shame many transgender people may be made to feel) can help them take a trauma-informed approach that could enhance the therapeutic relationship.

It is not necessary for a therapist to be transgender, non-binary, or a member of the larger LGBTQIA+ community in order to practice trans-affirming therapy. However, some transgender people may prefer a therapist who shares this identity.  

How to find a trans-friendly therapist

Although a therapist may describe themselves as gender-affirming or trans-friendly on their profile or website, it may be important to confirm this before you seek care from them. It can be helpful to ask a therapist you are considering as a care provider if you can have a brief conversation with them to ask certain questions. Some examples are listed below. 

Questions to ask a gender-affirming care provider

• What is your overall approach to therapy? 
• Can you tell me more about what your therapeutic approach entails?
• What are your belief systems related to the LGBTQIA+ community?
• Do you have any specific training related to working with members of the LGBTQIA+ community or gender-diverse populations?
• How long have you been working with trans people or members of the LGBTQIA+ community? 
• How would you describe your experience working with trans people or members of the LGBTQIA community?
• What identities do you hold?
• How do your identities inform your work?

Many therapists are accustomed to answering these kinds of questions. If you feel as though the therapist has a solid background in providing support for trans people, you may wish to schedule a few initial therapy sessions to gauge how the two of you can build a relationship. 

Finding a trans-friendly therapist can be a complicated process. You may not be able to find a person in your local area whom you feel comfortable with. If this is the case, you may want to consider online therapy options. Online therapy through services such as BetterHelp can widen your pool of potential therapists. Plus, many online therapy services allow you to share important information during the sign-up process, such as whether you would prefer a therapist who is a member of the LGBTQIA+ community or someone with specific training in working with those populations. 

Research has shown that online gender-affirming therapy may be as effective as traditional in-person therapy. One study found that online therapy helped to reduce symptoms of mental health conditions specifically related to minority stress experienced by lesbian, gay, bisexual, transgender, or queer people. If you are having difficulty finding a trans-friendly therapist or wish to experience the convenience of therapy in your own home, online therapy may be a good option for you.