How I work with Gender Dysphoria

When I work with gender dysphoria I dive deep into the world of the client. I help them explore their gender without restriction. The number of people expressing the need for support around their gender is rising. Here are some guiding principles I use in my approach.

• Exploring potential causes of gender dysphoria 
• Providing clients a range of ways to cope with gender dysphoria 
• Supporting clients at various stages of transition 
• Supporting clients who have detransitioned 
• Viewing gender identity as fluid 
• Employing a developmental lens on identity 

I strive to be neutral about outcome and be continually curious about my clients inner experiences. I seek to raise their clients self-understanding, acknowledge the complexity of human experience and the need to explore and consider many options.

We Need More Therapists Willing to Work With Gender

Some people fear that therapy with transgender individuals could run the risk of resembling conversion therapy. This has resulted in many mental health providers avoiding the issue of gender entirely. In my practice I welcome people with gender related distress because I know that even though it’s complicated, we can work towards a better future together. We need more therapists who are willing to work with gender dysphoria.

Many de-transitioners lament that everyone accepted their trans identity at face value, asked them no questions, and assured them transitioning was the best and only option. This creates immense pressure on people suffering from gender dysphoria. When the culture and everyone around is telling them that transitioning is the only way they can be happy they may feel forced down a narrow path that requires serious medical interventions.

Without someone in their life who cares about them, and shares a different perspective many gender questioning people feel trapped. An approach that isn’t open to different outcomes denies the client autonomy, forcing them down a pathway prescribed by the therapist. 

Open to Many Outcomes

I do not make assumptions about my clients based on what they first tell me, and am open to all potential outcomes. We know that gender identity is fluid and can changes over time. Someone who identifies as non-binary may later identify as transgender, and then at a later time cisgender. The fluidity of gender requires me to be flexible.

I must simultaneously hold the clients past, present and future potential identity. This approach arose out of a need, expressed by people who had de-transitioned, for a more careful and patient outlook on gender identity. One that considered many ways of coping with gender dysphoria, and helped clients to reflect on all aspects of themselves and their experiences. This openness is a quality of all good therapy.

Informed Consent

When I work with a client who is transgender I treat them as I would any other client. I start by conducting a mental health assessment, agreeing upon goals, and working step by step with them to achieve those goals. If their goals include working on gender dysphoria I explain my approach so that they can provide informed consent for that process.

If they identify as transgender but don’t identify their gender identity as an area of focus I don’t dwell on it. As I tell my clients ‘you set the destination and drive the car, I’m your co-pilot helping you navigate the landscape’. How I work with gender dysphoria is consistent with my personal ethics, and the ethics of my profession of social work. 

Back to the Basics 

My approach to working with gender seeks to remove politics and ideology from the therapy room and return to simple, effective therapy. I work with gender distress the same way I work with any other issue. I don’t politicize my client. I’m not afraid of my client. I seek to understand and validate their emotions and through dialogue explore where we may travel together. I strive to embrace complexity, challenge, and self-discovery. If you or your family member is struggling with gender distress I’d love to come alongside you in this journey. 

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