What Therapists Need to Know About Working With Transgender Clients

Over the past year, I’ve held a lot of intentional and sacred space for transgender people in therapy groups, individual therapy, personal relationships, energy healing practice, and more. I’ve sat with their meaningful stories as I examine my own life as a trans masculine, non-binary soul in parallel to theirs. 

I’ve heard stories of adversity, triumph, heroism, pain, loss, sadness, and complete euphoria.

I have a natural tendency toward helping others through grief, so I often zero in on the undeniable losses each person faces on their journey toward personal alignment. 

However, my usual tactics didn’t work last year. There was already an overwhelming amount of pain and grief. Some days it felt like we all needed a break from this intensity.

One Thursday night, in the virtual gender therapy group I led, I made a different choice—and the responses taught me important tools that I’ll never forget. 

The Nuances of Therapy with Transgender Clients

Much like all my other therapy groups, my intention when I started this virtual group meeting was to lead self-reflection and meditation.

I asked my clients to center on the feelings they were most present with that day, and I watched as they each went inward to find the words to tell me their stories. I waited. 

One by one, they began to share their present moment with me.

The last person to share said, “I feel euphoric because I have a consultation with an excellent surgeon for top-surgery and Moe already wrote a letter for me, so we can set the date this week!” 

I often hear as many beautiful stories of personal alignments as I do painful ones.

But, for some reason, on this day I wasn’t expecting that response.

As I noticed my surprise, I followed that feeling internally—I really wanted to understand my reaction. I asked myself, “Am I so used to people suffering in therapy that I really wasn’t expecting this moment of joy?” 

I was taken aback by my own reaction of surprise. I lingered on their words for a moment while the rest of the group shared their support and excitement for this client.
When I finally found the words, I realized what was happening for me. “Wow, you’re the first person to say ‘euphoric’ to me in all of my years as a therapist,” I said, with a smile wide enough to see a mile away. “I want us all to spend some time feeling that feeling with you and connecting with the magic of this moment.” 

Emphasizing Celebratory and Affirmative Care

That moment was more meaningful than I could put into words at the time.

As a transgender person and also as a therapist, I long for these moments of euphoria in my life and in other people’s lives. But this moment was as nuanced as it was full. 

This particular client came to me, like so many of my clients do, because their long-term therapist was unable to help them through their gender transition. Therapists often don’t feel as knowledgeable as they would like to about supporting medical transition. That’s why I offer continuing education support to other providers—so they feel confident in their abilities to support medical transition, while also being gender affirming and celebratory. 

It was a great honor to have written the letter in support of this client’s medical transition, and it felt like an even greater honor that they remained open to the therapy process even after they had to stop working with their long-term therapist. Sitting with them in their moment of euphoria, I felt the full circle of my lived experiences coming to the fore. 

I had a similar experience when my long-term therapist was unable to help support my medical transition. In that moment, I felt so disheartened to have to seek support elsewhere. But now, I’m grateful for that experience. It deepened my awareness of the importance and necessity of gender affirming care.

I’ve felt the most euphoria in spaces where I felt extremely visible and affirmed just for being myself—in the spaces I found applause and affirmation just for living. 

What to Know About Working With Transgender Clients 

I didn’t realize euphoria was a feeling I could experience as a transgender person until I participated in groups like this one, led by amazing therapists of all genders who were able to bear witness for me.

There are many things I wish for other therapists to know about supporting transgender clients, but here are just a few that I’ve learned in my journey as a therapist in gender transition alongside my clients.

1. Transgender Clients Will Most Likely Need You to Write a Letter of Support at Some Time

Therapists are unfortunately gatekeepers to the medical transition process and some aspects of the social transition process, like legal gender marker changes.

Most medical aspects of transition can’t be initiated without a therapist referral letter supporting the process. 

This means that you hold sacred space in someone’s journey toward healing and alignment. Take continuing education on writing letters of referral for transgender medical care to make sure you’re fully prepared for this occasion. Never take it lightly when someone asks you to support them on their way to euphoria, and try not to turn them away, unless clinically appropriate. 

2. Gender Identity Is Only One of Many Concerns and Experiences Clients Have to Discuss

The gender alignment process is brief in the course of someone’s life, with lingering effects through the rest of their story.

However, it’s but one small part of the myriad of experiences that make them who they are.

With this in mind, you can always approach working with transgender clients from an integrative space. 

The goal of integration is to help your clients process the new aspects of their identity and align those with their holistic identity. This means that the therapy with transgender clients is no different than work with other clients. 

Most of our work as therapists is helping our clients navigate the transitions of their lives.

Whether our clients are moving from one job to the next, from one city to another, from one relationship to another, we are the bridge to help them find the grounding in their new lives. Trust in your already developed skills as a clinician and feel assured in your ability to help anyone who sits on your couch, especially transgender clients. 

3. You Don’t Have to Be an Expert in Order to Be Competent and Compassionate 

It’s totally okay if you don’t know the perfect things to say or the right ways to be an ally.

This is an opportunity to expand your skills as a clinician.

Your affirmation and support are the majority of the work. It wasn’t my lived experience as a transgender person that made me an expert. It was my dedication to really listening to other people’s narratives, pausing, and really reflecting on my own experiences. You can always do this too. 

Allow yourself to sit with their narratives as you review your own in the context of a society where gender is socially constructed.

Examine your biases, build rapport, listen intently, and allow yourself to learn by being with them, rather than wanting to be an expert.

The truth is, they’re the only ones who can be experts in their lives. You only have to be affirming and celebratory. Then they can feel safe to share the full scope of their experience—including their euphoria—with you.

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