So You Wanna Find a Therapist: Choosing a Trans-Affirming Provider

Many transgender and non-binary people seek out therapy to support them in resolving past trauma, improving relationships, addressing symptoms of anxiety or depression, and exploring issues related to gender identity and expression. Unfortunately, trans people may find some therapists to be ill-equipped to address their concerns, and end up discontinuing treatment after attending just a few sessions. This is a common problem for transgender, non-binary and GNC individuals seeking mental health treatment; one study concluded that these negative outcomes are most often the result of limited provider knowledge regarding gender identity and related concerns (Rachlin, 2002). According to another recent study, many transgender individuals who seek out psychotherapy feel discouraged by the need to educate the provider on trans issues (education burdening), the therapist’s avoidance of speaking about gender (gender avoidance), or the seeming focus on “correcting” their gender identity (gender repairing) (Mizock & Lundquist, 2015). Many trans people have had negative prior experiences when accessing medical and mental health care, and finding a therapist can feel like a daunting or stressful task.

So, how can you find an affirming therapist or psychiatrist who understands issues of gender identity and how these may interact with other life areas (work, relationships with partners or family members, etc)? Here are a few tips for finding a therapist who is right for you:

1. Use your network. Oftentimes, friends or community members have had positive experiences with competent therapists or medical providers and may have recommendations for you. Online forums or groups may be a good starting point for getting suggestions or referrals.

2. Use websites like Good Therapy and Psychology Today that feature a large database of therapists. Use the advanced or keyword search to narrow things down and then read through therapist profiles. If you are using insurance, be sure to include it in your search parameters. Cross reference therapists’ profiles on these sites by checking reviews (websites like Zocdoc or Healthgrades may come in handy) and visiting their own website so you can make a more informed decision. Does the therapist say explicitly that they have experience working with transgender/non-binary/GNC clients?

3. Ask for a brief phone consultation with the therapist. Most therapists are willing to do phone consults so you can get a sense of their theoretical approach and experience. Have they, now or in the past, sought out specialized supervision or consultation related to working with trans and gender-diverse clients? Do they currently have any trans/GNC/non-binary clients?

4. Schedule an initial appointment. How does it feel to be in the therapist’s office? Did they seem comfortable speaking about issues of gender identity and any other concerns you want to address? Are they open to feedback?

5. Assess “goodness of fit.” If it felt relatively easy to share your concerns with the therapist, they listened empathetically and have experience working with trans clients, you may want to schedule 2-3 more sessions to determine whether it is a good long-term fit.

6. If you need a letter of support to access gender-affirming surgery, ask about this up front – does the therapist have experience in writing letters of this type? What are their policies about the number of visits or length of time in treatment before they feel comfortable writing a letter? Make sure you also request any requirements for letters of support from your surgeon and bring them to your session.

7. Have coverage that doesn’t include mental health benefits, or no insurance coverage? You may be able to explore sliding scale fees with qualified therapists. Many therapists do offer reduced fee sessions, but these may only be offered during less busy times of the day, such as the late morning or early afternoon. Another option might be to see a therapist at an LGBT health center, community clinic, or psychotherapy institute.

8. Still nervous about that first session? Bring a trusted friend or family member with you for the first appointment.

9. If you live in a rural area, consider non-traditional methods such as telehealth (phone or video) sessions. Not all therapists are able to offer this service, but you may be able to make an arrangement that will work for you. If the therapist is too far away or is not accepting new clients, ask for a referral to a trusted colleague. If you feel that you need immediate peer support, Trans Lifeline may be a good resource.

10. Having trouble finding local therapists? If you are under the age of 24, you can talk text, or chat with operators at The Trevor Project, who may be able to help you connect with resources near you. For both youth and adults, call The National Alliance on Mental Illness (NAMI) national helpline, 1800-950-NAMI, or email info@nami.org to request information and resources.

Sometimes finding the right therapist can feel overwhelming and take some time. Doing your research, asking some basic questions, trusting your instincts, and taking some time to get to know potential new therapists can make all the difference in the quality of trans-affirming therapy you receive. Good luck!

At G&STC we understand how hard it can be to find a therapist that works for you. We also understand that you shouldn't have to educate your therapist on basic competency or manage stigma, discrimination or microaggressions in a therapeutic space. Please contact us to schedule an intitial phone consultation and session!

Blog authors all hold positions at the Gender & Sexuality Therapy Center (G&STC). For more information about our therapists and services please contact us. This blog was written by former G&STC therapist Karalyn Violeta, LCSW.