Yes, You Will Work with Trans or Non Binary Clients and Their Loved Ones at Some Point: What Therapists Need to Know  

Just like most people entering therapy, trans, non binary, and many more non cis folx are not only entering therapy to address and/or explore gender/identity. We are often looking to build coping skills, learn to regulate, unlearn internalized harmful messages, stop self-gaslighting, find the power we possess within, differentiate between systematic oppression versus self-blame, and so much more. 

Like most other people, as trans, non binary, and many more non cis identities folx enter into therapy, we are often seeking someone to help us understand ourselves. However, we often lack the awareness that the person providing us care may not have the ability to provide this type of support, due to the lack of competent training that mental health providers have access to in unlearning our internalized transphobia.  

Oftentimes therapists have the mentality that they are safe for all people despite race, color, abilities, class, and so much more. This mentality can be harmful when, as professionals, our privilege prevents us from creating a safer space for others.  

We ALL—including trans, non binary people—have internalized transphobia, since we absorb the messaging of the society in which we live. 

We all constantly engage in micro/macroaggressions, and the majority of the time we are not aware of the harm that it is causing. In fact, when we exist in a mentality that we are a safe person, that is the moment that we are certainly a person who is causing harm because our privilege and ego prevent us from being aware that we are causing harm. 

A couple of years ago, I wrote a short article, Navigating Mental Health As A Trans & Non Binary Person, addressing the ways in which traversing the mental health field as a trans, non binary, and many more non cis identities person can be incredibly difficult.  

Rather than repeating information that is there, click on the link to read/access the information. Once you have read the article, please circle back to continue reading the rest of this one.  

Here are some things you can do as a therapist when working with trans and non binary and many more non cis identities clients:

1. Trust the client who is trusting you enough to share or not share.
    
2. Believe our realities as people and do not question them. Do not question our realities as people by saying things along the lines of, “Are you sure that is what this person meant?” Rather, believe what we are sharing with you. 
   
   
3. Remember that oftentimes there is no solution and trying to find or help us find a solution is not always viable. Instead, holding that space of pain, fear, anger, and so much more is what is healing. 
   
   For instance, I, as a non binary person whose pronouns are “they,” in English, and “elle,” in Spanish, will always be misgendered—on the phone, in the store, at a restaurant—no matter where I go. 
   
   Holding that pain, suffering, anger, and much more, is what is going to be affirming and create a safer space for me. Attempting to find a solution and/or challenging an experience that a mental health provider may label as a “cognitive distortion,” on the other hand, is painful and harmful. My cognitions are not “distortions,” my realities are real, and I have every right to feel any and all emotions every time it happens, even with the knowledge that it will always happen.
   
   
4. Do your own internal work to address the anxiety, discomfort, and much more, that comes up when engaging with a client who you may feel “had no solutions,” “is unwilling to accept,” or “change thought patterns,” “is someone who has another crisis of the week,” or so many other harmful labels that are given that are the antithesis of empathy.
   
   
5. Know that that we as therapists really know nothing, even within what we know It is our clients who will always know what is best for them. Even if we are not able to be aware of how the person’s understandings and/or engagements are what is best for the client, know that that person is the one who knows. 
   
   
6. Know that trans, non binary, and many more non cis folx may regularly experience suicidal ideations, sometimes even on a daily basis. This does not mean that a therapist needs to jump to a 5150 or institutionalization, which can add more trauma and harm especially for folx who have been historically marginalized. 

Instead, safety plan.  

Safety plans are more than just who to call. They are about what creates safety for the person. This can look like finding beverages that are comforting to the person, safer people, safer clothes, safer spaces, comforting temperatures, supportive textures, or regulating noises. Lean into the sense that tends to be soothing for the client, and expand on that to have a working list that the person can take to utilize. 

Base the safety plan on what the person has shared, not on what you perceive is best for the person.  

That includes things with which you may not agree, like smoking pot, masturbating, engaging in an orgy, and/or other forms in which the person consistently finds comfort and safety, does not worsen their experience, and does not create non-consensual harm for others. 

Therapy is not about inserting ourselves and beliefs into the experiences of others. Therapy is about meeting clients where they are at and providing a safer and consistent landing space. The more we take ourselves, our assumptions, and our “knowledge” out of the equation, the more we can truly be that space.

Van Ethan Levy, MA, LMFT, LPCC, (they) (elle), a trans and non-binary therapist, is a queer, non binary, trans, socialized as female, nBPOC (not Black Person of Color), who is autistic, and has dynamic disabilities amongst many more historically excluded identities. Van provides consultations and trainings on trans and non binary identities, is the organizer of the upcoming 2022 Virtual International Do Something: Identity(ies) Conference, authored the interactive book, Exploring My Identity(ies), and produced the Documentary, Do Something: Trans & Non Binary Identities, Website: VanEthanLevy.com