According to July data from the Census Bureau, symptoms of anxiety and depression have been found to be much more prevalent in 2020, during the pandemic, than they were in 2019—and, really, that’s not so surprising. Between the existential threat posed by the pandemic itself and its many unsavory implications including lack of financial security and loneliness from time spent in isolation, it does make sense that mental health quality may suffer. But, even under regular circumstances, the National Alliance on Mental Illness (NAMI) estimates that one in five adults in the U.S. experiences a mental illness each year. These harrowing statistics show that now and always, access to mental health care is essential—but for many, access isn’t enough.
Therapy is an incredible tool for navigating and managing our emotions, relationships, and feeling empowered rather than controlled by stressors of life. That is, however, so long as good, affordable therapists are available. For trans and nonbinary people like me, though, finding a gender-affirming therapist who is supportive of clients’ identities and experiences can be tough. “Historically, the mental health and health field has been a huge place of discrimination for queer folks. And, sadly, that’s still the case,” Rena McDaniel, licensed clinical counselor, previously told Well+Good.
Why it’s so important for trans and nonbinary people to receive mental health care
The need for mental health care is crucial for trans and nonbinary people, who—in connection to the prevalence of gender minority stress—are particularly at risk for depression, anxiety, and suicide. According to licensed clinical psychologist, ks Stanley, PsyD, gender minority stress is the combined effect of:
- A social environment that stigmatizes trans people via discrimination, prejudice, and non-affirmation
- The internalization of transphobic attitudes a person may harbor toward themselves.
- Non-disclosure of identity to others
- The experience of being misgendered
- Anticipatory anxiety about future gender-based victimization or rejection
- Feeling the need to defend personal identity, value, and legitimacy as a transgender or nonbinary person
Not only do trans and nonbinary people experience these harmful factors on a regular if not daily basis, but we also may have fewer people in our lives who accept and understand us fully. But, we still deserve and need spaces for emotional healing and coping where we feel safe, celebrated, and supported.
8 strategies for finding a gender-affirming therapist
While it’s not easy to find a gender-affirming therapist, in recent years, I’ve found—based on personal experience—increased accessibility to and availability of therapists who are educated on and sensitive to the unique needs of the transgender community. Those forward-moving strides are heartening when going about a search for a gender-affirming therapist. Some places to start your search include the following eight resources and strategies.
The World Professional Association of Transgender Health (WPATH) offers a global directory of gender-affirming health-care providers, including mental-health practitioners.
By first asking for your location and your specific needs, this service helps to match you with a therapist. If you choose to do so, you can specify how you identify (including as a trans man, trans woman, or nonbinary) and can include “identity” as a topic you’d like to discuss in therapy. This specificity can help ensure you are matched with a gender-affirming therapist.
3. Doctor recommendations
If you your primary-care provider is gender-affirming, ask if they have recommendations for a gender-affirming therapist, support groups, or group-therapy offerings.
4. Local LGBTQ Centers
Reach out to local LGBTQ+ health or community centers to see if they offer mental health care or have a directory of gender-affirming therapists in the area.
5. Peer recommendations
Try asking for recommendations from other trans or nonbinary people by posting in a local queer Facebook group or by polling your personal network.
The National Queer and Trans Therapists of Color Network (NQTTCN) is a healing-justice organization that prioritizes the mental health of queer, trans, people of color (QTPOC). The organization features a mental-health provider directory than can help connect people with a gender-affirming therapist.
Psychology Today listings are searchable by the ‘Transgender’ keyword, which can yield both therapists who identify as trans or nonbinary themselves and therapists who identify as trans- and gender-affirming.
This is another resource with a provider listing directory that’s inclusive of therapists who have a broad range of care training for LGBTQ+ identities.
While the number of directories available online and overarching destigmatization of seeking mental health services in recent years have increased both availability and accessibility, insurance issues may well still exist. If this is the case for you, consider consulting the the National Center for Transgender Equality for resources to help you navigating the process.
How to know if a gender-affirming therapist is authentic
Words are great, but how can you be sure that a therapist isn’t just hollowly slapping “trans-affirming,” “gender-affirming,” or “trans-inclusive” on their online listing without having any real experience or training in transgender and nonbinary communities? The sad answer is that you can’t, so being prepared to do some more digging, and potentially even interviewing the therapist is important.
An easy first step I take is to email a potential therapist a new-client inquiry. When I get an email back, I can always tell whether they include their pronouns in their signature, which is a small but promising sign that they are at least LGBTQ+-inclusive, if not gender-affirming.
Next, most mental health-care providers offer a short, free consultation, during which time you can ask questions. This provides you the opportunity to understand their values, training, experience, and therapeutic approach, especially as it relates to gender and trans/nonbinary people. Some questions you may ask during this informational session include:
- What specific training do you have in transgender mental health care?
- How long ago was the training?
- How many transgender and nonbinary clients have you worked with? How long did you work with them?
- Do you have any client testimonials?
- Do you offer letters for name changes and other forms of gender-affirming care?
- Do you have a favorite transgender icons?
How they answer these questions can provide some indication of whether they are qualified to work with clients in the transgender community. That said, this isn’t a perfect science; a provider can have one rigid idea of what the “trans experience” looks like or still perpetuate cis-heteronormativity despite providing answers that sit well with you from a gender-affirming point of view. Because of this, even if the informational session goes well, I’ve found that it’s best not to get too attached to a therapist very early on and not be afraid to move on to another therapist if you find that yours is not fulfilling your needs.
That’s because finding a gender-affirming therapist who is helpful not hurtful is ultimately the goal. This professional can help us navigate our mental health and relationships, and integrate how they intersect with our gender identity and experience. They can prompt fruitful experiences of self-exploration, gender expression, growth, confidence, and resilience—or, at the very least, help us get through another day feeling as strong as we are.
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