A study conducted by the Trevor Project in 2021 found that over one in four LGBTQ youth identify as non-binary. An additional 20% said they are not sure or questioning whether they identify as non-binary.
If you are a therapist and a client comes out during session, here are a few things to keep in mind:
You do not have to have all of the answers or know all of the “correct” things to say when working with trans or nonbinary youth. The experience of gender identity and exploration is completely unique to each individual client you work with and they are the expert on themselves. The best thing that you can do as a clinician is to stay open-minded, ask the client about their own experiences with gender and what it means to them, and not let fear of saying the wrong thing or not understanding get in the way of being genuinely present with and validating your client’s experience of their gender.
Remember the Iceberg
As a clinician, it can be very easy to fall into the idea that when a client comes out, their gender identity is then the main focus of therapy. It is important to remember, however, that gender is just one piece of a person’s identity and the scope and importance of that piece both in their everyday life and in their therapeutic goals varies widely from person to person.
One great way to think about working with transgender and nonbinary clients is by keeping in mind the idea of gender identity as an iceberg (see image). In the same way that we see only the 10% of an iceberg that is above water, clinicians must be careful not to focus only on the obvious topics and concerns around gender–things like pronouns, social transition, medical transition, coming out etc.
While these are all very important topics to touch on and talk about, it is imperative that we as clinicians don’t overlook some of the other underlying and equally important topics that the client is still dealing with. Our clients may come out as trans or nonbinary and still experience depression, anxiety, trauma, ADHD, academic difficulties, pandemic stress, social stress, and all of the other aspects of being a teenager. Unfortunately, coming out does not negate all of the other factors that could contribute to the myriad of other adolescent mental health struggles.
While gender could be an important topic of focus for some clients, it is not necessarily the main focus for all gender expansive clients. How much a client’s gender impacts their daily life is wholly dependent on the client themselves. There are some clients whose gender and gender dysphoria create significant sources of anxiety and depression for them and their other clients whose gender is just a part of how they identify and the depression and anxiety they experience is completely unrelated to gender. Be careful not to pathologize gender and honor it instead. Someone’s gender and gender exploration is never wrong or bad.
Let your client take the lead
A client-focused approach to therapy allows clients to take the lead in their therapy. If a client wants to use their sessions to talk about gender and transition, it is important to be present with those topics. If a client just came out as nonbinary and is asking you to use they/them pronouns but is more concerned about their physical anxiety symptoms around their AP Physics Exam, then it is important to help them cope with that anxiety. Our clients are the experts in their experiences and it is okay to lean into that when working with them rather than feeling pressure to have “answers”.
Important points to remember.
It’s okay not to know everything! You may be an expert in that you are a trained clinican, but the client is always the expert on themselves and their gender identity.
Trust your clients’ experience–they know what it’s like to be in their brain and in their body.
You’re going to make mistakes and when you do, you can correct them quickly and respectfully without putting pressure on the client to care-take (check out our blog on misgendering do’s and dont’s for more information on misgendering!)
Do your research to stay up to date on gender expansive issues and terminology so that your clients don’t have to spend time teaching out that they would rather spend talking about other things. And be sure to check your sources so that you are getting accurate information.
When in doubt, refer out. While it is important to not shy away from working with certain populations just because you are not used to that work, trust your gut to know when you can’t provide the best care to a client and help them find a provider who can better suit their needs.
Finally, while coming out may relieve some of the mental health symptoms that your client is experiencing it does not magically erase the symptoms or struggles that your clients may be dealing with. Keep looking below the surface so we don’t forget to talk about all the other things going on under the water.
Blog written by Sentier therapist Ashley Groshek, LMFT.