It’s an understatement to say that transgender and nonbinary people need access to therapy. Because of the widespread oppression they face — including experiencing higher risk of harassment, violence, homelessness, as well as their need to navigate discriminatory healthcare systems to access gender-affirming care — trans people experience mental illness at significantly higher rates than the general population. According to a 2019 report published by the Centre for Suicide Prevention, trans folks are twice as likely to think about and attempt suicide than their LGB counterparts.
Many trans and nonbinary folks aren’t able to pursue therapy in the first place, due to barriers like cost, location, insurance coverage, and stigma, among others. But many of those who do have access find it difficult to come by providers who can treat them with skill and compassion, due in part to a lack of trans-related training and education for therapists. “Schools offer minimal training on gay and lesbian issues and generally none whatsoever on trans issues,” Laura A. Jacobs, a genderqueer psychotherapist and member of the Manhattan Alternative Wellness Collective, writes to them. “Anyone can post ‘I work with trans people’ on their website.”
In order to tackle these barriers, therapists who are trans-inclusive and trans or nonbinary themselves have begun to create their own resources to make themselves more easily identifiable. In the past few years, nationwide networks including MyTransHealth and the National Queer and Trans Therapists of Color Network have sprung up. In addition, providers on Psychology Today are able to specifically note that they’re “trans-allied” to indicate their experience with trans issues. Jacobs confirms that there are some options for nonbinary clients in “more metropolitan and progressive areas,” but “[trans] communities still need so much more than is available.”
I talked with seven trans and nonbinary people to hear about their personal experiences and specific obstacles when trying to obtain sufficient mental healthcare. The overwhelming majority expressed that they’ve felt alienated from their providers, even if these professionals claim that they're able to deal with “LGBTQ+ issues.” Many say that they’ve been misgendered, invalidated, and discouraged from transitioning medically. Others say that they’ve had educate their own providers on certain nuances and terminology related to gender identity. And some of them speak to the added complication of needing a therapist who can also help them with issues related to race and trauma. Here are their experiences, in their own words.
Leah (she/her), 25, New York
I saw a therapist for around four years. I chose her in part because her website explicitly listed LGBTQ+ issues and gender identity as areas of specialization. At first, she was really supportive when I talked about playing with my gender presentation. But when we started engaging with the possibility that my gender itself was at stake, she was a lot less affirming. The first time I seriously brought up pursuing transition, she tried to redirect the discussion. She told me that I should be cautious about transitioning because trans people have a higher risk of suicide. During my time seeing her, I was coming to terms with surviving domestic violence, and I think she thought my desire to transition came out of that experience, while I see it the other way — that I was a target for that abuse because of the ambivalence I felt towards my body and my gender. Eventually, I stopped talking to her about transition or gender identity entirely. I made all of those decisions on coming out, starting electrolysis, and taking hormones independently of her. When I started transitioning medically, I stopped seeing her.