What to Expect in Your First Gender-Affirming Therapy Session
Finding a therapist and starting therapy in general can feel scary. Even more so if it’s the first time you’re seeking therapy for help coming out as trans. It’s normal to feel a mix of anxiety and excitement leading up to your first appointment with a gender therapist.
Unfortunately, the mental health field historically and continually serves as gatekeepers to trans folks being validated and given access to gender-affirming care. Thus it’s normal for trans folks to worry about being judged, misunderstood, or invalidated in therapy.
Good gender-affirming therapy is collaborative, supportive, and honors your autonomy.
What “Gender-Affirming” Really Means
Gender-affirming therapy or gender therapy most simply means the therapist brings a non-pathologizing approach and respects your identity and gender expression. You should clearly be able to feel or even be reminded by the therapist that being trans is not a mental disorder. The therapist is there to support you, your wants, and your goals, not to make decisions for you or tell you who you are.
Gender-affirming therapy helps you discover and clarify your identity. It helps you figure out what changes, if any, you want to make in your life to affirm your identity. There isn’t one single way to affirm yourself: your goals for affirmation may or may not involve medical transition.
The First Session Is Mostly About Getting to Know Each Other
Your first gender-affirming therapy session is typically going to be more structured than the following sessions. This appointment is a chance for you and your therapist to get to know more about each other. Typically the first appointment includes:
Reviewing paperwork and consenting to therapy.
Discussing limits of confidentiality and how your information is protected.
Learning more about why you’re seeking therapy at this time and what you’re hoping to get out of therapy.
It’s totally ok and normal to not have everything figured out on your first day of therapy. Feel free to let the therapist know if you need them to slow down, if you want to wait on answering any questions, or if you simply don’t want to answer a question.
What’s important is that you just allow yourself to start sharing with someone supportive.
Here’s a sample of some questions a gender-affirming therapist might ask in the first appointment:
“What brings you in?”
“What feels important for me to know about your identity or experiences?”
“What does support look like for you right now (friends, partners, online community, etc.)? Who is someone you turn to when you’re upset? Who did you turn to when you were a kid?”
“What would make therapy feel safe and useful?”
“What mental health struggles have you had in the past? Do you see any of these as being related to suppressing your gender identity or are they unrelated?”
“What, if anything, has felt exciting with gender?”
“What, if anything, has been stressful or hard when it comes to gender?”
“What are your hopes, goals, or questions about transition (social, legal, medical, or none at all)?”
Clearing Up a Common Concern: Therapy Is Not a Test
You shouldn’t have to prove your identity or be in therapy for a certain length of time in order to be respected and supported by your therapist. Gender therapy is not about proving your identity to your therapist. It’s about learning how to trust and listen to yourself.
Gender therapy feeling like a “test” stems from insurance companies and gender therapists using the WPATH Standards of Care (SOC) criteria to assess someone’s readiness for gender-affirming surgery. However, getting a letter for surgery should still be done collaboratively. The process should respect the fact that trans people deserve bodily autonomy and are capable of making informed health decisions.
The history and context of WPATH make it all too common for trans folks to feel they need to provide the “perfect narrative” about their gender journey. It can also make you feel like you have to present more femme or more masc than what’s authentic for you. The things you feel in response to an unjust system are valid. It’s the system of gatekeeping that’s invalid.
Qualities to Look for in a Gender Therapist
A good trans-affirming therapist is someone who:
Is trauma-informed.
Affirms trans folks in therapy session and also fights for trans liberation and justice. They share their understanding of the injustices trans people face.
If they’re cisgender they acknowledge their identity and the power/privilege it carries.
Knows and shares local resources, such as gender-affirming hair stylists, physicians, and community spaces in Minneapolis or your city.
Validates your feelings and openly recognizes the leap of faith you take in sharing with a therapist.
Asks how you are feeling about therapy and your work together, instead of assuming they know how you feel.
WhatYou Might Want to Ask A Therapist
“What is your experience working with trans and nonbinary clients?”
“Is [what I’m feeling/thinking] normal?”
“How do you handle sharing pronouns or name changes?”
“How do you approach letters for gender-affirming medical/surgical care?”
“How do you advocate for trans and nonbinary people outside of therapy?”
Finding a Good Fit
One of the most important factors for having a good therapy experience is a solid connection with your therapist. The relationship with your therapist should feel respectful, collaborative, affirming, and honor your autonomy. Listen to your gut when you talk with a new therapist for the first time. It’s ok to turn down a therapist or switch therapists if the vibe is off.
What You Might Feel After the Session
After your first appointment with a gender therapist you might feel relief, clarity, or even fatigue. It’s also ok if you leave the session feeling uncertainty. Regardless of any feelings that show up, I hope you acknowledge this milestone: You took the chance to share your gender journey with someone, thereby being less alone to figure it all out. This step alone is a significant and caring step you’ve taken for yourself.
Make sure to show yourself extra gentleness and care leading up to and following your first session. This could mean taking time to rest, journal, do some grounding exercises, or connecting with loved ones.
Closing Thoughts
Trans and nonbinary folks need a safe therapy experience. Coming out and dealing with transphobia is hard enough as it is. You should have a therapist who gets it. You deserve to feel seen and supported as you learn more about yourself and your gender.
If you're looking for gender therapy in Minneapolis and want a therapist specialized in trans mental health, I’m here for you. As a queer and trans-affirming gender therapist in Minneapolis, I offer LGBTQ+ therapy that validates you and supports your mental health. Reach out today to begin.
