There is a growing number of trans-identified therapists and psychologists, which I find an exciting development in the profession. Over time, this will lead to a substantial body of literature de-pathologizing trans identity, which will in turn lead the therapy/psychology professions in the direction of being more helpful to trans clients than has traditionally been the case.

A parallel process has been underway around gay/lesbian/bisexual identities since the late 1960s. More openly-gay men, lesbians, and bisexual people began entering the therapy profession, to serve their own. Now, there is an extensive body of professional literature addressing various aspects of living within those communities.

However, “serving one’s own” can have a component of activism to it. If that component is the strongest motivation, then entering the counseling profession might not be the most appropriate outlet. One of the mantras of the therapy profession is, “It’s all about the client.” It’s hard to maintain that focus when approaching the profession from an activist stance. The temptation to jump in and try to “fix things” for the client would be strong, as this would be an activist response. Rather, the therapeutic response is to support the client in “fixing things” for themselves. The desired outcome of a therapeutic relationship is that the therapist becomes unnecessary for that client.

It would seem logical that a trans-identified client would automatically work best with a trans-identified therapist, but I don’t believe that’s the case. It’s been my experience that the trans or cisgender identity of the therapist matters less than whether they’ve done sufficiently deep work around their own gender identity and relationship to others’ gender. I’ve met a few trans therapists I would never refer trans clients to, as well as cisgender therapists I would never refer any client to. And the reverse is true: I’ve met trans and cisgender therapists alike I would definitely refer trans clients to.

One of the most critical differences between someone I’d refer a client to and someone I would not is this: Can the therapist tell the difference, in the moment, when their reaction to a client’s statement is based in their own personal “stuff,” or is it a genuine reaction to the client’s story? This is a boundary issue, and especially important when the therapist’s identity is similar to the client’s (as in, both trans). It’s all the more likely that something in a client’s story will “trigger” their therapist in some way; it’s not helpful to the client if the therapist doesn’t recognize this is what’s happened, and put their reaction on the shelf. (Again: “It’s all about the client”) It’s hard to do in the moment, as it requires being fully present at all times, but it’s an essential therapist skill.

There are two main reasons why trans-identified clients might believe a trans-identified therapist would automatically be better — they don’t want to feel they’re paying to educate their therapist, and they feel a trans therapist will understand their issues on a more visceral level than a cisgender person can. That’s why I provide consultation and continuing education training for therapists. I can’t work with every client, and it will always be the case that most therapists will be cisgender. But they have gender identities, too; the work they need to do is similar to Euro-American people coming to understand and feel their white privilege at work. I’ve met some cisgender therapists who “get it” around trans issues better than some of the trans therapists I’ve met, who were so closely attuned to their own transition processes, it was hard for them to develop rapport with those whose paths were very different from their own.

The bottom line is, you may find yourself better served by a cisgender therapist you have a great rapport with, and who has that boundary skill, than a trans therapist you either don’t have a great rapport with, or one whose boundaries are “mushy.”

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