When it comes to gender identity, there’s kind of a lot to unpack. Like a Mary Poppins’-carpetbag amount.
For instance, you may feel like you don’t identify with the gender assigned to you at birth. Or, if you’re cisgender — meaning you do identify with the gender you were assigned at birth — you may still grapple with stereotypes, societal expectations, or other gender-related issues.
“I work with a lot of gender-nonconforming clients,” says Powell Burke, LCSW, a psychotherapist in private practice in Atlanta, Georgia, who specializes in gender therapy or gender topics. “I also see a fair number of gay, lesbian, bisexual, pansexual clients. But I also just work with a lot of cisgender men and women — gay or straight — who don’t necessarily feel like they fit into a gender box.”
Gender therapy is a broad term. It covers any topic you’d like to discuss with a mental health professional surrounding gender.
Burke says he sees clients for a range of reasons, but sessions typically fall into two categories. “The first is they have questions or curiosity about their gender identity,” he says. “But there’s almost always some emotional distress that they’re experiencing around it.”
Someone might have questions about their assigned gender, or what it means to be nonbinary, and they want to explore those questions in a safe environment. Even people who aren’t necessarily questioning their assigned gender can benefit from sessions that explore gender if something is weighing on their mind.
“[Someone] may feel like their temperament, their personality, their way of moving through the world,” Burke says, “that it’s somewhat in conflict with what culturally we’re taught men and women are supposed to be and what they’re supposed to do.”
He offers this example regarding gender stereotypes. “I’ve worked with a number of great cisgender men who maybe have grown up and still struggle with feeling like they don’t fit into some kind of alpha male mold,” he says. “That’s something that can create a lot of distress.”
The second category Burke describes is when clients have already done some exploration of gender identity. “I also get clients who identify as transgender or gender-nonconforming,” he explains. “And maybe they are looking for some guidance on figuring out the next best steps for them.”
A therapist specializing in gender can serve as a valuable ally and resource hub.
“Somebody may have goals for gender-affirming medical interventions,” Burke explains, “maybe hormone therapy, top surgery, bottom surgery. They may be looking to get connected with resources, medical professionals — or just talk through their questions and anxieties around those issues.”
Gender therapists like Burke have their pulse on their communities and know trusted gender-affirming surgeons, primary care professionals, and other healthcare professionals. “I can refer them or walk them through how to get connected,” he says.
Some insurance policies and physicians require a letter from a therapist for certain medical interventions, and Burke says he’s able to provide that letter for his clients if needed. However, this gatekeeping practice is being phased out.
“More and more, it’s becoming the informed consent model,” Burke says, “where the client is considered to be the expert. More and more clinics that do hormone therapy are working under that model, which does remove a lot of barriers for people getting that type of care.”
The important thing to understand about any gender therapy session is that it’s intended to be a safe space to unpack questions and curiosity and tackle topics surrounding gender. Mental health professionals who specialize in gender therapy do not have ulterior motives.
“It’s not conversion therapy of any kind,” Burke says, “If somebody is not transgender, is not gender-nonconforming, it’s never about trying to persuade them that those other labels are for them. And the opposite is true. If somebody is transgender, is gender-nonconforming, it’s never going to be about persuading them to bury that identity.”
Not all therapists specialize in gender therapy, so it helps to do your homework to find the right mental health professional to fit your needs.
“In a perfect world any practicing therapist would be comfortable and competent providing therapy around these issues,” Burke says. “The reality is that’s just not the case. Everybody’s not an expert in everything. Some people have biases or blind spots that they may not even be aware of.”
He recommends seeking personal recommendations from others who’ve sought out gender therapy or asking healthcare professionals who are knowledgeable about transgender and gender-nonconforming issues. “They usually have a lot of professional connections within that sphere,” Burke says.
You can also search provider directories by location or specialty and narrow your search to a manageable level.
If you’re using your insurance coverage, you can also explore in-network therapists on your healthcare plan’s website, and then review the therapist’s individual website.
“I think it’s always good to try to get the therapist on the phone,” Burke says, “even if it’s for a 5-minute, 10-minute phone conversation. That 5 or 10 minutes can really tell a potential client a lot about whether this particular therapist is going to be a good fit for them.”
When it comes to summing up what gender therapy is — and isn’t — Burke does so beautifully.
“It’s about coming to an understanding of your authentic self — talking about thoughts, emotions, life experiences, around gender identity,” Burke says. “When I go into conversations around gender identity with clients, I never go in with any agenda except to help them get to that understanding of their authentic self.”