New Book! Sex, Sexuality & Trans Identity: Clinical Guidance for Psychotherapists & Counselors

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Forthcoming in 2019

From Jessica Kingsley Press

In the last year, I’ve been very privileged to have had the opportunity to work with an exceptional group of colleagues; psychotherapists, counselors, psychoanalysts, theorists, psychologists, educators, advocates, and medical providers. These folks have been extremely generous with their time and talent and I cannot wait to share their incredible knowledge with our larger professional communities!

Here’s a taste, from the Intro (Violeta, Niemira, & Jacobson, 2019): “Since 2008, ICP’s Psychotherapy Center for Gender and Sexuality (PCGS) has hosted a biannual transgender mental health conference. These symposia have informed, explored, and expanded clinical discourse for those working with and within the transgender community, addressing a wide range of themes such as culture, intersectionality, and most recently, sexuality. The current volume represents a sample of the presentations made during the 2016 conference which explored the constructs, practices, and complexities of sexuality among transgender people and their partners. This symposia brought multidisciplinary presenters and hundreds of attendees from around the world to contribute voices from the leading edges of this rapidly advancing field of inquiry and experience. 

The contributions herein represent many points of view from clinicians, academics, advocates and educators who are transgender, non-binary, genderqueer, gender expansive, cisgender, or who identify at other points along the gender spectrum. They represent many clinical orientations, professional experiences, and personal positionalities; all are passionate about their work and their ideas as is evident in their writings. We believe that bringing these perspectives together allows us to break out of our respective echo chambers to challenge our too-firmly held understandings of gender, sexuality, and the clinical interactions we have with our trans patients. It is in this context and with these overarching intricacies that we are tasked with the challenge of having a meaningful discussion of sexuality and sexual expression among trans people and their partners…”


So You Wanna Find a Therapist: Choosing a Trans-Affirming Provider

I often get calls and emails from TGNB people who are struggling to find a therapist. Many transgender and non-binary people seek out therapy to support them in resolving past trauma, improving intimate relationships, addressing symptoms of anxiety or depression, and exploring issues related to gender identity and expression. Sometimes, gender identity may not be one of the concerns they are looking to address in therapy, but they’re looking for a therapist who “gets it,” someone they won’t need to educate.

Unfortunately, TGNB people may find some therapists to be ill-equipped to address their concerns and end up discontinuing treatment after just a few sessions. This is a common problem for TGNB people seeking mental health treatment; one study concluded that these negative outcomes are most often the result of limited provider knowledge regarding gender identity and related concerns (Rachlin, 2002). According to another recent study, many transgender individuals who seek out psychotherapy feel discouraged by the need to educate the provider on trans issues (education burdening), the therapist’s avoidance of speaking about gender (gender avoidance), or the seeming focus on “correcting” their gender identity (gender repairing) (Mizock & Lundquist, 2015).  Many trans people have had negative prior experiences when accessing medical and mental health care, and finding a therapist can feel like a daunting or stressful task.

So, how can you find an affirming therapist or psychiatrist who understands issues of gender identity and how these may interact with other life areas (work, relationships with partners or family members, etc)? Here are a few tips for finding a therapist who is right for you:

1.     Use your network. Oftentimes, friends or community members have had positive experiences with competent therapists or medical providers and may have recommendations for you. Online forums or groups may be a good starting point for getting suggestions or referrals.

2.     Use websites like Good Therapy and Psychology Today that feature a large database of therapists. Use the advanced or keyword search to narrow things down and then read through therapist profiles. If you are using insurance, be sure to include it in your search parameters. Cross reference therapists’ profiles on these sites by checking reviews (websites like Zocdoc or Healthgrades may come in handy) and visiting their own website so you can make a more informed decision. Does the therapist say explicitly that they have experience working with transgender/non-binary/GNC clients?

3.     Ask for a brief phone consultation with the therapist. Most therapists are willing to do phone consults so you can get a sense of their theoretical approach and experience. Have they, now or in the past, sought out specialized supervision or consultation related to working with trans and gender-diverse clients? Do they currently have any trans/GNC/non-binary clients?

4.     Schedule an initial appointment. How does it feel to be in the therapist’s office? Did they seem comfortable speaking about issues of gender identity and any other concerns you want to address? Are they open to feedback?

5.     Assess “goodness of fit.” If it felt relatively easy to share your concerns with the therapist, they listened empathetically, and have experience working with trans clients, you may want to schedule 2-3 more sessions to determine whether it is a good long-term fit.

6.     If you need a letter of support to access gender-affirming surgery, ask about this up front – does the therapist have experience in writing letters of this type? What are their policies about the number of visits or length of time in treatment before they feel comfortable writing a letter? Make sure you also request any requirements for letters of support from your surgeon and bring them to your session.

7.     Have coverage that doesn’t include mental health benefits, or no insurance coverage? You may be able to explore sliding scale fees with qualified therapists. Many therapists do offer reduced fee sessions, but these may only be offered during less busy times of the day, such as the late morning or early afternoon. Another option might be to see a therapist at an LGBT health center, community clinic, or psychotherapy institute.

8.     Still nervous about that first session? Bring a trusted friend or family member with you for the first appointment.

9.     If you live in a rural area, consider non-traditional methods such as telehealth (phone or video) sessions. Not all therapists are able to offer this service, but you may be able to make an arrangement that will work for you. If the therapist is too far away or is not accepting new clients, ask for a referral to a trusted colleague. If you feel that you need immediate peer support, Trans Lifeline may be a good resource.

10.  Having trouble finding local therapists? If you are under the age of 24, you can talk text, or chat with operators at The Trevor Project, who may be able to help you connect with resources near you. For both youth and adults, call The National Alliance on Mental Illness (NAMI) national helpline, 1-800-950-NAMI, or email to request information and referrals.

Sometimes finding the right therapist can feel overwhelming and take some time. Doing your research, asking some basic questions, trusting your instincts, and taking some time to get to know potential new therapists can make all the difference in the quality of therapy you receive. Good luck! 

Procrastination, Perfectionism, & Negative Self-Talk

Putting off writing that report by scrolling through your newsfeed again? Have you planned to spend the afternoon sending out resumes and cover letters, and then found yourself deep cleaning your bathroom tile? I myself was planning to write this blog post on procrastination, but decided to watch an episode of ‘Pitbulls and Parolees’ and then take my dog for a walk.

Procrastination snags us all from time to time, so it’s important to keep things in perspective. In general, we tend to gravitate towards tasks we enjoy, that we feel competent in, or that have a more immediate pay off. These are the items that are often more easily checked off our to-do lists. I personally can’t say that I’ve ever procrastinated a barbecue, a day at the beach, or a vacation. If it makes us feel good, it’s less likely that we will avoid the task. When it comes to tasks like filing taxes, paying bills, writing papers, or returning phone calls, it’s harder to summon up the motivation to complete them without a looming deadline.

Why do we avoid certain tasks, even when delaying them brings worry and anxiety? This is a question I frequently speak about with my clients, and there is no simple answer. For many of us, the fear of failure may prevent us from even taking that first step towards completing a task. Perhaps the specific task evokes an emotional response that we’d rather not deal with? For example, some of us grew up in households where there was not enough money to pay all the bills, and we watched our parents worry as they struggled to make ends meet. As adults, we may feel anxiety or apprehension each month when our bills are due, or avoid even opening bills that are sent by mail. I once heard someone describe the cardboard box where he deposited unopened, unpaid bills as his “box of fear.”

Perfectionism and procrastination are interrelated, and we may feel paralyzed by tasks that put us in the position of having our abilities and competencies judged by others. The fear of failure can prevent us from ever clicking “submit” on those graduate school applications or applying for our dream jobs, and keeps us treading water. It may be that we have trouble trusting our own decision-making ability and so we either avoid making decisions altogether or vacillate between options, finding ourselves unable to settle on a single solution or choice. We may tell ourselves that we “work best under pressure,” but waiting until the last possible moment to complete important tasks means that they will likely not be completed accurately and thoroughly… and then if we fail, we can always blame it on our lack of preparation, right?

While actively procrastinating, we may also engage in negative self-talk and worrying. This can affect our mood and further diminish our motivation.  For example, thoughts like “I can never finish anything,” or “I’ll only fail if I try, so why bother” only serve to make us feel depressed and demoralized.

Some tips for avoiding procrastination:

  • Break down larger tasks into smaller steps. Once you’ve completed a step, find small ways to reward yourself

  • Reduce distractions and increase productivity when working on your computer by using an app like Freedom (

  • Make sure you’re getting the right things done – make a smart to-do list that focuses on the tasks that you are less motivated to complete, not the ones you are more likely to do

  • Ask someone for help or make your attentions known to others – sometimes it helps to be accountable to another person

So, how do we ultimately overcome procrastination? I think we need to start by accepting that failure happens. Not succeeding is not necessarily a problem in itself because there will likely be other choices to make and opportunities to pursue. It’s what we are telling ourselves about WHY we failed that continues the cycle of disappointment and self-blame. In therapy, we can identify and examine the negative assumptions that are holding us back, and find strategies that help to overcome procrastination and perfectionism.

Self-help Tools for Managing Anxiety

Managing anxiety can be difficult, and accumulated stress negatively impacts our emotional and physical health. Those of us who are engaged in community work, volunteering, and activism tend to juggle many responsibilities at once, and we need to care for ourselves by regularly discharging some of that stress. Fortunately, we can access tools right on our cell phones, tablets, or computers that can help us to take short "mindfulness breaks" during the day, help us to fall asleep at night, and help to increase conscious, mindful awareness by helping us connect with our current feelings and thoughts. 

Most of the apps listed below are available for iPhone and Android, and many offer a free version. Some can be upgraded for more functionality with either a one-time payment or monthly subscription. Give them a try and see which ones appeal to you the most! You might try using them in the morning, before sleeping at night, or even to re-focus and re-center yourself during your lunch break. Let us know in the comments which of these apps you find most helpful or tell us about another app not listed here. 

Breathing Apps:


Breathe Synch

Universal Breathing - Pranayama Free

Meditation & Mindfulness Apps:


Calm – Meditate, Sleep, Relax

End Anxiety

Stop Breathe & Think

Chill – Daily Mindfulness


Self-Help for Anxiety Management