Therapists don’t know everything. Sometimes they are generalists, and sometimes they have focused their training on very particular techniques, illnesses, and challenges their clients might face: depression, anxiety, trauma, personality disorders, CBT, DBT, or EMDR.
There are a lot of ways to categorize a person’s struggle, and there are a lot of ways to find relief. But no therapist is an expert in all of them.
While no one is an expert in your life the way that you are, if your particular needs are outside the scope of a therapist’s training, or your problem is unlisted on their Psychology Today profile, you may not be a great fit for each other.
But what if you live at the intersection of many challenges, many identities? Is it possible to even find a therapist who understands your struggles and can meet all your needs?
Because we live in a society that harms and discriminates against trans people, we are at a disproportionate risk of many traumatic experiences and mental health struggles—including sexual and relationship violence. This complexity is compounded by the presence of other marginalized identities, like race or disability.
How do trans survivors of trauma pick a therapist? Although there are a few lists of therapists that are both trans and trauma-informed, they tend to be in urban areas and may not be taking clients or your insurance. So what if circumstances dictate that trans survivors have to choose between a therapist who is familiar with trans identity and one who has expertise in trauma?
Trans survivors face particular risks in making this decision. As one trans survivor quoted in Transgender Survivor Therapist Guide said, “I’m afraid to go to a mainstream provider because I don’t want to have to justify my existence to receive help, but I am afraid to go to a trans-knowledgeable provider because I know the SOC [typical Standards of Care for transgender people] are more harsh if you are an assault survivor. I feel like I’m falling through the cracks and no one cares.”
As you face predicaments like these, we want to affirm that just by surviving as a trans or gender non-binary person, you have demonstrated resilience. We trust your capacity to manage challenging and unjust situations like this one, and want to provide some tools to make it easier as you go through the process of selecting a therapist.
As discussed in our Therapy Guide, here are some considerations to keep in mind as you decide how to navigate this challenge:
- Which issue is more pressing in your life right now, trans identity, trauma, or any number of other issues you might be facing? Could you choose not to share information about an issue or limit what you do share? Of course, you should never have to make choices like these, but please consider if they feel at all viable. Do you need your therapist to write a letter in order to obtain a medical intervention like hormones or surgery? (This is sometimes dictated by insurance or a medical provider themself.) If so, it is more important that your therapist is trans-competent. And if your therapist is providing a letter, it more critical that your therapist understand that trauma does not undermine the legitimacy of your trans identity or your need for trans health.
- Could you have one trans-informed therapist and one trauma-informed therapist? While this is a tidy solution for many trans survivors, many therapists are uncomfortable with their clients working with more than one mental health provider, so you could ask prospective therapists about their comfort with this possibility as you screen them.
- Would you want to disclose your trans status to your provider? When? How might they react? Some therapists (inappropriately) believe trans clients are deceptive if they don’t disclose right away. Might your therapist have a reaction like this? Are there things you could ask in the therapist selection process to suss out how they might react without revealing your own trans status?
- In some cases, your trans identity/history may become known without your consent or approval. This happens most commonly through:
- Medical care (emergency or routine) that involves parts of your body that may be viewed as “noncongruent” to the provider.
- Identity documents that may not match with your gender presentation and/or different documents that may have different names or gender markers. If you are required to show your driver’s license or insurance card prior to receiving services, these documents may “out” you to as trans to staff.
- Therapists or other staff may make assumptions or guesses about your gender if your gender presentation does not align with their presumed standards of a specific type of femininity for girls and women or masculinity for boys and men.
- Someone else’s disclosure, intentionally or accidentally, without your consent. Involuntary disclosure may be doubly distressing to a survivor whose sense of control and safety have been damaged by this sexual assault and/or previous sexual assaults. Might this happen for you? If so, how would you like to approach it?
- Finally and perhaps most importantly, Does your prospective therapist possess humility and openness? Would they believe your experiences of both gender and trauma, regardless of their own knowledge (or lack thereof) of these areas? You could assess for this humility by asking your prospective therapist about how they handle new knowledge and knowledge that contradicts their understanding of the world.
As you navigate this search, know that although you may not find someone who immediately understands everything about your experience and identity as a trans survivor, you still have a right to be seen and heard in your wholeness. And it is possible to find a path to this recognition, both inside and outside a therapist’s office.