In the current socio-political climate, TNBQ individuals face an increasingly hostile environment in the UK and beyond. This hostility exacerbates mental health challenges already prevalent in these communities, making access to supportive, affirming therapy crucial. However, the (therapeutic) landscape of psychotherapy and counselling is fraught with potential pitfalls, including the risk of encountering harmful practices such as conversion therapy or therapists lacking adequate knowledge of TNBQ issues. It’s vital that TNBQ people can seek therapy with confidence that their identities will be respected, understood, and supported.

Please note that this article discusses harmful practices, including conversion therapy.

The Challenge of Finding the Right Therapist

One of the significant barriers TNBQ people face is the difficulty in identifying therapists who are truly proficient in working with gender diversity. While the World Health Organisation has stated that "trans-related and gender diverse identities are not conditions of mental ill-health", the legacy of pathologisation remains in some therapeutic practices. This, coupled with the lack of comprehensive training in standard psychotherapy courses regarding TNBQ lives, creates a vacuum where harmful or inappropriate practices can flourish.

Without proper understanding, therapists may reinforce cisnormative biases or engage in questioning that undermines the client’s identity, leading to further distress. For instance, an untrained therapist might unintentionally replicate societal transphobia within the therapeutic space, making it a potentially harmful environment rather than a safe haven.

Affirmative vs Non-Affirmative Approaches

In discussions around therapeutic practices for TNBQ clients, the terms ‘affirmative’ and ‘non-affirmative’ are often used to describe two contrasting approaches. Affirmative practice centres on the belief that clients are the best judges of their gender identities, and the therapist’s role is to support them without imposing preconceived notions or expectations. This approach does not seek to predict, diagnose, or pathologise the client’s gender, nor does it assume a need for medical or surgical intervention unless that’s the client’s goal.

On the other hand, non-affirmative practices may begin from a position of scepticism about the client’s self-identified gender. These approaches can involve prolonged questioning and attempts to explore underlying causes for a TNBQ identity, often implying that such an identity is a result of trauma or confusion. This stance is not only misaligned with contemporary understandings of gender but can also be deeply harmful, as it tends to pathologise and undermine the client’s self-knowledge.

Conversion Therapy

Despite its widespread condemnation, conversion therapy remains legal in the UK, posing a severe risk to TNBQ individuals seeking help. Conversion therapy encompasses any practice aimed at changing or suppressing a person’s gender identity or sexual orientation, often under the guise of ‘helping’ the individual conform to societal norms. This practice is fundamentally unethical, leading to significant psychological harm and perpetuating the notion that TNBQ identities are deviant or disordered.

Countries like Canada, Germany, and New Zealand have banned conversion therapy, recognising its damaging effects. In contrast, the UK’s continued allowance of such practices represents a significant failure in protecting the rights and well-being of TNBQ individuals.

Gender Exploratory Therapy

Gender Exploratory Therapy (GET) has emerged as a controversial approach, criticised for its similarities to conversion therapy. GET often involves exploring potential ‘pathological’ roots of a client’s gender dysphoria, particularly in young people. This approach tends to frame TNBQ identities as problematic outcomes of underlying issues rather than legitimate identities in their own right. By starting from a position of scepticism or disbelief, GET can act as a subtler form of conversion therapy, pressuring individuals to conform to cisnormative standards.

This approach is especially damaging as it perpetuates the idea that being TNBQ is inherently undesirable, framing it as something to be questioned, tested, and potentially ‘fixed’. Such practices are deeply misaligned with ethical therapeutic standards and can cause significant harm to vulnerable individuals.

Intimata's Stance

At Intimata, we firmly believe that TNBQ individuals have the right to a therapeutic experience that is affirming, non-judgmental, and free from harm. Therapy should be a space where clients feel safe to explore their identities without fear of disbelief or pressure to conform to cisnormative standards.

We advocate for transparency in therapy, where practitioners openly share their knowledge and experience with TNBQ issues and are clear about their stance on gender identity. TNBQ identities are not pathologies; they do not require fixing. Any attempt to change or suppress a person’s gender identity is not only unethical but also causes profound harm.

For more information and resources, we highly recommend checking out Gendered Intelligence, including their list of trans-friendly therapists.

Intimata is proud to be a member of TACTT (Therapists Against Conversion Therapy & Transphobia). Learn more about our work here.