Recommended terminology, pronouns, and documentation for work with transgender and non-binary populations.

Abstract

Therapists may encounter many opportunities and dilemmas when working with transgender and non-binary clients. Transgender and non-binary clients may use pronouns that are new or unfamiliar to their therapists, but little is known about the unique impact that pronoun use may have in therapy. The pronouns and preferred names that transgender and non-binary clients use may also shift during the course of the therapeutic relationship. Best practices for affirmative therapy include recognizing and validating a client's gender identity, use of gender pronouns that are congruent with a client's gender identity, and using the client's preferred or chosen name, not their birth name. These clients may present to therapy for a variety of reasons; therefore, it is important to trust the client's self-perception of their own gender identity and to not engage in harmful gatekeeping practices. Scholars have highlighted the negative emotions that individuals may experience when they are misgendered, deadnamed, invalidated, or otherwise denied access to medically appropriate care. Therapists may experience anxiety about providing care that is transgender-affirmative, which may affect the therapist-client alliance. The authors draw on their own experiences as therapists working with transgender and non-binary clients and provide recommendations and guidance for therapists. Clinical Impact StatementThis article provides guidance and information about pronoun use, documentation, terminology, and clinical errors in an effort to support clinical work with transgender and non-binary individuals. Throughout the article, vignettes, examples, and practical applications are provided.

What are Your Pronouns? Examining Gender Pronoun Usage on Twitter

“…Recognizing gender pronouns beyond the binary categories is one of the best paths forward to developing gender-inclusive language [13,41,46,62,67]. Using a person's correct pronouns shows respect and validation for their chosen gender identity and self-representation [46,67].…”

“…Recognizing gender pronouns beyond the binary categories is one of the best paths forward to developing gender-inclusive language [13,41,46,62,67]. Using a person's correct pronouns shows respect and validation for their chosen gender identity and self-representation [46,67]. However, despite the best of intentions, Levin [53] argues that mandatory gender pronoun sharing may instigate anxiety for those who already struggling with their gender identities.…”

A pilot test of a text message-based transgender and nonbinary affirmative cognitive-behavioral intervention for anxiety and depression.

“…Researchers continue to call for the development of health-care practices that are based on TNB research and that affirm TNB people (i.e., transgender-affirmative care; Budge, Israel, & Merrill, 2017; dickey & Keo-Meier, 2018; Porter et al, 2016). TNB-affirmative recommendations include validating a client’s gender identity, building a knowledge base of TNB experiences, reflecting on one’s own gender-identity development, cultivating social support, and providing resources (American Psychological Association, 2015; Knutson, Koch, & Goldbach, 2019; Matsuno & Israel, 2018; Puckett, Matsuno, Dyar, Mustanski, & Newcomb, 2019; Singh, 2016).…”

Deconstructing cissexism: The journey of becoming an affirmative family therapist for transgender and nonbinary clients

“…This could involve asking all clients about how they identify in terms of gender identity and using their language after taking the time to gain an understanding of what the identity terms mean to the client (Conlin et al, 2019). This could also involve asking clients about what pronouns they use and then working to consistently use those pronouns (Anzani et al, 2019; Austin et al, 2017; Blumer et al, 2013; Knutson et al, 2019). When providing family, relational, or group therapy, it is essential for therapists to facilitate a way for clients to initially share their pronouns confidentially in order to avoid creating a situation where individuals are faced with the choice of outing themselves or not being able to share their true identity.…”