Here in 2025, Transgender Awareness Week (November 13 – 19) finds us in a time when being seen, heard, and noticed is actively dangerous for many Trans folx. The political and legal oppression being pushed in the U.S. puts many of us at risk. People have lost their jobs. Academics have lost their funding. Clients have lost access to gender affirming care. People have died.
And yet we are here, in need of support and care. Affirming mental health support is a major protective factor for TNBGE (Trans, Non-Binary, & Gender Expansive) folx, reducing the risk of suicide and harm. In these trying times, it’s more important than ever Marriage and Family Therapists (MFTs) stand up to oppression and engage in gender affirming care.
Gender-affirming mental health care has many aspects, but let’s focus on affirmation. One of the first things a student learns is how to join and connect with clients. Identity affirmation is, or should be, vital to that work. We need to know you see and hear us, accept us, and can reflect that acceptance. Internal acceptance isn’t enough. It needs to be overt, clear, and direct.
Start with affirming curiosity: having and expressing genuine interest about your client and affirming what they tell you. While you might hesitate to ask about a trans person’s life, body, transition, etc. if you met them for tea, therapy is different. Show you’re interested in our experiences and can hold that information appropriately. Ask questions about our journey, how we express our gender, the struggles we face, the fear/anxieties we carry, and how holding this identity, in this world, impacts us. Ask about who we are and who we want to be. Then make affirming statements like:
- “I can see the _______ in you.”
- “That makes sense to me.”
- “I can see the impact it’s had on you.”
- “You’re welcome to show more of _____ with me.”
- Beyond questions, create a welcoming environment in your physical and emotional space. Ask yourself, “Does my office (or virtual environment) signal to the client they can be themselves with me?” Ask our name, gender, and pronouns. Use those even when it doesn’t match legal identification. Share your name, gender, and pronouns as a matter of course. If you’re cis, use broaching to make the difference overt, and to tell us you’re here for us even though you don’t share our identity.
- Do what you can to protect your clients. Giving us a safe space is important, but not enough. Recognize the issues impacting us. Research the anti-trans laws in effect for your state and the threats the local trans community is facing. Talk with us about it, the impact, and what it means for our lives.
- Trans awareness is about more than our identities. It’s about facing the oppression, harm, and terror we face. And then, if you’re able, doing something about it.
Interested in learning more about how to work with TNBGE clients? Check out AAMFT’s new Systemic Family Therapy Certificate, Foundations of Gender Affirming Care.
Sar Surmick is a Human Sexuality Professor at Antioch University and a Marriage and Family Therapist with specialties in identity, consent, and non-monogamy. She is an international speaker on identity and consent in addition to being a supervisor, author, advocate, and consultant. As non-binary trans fem herself, Sar carries a strong belief in the right to identity affirmation, and this shows up across her work. She can be found at www.sarsurmick.com
