Out On The Couch

Gender Pronouns: Key Things Therapists Should Know

Posted: 7-20-22 | Andrew Kravig

Key Things Therapists Should Know About Gender Pronouns

Gender pronouns are an essential part of understanding how an individual identifies and communicating with them appropriately. As a therapist, using the correct gender pronouns for your clients will elevate your practice by helping them feel both seen and heard. If you don’t identify as trans or gender non-binary (TGNB) yourself, it can be hard to understand the visceral fear members of this community experience before meeting new people. Imagine entering social situations where you might have to explain your gender identity, pronouns, presentation, physical appearance, and more to rooms full of curious (if not hostile) strangers. In these circumstances, it’s easy to feel like your sense of self is on trial and you are being forced to defend your gender identity from swarms of foes. This might sound hyperbolic, but the stakes can often feel just that high for TGNB folks everywhere.

Pronouns and Treatment

As healthcare professionals, it is important to understand how negative experiences in clinical settings can affect engagement with treatment. Researchers from the ​​Australian Research Centre in Sex, Health and Society found that one third of gender diverse Australians aged 14–25 years chose not to see a mental health professional because of past negative experiences (Smith et al, 2014). Research in the United States has indicated that 25% of TGNB individuals have postponed healthcare appointments because of discrimination (Cruz, 2014). This fear of discrimination regularly causes clients to postpone treatment and reduces the likelihood that they will attend any follow-up appointments, making a clinician’s first impression with TGNB patients of great importance. Your understanding of gender minority stress and how it affects your TGNB clients will allow you to appreciate their struggle and provide the necessary affirmative care.

As a therapist, it is critical that your TGNB clients never feel the need to defend their pronouns to you. With that in mind, here are just a few key things therapists should know about gender pronouns.

Your Client is Always the Expert (when in doubt, just ask…)

Allow your client to set the tone for gender pronoun usage in the therapeutic space. Avoiding assumptions and prejudices in therapeutic practice is important. So, let’s start with you! When introducing yourself to the client, follow your name with the pronouns you would like them to use with you. This is a simple and welcoming step you can take, opening up the space for others to offer their pronouns without feeling alone or singled-out. It’s also a good practice to integrate into all of your new client sessions, regardless of your client’s gender identity. If a client doesn’t offer you their pronouns, it is always okay to ask. A good rule of thumb is: when in doubt, just ask. When they respond, never question their answer and always try to remember the first time. If you have to ask your client how they identify more than once, you are likely doing damage to the therapeutic alliance. Mistakes happen, and learning is a process, and there are ways to repair the rapport between you and your client

What is Your Client Comfortable With? (again… just ask!)

There may be some TNGB clients who would like to explore their gender identity with you. This process often requires therapists and clients alike to utilize a gentle curiosity around their presentation, pronouns, embodiment, et cetera. This kind of exploration, however, must be completely on the client’s terms and at their comfort level. If a client wants to try out new ways of expressing their gender in session, it is your job to hold a safe, playful, supportive space for them to do so without fear of judgment or othering. Pronouns are serious things! And also a lot of fun! They are a celebration of the diverse, wonderful world we live in. As a TGNB individual’s therapist, you might be the first person with whom they get to celebrate their truest self, and that might just start with something as simple as using the correct pronouns.
Gender pronouns, like all human vocabulary, are an ever-shifting landscape, and will continue to shift and find redefinition for years to come. Affirmative clinicians should remain aware of the shifting pronoun landscape, educating themselves in order to avoid being caught off-guard. Here is a handy little chart of some of the pronouns your clients might be using today:

A table in the Affirmative Couch branded rainbow colors that includes pronouns in every tense. The red row identifies the subject tense. The yellow row identifies the object tense. The green rown identifies the possessive tense. The blue row identifies the possessive pronoun. The purple row identifies the reflexive tense. Row one. ae, aer, aer, aers, aerself. Row two. e/ey, em, eir, eirs, eirself. Row three. he, him, his, his, himself. Row four. per, per, pers, pers, perself. Row five. is she, her, her, hers, herself. Row six. They, them, their theirs, themselves. Row seven. Ve, ver, vis, vis, verself. Row eight. Xe, xem, xyr, xyrs, xemself. Row nine. Zi/zie, hir, hir, hirs, hirself.

Practicing using Pronouns

In context, with clients, it may feel confusing to use pronouns that you are less familiar with. In these instances, it can be helpful to practice using the pronouns in advance of any client communication. For example, if you learn that a client uses the pronouns ze/hir/hirs, you could practice writing or speaking sentences using those pronouns such as: “Drew used hir water bottle because ze was thirsty.” Taking the time to get pronouns right and putting in the work to help your clients feel safe and seen will only improve your practice and enhance the therapeutic alliance.

Only YOU Can Make Therapy a Trustworthy Space

Using a client’s pronouns correctly can help you build trust and establish rapport early on in therapy. The LGBTQ+ community deals with an immense amount of judgment and oppression from society, so in therapeutic spaces, it’s crucial that they feel safe and accepted. Using an individual’s correct gender pronouns can help you build a strong container where they feel seen, heard, and understood. Creating this feeling of safety will enable you to focus on making therapy effective for your clients. Now that you’ve learned about some of the key things therapists should know about gender pronouns, you can begin implementing these strategies into your therapeutic practice to better serve your clients. 

Learn more about working with transgender and nonbinary clients

     Text "helping transgender and nonbinary young adults practice self-compassion presented by addyson tucker, PsyD 1.5 CE course" under an image of two hands making a heart. One hand has the colors of the transgender flag and the other hand has the colors of the genderqueer flag.    A couch with a pride flag draped over it.


Cruz, T. M. (2014). Assessing access to care for transgender and gender nonconforming people: a consideration of diversity in combating discrimination. Social science & medicine, 110, 65-73. https://doi.org/10.1016/j.socscimed.2014.03.032

Smith, E., Jones, T., Ward, R., Dixon, J., Mitchell, A., & Hillier, L. (2014). From blues to rainbows: The mental health and well-being of gender diverse and transgender young people in Australia. https://doi.org/10.4225/50/557E5925A5A83

About The Author