Out On The Couch

Psychotherapy with Unsupportive Parents of Transgender and Gender Nonbinary Clients

collage with transgender and gender nonbinary or gender nonconforming children or teens

Ask Us Anything: How should I handle the pronouns of and name for adolescent trans clients when their parents refuse to use the correct ones? Obviously I want to support my client by using their pronouns and name, but I also feel like it is a fine line between that and making parents angry so they stop bringing their child to see me.

This is a conundrum that many affirmative therapists may face in the course of their work with young trans and gender non-binary clients, and your question is a critically important one! Training in working not only with transgender and gender non-binary communities but with their families can be invaluable. This is a short response to a complex answer, so we recommend further consultation and training!

Although difficult for all affirmative therapists, this situation can be particularly triggering for transgender and gender non-binary therapists. It can be triggering for those TGNB therapists who have experienced unsupportive parents. Make sure to take care of yourself, as this is a difficult situation for affirmative therapists to navigate. Consultation with colleagues, your own therapy, and whatever self-care works for you can help you be emotionally available as a therapist for this difficult situation.

In a situation like this, it can be best to have a meeting or several with only the parents in which you refer to the client simply as “your child” to help build rapport. During this time, you are establishing your ‘authority’ by building a solid relationship with them. Having some level of perceived authority or expertise established is what will help with challenging them on names/pronouns after you have good rapport with them.

Note that, of course, this is something you can do for only a short period of time as you are building rapport with the parents. This method can get awkward quickly as sentence structure can get clunky. It takes a lot of mental energy to avoid using any pronouns altogether, so there is also an energetic cost to the therapist.

Avoiding names/pronouns isn’t an affirmative stance, but rather a neutral one. Avoiding using names or pronouns avoids misgendering and deadnaming, but it also avoids embracing the child’s authenticity. This should not be done in front of the child, as it communicates to them that you don’t support their identity and will destroy rapport with the child. The point here is to avoid a power struggle with the parents, build rapport, and establish yourself as a helpful figure who can help them navigate this new information about their child. As you establish rapport, you can start to challenge their transphobic thinking to help them move towards a more supportive, affirmative stance towards their child.

It is important to help parents connect with their love for the child. Every parent wants ‘what is best,’ but they don’t always know what that is! Every parent wants their child to grow up happy and healthy, but there is so much information about how transgender and gender non-binary people struggle and suffer that parents get terrified! Building a connection with the parents about love for their child driving their fears will be helpful to building rapport.

Once you communicated clearly that you, the therapist, know how much the parents want to help their child grow up into a successful, fulfilled adult, then you can start educating about the best ways that parents can help. This is where that perceived authority is important. You do know what is best for the transgender or gender non-binary child; the research is clear. Supporting the child through using their name and pronoun is a huge protective factor! The world is a tough place and it is the parents’ job to prepare them for it. We do this by building resilience through offering a support system. It is essential to educate the parents about the importance of their being a support system for their child–if they want their kid to succeed in the world, they really have to show up 110%. Sharing research about the importance of parental support in mental health can be helpful, as no parent wants to be responsible for their kid’s misery.

You’ll want to drive that point home to them; your most effective route will be “I know you want what’s best for your child.” If you find that it’s particularly difficult to foster empathy in this situation, that’s completely understandable–but it is essential, because you’re right: if you attack the parents, they will shut down and terminate.

Referring the parent to affirmative resources can be helpful. Connecting parents to good information can help them learn on their own time rather than having their child educate them. Parenting is hard! Connecting with other parents going through the same process as they are can be transformative (no pun intended here). Here are some resources that can be helpful for you and possible referrals for the parents: