Gender Dysphoria Treatment: Talk Therapy

Highlights

• Gender dysphoria refers to people who feel the incongruence between their assigned gender and the gender they experience. 
• Transgender persons may need various gender-affirming options, such as surgery, hormone therapy, or simply legal recognition of their desired name. 
• Gender dysphoria treatment with talk therapy is often necessary to access gender-affirming solutions, including hormone treatment and surgery. 
• Psychological counseling can help someone understand and embrace their gender identity.

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People with gender dysphoria feel that their real gender doesn’t match the body they were born in. Some look for ways to express their gender identity, while others need to match their physical features with their true gender. Talk therapy is a form of gender dysphoria treatment used as a stand-alone form of support or in combination with gender-affirming medical procedures.

What Is Gender Dysphoria?

Gender dysphoria is the term used in the diagnostic guidebook DSM-V of the American Psychiatric Association. It’s defined as “marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration.” 

It’s important to note that gender dysphoria is no longer regarded as a mental disorder. Experts stress that transgender people usually suffer not because of their identity but as a result of family or societal treatment. To learn more about gender dysphoria, read our in-depth article here. 

Support Options for Individuals With Gender Dysphoria

People who are transgender may seek gender affirmation on different levels, which can include any of the following:

• Medical (for example hormone therapy)
• Surgical (genital interventions, breast surgery)
• Legal (updating official documents to match the person’s gender or change their name)
• Social (acceptance by family and peers)

Whether a person will have access to any or all of these depends on where they live. Some countries and states have a progressive approach to gender. In other parts of the world, being a trans- or gender-diverse person is seen as pathological or even criminal. 

Gender Dysphoria Therapy

Being transgender is not a mental health condition that requires treatment. What transgender people need is the right to express themselves and live in accordance with their perceived gender. 

Not all trans persons will experience gender dysphoria. Those who do may need psychological counseling for a variety of reasons. For example, in most healthcare systems, you need an official diagnosis to access gender-affirming hormone therapy or surgery. If a transgender person chooses to have a medical intervention, therapy can assist them in the process and help them adjust to living in their changed body. 

Some people may need counseling in connection with discrimination and even violence they experience because of their transgender identity. It’s not uncommon for transgender individuals to have high levels of stress, depression, or anxiety. 

Types of Counseling for Gender Dysphoria

People who need psychological support in connection with their gender identity can participate in individual or group therapy. Those who have an additional mental health condition may need to see a psychiatrist, who can prescribe medication like antidepressants.

Here are some of the therapy approaches for gender dysphoria.

• Acceptance and commitment therapy (ACT). ACT helps people explore their gender identity through mindfulness and self-acceptance. Patients can go beyond their self-limiting beliefs and lead fuller lives. 
• Mentalization-based therapy. This form of therapy helps people with gender dysphoria gain more clarity around their convictions surrounding gender. It allows them to understand their feelings and the feelings of others. 
• Expressive arts psychotherapy. This treatment modality encourages patients to understand and express their feelings through visual arts, music, dance, or drama. The talking still takes place, but the art activities help the person gain access to their emotions. 

What Happens During Gender Affirming Therapy?

Classic psychotherapy is talk-based, which means the patient and therapist discuss ongoing concerns and look for causes and solutions. The whole process can last a few months or several years (especially if a person is in a lengthy medical and legal process of gender affirmation). 

Psychotherapy for people with gender dysphoria has two main goals:

• To understand the role of gender in their life. 
• To get more stability, acceptance, and satisfaction with one’s gender identity.

During early sessions, the client talks about their history, especially in the context of gender roles and identity. The therapist also screens for additional mental health issues, such as depression or substance abuse. 

Topics of later sessions will depend on the person’s goals. Beliefs about gender are a common subject. Many people have traditional views on manhood and femininity. Encouraging broader perspectives of gender can help them accept their own complex identity. 

Some patients will need help deciding whether to take gender-affirming steps and if so, to what extent. Others may need help navigating family or work life. A therapist can offer role play to prepare the clients for important conversations. Problems such as low self-esteem or complicated emotions may also take center stage. 

In some cases, the counselor will ask the client to do homework assignments like keeping a journal of their feelings and fears. 

How To Find a Gender-Affirming Therapist

The scientific understanding of gender identity is changing, but as yet, not all psychotherapists feel confident working with individuals with gender dysphoria. 

If you or someone you know needs mental health support for this concern, it’s best to get recommendations from a local LGBT+ organization. Medical doctors who specialize in gender-affirming care are also good resources for psychological referrals. 

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