10 factors to consider when searching for a gender-competent therapist for your child

Finding qualified psychological services for gender-diverse children and adolescents can be challenging for parents and guardians. This guide can help you assess potential therapists to determine if they are competent to provide supportive and affirmative care, and if they will be a good fit for your child or adolescent. It may be helpful to view this process much as you would any other important consumer choice. Being as informed as possible as you start the search and knowing what kinds of questions you will want to ask can make the process easier.

Parents or guardians seek psychological services for their children for many reasons. Some children and adolescents experience symptoms of anxiety and depression. Some also encounter significant and challenging life changes or trauma. For children or adolescents who identify as transgender, gender nonbinary, or gender diverse, or who wish to safely explore these feelings, affirmative psychotherapy can help. This type of support can help gender-diverse children and adolescents manage experiences of gender dysphoria (distress related to their experience of gender and/or their gender identity), stressors in their relationships with peers or family related to their gender, and feelings of depression and anxiety, which arise due to difficulty adjusting to these experiences. However, many children and adolescents do not experience stress related to their gender-diverse or transgender identity. A gender diverse identity alone is not necessarily a reason to seek psychotherapy. Rather, therapy should be an affirming experience where children, adolescents, their parents, families, and guardians can seek support and assistance if issues around gender identity, or any aspect of identity, arise for the child, family, or larger community.

Psychologists who specialize in psychotherapy and other forms of psychological treatment are highly trained professionals with expertise in the areas of human behavior, mental health assessment, diagnosis, and treatment, and behavior change. Psychologists work with clients to change or manage their feelings and attitudes and help them develop healthier, more effective patterns of behavior. Psychologists also help people obtain insight into their thoughts, behaviors, and emotions, as well as process how to, at times, accept challenges in their lives and develop improved coping skills or new ways to approach these challenges. Psychologists must be licensed by the state or jurisdiction in which they practice. Licensure laws are intended to protect the public by limiting licensure to those persons qualified to practice psychology as defined by state law.

Here are 10 factors to consider when searching for a gender-competent therapist for your child:

Finding a therapist with whom you and your child connect and communicate well is critical. It is important to make sure the therapist can grasp your child’s mental and behavioral health, as well as be sensitive to family, culture, and the community where you live.

You can begin to assess your fit with a prospective therapist by asking the therapist questions of importance to you and your child or adolescent, and by paying attention to how your child or adolescent responds to initial visits. The first therapist you visit may not be the one you ultimately select.

Be sure the provider has a strong foundation in child and adolescent development or the common developmental concerns and considerations of childhood and adolescence.

Not every provider is trained to work with people across the lifespan. A trained provider with gender identity expertise in adults is not necessarily qualified to assist you with the concerns of your child or teenager.

This may be training they have sought out themselves after obtaining their degree as such training is not included in many training programs. Evidence of specialized or focused training may consist of specialized coursework while in training to become a psychologist, continuing education (such as conferences, workshops, webinars, reading foundational and current journal articles, and research), and consulting with well-established providers with expertise. Formal continuing education is required for licensed clinical psychologists to maintain and renew their licenses in almost every state and territory. Specific requirements vary by state. 

If you are unsure of a provider’s experience, ask the therapist about experience with training, ongoing education, and previous work with children, adolescents, families, and guardians where gender identity was a primary area of focus. Are they contributing to the development of knowledge in the field or in the training of colleagues to increase their knowledge? The answers to these questions may better help you guide your therapist selection process.

This can help you understand how they view their role in helping your child, adolescent, and family. Ask how the therapist approaches questions or concerns related to gender identity development, processing, and clarification of identity, whether with very young children (around ages 1-5), middle childhood (around ages 6-11), or children moving into adolescence. 

A provider should be able to tell you something about how your child’s cognitive development and physical development may influence and factor into the processing of gender identity at different ages.

Gender-competent providers know that every child and adolescent is unique and may or may not have the need for other services.

Providers should be able to tell you about medical interventions, which may significantly help some children and adolescents in their gender identity clarification process, and how to address symptoms of gender dysphoria. Some of these services may be temporary puberty suppression, hormone therapy, and/or, at times, though rarely with minors, surgical interventions.

Psychologists and other therapists who provide treatment in this area need to be up-to-date on gender diversity. This includes research and scientific information regarding gender identity and standards of care in the areas of gender diversity, gender development, and treating gender dysphoria. 

You may want to ask a provider about their awareness of the World Professional Association of Transgender Health’s (WPATH) Standards of Care and the APA Guidelines for Psychological Practice With Transgender and Gender Non-conforming Peopleopens in new window (PDF 416KB), or other guidelines or standards from professional associations in the provider’s discipline (such as psychology, counseling, social work, psychiatry, and medicine). In APA’s guidelines, guideline 8 is specific to gender questioning, transgender, and gender nonbinary youth, and the different developmental needs of children and adolescents. It also addresses the fact that not all youth’s gender expressions and identities will persist into adulthood.

Providers should offer appropriate information regarding options to help reduce gender-related distress (also called gender dysphoria resulting from gender incongruence) if present. They should also ensure increased comfort for children and adolescents as their identity develops and cognitive and physical development continues to take place. 

It is important to note that the WPATH standards of care and other professional best practices (such as the Endocrine Society Clinical Practice Guidelines on Gender Dysphoria/Gender Incongruence) often recommend limiting physical (medical) intervention to adolescents going through puberty. An exception, on a case-by-case basis, may be indicated for temporary puberty suppression (where it is the professional opinion of healthcare providers that it would be helpful) for children experiencing significantly heightened gender-related stress, particularly around impending pubertal development. This serves to both reduce distress and allow time for further consideration of how to proceed with fewer or additional interventions, and with the understanding that every child has a different and unique trajectory for treatment.

Some children may appear insistent as to a gender-diverse identity at a young age (as young as 18 months to 2 years of age). Others show few outward “signs” or “gender expressive indicators” of nonbinary gender and only disclose what they are experiencing either as puberty approaches or even well into puberty. It is important that the therapist understands that not all coming out processes follow the same path. A child’s comfort using language to describe these feelings and their anxiety about interacting with others, such as at school, with peers, or family, may affect a child’s coming out process. In some cases, their family’s or community’s religious and cultural values on gender-diverse identities may also affect a child’s coming out process.

Ensure the therapist knows the difference between gender identity and gender expression as some may conflate the two. Gender identity is a psychological sense of self and may or may not be “visible” to others prior to disclosure. Gender expression refers to the presentation of an individual, including physical appearance, clothing choice and accessories, and behaviors that express aspects of gender identity or gender role. Parents and guardians may report not hearing or seeing gender variance in their child, nor observing any gender dysphoria prior to disclosure. Some children disclose what they are experiencing with regard to gender shortly before or once puberty has begun or is completed. Often, these disclosures occur during these times as a young person may experience a sense of an inappropriateness with gender identity, social role, and possibly changing physical or secondary sex characteristics.

Your child’s provider should consider how other symptoms, or aspects of symptoms, may influence overall function in order to make appropriate decisions regarding treatment. It is important to know that gender identity exploration and processing is a normal part of development. 

Some children have little to no distress associated with this aspect of their identity, while others feel at odds, or an incongruence, with a gender identity as assigned or assumed at birth. A gender-competent provider can assist a child or adolescent with this exploration without undue influence toward a specific outcome for a child or adolescent’s eventual affirmed gender identity. A person’s gender identity and gendered sense of self is not something a provider, parent, or community can determine. A child’s support system can seek to understand, help navigate, and facilitate good decision-making for the best and healthiest outcomes.

The therapist’s interventions should align with each child’s or adolescent’s unique needs and be ready to identify supports or resources needed. Gender-competent providers should also be able to refer to a network of gender-affirming and competent health professionals, including pediatricians, endocrinologists, when appropriate, family therapists, psychopharmacologists, and others. 

Competent providers should be able to navigate the child’s or adolescent’s process of gender exploration with the family’s comfort and acceptance. Competent care often includes understanding when and how to refer parents or families for counseling to address family dynamics that may arise when a child discloses a shift in gender expression or identity.

In summary, best practices in gender identity-related care include performing a thorough psychosocial history, addressing other diagnoses that may be present, and exploring the implications, possible risks, impacts, and benefits of all aspects of gender identity clarification (social and medical, if applicable). You should expect a provider to engage in these activities with your child or adolescent, their families, and their support systems.

APA recognizes the need for more research in this area. More well-conducted research and further development of evidence-based practices are an integral part of treating and assisting with any psychological concern. A gender-competent provider should be able to help young clients and their support systems navigate new information presented in the research with an eye to appropriate and valid research methods. If you have a concern about something you have read, ask your provider to help you understand.