Carolina Partners In Mental Healthcare, PLLC

Supporting Gender Variance in Mental Health Treatment - Louise Newton, MSW, LCSW

How many times have you heard the well-intentioned but misguided remark, ‘I don’t see gender, I just see people’? Conversely, the media would have us believe a simplified and essentialist view of gender characterized by the adage, ‘Men are from Mars and women are from Venus’. Operating clinically from either of these viewpoints will create glaring holes in your practice.

Gender Matters

Many mental health practitioners look forward to a day when women are no longer three times more likely to be killed by their partner than their male counterparts. We will rejoice when our male clients have stopped their reports that they were told to ‘man up’ when they were upset as a child. As clinicians we know that understanding and being sensitive to gender difference plays a critical role in treating mental health. Whether we specialize in working with trauma, addiction, parenting, relationship issues, or mental health disorders, we know that men’s and women’s socializations and varied access to resources are key factors in our patient’s recovery.

While clinicians are well aware of gender differences between men and women, how many of us are informed and prepared to support gender variance in our practice? Compiling data on transgender (trans*) community members has proven to be difficult for a number of reasons. Some estimates report that 2%-5% of the population identify as transgender: an umbrella term that includes individuals who experience their gender differently from the sex they were assigned at birth. This includes female to male (FTM) transsexual men who were designated female at birth but have a male gender identity and sometimes a masculine gender presentation. Male to female (MTF) transsexual women were designated as male at birth but have a female gender identity and sometimes a feminine gender presentation. Additionally there are many trans* folks who identify as third gender, agender, genderqueer, and gender fluid. We know there are as many gender identities as there are people; these are currently the most common identities found under the trans* umbrella.

Developing a Gender Variant Informed Practice

So why develop a gender variant informed clinical practice if the rates of trans* identities are a small minority in our population? First and foremost, we know that there are far more trans* folks than the data represents. Secondly, you are most likely already working with trans* identified clients and may not know it. As is the case with other minority populations, trans* folks experience disproportionately higher rates of mental health disorders, substance abuse, and trauma relative to their normatively gendered counterparts. In addition, the code of ethics for the National Association of Social Workers, American Psychological Association, and the American Medical Association call for clinicians to develop competencies in working with trans* identified clients and assist gender variant folks remove barriers to care.

More and more clinicians are developing specialties in treating trans* folks for Gender Dysphoria and/or co-occurring needs ancillary to their experience of their gender. Gender Dysphoria, formerly referred to as Gender Identity Disorder, is the diagnosis in the DSM V that is characterized by psychological distress related to the incongruence between the sex one was assigned at birth and the gender identity one has developed. There is a debate in the field about the usefulness of Gender Dysphoria as a mental health diagnosis. Many argue that it is a rigid and antiquated gender binary system that causes distress in trans* identified folks and that the phenomenon should not be considered disordered. Still others argue that keeping the diagnosis in place allows trans* patients access to and insurance coverage for necessary medical care such as hormone replacement therapy and gender confirmation surgeries.
Developing a gender variant informed practice is not only accessible but also ethical. For more information on the Standards of Care and clinical educational resources please consult the World Professional Association for Transgender Health at

J. Louise Newton, MSW, LCSW is a psychotherapist and the managing partner of the New Hope Court practice of Carolina Partners in Mental HealthCare, PLLC. Louise is also a co-founder and director of the Gender and Sexual Diversity Spectrum (GSDS) Initiative. For more information please visit or