What Does it Mean to Create a Trans-Affirming Practice?

We see a lot of providers now advertising as “safe”, “accepting”, “lgbtq-friendly” or “trans-friendly” clinicians, practices, and offices. While that’s an improvement from the past, these labels stop short of being truly affirming. There’s a difference between being “okay with” or “non-judgmental of” someone and understanding and celebrating their existence and experiences.

And one more personal opinion is that I can’t designate myself as a “safe space”. Other people with varying identities have to determine the level of safety they feel in my office and in my presence. And I have to be open to feedback about that.

So how do we move from acceptance to affirmation? And how do we implement our responsibility to create these environments? Let’s start with what people find when seeking out clinical help. I’ve had a number of gender non-conforming folks tell me: “I was looking up therapists and a Psychology Today profile came up. Their listing would say “transgender specialty” but then nothing on the profile or their website showed that they knew specifics about working with trans people”. That’s not super re-assuring when someone’s seeking care.

If someone resonates with finding you or your practice online, the next place they find themselves in is your waiting room or lobby. Over the past few years I’ve worked in a space where there are posters on the wall about gender and trans rights, art created by trans people, photos and portraits of people of color activists and scholars.

There are children’s books about gender and queer health magazines. There are books about LGBTQ relationships, gender expression spectrum, and indigenous history. These types of things communicate a message of affirmation. One black queer cis woman said about the space “I walked in and immediately felt seen and reflected”. A white transfeminine client from a large midwestern city said “I’ve never been able to be in a mental health space that felt this good as a trans person”.

The usual experience is of sitting in a waiting room with popular magazines that don’t usually feature any trans person unless they’re sensationalized, and therapy and medical books that are cis and hetero centric. Another experience is of being in a totally “neutral” waiting area, you know, with calming pastel beach scapes on the wall, a water cooler, and no reading materials. The practitioners in those spaces might think they’re offering a place that would be comfortable to all, maybe out of fear of alienating transphobic clients, but the absence of obvious affirmation of marginalized identities still communicates something.


This is part 1 of a 2 part series on developing a trans-affirming practice.


Tavi Hawn, LCSW-C is a clinical social worker licensed in NC and MD. Tavi recently re-located to Baltimore, MD where they will be teaching as adjunct faculty at UMB School of Social Work and continuing a therapy and consulting business. Tavi primarily works with transgender and gender non-conforming people of all ages and is co-founder of QORDS summer camp. www.hawntherapyandconsulting.comwww.qords.org

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