Alexa Brand, AMFT



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November-December 2019

Member Contributor — Alexa Brand, AMFT

Why It’s Imperative to Understand
Gender Identity & Gender Pronouns and
12 Strategies to Make Your Therapeutic Practice More Inclusive

We are aware of the importance of cultural consideration in therapeutic practice, but how often have you incorporated gender identity into your cultural consideration? Have you ever inquired into your clients’ gender identities or pronouns? Have you assumed their gender identity and pronouns based off of their appearance? Assuming is likely something we have all done in our lives and in our practice. However, in doing so, we can foster unsafe therapeutic environments and potentially harm our clients. Here is some information for you to integrate into your practice to help make it more inclusive and less assumptive.

Gender Identity
Due to our society’s history of equating assigned sex at birth (male or female) with gender identity, people often confuse the two. Due to this history of cisnormativity (a worldview that promotes sex-assigned, binary gender), people tend not to be educated on the vast array of gender identities. Human Rights Campaign defines gender identity as “one's innermost concept of self as male, female, a blend of both or neither — how individuals perceive themselves and what they call themselves. One's gender identity can be the same or different from their sex assigned at birth” ( As you can garner from this definition, one’s gender can be the same as their assigned gender at birth (cisgender), but gender identity is more complex and inclusive of the male/female binary. Perhaps you have heard of people identifying as transgender, non-binary, and/or two-spirit. These are examples of gender identities that (very-likely) do not correspond to one’s assigned sex at birth. This places those who do not confirm at risk and makes them more vulnerable to harm.

Side note: There is a vast array of gender identities that have unique definitions and meanings to different people. Therefore, I do not list out definitions for each as they may vary by person. See strategies below for more details on how to manage this.

Gender Pronouns
Gender pronouns are words used to refer to someone we are talking about. Gender pronouns are linked to gender identity as pronouns are an expression of one’s gender identity. We are all familiar with the gender-binary pronouns — she/her/hers and he/him/his. Gender-neutral pronouns, however, are likely to be less familiar (e.g. they/them/theirs, xe/xem/xyr). There are a range of gender-neutral pronouns that one should familiarize themselves.

Why is this important to therapeutic practice?
Understanding gender identity and pronouns is critical to therapeutic practice as it will allow us to create an inclusive space that decreases our likelihood of harming our clients. This is our ethical duty (see CAMFT Code of Ethics’ standards 1.1, 1.11, 3.5, 3.6, 3.7). As stated earlier, it can be harmful for therapists to assume their client’s gender identity and/or pronouns. It can make our clients feel unsafe, unheard, and misunderstood. Additionally, it can give off the impression that we are empowering a cisnormative society that oppresses those who do not conform. By NOT assuming our client’s gender identity and pronouns and by simply asking, we are building safety for our clients and empowering them. Furthermore, it’s important to remember intersectionality when discussing gender identity. There are additional complex identities that are also influencing our clients. For example, a latinx or black trans woman is at greater risk of harm due to society’s treatment of these cultural identities. By being aware of all of this information and utilizing the tips below, you are likely to build a stronger therapeutic-alliances and stimulate more positive change with clients who are gender nonconforming.

12 Strategies to make your practice more inclusive:

  1. Educate yourself on gender identities and pronouns in use. It is imperative to have a baseline understanding of gender identities and pronouns (see resources below). However, doing further research and asking your client for their personal definitions are recommended to make yourself a more well-rounded, culturally-competent therapist.
  2. On your intake forms, include prompts for the client to write down their gender identity and pronouns. Review before you begin your first session and ask clarifying questions.
  3. When you introduce yourself as a therapist, state your own gender pronouns (e.g. “Welcome! My name is Alexa and my pronouns are she/her/hers”). This can prompt the client to share their own pronouns and can build safety.
  4. If your client has not informed you of their gender identity and pronouns, just ask. Do not assume. Just because someone presents as female or male in your eyes does not mean that the person actually identifies as female or male.
  5. Have your client explain their gender identity if you are unsure of what it means (e.g. “What is your definition of being non-binary, as I know this can vary from person to person?”).
  6. Just use your client’s name before they tell you their gender pronouns. Again, do not assume their pronouns.
  7. Remember not to confuse sexual orientation and gender identity. Gender identity is who you go to bed as. Sexual orientation is who you go to bed with.
  8. If you use the wrong pronouns with a client, do not make a big deal out of it. Apologize, and process the moment or move forward.
  9. Ask for feedback and clarification from the client.
  10. Use gender neutral language in group therapy settings. Instead of saying “ladies and gentlemen,” you could say “friends,” “folks,” or “wonderful people.”
  11. Think about and challenge your own biases/assumptions of nonconforming genders. Address your countertransference. And, again, educate yourself.
  12. Finally, if a client is presenting with challenges around their gender identity that is out of the scope of your professional competence, refer them to therapists who specialize in working with the LGBTQ+ community.

Recommended resources:

Genderspectrum’s education on gender —
The Trevor Project’s Coming Out Handbook —
Safe Zone’s online training program to foster inclusive environments —
IPM’s List of LGBTQ+ Terms/Definitions —
Los Angeles Gender Center —
Los Angeles LGBT Center —

Alexa Brand, MS (she/her/hers) is an Associate Marriage & Family Therapist who presently works as an LGBTQ+ program therapist and school-based therapist. She has specialized training in therapeutic approaches with the LGBTQ+ community and previously contributed as a writer/editor for the intersectional feminist website Adios Barbie. For inquiries, please email

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