gender – Therapists Against Conversion Therapy and Transphobia

Trans-affirming checklist: extended guide

We recently shared our new trans-affirming therapist checklist in the form of images which can be shared and referred to. Here, we are sharing a longer version of the checklist with more detailed points for consideration, and some suggested questions you could ask a potential therapist or reflect on yourself.

This guide is for anyone who is looking for a trans-affirming therapist. It might be useful to you when you are looking for therapy if you are trans or non-binary, or a loved one is, or you are exploring your gender.

It may also be useful for therapists who are thinking about how to increase their cultural competence when working with trans, non-binary, and gender exploring clients (if that’s you, we also suggest checking out our resources page). We start by giving a green flag list and we suggest that a therapist who is competent to work with trans topics is familiar with most, if not all of these concepts. Then we give a list of red flags and suggest that if a therapist says these things to you, that you exercise caution around having therapy with them.

Underneath we have given a set of questions you can ask of a therapist. A trans-friendly (affirming) therapist should be able to answer these questions without reacting defensively, whatever their counselling/psychotherapy approach is. Inspiration for this checklist came from Sonny Jane Wise’s checklist https://www.livedexperienceeducator.com/s/Is-your-provider-neurodiversity-affirming-1.pdf

Therapist Green Flags:

Listens to you and validates your experience without trying to be the expert on your life.

Supports you to decide what is important to you, and what you want to work on.

Accepts that being transgender is not better or worse than being cisgender, and doesn’t believe there’s a correct way to be any particular gender.

Understands the diversity of the trans umbrella and that each person’s experience of being trans is valid, no matter how unusual the label or description may be. Understands that a western/ European perspective is only one way to understand being trans and that not everyone fits within this.

Encourages self-advocacy and is able to talk about and promote trans joy, not just the absence of trans suffering.

Can work with distress related to being trans (e.g. dysphoria and discrimination) without trying to convince you it’s better to live as the sex you were assigned at birth.

Doesn’t believe that trans people are trying to avoid being ‘gay’, or are trans because they were abused.

Understands that the mental health struggles trans people can experience are often due to how trans people are treated in society and not an inherent part of being trans.

Accepts that some trans people are neurodivergent, and that any neurodivergence does not negate your trans identity.

Understands that being a trans woman or a trans man is a different experience than being a cisgender woman or a cisgender man, especially if you’re often perceived as trans. As a result, trans people can experience specific types of discrimination and hostility, which can lead the person (especially trans women) to be in danger simply whilst existing in the world.

Understands the specific challenges that non-binary and gender non-conforming people face including lack of legal recognition for non-binary identities, erasure of their experiences, and bias when seeking transition care.

Situates trans identity within other systems of power such as colonialism, capitalism, patriarchy, and has an understanding of the history of trans identities.

Recognises that other aspects of identity (such as race, class, age, disability, access to money) will interact with and impact on your experiences as well as your ability to access a medical transition (whether private or NHS).

Recognises the complexity and disparity between private and NHS trans healthcare and the devastating impact of spending years on NHS waiting lists in order to access vital health care.

Understands the complexity of fatphobia in trans experience including medical gatekeeping due to BMI, mandated weight loss which may or may not be possible or desired and gendered expectations around body size/shape.

Understands that there are many reasons why you may choose not to or be unable to follow a medical transition path. Recognises you as a valid trans person regardless of who you are ‘out’ to or what kind of transition steps you have taken. Doesn’t pathologise you if you’re a ‘stealth’ trans person.

Understands that not all trans people will describe, or understand themselves as having dysphoria, and that there is a difference between physical, and social dysphoria. Doesn’t assume that all body related discomfort is dysphoria.

Avoids misgendering and takes active responsibility for it if/when they do without making you feel responsible for their feelings.

Actively educates themself on trans topics (and correct language use).

Understands and can discuss with you the differences between conversion therapy and affirmative therapy.

Is aware that all therapy is exploratory, but that the specific term ‘exploratory therapy’ may indicate a pathologising stance towards trans experience.

Therapist Red Flags:

Believes in “rapid onset gender dysphoria” and/or social contagion of transness

Uses statements such as ‘biological man/woman’ and/or suggests that a trans woman is “biologically male” or that a trans man is “biologically female”.

Uses the word “ideology” only about transgender topics, (rather than recognising that an ideology is a set of beliefs that people hold about any number of topics).

Tells you that you should come out to people, even if you’re not ready or you don’t feel you have people you can trust.

Misgenders you/other trans people frequently (and doesn’t understand the damage caused), or uses ‘they/them’ or other “neutral” language to avoid using your gendered language.

When discussing a pre-transition childhood, insists on referring to you as your assigned sex, or if they know it, any name you no longer use.

Accepts binary and gender conforming trans people but thinks that non-binary/genderqueer people are somehow ‘confused’ or unwell, or are in denial about their binary trans (or cis) status.

Tries to push you into, or away from a particular medical pathway. For example suggesting you need more time in therapy before moving on to a waiting list/starting medical intervention or social transition, or suggesting that you shouldn’t transition without more social support. They may also steer you away from ‘permanent’ changes such as hormones or surgery and towards alternatives like new clothing or hairstyles.

Doesn’t recognise the impact of transphobia, lacks real understanding of the current climate for trans people, isn’t informed about current guidance and legislation.

Minimises the harm you’ve been caused as a result of others’ transphobia (for example, family members, friends and previous therapists who may not have meant to be transphobic but who have nonetheless caused harm by expressing their problematic opinions)

Focuses on how hard it must be for other people in your life to adjust to your new identity/new pronouns etc.

Pressures you to become more resilient, because you need to ‘get used to transphobia’ (unless that’s what you specifically asked to work on).

Focuses too much on trans/gender identity and connects every issue back to that, whether or not it is relevant to the issues you are actually wanting to discuss.

Makes assumptions about your sexual orientation from either your gender or presentation. Conflates or confuses sexual orientation and gender identity.

Uses outdated language (such as ‘transsexual’) when those weren’t your words, and doesn’t update their language.

Questions for a potential therapist and for self-reflection:

Below are some questions to ask any potential therapist in a first conversation, and some questions for your own reflection. The questions are either adapted from or copied from https://pinktherapy.com/choosing-a-therapist/ which in turn are adapted from this book https://www.goodreads.com/book/show/1344528

Questions for a potential therapist

What is your understanding of conversion therapy, affirmative therapy and exploratory therapy and how do these differ?

Are you willing to accept that I am the expert of my experience, even if it feels difficult to understand?

What is your understanding of transgender as an umbrella term?

How do you understand dysphoria?

Do you believe an openly trans person can live a rich and satisfying life?

How do you generally work with trans people?

What work have you done to explore any of your own anti-trans bias?

What is your understanding of the legal situation around trans people in the UK (for example the 2026 EHRC toilet guidance)?

How does transphobia impact trans people?

What books or CPD have you utilised when working with trans people?

When did you last attend any training around working with gender divergence?

What reflection and work have you done on your own gender?

Have you worked with other trans clients?

Questions to check in with yourself about afterwards:

Did their values feel compatible with yours?

Did you feel understood?

Did you have an initial feeling of trust in the therapist?

Did you feel respected by the therapist?

Were they sensitive to your feelings?

Did you feel a sense of warmth, or liking towards or from the therapist?

Did anything make you feel uncomfortable?

Were you able to be yourself?

Did you feel a need to hide anything?

Did you get any feedback from the therapist? Was it helpful? Insightful?

Did you come away with any greater understanding of yourself than you had before the first meeting?

Did you disagree with the therapist at any point? How did that go? Was the therapist defensive?

Were you invited to ask any questions about the therapy process? How were these answered?

How do you feel about speaking to them again?

New resource: trans affirming therapist checklist

A checklist of red flags and green flags to be aware of when working with a therapist on areas that include trans topics.

Looking for a therapist can be hard at the best of times. With the increasing rise in transphobia and trans antagonism, we know that for many trans and non-binary people, doing so can be risky; it can be hard to know whether a therapist practices in a way that respects and affirms your identity and experience.

That’s why we have developed a new trans affirming therapist checklist (alt text included on image and in a linked file below). The short version is below, and you can also check out the extended version here.

Trans-affirming therapy checklist. The alt text is also linked in a file below.

This is designed primarily as a resource for anyone who is looking for a therapist and wants to be reassured that their therapist is trans affirmative and does not practice any form of conversion therapy.
This resource might be useful to you when you are looking for therapy if you are trans or non-binary, or a loved one is, or you are exploring your gender.

It may also be useful for therapists who are thinking about how to increase their cultural competence when working with trans, non-binary, and gender exploring clients.

You can use these links to download different file formats. They are free – please share them widely!

Pdf
Jpg
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Alt text – please feel free to use this when posting the images on social media for people using screen readers. Please note that the alt text may be too long for some sites and you may need to abridge this- it may be worth posting the top few points and signposting people to the alt text link as included here.

The checklist was inspired by the Neurodiversity checklist created by Sonny Jane Wise. It was developed through discussions between TACTT members – drawing on both our professional experiences, and the experiences many of us have searching for trans-affirming therapists as clients.

Response to Telegraph article

The Telegraph newspaper recently published an article claiming that leaders of membership bodies including the UKCP have been “ousted” for raising safeguarding concerns relating to gender-affirming therapy for children. We have written a response to this in the form of a letter to the editor which you can read in full below:

We are a group of over 400 therapists, including members of the UKCP, BACP and NCPS, writing in response to the article ‘Top therapist ‘ousted’ after trans activist row’ (26 October 2025). We were disappointed to once again see a news story about trans lives and care that did not speak to or consider the perspectives of trans people. We believe that people should be free to be themselves and live within a true understanding of themselves, and that the way to “protect children from harm” in therapy is to allow them a safe place to explore who they are.

The article reports claims from former UKCP Chair Christian Buckland that activist pressure from within the therapeutic profession has created a coercive environment regarding the treatment of gender-questioning children, and describes allegations of intimidation, governance failures, and the marginalisation of voices calling for exploratory rather than affirmative approaches. In particular, the article focuses on claims that Buckland, and leaders of other therapist membership bodies, have been “ousted” for raising safeguarding concerns relating to gender-affirming therapy for children. These centre around Dr Buckland’s decision to withdraw the UKCP from the UK’s Memorandum of Understanding on conversion therapy (the MoU). Dr Buckland claims this was done because he “became aware” that the MoU (which states that conversion therapy in relation to sexual orientation or gender identity is unethical, harmful, and not supported by evidence) applied to children as well as adults.

We deplore the threats of violence that Buckland says he has been subjected to as we deplore hate and violence against any individual, trans or cis. We also object strongly to the implication that threats and violence are tactics consistently and deliberately used by some hypothetical ‘pro-trans’ lobby.

Dr Buckland’s claim that he was unaware the MoU applied to children as well as adults seems disingenuous; there is a paper trail relating to the MoU, including a press release back in 2019 showing that it was discussed that the guidance should apply to all ages. There has never been an explicit exclusion from conversion therapy practices for children, because there has never needed to be one. There is no evidence that conversion therapy works for any age, and plenty of evidence that it harms, as made clear in a Government report of 2021.

Buckland and Martin Pollecoff both had ample time in the 7+ years of discussion around the MoU (and the revised edition) to ask for clarification on whether the word “people” as used in the document included “people under the age of 16”. It would appear that this did not happen, until Buckland decided in a meeting in 2023 that he was unaware that those under 16 were in fact “people”. Rather than discuss those concerns, his statement (according to someone present in that meeting) was that he would need to speak with those linked in UKCP to working with minors. No further communication followed that we are aware of, as UKCP was withdrawn as a signatory before the next meeting.

It should be noted that, despite UKCP citing concerns around work with children as their reason for withdrawing from the Memorandum of Understanding on the prevention of conversion therapy, UKCP’s own website ‘clarifying’ this decision makes a very clear statement that: “We want to be clear that we are against conversion therapy for any age, adults or children.” It is unclear, then, why the UKCP is withdrawing from an understanding that conversion therapy is bad for all ages, whilst unequivocally stating on its website that conversion therapy is bad for all ages.

The article stipulates that Buckland received backlash for “trying to protect gender-questioning children from policies that would encourage them to be trans and go on to receive life-altering drugs and surgery” and says that gender affirmative approaches pose “significant harm”. The article does not elaborate on the nature of this alleged harm, only implying that it is inherently harmful to allow for the possibility that a child or young person is transgender. We do not believe that acknowledging that a person – of any age – who is wondering if they are trans may in fact be trans is harmful. In fact we believe that acknowledging that transness exists as a valid, non-pathological identity protects people from harm, particularly in a world where transphobia is so prevalent.

Also published was the claim that the MoU is “encouraging 100 per cent of children [with gender dysphoria] to go down the medical gender reassignment route”, concluding that “The crux of the split is around how children who are confused about their gender or believe it does not match their sex should be treated.”

This misrepresents what is meant by ‘affirmative therapy’. “Affirmative” (the term borrowed from, and endorsed by, Dominic Davies who wrote about “gay affirmative therapy” in the 1990s) refers to a framework which affirms the client “in their right to explore and to use words that are right for their identity”, and within which the therapist has no preference for the client to hold any particular identity. Affirming therapists do not seek to convert, persuade, or coerce, and do not seek any particular outcome other than the growth and flourishing of our clients, whatever their age. Affirmative therapy simply means that we do not think it is a worse outcome if a client decides, for themself, that they are or are not cisgender (TACTT, 2024).

We do not actively wish for children to be trans anymore than we wish them to have any other particular identity. We worry for our trans clients – of any age – because we understand the difficulties inherent in being a trans person in 2025; with significant, almost uniformly negative media representation, constant public debate, and steady erosion of rights. We firmly believe that people should have the space to work out if they are trans, and if they are, we will affirm that position. If someone comes to the decision that they are not trans, we will affirm that identity also. “Affirming” does not mean “coercive”. It means accepting someone’s view of themselves as valid.

Those of us who disagree with Dr Buckland’s decision are denigrated as “activists”, as if being an activist is something one should avoid being, when in fact, we are activists merely because we care about the lives of all people (and this includes trans people). This denigration also undermines our collective wealth of experience in the fields of psychotherapy and clinical research.

Yours,

Therapists Against Conversion Therapy and Transphobia