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  • Does not have knowledge of transgender and/or gender diverse identities. 

  • Feels using a person’s chosen name and pronoun may be giving credence to mental illness. 

  • Believes genitalia determines someone’s gender. 

  • Believes identifying with a gender other then the gender assigned at birth is due to mental illness.



  • May or may not be interested in learning more about transgender identities.  

  • May or may not have interacted with transgender people.  

  • Is undecided on whether to refer to someone by their birth name or chosen name. 

  • Is unsure if gender is determined by genitalia or other factors.



  • Has very limited or no knowledge of transgender or gender diverse identities.  

  • Has very limited or no interaction with gender diverse or transgender people.  

  • Is interested in learning about different models of working with transgender people.  



  • Has limited knowledge of transgender identities and is willing to learn more. 

  • Has interacted with transgender and gender diverse people and is respectful of client’s gender expression and identity. 

  • Feels comfortable being around transgender and gender diverse folks.

  • Has created an LGBTQIA+ affirming environment via literature on a website or supportive materials in the office.



  • Has some knowledge of gender diverse identities and refers to clients with correct name and pronouns, has gender affirmative intake documentation. 

  • Has developed limited clinical skills through training, consultation, or readings to help a client with initial exploration of their gender.  

  • Understands the history of transgender and non-binary people’s relationship to the medical and mental health community.  

  • Has knowledge about the impact of transphobia and the various ways it impacts healthy development.  

  • Has begun to study intersectionality, privilege, and explored their own views of gender and gender roles.

  • Believes gender diversity and gender expression of all kinds is healthy and a sign of a healthy society.

  • Office staff is gender affirming, if applicable.


Competent: (Affirming plus, may also identify themselves as a Gender Therapist) 

  • A licensed mental health clinician who has obtained education, training, consultation, clinical experience, and engages in ongoing continuing education in working with a gender diverse caseload.

  • Able to provide psychoeducation to clients regarding social and medical changes to their gender.  

  • Continued learning about intersectionality and their own experience of privilege such as, cisgender, heterosexual, race, education, class, etc.

  • Experience writing a variety of referral letters/letters of support to assist clients in receiving gender affirmative care (i.e. gender affirming hormone therapy, name and gender marker change, surgery)

  • Knowledge of local resources (i.e. support groups, endocrinologists, affirming providers) and national resources (i.e. WPATH, Trans Lifeline, Transgender Law Center).  


Created by Adam Sauceda, LPC-S and Lisette Lahana, LCSW

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