4.2 What is affirmative practice?
Affirmative practice is the opposite of conversion therapy – where conversion therapy holds that some identities are inferior – as affirmative practice gives all LGBTQA+ identities an equal value. To offer affirmative practice, all practitioners, including those who are LGBTQA+ themselves, are likely to need to have worked on ideas and biases they have internalised from the culture around them that say that some identities are more correct or authentic, valid or valuable than others.
Affirmative practice can also be understood as the opposite of poor practice. Research studies examining trans clients’ experiences of psychological therapies suggest that they are likely to have poor/negative experiences (e.g. Compton et al., 2022; Mezzalira et al., 2025). A 2019 systematic review of this research concluded that: ‘the incompetence of MHPs [mental health professionals] appears to be a common theme across time and space, and that should not be the case’ (Snow et al., 2019, pp. 154). To understand more about what the existing literature suggests contributes to poor experience of psychological therapy for trans clients, try the next exercise, derived from the findings of Mizock and Lundquist (2016).
Activity 4.2: Common missteps in therapies with trans clients
Pair the definitions with types of misstep:
Two lists follow, match one item from the first with one item from the second. Each item can only be matched once. There are 7 items in each list.
Education burdening
Gender inflation
Gender narrowing
Gender avoidance
Gender generalising
Gender repairing
Gender pathologising
Match each of the previous list items with an item from the following list:
a.Conducting psychotherapy as if the transgender identity of a client is a problem to be fixed
b.Relying on the client to educate the psychotherapist on transgender issues
c.Overlooking other important aspects of a transgender client’s life beyond gender
d.Stigmatising transgender identity as a mental illness to be treated or as a cause of all problems
e.Applying preconceived, restrictive notions of gender onto transgender clients
f.Making assumptions in psychotherapy that all transgender individuals are the same
g.Lacking focus on issues of gender in psychotherapy with transgender clients
- 1 = b,
- 2 = c,
- 3 = e,
- 4 = g,
- 5 = f,
- 6 = a,
- 7 = d
Trans broken arm syndrome
What ICTA participants said about their experiences of psychological therapies is discussed below, but the ‘missteps’ identified by Mizock and Lunquist are also present in the ICTA data. There were additional themes, too. ‘Trans broken arm syndrome’ is a phrase used by trans people to describe the phenomenon whereby everything is inappropriately related back to them being trans. As one participant said:
‘[If] I’ve got mental health problems, oh that’s because you’re trans. Not because of, you know, I’ve had a major bereavement or something like that. And they looked around to tie it back into transitioning or being a trans… they try too much to tie things back. And I think sometimes the mental professions have already got that fixed idea of the cause without being open to it being other things.’
When a trans person accesses therapy for something entirely unrelated, it is very important professionals do not inappropriately reference a client’s trans identity or, worse, tie something unrelated into a trans identity.
4.1 Memorandum of Understanding against conversion therapy