Affirmation to fulfillment: Therapy experiences of transgender and nonbinary clients over time.

Abstract

Transgender and nonbinary (TNB) people experience marginalization due to gender minority stigma. Research has demonstrated that many TNB people seek therapy to manage these stressors as well as more general distress. Given psychology's complex history with TNB care, it is of particular importance to facilitate therapy experiences for TNB clients that are fulfilling and affirming. In this longitudinal study, we investigated TNB peoples' perceptions of how their therapists responded to ongoing contextual factors related to systems of power (e.g., current events, political climate) in TNB peoples' lives and positive and negative experiences in therapy. Participants included 70 TNB people in therapy at the time of the study, intentionally sampled from states with a range of sociopolitical climates (Oregon, Michigan, Tennessee, and Nebraska). On a monthly basis, participants answered a series of questions about their experiences in therapy. Using longitudinal qualitative data analysis matrices, we examined how each participant's therapy experiences changed-or remained consistent-over time. These data were woven into three primary assertions: (a) fulfilling, long-lasting therapy for TNB clients is TNB-affirming, entails insight and guidance, and provides practical support; (b) contextual factors may motivate TNB clients to remain in unfulfilling therapy relationships; and (c) TNB-affirming therapy facilitates multiple paths forward for TNB clients. Findings indicate that a combination of TNB-affirming therapy, therapeutic insight, and practical support can facilitate richer therapy relationships across a variety of trajectories. These findings shed light on how to foster an environment wherein long-lasting, fulfilling therapeutic relationships with TNB clients can thrive. (PsycInfo Database Record (c) 2026 APA, all rights reserved).