Experiences of non-binary patients in psychotherapy: Understanding the effect of uncomfortable VS affirmative settings

Aim: Non-binary patients (i.e.., people who perceive their gender as neither male nor female) often face challenges in having their gender identity recognized within psychotherapeutic contexts. This lack of recognition may have a meaningful impact on the therapeutic relationship and, in some cases, may lead to a dropout from psychotherapy. The aim of this study was to explore the experience of non-binary patients with regard to ongoing or recently ended psychotherapy. Methods: Eighteen participants whose age ranged from 22 to 35 years (M=28, SD=4) were administered a semi-structured interview created ad hoc for this study. The interview protocol allowed to investigate several aspects of the therapeutic experience in relation to the participants’ gender identity, such as: psychotherapists’ competence on non-binary gender identities; experiences of participants’ coming-out (psychotherapist’s reactions, attitudes, and emotions); the proper and improper use of pronouns; therapists’ assumptions and prejudices about their patient’s gender identity; episodes of therapeutic failures and (potential) resolutions. Results: Using a Thematic Analysis method, we identified three main themes: 1) Psychotherapy as an uncomfortable setting where to talk about one’s gender identity; 2) Patients’ ability to educate their psychotherapists on non-binary gender identities; 3) Psychotherapy as an affirmative setting to discuss and experience one’s gender identity. Discussion: Psychotherapists’ awkwardness in addressing non-binary gender identity issues may lead to the patients’ discomfort and subsequent dropout. Some participants reported never having discussed in the therapeutic setting about their non-binary gender identities, because of negative expectations. Other participants recounted they felt embraced by their therapists when explaining their gender experiences. A positive attitude from therapists represented, for some participants, the opportunity to experience their social transition in their clinical setting for the first time. Affirmative settings also allowed to remedy the effect of negative experiences (e.g., unintentional microaggressions) that occurred within the therapeutic relationship.