Non-binary clients’ experiences of psychotherapy: uncomfortable and affirmative approaches

Introduction: Non-binary individuals often encounter unique challenges in psychological settings due to psychotherapists’ general lack of preparation in handling non-binary gender identities. This unpreparedness can lead to both overt and subtle prejudices, adversely affecting the therapeutic alliance. This study aims to shed light on both positive and negative experiences of non-binary clients within therapeutic relationships. Method: The study involved twenty-five interviews with non-binary individuals aged between 19 and 35. Results: Through codebook thematic analysis, three primary themes were identified: (1) the self of the psychotherapist, which includes the influence of the therapist’s personal (e.g., sexual identity) and professional (e.g., competence) characteristics on the therapeutic experience; (2) the practice of the psychotherapist, characterized by either affirmative actions (such as validation and microaffirmations) or negative interactions (including efforts to change gender identity, manifest aggressions, and microaggressions); (3) the therapeutic relationship, focusing on the formation of the alliance, as well as its ruptures and repairs, which hinge on the therapist’s openness to non-binary identities. Discussion: Ensuring a safer environment for non-binary clients requires that psychotherapists include gender minority issues in their training. It is crucial for therapists to recognize and acknowledge clinical mistakes and foster a proactive attitude toward learning from clients’ experiences, thereby valuing their unique perspectives. The findings are discussed by integrating insights from a study on the countertransference reactions of cisgender therapists working with transgender and non-binary clients.