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What is affirmative therapy, and is it person-centred?

by John Yuen
Published on 29 September 2021

By Sam Hope

Sam Hope is a non-binary, BACP accredited therapist and author of Person-Centred Counselling for Trans and Gender Diverse People, available now. Their website is


The UK government just announced there will be a public consultation regarding the banning of conversion therapy – therapy to change someone’s gender identity or sexual orientation. Sadly, this has already initiated an outpouring of misinformation, often centred on the idea that the ban would prohibit counsellors working with clients around “identity confusion”.

Particularly focused on trans rather than gay or bi identities, the outcry implies that the approach LGBT+ organisations support – affirmative therapy – forecloses on a client’s opportunity to genuinely explore who they are. This could not be further from the truth.

In my book, I talk a lot about working in a trans affirmative way. This is a tough thing to ask of therapists when the country is in the grip of a moral panic about “social contagion”, undue influence, and the fear that a person might be “encouraged” into a trans identity, as if you can “make” someone trans by giving them information or access to healthcare.

The truth is, you cannot make someone trans or not trans. The evidence suggests that some people just are trans, where trans is a plural, diverse, and multi-determined experience of incongruence with one’s sexed body or assigned gender. No two trans people are alike, and words and definitions remain imperfect to tell the story of this broad community.

Does “trans affirmative” mean telling people it’s better to be trans than gay, or telling people they are trans even if that’s not how they see themselves? Of course not. Being trans affirmative is no use if I am not also equally lesbian and gay-affirmative (and bi and ace affirmative, etc.). I must hold in equal value binary and non-binary identities, the desire to transition or not to, to change one’s body or keep it the same. Being affirmative means “your self-experience is valid: I hold that you understand yourself best”. It accepts the diversity, plurality and complexity of our relationships with our sexed bodies, assigned genders, and sexualities.

I should not seek to place my own language and labels on the client’s experience. Underlying our inadequate words there is an enormous diversity of ways in which people experience and relate to assigned gender, gender roles, sexed bodies, sexuality and an internal sense of a gendered self.

What is my role as a therapist? Well, to listen and be affirming (prizing, empathic, non-judgemental) of experiences that are divergent from societal norms, without making assumptions. To not make assumptions, I need to do a lot of work on exploring my own unconscious biases. If I do not realise my brain has already been trained to effortlessly think about sexual orientation, sexed bodies and social gender in particular ways, then how will I notice the assumptions, and ultimately judgements, I am making? How can I show true empathy if I am hearing a client’s story through filters I am barely aware of?

If we stop thinking about labels to box people into and think of words as ways to tell a story, I think that can help. Affirmative therapy is not about the therapist “diagnosing” and labelling the client, or confirming the client’s self-experience in an “expert” way, as if it us who is to decide whether the client is correct or not in their experience.

We tune into the client’s story, get to grips with their own ways of making meaning of their world, trust they are not confused, deluded or in error. We prize all diverse identities and signal our valuing of lesbian, gay, bi, trans, ace people equally so that we are not subtly setting up hierarchies where, for example, trans is okay but gay and not trans is better, or a trans man or woman is better than a non-binary person, or identity must be fixed rather than fluid.

The prevalent arguments against affirmative therapy display a common variety of transphobia. The foundation of transphobia is often a belief that many or all trans people’s understanding of themselves is wrong, deluded or confused. Transphobic discourse wildly exaggerates the number of people who regret transition. In reality, regrets are incredibly rare, and children don’t “grow out of being trans” as many claim. Nor is the known fact that autistic people are more likely to be trans a sign that transness is merely a symptom of autism that can be mislabelled “gender confusion”.

If we buy into this transphobic climate where trans identities in particular are to be questioned and doubted, then we are unable to offer any client exploring their gender true non-judgement and a space where they are fully regarded as the expert on their own life and valued no matter what identity may emerge.

To value trans and gender diverse clients, supporting a ban on harmful conversion therapy and endorsing affirmative therapy is a minimum requirement.

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