It’s the end of our first session and we’ve agreed our next appointment. ‘You gonna write that down then?’ Jack asks, nodding towards some paper. ‘I don’t carry pens – I’m not queer!’ He laughs. I’m taken aback and stuck for words. I feel vulnerable and exposed – I am ‘queer’ and feeling that being ‘queer’ is not a good thing in Jack’s eyes. After some reflection, it occurs to me this isn’t about sexuality, it’s about something else. I recall his earlier comment that he feels ‘weak coming here’; that he needs to ‘man-up a bit’. I think about Jack’s disclosure of suicidal thoughts and the vulnerability to suicide for men around his age.

Ben sits opposite me, head in hands, declaring his dislike of himself. Growing up, he was badly bullied, not only by his peers, who perceived him as feminine, but simultaneously by a father who felt that if he ‘acted like a man’ the problem would go away. It’s taken Ben a long time to accept himself as gay and even longer to feel any warmth towards himself.

Louise has had a tough day; she’s told her parents she’s transgender and wants to transition and live socially as a woman. It did not go as she hoped. Walking home, she passes two men who call after her with transphobic abuse. The pain of invalidation hit her hard.

At first glance, these clients may seem worlds apart, yet the collective picture highlights something crucial. Traditional understandings of gender can not only be limiting but can also be deeply harmful.

The dominant model of gender depicts two sexes with corresponding gender identity, gender expression and (hetero)sexuality. An example of this is how a baby is gendered at birth as a boy if a penis is present. They are then socialised as male, expected to see themselves as male, and assumed to experience desire exclusively for females. When presented as natural and the norm, all that falls outside this can only be perceived as abnormal. Questions that arise around what makes someone transgender (or gay), highlight how deeply embedded these norms are in our society.

However, gender is socially constructed. We are born into a system that predates us, and are repeatedly called into gender throughout our lives. We see this in the clothing and toys we are permitted as a child, the prefix before our name, how others address us (eg ‘ladies’ or ‘gents’), the signs on public toilets and, ultimately, the way others interact with us depending on how they perceive our gender. This process is so naturalised that we barely notice it –that is unless we have a strong sense that the way we are being perceived is not who we know ourselves to be. For people who experience this mis-gendering, it can be incredibly painful and jarring to a sense of self. High rates of mental health distress and suicidality in trans communities tell us that, for some, it feels unbearable.

People who are trans (or perceived as ‘crossing gender’) are highly vulnerable to psychological and often physical violence from those who refuse to accept deviation from ‘the norm’. Policing of gender can be seen in ‘jokes’, transphobic, sexist and homophobic comments – and can be deadly. GLAAD (formerly the Lesbian & Gay Alliance Against Defamation)1 declared 2016 the deadliest year on record for murders of trans people, adding that figures were likely to be an understatement, with trans people’s gender identities often erased/ misrepresented in police reports and the media. According to The Independent, 2 transphobic hate crimes rose a staggering 170 per cent in 2016. While, across the world, those perceived as crossing gender often face persecution. Globally, we know that being LGBTQ is still a crime in 74 countries, resulting in imprisonment and, sometimes, the death penalty. One might then ask, if the dominant gender model is natural, why does it need to be constantly reproduced and (at times violently) reinstated?

Despite such challenges, we know that increasing numbers of people are coming out as transgender or questioning their gender identity. Gender identity clinics have seen a huge rise in people seeking support, including those with a non-binary gender identity (feeling neither wholly male nor female). Changes such as greater societal awareness, legislation and LGBTQ spaces have made an impact. Older people note they now have the narrative to name their experiences and the space to explore their identity. Meanwhile, children are coming out younger than ever before.

Trans activism has led to greater visibility and created a shift in our thinking around gender. While feminist activism challenged the naturalness of gender roles, and the gay rights movement has shown us that homosexuality and bisexuality are as natural as heterosexuality, trans activism has demonstrated that the sexed body does not automatically denote someone’s gender. In addition, intersex activism tells us that babies born intersex are far more common than depicted – with the process of ‘correcting’ ambiguous genitalia (and then assigning a gender) deeply harmful and inhumane.

The law still only recognises two genders, yet societal shifts reflect changes in the gender landscape. The Merriam-Webster Dictionary tells us gender identity is: ‘A person’s internal sense of being male, female, some combination of male and female, or neither male nor female.’ Social media sites are presenting numerous options for gender identity upon registration. At the end of 2016, Metro bank became the first bank to offer ‘non-binary’ as an option, alongside male and female. Increasingly, organisations and businesses are recognising the need to adapt.

Several new models have emerged that reflect our growing understanding of gender, offering gender as a spectrum rather than a binary, and presenting and offering a wealth of possibilities as individual as we all are (google ‘the gingerbread model of gender’, or ‘the gender unicorn’ for examples). Despite the newness of some of these models, pluralistic understandings of gender have been around for numerous years and exist in societies across the world.

One of the key things I’ve learned is that I cannot support clients around their gender identity if I subscribe to a traditional model of gender. I must support my clients to express all of who they are – their masculinity, femininity and androgyny, without judgment or restriction. I see the client who appears as a man but has a female gender identity as the woman she is, knowing that gender expression is not the same as gender identity. Knowing that, whether the client has transitioned or not, they are still valid. Knowing that the therapy room may be the only space that person gets to be seen, heard and recognised by another as who they truly are.

Debbie Clements BA, PgDip, MA, MBACP, JNC is a counsellor, psychotherapist and trainer who specialises in supporting adults and young people around gender and sexuality.


1. GLAAD. [Online.] (accessed 27 November 2017).
2. Yeung P. [Online.] Independent 2016; 28 July. html (accessed 29 October 2017).