Nonbinary and Genderqueer Care

I specialize in working with nonbinary, genderqueer, and genderfluid folks because that’s how I am, too. It took me a long time to figure out my gender situation, because there weren’t words for it when I was growing up. Luckily, now we have the Internet, and access to all kinds of exciting language to describe ourselves and figure out where we fit in.

Sasha Strong during a visit to Grenoble, France in 2017.

Nonetheless, being NB/GQ and other exciting kinds of gender-different can be tough: you get misgendered all the time, people can’t remember your pronouns, they assume you must like certain things or act a certain way based on how they misread you, they ask “when are you having that surgery,” or they undermine your identity as just “on the way” to a binary transition. And each mis-naming, mis-gendering, and erasure is like a little cut, and you can’t get the mirroring you need. Therapy can help with some of these, and alongside supportive friendships and life practices, nonbinary, genderqueer, genderfluid, and other identities can actually make life a lot more fun and creative.

I can help with the therapy part, because I’ve been there, and I know how it feels. I’ve done my own work with books like My New Gender Workbook  (one of my favorites!), and while I wouldn’t say that I’ve figured everything out about my gender (which would be, like, totally anticlimactic), I have teased out a lot about it, and I’ve gotten comfortable with my fluid mishmash of masculine, feminine, and other gender experience, pan-bi-whatever sexuality, and the right kinds of affective, romantic, and social connections. I’m lucky that I live in Portland, where there are lots of folks like me, and I don’t need to be worried about getting beat up (mostly)— but I still get misgendered, erased, and treated differently than I like daily. So I decided to build community and make a difference through my profession.

Sasha Strong and Sagan Wallace co-presented at Gender Odyssey Professional in Seattle, 2017

Culturally Competent Counseling for Nonbinary and Genderqueer People

When I was looking around for resources in Portland a few years ago, I realized that I needed more community, so I founded a peer support group that ran for about eight months in 2016–2017. Along with my friends-colleagues-fellow members, we did a participatory action research study on “How nonbinary/genderqueer people describe culturally competent counseling.” I was interested to find out what we already knew about good and bad counseling, and I wanted to spread the news to other mental health professionals, so that folks like us could get access to better care and experience fewer micro-aggressions and gender-disconfirming experiences.

We conducted interviews with 7 people and analyzed the data during 2 focus groups. (In qualitative studies like this one, small sample sizes can be appropriate, because we’re looking for subtlety in human experience. The sample size doesn’t need to be large, because we’re not looking for a sample that is statistically representative. Rather, if you’re a NB/GQ person, judge for yourself if our findings resonate with your experience.) We came up with the following themes and best practices for therapists.


We thematically analyzed 61 meaning segments gathered from focus groups, in-person interviews, and email submissions, and grouped the items into 5 overarching themes and a list of 12 best practices.

Validation 101

Non-binary/genderqueer people need to be basically validated as they are, without being told they should fit into a different identity, performance, or set of norms.

Holding space for complexity

NB/GQ identity and development are complex and can take many forms over time. Clients and helpers need to hold space for that complexity.

Finding safe spaces

NB/GQ people need to find and inhabit safe spaces, when accessing services, in home life, with friends, and in community. Peer support can be very helpful.


NB/GQ experience is characterized by erasure in the mainstream social context. It is crucial that helpers understand the pain of erasure and that they not recapitulate it.

Trauma-informed intersectionality

NB/GQ people may have experienced trauma, and may belong to other oppressed groups. This complex issue demands sensitivity and discernment.

12 Best Practices for Culturally Competent Counseling with Non-Binary/Genderqueer Folks

  1. Embrace gender transition as an open-ended, lifelong process of exploration and joy.
  2. Be curious about NB/GQness in general and your clients’ experience in particular.
  3. Don’t use your clients for your professional education.
  4. Get our pronouns right (and if you mess up, apologize and move on).
  5. Appreciate the rich complexity of trans*ness.
  6. Start from within: Analyze your own gender assumptions and limitations.
  7. Change your intake forms and processes to avoid binary gender assumptions.
  8. Change your speech to avoid binary gender assumptions.
  9. Develop a relationship with the community that goes beyond learning from us.
  10. Understand that trauma and NB/GQ experience co-arise and are intertwined, but one does not necessarily cause the other.
  11. Develop a critical analysis of systems of oppression and intersectionality.
  12. Carry forth these principles and become an NB/GQ ally and activist!

If you think these principles are good directions for culturally competent counseling for you, in the uniqueness of your gender experience, please spread the word to folks in the mental health professions, and feel free to get in touch. I’d be happy to work with you as a client, or offer trainings or consultation if you are a mental health professional. Let’s work together to create a world where nobody gets marginalized or abused just for being different.