Best practices for therapists working with immigrant mental health
Gender identity therapy worksheets can be a helpful tool to support clients in exploring their gender in the safety and acceptance of a therapeutic relationship.
This article provides an overview of gender exploration and coming out discussion questions that clients may find helpful in guiding their exploration of gender identity.
We’ve also included a free downloadable gender dysphoria therapy worksheet to save to your electronic health record (EHR) and use in your practice.
Understanding gender identity
Gender dysphoria is a clinical term used to describe the distress or discomfort that may occur when a person's gender identity differs from the sex they were assigned at birth. It's important to note that not all people whose gender identity differs from their assigned sex experience dysphoria.
Clinicians often use gender dysphoria therapy worksheets to help clients identify and navigate these feelings.
When thinking about gender, it’s important to know that gender identity is a social construct created to help categorize people into specific groups, each with a set of gender expectations, such as how someone should dress, talk, act, and experience emotions.
For example, traditional societal views and stereotypes see gender as a binary of male or female. In this view, males may be less likely to express emotion and wear more masculine-presenting clothes. In contrast, females may be expected to express their feelings more freely and dress in a more feminine way.
However, gender roles are not set in stone. Many people experience their gender identity on a spectrum.
Some people may not conform to fixed ideas of gender, some may see their gender as more fluid, and others may experience and express a gender different from the sex they were assigned at birth. For example, a person may be assigned female at birth but later discover they are more aligned with a non-binary identity and express themselves in what may be considered more masculine or feminine ways.
There are many ways to experience and express gender, and it's a deeply personal and often evolving process that you can explore at any age.
While this list is not exhaustive, these common terms can help provide a framework for exploration:
Transgender: An umbrella term for people whose gender identity differs from the sex they were assigned at birth.
Trans man: A person who was assigned female at birth (AFAB) and identifies as a man.
Trans woman: A person who was assigned male at birth (AMAB) and identifies as a woman.
Genderqueer/non-binary: Terms for those who do not identify exclusively as male or female. This may include identifying as both, neither, or moving between genders.
Transmasculine: A person assigned female at birth (AFAB) who identifies with a more masculine gender identity, though they may not identify strictly as a binary man.
Transfemme: A person assigned male at birth (AMAB) who identifies with a more feminine gender identity, though they may not identify strictly as a binary woman.
Two-Spirit: A culturally specific identity used by some Indigenous and Native American people to describe a person who fulfills a traditional third-gender (or gender-variant) ceremonial and social role in their community.
Some ways to explore gender may include:
Reflecting on differences in how you experience your gender and how certain cultural or societal expectations impact that
Trying different names, pronouns, or gender expressions
Understanding the difference between gender identity, expression, and sexual orientation
Finding ways to affirm your identity and expression, such as by working through gender identity therapy worksheets, and building a supportive network of people who accept you as you are
Gender exploration questions
The following prompts, also found in gender identity therapy worksheets, may help your clients gain more clarity and understanding about gender identity and expression.
Clinicians should help clients prioritize their physical and emotional safety by assessing their environment before testing new names or expressions in public spaces.
Understanding gender identity
What messages did you learn about gender?
When did you start questioning your gender?
How does it feel when people use certain gendered words to describe you? For example, if someone called you a girl or a boy, how would you feel? What if they use pronouns like she, he, or they?
What aspects of your gender identity feel misaligned or confusing?
How would you describe your gender identity if you were to let go of cultural expectations?
What name do people call you?
How do you feel when people use that name?
What labels would you use to describe yourself?
What name would you like to use?
What pronouns would feel more aligned with your identity?
What do you like about your gender identity?
What do you dislike about your gender identity?
Gender expression prompts
Gender expression is the way you present yourself in the world, such as what you wear, how you talk, or how you style your hair. It may also include expressing yourself as masculine, feminine, or gender neutral/androgynous.
These prompts, which are standard components of many gender dysphoria therapy worksheets, help clients visualize how external changes might alleviate internal distress:
How would you feel if you were perceived as masculine?
If you were perceived as feminine, how would you feel?
How do you feel about being perceived as gender neutral?
How do you feel when wearing more masculine or feminine clothes?
What gender expression makes you feel most affirmed or seen by others?
If you identified as a different gender, would that change how you express yourself?
Finding affirming spaces and support questions
Identifying safe spaces is a key part of gender exploration. Many gender dysphoria therapy worksheets focus specifically on mapping out a client's support system to ensure long-term emotional safety.
For example, these types of questions found in the gender identity therapy worksheets include:
What spaces feel safe to be who you are?
Which people in your life support you in exploring your gender?
Are there people or spaces that feel unsafe or uncomfortable to express your gender?
What do you want your friends and family to know about how you identify and express your gender?
How to use the gender identity therapy worksheets
You can download and use the gender exploration worksheet in several ways.
For example, use it in a session to support the client in exploring their gender identity. Provide the gender identity therapy worksheets to your client as homework to remind them of what you discussed during therapy. Ask the client to reflect on the gender exploration questions between sessions and share their reflections at their next therapy appointment.
Print copies of the gender dysphoria therapy worksheet to keep in your office, or share the worksheet with peers, coworkers, or supervisees.
You can also combine the worksheet with other LGBTQIA+ or transgender therapy worksheets and resources.
By consistently integrating gender identity therapy worksheets into your clinical practice, you can create a structured, evidence-based environment for clients to explore their most authentic selves.
Sources
Garg, G., Elshimy, G., & Marwaha, R. (2023). Gender dysphoria. In StatPearls. StatPearls Publishing.
Testa, R. J., Coolhart, D., & Peta, J. (2015). The gender quest workbook: A guide for teens and young adults exploring gender identity. Instant Help Books/New Harbinger Publications.
The Trevor Project. (2024). Understanding Gender Identities and Pronouns.
Resource Center for Sexual and Gender Diversity. (n.d.). Questioning and Gender Exploration. UC Santa Barbara.
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