NHS Arden & GEM National Referral Support Service

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Working therapeutically with young people exploring their gender

Our service has developed some primary therapeutic aims (See Our Values and Ethos) which we have used to guide our work. Clinical work with young people can take a variety of formats, including one-to-one sessions or increasingly group work where other young people alongside professionals can provide support. Follow this link for more ideas about how to work with young people and gender. 

Listen and understand

Join the young person where they are in terms of their gender identity, and listen to understand (rather than to offer immediate solutions).

Part of your role could be to help the young person come up with their own solutions, and weigh up the pros and cons of choices they might be considering (e.g. in relation to socially transitioning).

A respectful approach

Maintain a respectful and non-judgemental approach to working with the young person.

This might involve using their preferred names and pronouns, even if other people choose not to.

Gender expression

Help them experiment with their gender expression.

Is there a safe place that the young person could try things out (in terms of dress, names, pronouns etc), without having to commit to anything? 

Gender as a concept

Discuss gender as a concept.

Gender is complicated and multi-faceted, and can be understood as being a spectrum rather than necessarily needing to be a binary choice between male or female. What does the young person think about this idea? What gender role models do they have? For more insight, see the ‘Genderbread person guide’ on Sam Killermann’s website


Challenge gender stereotypes and norms.

Reflect on the pressures to conform – which of these does the young person feel affects them, and where do these messages come from? What it is like to be someone who does things differently?

Keep options open

Help to keep options open and maintain safe uncertainty.

Young people’s identities are developing throughout adolescence and into adulthood, and some people decide that they would like to express their gender identity in lots of different ways, which may change over time. Keeping options open is important to allow a young person to feel able to change paths if they want to.


Work with the family.

Provide a space for different views to be listened to and thought about. Encourage open communication about gender, in a way that feels safe for the young person. 


Keep the network in mind.

Who else knows the young person and what support may they be able to provide, if necessary? Keep in touch.


Help them build a community.

Young people can benefit from making links with other people in a similar situation, hearing about different ways of expressing gender, and how others may have dealt with particular situations. Are there local LGBT groups, or would the young person benefit from linking in with the organisations listed on this website?

Risks and difficulties

Assess risk and associated difficulties.

Young people who are questioning their gender may experience a range of associated mental health difficulties, including self-harm and suicidal ideation. It is important this is assessed and managed locally. Gender does not exist in a vacuum and seeking support for gender-related distress does not necessarily mean that all other difficulties will improve as a result – there are often other complexities that need to be thought about and it will be important to discuss with the young person about how best to do this.

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