Affirming therapy for trans and nonbinary people — who you are is beautiful
Online therapy for transgender, nonbinary, and gender-expansive adults across California, Oregon, Washington, and New York, led by Harry Dixon, MA, LMHC, LPCC, LPC, CST, who has worked with trans and nonbinary clients since 2016. You bring the knowledge of who you are. We bring clinical skill, steady care, and no agenda about where your gender should land.
Being trans is never the problem — how the world responds often is
Trans and nonbinary clients often tell us they're carrying a lot: misgendering at work, hostile headlines, health care that feels like a checkpoint, and family members who are still catching up. That stress is real. As a 2024 framework for gender-affirming psychotherapy puts it, being transgender isn't inherently harmful to mental health — the discrimination that often comes with it is.
Many clients also describe past therapy where they spent their first sessions teaching the basics, defending their identity, or bracing for the next wrong pronoun. Here, you can skip all of that.
At Rainbow Connection Counseling Collective, our therapists are LGBTQ+ and BIPOC identifying, and we hold your gender as one part of a whole life — alongside your sexuality, race, culture, faith, body, and relationships. Sometimes gender is the center of our work. Sometimes you just want help with your depression, your relationship, or your job, from someone who won't make your gender the problem.
Since 2016, this work has shown me trans excellence
Since 2016, I've had the privilege of working alongside trans, nonbinary, and gender-expansive clients — people questioning for the first time, people decades into living as themselves, and the partners and families learning alongside them.
I want to be clear about what this page is and isn't. It isn't me speaking for trans and nonbinary people. No cis clinician can or should do that, and trans and nonbinary people speak for themselves — through their own leaders, writers, organizations, and survey data like the numbers above. What I can speak to is what I've learned in the therapy room: the patterns that come up, the approaches that help, and what gets in the way when care isn't affirming.
That's why I practice from cultural humility rather than claiming expertise about anyone's identity. Every client's understanding of their gender is shaped by their own culture, family, faith, and history, so I stay curious, I'm honest about the limits of what I know, and I welcome correction. In my experience, that stance — more than any single technique — is what makes therapy feel safe enough to do real work.
This work has also shown me, again and again, the remarkable resilience and strength of the trans and nonbinary people I've worked with — strength often built while navigating families, workplaces, and systems that weren't designed with them in mind. Good therapy builds on that strength; it doesn't only focus on what hurts. And I've come to believe that living your truth is a radical act of compassion and self-love — one that deserves to be honored, not just survived.
You are the expert on your gender. My job is to bring clinical skill, curiosity, compassion, and a safe place for you to heal — and to keep doing my own learning, so you never have to teach me who you are.
- Transition isn't only physicalIt can also be a psychological shift — from a perceived or assumed gender to your true gender identity — whether or not medical steps are part of your path.
- Unlearning old norms can bring griefLetting go of the rules and roles you were raised with can involve real loss, alongside the relief. That grief deserves room in therapy.
- Living in your affirmed gender takes courageMany clients describe an imposter-like feeling along the way. It's an understandable response to unlearning years of messages — not evidence that you're "not trans enough."
- Euphoria deserves as much room as dysphoriaTherapy shouldn't only be about what's hard. Noticing what feels right is part of the work, too.
- Repair matters more than perfectionIf I get something wrong — a name, a pronoun, an assumption — I want to know. I'll own it, correct it, and keep going.
- Gender isn't always obvious — and that's okayYou can't know someone's gender by looking at them, and sometimes it isn't clear to the person yet, either. Questioning, trying on new language, or landing somewhere unexpected are all part of the process.
- Gender needs to be decolonizedMany cultures understood gender beyond a strict binary long before colonization imposed one — including Two-Spirit people in many Native North American nations and māhū in Native Hawaiian culture. Those identities belong to their own communities and aren't interchangeable with Western labels. In therapy, that means questioning binary assumptions and making room for each client's own cultural understanding of who they are.
What trans and nonbinary clients often bring to therapy
These are themes that come up again and again in our work — not a definition of anyone's experience. Your reasons for reaching out are your own. Select an area below.
Questioning & Exploring
Space to explore your gender without pressure to land on a label, a timeline, or anyone else's idea of what being trans "should" look like.Social, Medical & Legal Transition
Thinking through what transition means for you — names, pronouns, presentation, medical steps, the inner shift of living as yourself, or none of the above — at your own pace.Nonbinary & Beyond the Binary
Living as nonbinary, agender, genderfluid, or genderqueer in a world built around two boxes — and the fatigue of being misread.Dysphoria & Euphoria
Coping with dysphoria when it's loud, and noticing, naming, and building more of the moments that feel right.Coming Out & Inviting People In
Deciding who to tell, when, and how — and navigating the reactions, the questions, and the people who need time.Work & Public Life
Misgendering, disclosure decisions, and safety at work, school, and in public spaces — plus the weight of being "the only one" in the room.Family Acceptance & Distance
Navigating parents, siblings, and relatives who are supportive, struggling, or rejecting — and deciding what relationship you want with each.Gender Across Cultures
Being trans in an immigrant or bicultural family, in a language that genders everything, or in a culture with its own gender expectations and histories.Trans & BIPOC
Carrying racism and transphobia at the same time — hypervisible in some spaces, overlooked in others.Faith & Spirituality
Healing from religious rejection, or finding a way to keep your faith and your gender in the same life.Chosen Family & Community
Building and keeping the relationships that hold you — and grieving the ones that didn't make the journey with you.Loneliness & Isolation
Feeling alone in your experience — distance from family, few people who truly get it, or isolation in rural areas, conservative communities, or even queer spaces — and finding connection that feels safe.Political Climate & Safety
The weight of anti-trans legislation and news, hypervigilance about safety, and decisions about where you can live well.Dating & Disclosure
When and how to share your trans history, dating apps, rejection, and finding partners who see you clearly.Partners Through Transition
Supporting relationships when a partner comes out or transitions — including how each of you understands your own identity and orientation.Sexuality After Transition
Shifts in desire, orientation, pleasure, and how your body feels during sex — explored with an AASECT Certified Sex Therapist, without judgment.Body Image & Embodiment
Building a more livable relationship with your body, whether or not medical transition is part of your path.Fetishization & Objectification
Recovering from being treated as a fantasy or a curiosity rather than a whole person — in dating, media, and community.Queer & Trans
Being trans and gay, lesbian, bi, pan, ace, or queer — and the layered coming-out journeys that can bring.Your struggles have context
Clinically, we draw on the gender minority stress framework (Hendricks & Testa, 2012), which locates much of the distress trans people face in stigma and the work of anticipating it — not in being trans.
Pressures Clients Often Describe
- Minority StressThe steady, cumulative strain of stigma, discrimination, and having to anticipate how others will react to you.
- Misgendering & DeadnamingSmall, repeated invalidations that add up — especially from family, coworkers, and health care providers.
- Health Care GatekeepingHaving to prove yourself to access care, and the mistrust that builds after being treated poorly.
- Anti-Trans Laws & MediaLiving with public debate about your existence, and the fear and fatigue that can come with every new headline.
- Economic & Housing StrainJob discrimination, unemployment, and housing instability that make everything else harder.
- HypervigilanceAlways scanning for safety — in bathrooms, on the street, online — and a nervous system that rarely gets to rest.
Where Gender, Sexuality & Culture Meet
- Racism and Transphobia TogetherTrans people of color can face both at once — including racism inside LGBTQ+ spaces and transphobia inside cultural ones.
- Cultural & Religious ExpectationsFamily traditions, faith teachings, and gender roles that leave little room for who you are.
- Orientation in MotionQuestions about attraction and sexual identity that can open up during or after transition.
- Exclusion in Queer SpacesFeeling like the "T" is an afterthought — or that nonbinary people don't quite count.
- Family Duty & BelongingWanting to stay close to family and culture without having to hide your gender to do it.
- Language & TranslationExplaining your gender in a family language that has no words for it — or too many gendered ones.
None of these are personal failings. The same research also names what protects: community connection, pride, and affirming relationships. Naming the pressures and building the protections both belong in our work together.
Your gender doesn't live in a separate room
Gender is sometimes treated in therapy as a standalone topic. In our experience, it rarely works that way. Being trans or nonbinary can shape how you date and how your sexuality is read, how your family's culture and faith respond, how racism lands on you, and how safe you feel in queer spaces. Those threads don't untangle neatly, so we don't ask you to separate them.
Our work happens every day where gender identity, sexual identity, race, and culture meet: with trans people of color, trans and queer Asian Americans, nonbinary people from religious families, trans people in queer, interracial, and nonmonogamous relationships, and partners learning how a transition changes them too.
Our therapists are LGBTQ+ and BIPOC identifying, and our clinical depth — AASECT Certified sex therapy, IBCT couples therapy, trauma-informed care, and evaluations for gender-affirming care — means the parts of your life that other practices refer out are things we can hold in one place.
Proven approaches, adapted to you
Gender-affirming therapy is a stance, not a single technique, so we bring it to every modality we use — adapting each one to your identity, culture, and goals rather than asking you to fit a cisgender template.
ACT helps you make room for hard feelings without letting them run your life. For many trans and nonbinary clients, it's a useful way to keep moving toward what matters even when the outside world is loud.
- Clarify your values around gender, relationships, work, and community
- Hold fear and hope together when making decisions about coming out or transition
- Unhook from internalized messages like "I'm too much" or "I'm asking for too much"
- Take committed steps toward the life you want, at a pace you choose
CBT helps identify the thought patterns that keep anxiety and depression going. We adapt it carefully, so it never treats realistic fears about safety as distortions — only the beliefs that aren't serving you.
- Challenge internalized transphobia and the "not trans enough" voice
- Reduce social anxiety in public spaces, at work, and with family
- Separate real risk from rumination so you can plan for safety without living in dread
- Practice self-advocacy with doctors, employers, and loved ones
Many clients describe absorbing years of messages that something about them was wrong. CFT counters that shame by building self-compassion — a quiet but powerful kind of healing.
- Soften the inner critic shaped by family, faith, or culture
- Grieve what you missed without getting stuck there
- Build self-soothing practices for dysphoria and hard days
- Make room for joy and gender euphoria, not just survival
Transition can change a relationship as well as a person. IBCT helps partners understand the deeper themes behind recurring conflict and build both acceptance and change.
- Navigate a partner's coming out or transition together rather than apart
- Explore shifting identities and what each of you needs to feel seen
- Support queer, interracial, and nonmonogamous relationship structures
- Rebuild intimacy and trust after big changes
Sex can change in surprising ways when your gender, body, or orientation shifts. Sex therapy offers a shame-free space to explore what feels good now.
- Navigate dysphoria during intimacy and find what feels affirming
- Explore desire and orientation as they evolve
- Address sexual concerns like low desire, pain, or performance anxiety
- Heal from fetishization and reclaim your sexuality as your own
What therapy looks like at RCCC
Treatment is collaborative from the very first conversation. Here's what to expect.
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Free consultation
A short call to talk about what you're carrying, ask your questions, and see whether we're the right fit — no commitment, no pressure. -
Getting to know you
We get to know your whole story — gender as much or as little as you want to share, plus family, culture, relationships, and what brought you here now. -
A plan built with you
Together we set goals rooted in your values — not someone else's expectations — and choose the approaches that fit you. -
Ongoing therapy
Regular sessions from wherever you feel safest, with ongoing check-ins on what's changing — so we can adjust as you grow.
You set the pace. Gender might be the center of our work, or it might barely come up. Either way, we use your name and pronouns — always — and you never have to earn our respect for who you are.
Common questions about
trans and nonbinary therapy
Answers to the questions we hear most often from trans, nonbinary, and gender-expansive clients considering therapy.
Not at all. Many clients come to us while they're still questioning, and some never settle on a single label. Therapy is a place to explore without pressure — there's no timeline, no "right" outcome, and no expectation that you arrive with answers.
The American Psychiatric Association describes gender-affirming therapy as a therapeutic stance that affirms a person's gender identity rather than trying to "repair" it, with respect for the client's autonomy. In practice, that means we won't steer you toward or away from any transition step, you don't need a diagnosis to start, and your identity is never the problem to be solved. It also means helping you connect with community support, legal resources, and affirming health care when that's useful.
No. In our experience, transition can also be psychological — a shift from a perceived or assumed gender to living as your true gender identity. That process can include unlearning old norms, grieving what changes, and getting used to living in your affirmed gender, sometimes with moments of feeling like an imposter. Those feelings are common and understandable, and therapy can support all of it — whether or not medical steps are part of your path.
Our founder and lead clinician, Harry Dixon, MA, LMHC, LPCC, LPC, CST, has worked with transgender, nonbinary, and gender-expansive clients since 2016, across individual therapy, couples therapy, sex therapy, and evaluations for gender-affirming care. We're also honest about what that experience is and isn't: clinical expertise is not lived experience, and you remain the expert on your own gender. If working with a trans or nonbinary therapist matters to you, ask us during your consultation — we'll be straightforward about who's available and help you find a good fit if it isn't us.
Only if you want it to. Trans and nonbinary clients come to us for depression, anxiety, trauma, relationships, sex, family stress, faith, work, and more. Your gender is context, not the problem to be solved — and you won't have to explain it before we can help with everything else.
Not as a rule. The current WPATH Standards of Care (Version 8) do not make psychotherapy a requirement for gender-affirming medical care, and we don't believe therapy should be a gate. Therapy is here if it's useful to you, not as a hurdle to clear. Some insurers and surgeons do ask for a mental health evaluation, and we can help with that when you need it.
Yes. Our clinicians provide evaluations for gender-affirming care and, when clinically appropriate, letters of support for gender-affirming surgery. We follow the WPATH Standards of Care, Version 8, and approach evaluations as a way to support your access to care — not to gatekeep it.
Tell us — you're never being difficult by correcting us. We'll thank you, correct it, and keep going, without making you manage our discomfort. Using your name and pronouns is the baseline of affirming care, and owning our mistakes is part of it too.
Yes — it's central to our practice. Our therapists are LGBTQ+ and BIPOC identifying, and we focus on the places where gender identity, sexual identity, race, and culture meet: being trans in an immigrant or religious family, facing racism in queer spaces and transphobia in cultural ones, and staying connected to community without hiding who you are.
Yes. Every clinician who works with you is licensed in the state where you're located, and all sessions are conducted via HIPAA-compliant telehealth. Our founder, Harry Dixon, is an AASECT Certified Sex Therapist licensed in California (LPCC #4340), Oregon (LPC #C8199), Washington (LMHC #LH60684311), and New York (LMHC #015648). The only requirement is that you are physically present in one of these states at the time of your session.
Yes, Harry Dixon, MA, LMHC, LPCC, LPC, CST is our only clinician in network with Cigna. During your free consultation, we'll discuss your specific insurance situation and help you understand your coverage. We also offer self-pay options and can provide superbills for out-of-network reimbursement. Reach out here or call 619.363.4674.
The easiest way to start is to schedule a free 15-minute consultation. During that call, we'll hear a little about what brings you to therapy, answer any questions you have, and get a sense of whether we're the right fit — no commitment, no pressure. You can also reach us directly at 619.363.4674. We typically respond to all inquiries within one to two business days.
Resources led by trans people
Therapy is one kind of support. These organizations are run by and for trans people, and we point clients to them often.
Rainbow Connection Counseling Collective is not a crisis service. If you are in immediate danger, call 911. We aren't affiliated with the organizations above; we share them because they're valuable to the people we work with.
- American Psychiatric Association. Gender-Affirming Therapy (2017).
- Boyle, P. What is gender-affirming care? Your questions answered. AAMCNews (2022).
- Hendricks, M. L., & Testa, R. J. A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the Minority Stress Model. Professional Psychology: Research and Practice (2012).
- Price, M. A., et al. Gender Affirming Psychotherapy (GAP): Core principles and skills to reduce the mental healthcare "gap" for transgender youths. Psychiatric Services (2024).
- National Center for Transgender Equality (now Advocates for Trans Equality). Early Insights: 2022 U.S. Transgender Survey (2024).
Licensed & accepting clients in 4 states
Online therapy — from wherever you feel most comfortable and safe.
Come as you are — all of you
Schedule a free consultation with clinicians who honor your gender, your sexuality, your culture, and every part of who you are — and who know you're the expert on your own life.
Questions? Call us at 619.363.4674 or send a message