Episode 390: Gender Identity in Therapy & Standing Up to Mom

Hello friends! In today’s episode, we tackle two profound listener questions that may resonate with many of you:

  • Dealing with Hurtful Family Comments: A listener is troubled by their mother’s deeply hurtful comment, suggesting they have been a source of stress since birth. We explore the emotional impact of such comments, consider the role of health issues in behavior, and discuss strategies for coping and moving forward.

  • Navigating Identity and Therapy: Another listener, a closeted trans man, shares their experience of coming out to their therapist and the mixed responses received. We delve into the importance of understanding and navigating gender identity within therapy, especially in conservative environments, and ponder whether seeking a gender specialist, in addition to their current therapist, might be beneficial.

As always, you can send me questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode390


This episode is sponsored by Babbel, the language learning app that’s as close as you can get to immersion from your own home. Designed for real-life conversations, Babbel is backed by science and makes learning new languages practical and enjoyable. I’ve even used my Spanish skills from Babbel in a real client meeting! Get started with Babbel and enjoy 55% off your subscription by visiting babble.com/duff. Conditions apply.

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Question 1:

Hello Dr. Duff, Hope you are well.

I just want to ask a question and I hope you can help me out. How does one react when one’s mother says ”You have caused me stress from the day you were born”? For the record- my own mother said this to me today. I understand she’s going through health issues but she says this to me despite everything I’ve done for her. So, how the hell do I react?


Thank you for sharing your question with me, and I’m sorry to hear about the painful comment your mother made. It’s incredibly tough to hear something like that from a parent, regardless of their health situation. First and foremost, it’s vital to acknowledge that your feelings of hurt are valid. Such a statement can be deeply wounding, as it criticizes the very essence of your existence.

It’s worth considering that health issues can significantly impact a person’s mood and behavior. For instance, certain conditions, especially in older adults like urinary tract infections, can cause confusion and agitation. Neurological issues such as dementia, strokes, or even chronic pain, can alter a person’s personality and behavior. Medications, too, can change how someone behaves or perceives their environment.

Given the context of your mother’s health issues, it’s possible that her harsh words were influenced by her condition. This, however, doesn’t excuse the pain caused. It’s essential to protect your well-being in such situations. If this behavior is uncharacteristic of your mother, it might be a sign of an underlying health issue needing attention.

Reflecting on your relationship and the support you’ve provided, it’s clear you care deeply for your mother. Cultural and personal expectations can complicate these dynamics, especially if you’ve been involved in caregiving. It’s crucial to recognize the complexity of emotions involved for both of you.

Taking her statement at face value, it might indicate unresolved issues on her part, perhaps reflecting her struggles rather than your actions. Parenthood, inherently stressful, brings its challenges, and it sounds like she may be projecting frustrations unrelated to you.

In dealing with this, honesty is critical. You have every right to express that her words were hurtful. Dialogue, approached calmly, could provide an opportunity for clarification or apology. Setting boundaries is also essential; it’s okay to demand respect and consider reducing involvement if negative treatment continues.

Self-reflection is important, too. Ensure that your actions align with your values and consider professional support to navigate this complex situation. Ultimately, your worth isn’t defined by your mother’s words. Building a sense of self outside of this relationship can bolster your resilience against such hurtful comments.

In summary, while it’s important to consider the potential impact of health issues on behavior, you must also protect your emotional health. Open communication, setting boundaries, and seeking external support can help manage the situation. Remember, your value is intrinsic, not contingent on another’s approval or state of health.

Question 2:

I am a closeted trans man and recently came out to my therapist who I have been seeing for the past few years. We have a great relationship and he has helped me a lot. He was supportive which I was grateful for since I live in a very conservative state and so have been reluctant to tell friends or family for fear of rejection.

However, while discussing this with him, he consistently used incorrect terminology- such as calling gender dysphoria gender dysmorphia, and referred to a non-binary client he was helping by the incorrect pronouns (client told him they used they/them pronouns, but he kept referring to them as “she.”) I pointed these things out to him as politely as I could, thinking maybe his errors were due to a lack of education, but he didn’t make any effort to correct himself and even mentioned to me that he wasn’t going to write a letter of support for the non-binary client because they weren’t dressing masculinely enough. This made me incredibly uncomfortable and sad for this person and has made me question whether I should continue seeing this therapist.

I’m not sure what to do- keep the therapist with whom I have good rapport or find a new one who is more experienced in gender issues, but without the rapport. I should add that I have had a few negative experiences with therapists in my state and have yet to find one that I trust as much as my current therapist. Would it be possible to see my current therapist and a gender therapist at the same time? Would be interested to hear your thoughts on this.


Addressing your concerns and feelings about your current therapist, who, despite a strong therapeutic rapport, has demonstrated a lack of understanding and sensitivity towards gender issues, requires thoughtful consideration. Your bravery in coming out to him, especially in a conservative setting, is commendable and reflects a significant step in your journey towards living authentically. It’s understandable that his response, while initially supportive, has led to mixed feelings due to subsequent actions and comments that indicate a lack of expertise or sensitivity towards transgender and non-binary issues.

Your therapist’s incorrect use of terms and reluctance to respect pronouns not only undermines the trust and safety essential in a therapeutic relationship but also reflects a broader issue within mental health care regarding the recognition and support of LGBTQ+ identities. The scenario with the non-binary client and the therapist’s rationale for not writing a support letter raises ethical concerns and highlights a misunderstanding of the complexities surrounding gender identity and expression.

Living in a conservative area complicates finding knowledgeable and supportive mental health professionals. Your fear of rejection and the difficulties you’ve faced in finding a therapist you trust are valid and significant barriers to seeking support. The idea of seeing a gender therapist, in addition to your current therapist, to address specific gender-related concerns is a viable option. Many people benefit from consulting multiple specialists to address different aspects of their health and well-being.

Before making a decision, consider discussing your concerns directly with your current therapist. This conversation could provide clarity on his willingness to learn and adapt his approach to better support you. It’s crucial for your therapist to acknowledge the importance of correct terminology, respect for pronouns, and a nuanced understanding of gender identity’s impact on your mental health.

If the outcome of this discussion doesn’t align with your needs, seeking a therapist with specific expertise in gender issues might be the best course of action. Online therapy options and LGBTQ+ organizations can be valuable resources for finding knowledgeable professionals in conservative areas.

Ultimately, your mental health and well-being are paramount. A therapeutic relationship should provide a safe, respectful, and understanding environment. Your experiences and identity deserve validation and support, and it’s important to prioritize finding a therapist who can offer this. Whether you decide to continue with your current therapist while seeing a gender specialist or transition to a new therapist altogether, ensure that your chosen path feels right for you and supports your journey towards healing and self-acceptance.

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