Transgender and gender diverse (TGD) adolescents and their caregivers have highlighted the dearth of providers trained in gender-affirming care as a critical treatment barrier, yet little is known about their specific experiences in mental health therapy. The present study sought to elucidate these experiences. Qualitative description was employed to code data from 105 clinical interviews completed with TGD adolescents (n=49; ages 11–20) or their caregivers (n=65) seeking medical gender transition services at a pediatric gender program in the U.S. Participants highlighted satisfactory experiences with therapists they perceived as gender-affirming and those who actively involved caregivers in therapy. Several participants reported unhelpful experiences with therapists viewed as non-affirming. In a few cases, caregivers were alienated from therapy when therapists told them to affirm their adolescent’s gender in highly directive ways. Findings underscore the need to train therapists in gender-affirming practice and highlight the importance of thoughtfully engaging caregivers in therapy.
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