A Provider’s Thoughts on Gender-Affirming Care with Leia Bellinger, LMHCA

Leia Bellinger, LMHCA, is a licensed associate therapist at LightHeart Mental Health’s Anderson Park clinic. She provides therapy both in-person and via telehealth and specializes in gender-affirming care, ruminative thought work, and integrative therapy approaches. Leia has extensive experience working with LGBTQ+ clients and brings modern research, compassion, and creative clinical thinking to every session. In this conversation, Leia shares what gender-affirming care means to her, how it supports mental health, and why collaboration is at the heart of her work with clients.

What gender-affirming care means

What does gender-affirming care look like in your practice?

Leia: I always say that the easiest part of being a therapist is gender-affirming care because it feels so automatic and so integral to just counseling in general. Gender-affirming care is really about meeting someone where they’re at, and the exploration of their gender and their exploration of how they view themselves now versus how they want to view themselves. There are so many segues in gender-affirming care for other means of approaching maladaptive behavior.

Gender-affirming care at its core is really just this collaboration of visualizing and seeking out whoever my client thinks that they are.

I come back to this word “collaborative” a lot, because gender-affirming care—unlike some other approaches to counseling—relies heavily on the client shaping their own perceptions of self. It’s one of my favorite parts of being a mental health counselor, because there are so many parts of the field where the counselor is kind of the end-all-be-all or is really driving the car. But it’s one of those moments where it’s like a sidecar with your client. Sometimes you get to sit in the back a little bit and watch your client make these decisions, make these discoveries. What your job is, is to facilitate a space that allows for curiosity.

Who gender-affirming care is for

Is gender-affirming care only for people in crisis?

Gender-affirming care is not just for someone in crisis or someone at the brink of something serious. A lot of the time it is—because it’s so needed and maybe denied or ignored for an extended period of time—but it really is for everyone in terms of just self-discovery.

How do gender identity and mental health connect in the work you do?

Studies show that there’s such a connection between gender dysphoria and anxiety, low self-esteem, depression. The connection between gender identity and mental health, in my approach, often involves challenging the narratives people carry—narratives that say they have to be a certain kind of person or meet certain expectations.

Challenging internalized expectations

What do you focus on when helping clients unpack those expectations?

I’ll often ask my clients, “What’s the rubric for this? What’s the expectation here?” And most of the time, when we unpack it, it has nothing to do with their actual experience or needs. It’s like an arbitrary expectation: from your culture, from your family, from your friends, from those closest to you. I focus a lot, when providing gender-affirming care, on understanding empathy. Because there are a lot of times that my clients will say things—or even do things—to themselves that they would never do to someone close to them. Someone that they love or respect.

What changes do you notice in clients once they begin this work?

I’ll have clients who start seeing me just for something symptomatic like anxiety or self-esteem issues, and by the end of six months, we’re looking at a completely different person: physically, mentally, spiritually. When a client talks about their soul, it’s different. It can be a very fast-paced process. It doesn’t have to be, it’s very much guided by the client. But I think the strongest feeling that’s palpable in the room is: I found something I’ve been missing.

What do you tell clients about progress and setbacks?

I often tell my clients that life is nonlinear—therefore why wouldn’t your transition be nonlinear? So it’s not that depression disappears once a transition begins, or that you can’t be both trans and depressed. In fact, those feelings can still be very present and intense. But the most important thing is that at least a client has a bearing of themselves—at least has an opportunity to mitigate something and have control over something in their life, which is their identity.

What gender-affirming care is — and isn’t

Do clients ever come in expecting all their problems to be solved through identity work alone?

Sometimes. I’ve had clients that seek me out because I’m very open about my journey as a transgender woman, and I don’t shy away from self-disclosure if it’s helpful. And I’ll have clients that come in like I’m a genie in a bottle, that they’ll get what they need in three sessions. They want to ask me a million questions about me. And I have to say, “I’m the master of my own experience, but you’re the master of yours.” If it allows someone to even open the door of gender-affirming care and therapy, I welcome that. But it’s also an opportunity to say: you’re a complex person. You have your own experiences in life.

And let’s take the lead from your perspective, not anyone else’s. Not anyone else’s transition or story. But instead: you.

I like to laugh about that a bit with my clients—because often, when they ask me a question, I want to ask them the same one. There’s a kind of leveling that needs to happen with self-disclosure.

What do you want your clients to walk away with?

I want my clients to be in a space where empathy isn’t solely nurtured outwardly but inwardly as well.

You don’t have to have everything figured out to start therapy.

If you’re questioning, exploring, or just want to talk to someone who sees you for who you are, you’re not alone, and you don’t have to navigate it by yourself. Our team is here to support you with care that’s respectful, collaborative, and affirming.