Pronouns can feel like a tiny detail until you realize they are a real-time test of safety. When someone’s identity has been questioned, policed, or punished, the smallest moments in a therapy office can signal either danger or relief. I sit down with Dr. Lou Himes, a licensed psychologist and certified specialist in transgender mental health, to get concrete about what gender-affirming care looks like when trauma, dissociation, and systemic betrayal are part of the story.

We talk about how Dr. Himes found their way into working with transgender clients, why many well-intentioned clinicians still hesitate, and how a trauma-informed lens can help us understand anger and guardedness as protection rather than “resistance.” We dig into identity-affirming therapy as dignity-affirming care and self-determination, including why it can be more healing to honor a client’s self-definition early on than to rush toward certainty or a perfect clinical formulation. Dr. Himes also shares how psychodynamic psychotherapy makes room for contradiction, parts of self, and shifting truths without treating clients as deceptive.

We also zoom out to the sociopolitical climate and what helps when anxiety spikes: boundaries around the news, a return from hypervigilance to inner focus, and simple co-regulation that prioritizes breath and presence. Finally, we touch the tender terrain of spirituality and religious trauma, and the idea that deep therapy is “soul work” that helps people grow back the parts of themselves they had to hide.

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Learn more about Dr. Himes here: https://drhimes.com/

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