Attune (Don’t Assume)
Five common pitfalls psychotherapists should avoid when working with people grappling with a trans experience. By Claire Blaze
After a year of facilitating Women’s Circle, a peer support group for female adults who are questioning or ceasing their medical transition, I am reminded of a foundational element of good psychotherapy: attunement. Attunement is the process of being fully present, aware, and responsive to another person’s needs. It is a skill that takes intention to develop and hone, and even the most practiced therapist, parent, or supporter can easily stumble when executing this important task. Often, our own assumptions get in the way of our attempts to support someone else.
In this article, I will lay out five common pitfalls made by those of us intending to help, how they may affect a person with a trans experience, and what to do instead.
The Yes-Man Pitfall
For those concerned about the affirmation-only approach to gender dysphoria, this is an easy one. The yes-man pitfall involves taking everything at face value and too hastily cheering on someone’s decision without questioning, exploring, or digging deeper. Those who behave as “yes-men” often act from a desire to avoid being perceived as anything other than nice and agreeable. In this way, they often center their own need to be perceived in a certain way above what might be in the best interests of the person they purport to support. When this occurs in the context of a medical transition, it puts patients at risk of moving too quickly and failing to fully understand the risks, limitations, unknowns, and alternative options, all of which are crucial elements of informed consent.
What to do instead:
Rather than defaulting to any one type of response to what another person shares (for example, automatically affirming it or automatically challenging it), think carefully about what might be most useful for the unique situation in front of you. This may include listening to, believing, or trusting another person’s experience; questioning, challenging, or thinking critically about the situation; or some combination of these options. Each situation is different and will require a unique approach that includes the right amount of various different types of responses. Don’t assume every thought and feeling necessarily needs to be validated.
Maybe it can be accepted and still gently challenged. Don’t assume every cognitive distortion needs to be immediately challenged; sometimes the perception does need to be validated and understood. There is no simple formula that we can follow in every situation. Rather, we must approach each situation with curiosity, thoughtful consideration, and flexibility.
The Toxic Positivity Pitfall
Have you ever opened up to someone about a painful situation and been told to “look on the bright side” or “be grateful”? This concept has been written about elsewhere and is sometimes referred to as toxic positivity. Often, toxic positivity is used by individuals who struggle to tolerate difficult emotions in themselves and others and wish to avoid talking or thinking about these heavier topics. In this sense, the person promoting toxic positivity is centering their own avoidance and desire for comfort above the other person’s need for support, often without even realizing it. Most people can sense when this is occurring and learn not to open up about their emotions for fear that it will burden the other person and because they come to believe that their attunement needs will not be met. This leaves the individual even more isolated and alone with their painful emotions. While some do benefit from an optimistic outlook, presuming that this approach is best for everyone in all situations undermines true attunement.
There are various ways this can go awry in the field of “gender medicine". For example, focusing only on the positive aspects of medical transition may give potential transitioners an incomplete view of its reality. And for individuals who are struggling with difficult feelings about their medical transition, being encouraged to focus on positivity at the wrong time can further isolate them and/or dissuade them from fully accepting, processing, and ultimately healing from difficult emotions.
What to do instead:
Rather than automatically encouraging others to consider the “silver lining,” pay attention and stay with what is coming from that individual. Refrain from injecting your own perspective, framing, or interpretation. Practice reflecting what you are hearing or offering empathy. For example: “I can understand why you feel that way. That sounds hard/scary/frustrating,” etc.
There’s a time and a place for gratitude, and there’s a time and a place for accepting painful feelings. Do not assume that gratitude is automatically the right way for someone else to think about their own situation. Recognize and appreciate the value of holding space for pain without trying to avoid it by pushing gratitude.
The Fix-It Pitfall
A desire to solve someone’s problems often comes from a caring place. However, just as with toxic positivity, rushing to solutions can sometimes arise, at least in part, from the helper’s need to avoid difficult emotions. Again, this risks further isolating the individual in need of support, leaving them without the connection, comfort, and space they may need to process. There is also potential danger in rushing into solutions without fully understanding the problem and the various options for addressing it. For example, in the affirmation-only approach to gender dysphoria, medical transition is sometimes assumed to be the ideal treatment for any client who experiences distress about their biological sex or body.
When practitioners jump into fix-it mode and immediately offer a path to medicalization, clients may not realize that they have various options available to them and may miss the opportunity to explore the possible deeper psychological layers of their gender distress. Not only does this leave these deeper psychological issues unresolved, but it also introduces potential risk from intrusive medical interventions, which some transitioners come to regret.
Many people assume that if a problem is solved, then emotions will immediately dissipate. The truth is that emotions often require acceptance, curiosity, and a safe connection with a trusted person to be fully processed and ultimately resolved. While practical solutions can provide real relief to someone’s suffering, if they are recommended too early in the process, the individual needing emotional support misses something crucial: attunement and emotional support.
What to do instead:
As a layperson, rather than automatically rushing to solutions, pay attention to what it is the individual may need emotionally. If you are unsure, it can help to ask directly: “Are you looking for solutions to this problem? Or would you prefer that I listen and provide empathy? Or is there something else that would feel helpful?”
As a therapist, notice the affect that the client or patient is expressing and hold space for their feelings. Model distress tolerance and acceptance for these difficult emotions. Aim to sit with and explore them, approaching them as valuable information rather than as a problem to be solved.
The Overconfidence Pitfall
Even the most empathic and caring person can at times become clouded by what another person’s story brings up in themself. We hear a sad story and think to ourselves, “they must feel so devastated” without taking the time to explore whether this hypothesis is accurate for that other person. We then express our sympathy, assuming it will resonate with the other person. No matter what our interpretation of an event is, until we truly learn another person’s perspective, we can only really know what is within our own mind. Even what we imagine about someone else’s feelings ultimately comes from our own brain, not theirs. Because of this, it’s easy to accidentally ascribe our own thoughts to someone else. When we lose sight of this potential, we risk incorrectly assuming how someone else feels. Even when well-intentioned, making assumptions about how another person thinks or feels can land poorly. This can be especially true for a detrans person who may feel they have been told how they should feel about their transition experience many times before.
Overconfidence, or assuming that we already know how someone else feels, can take various forms. Sometimes it comes out as assumed similarity, where we presume that someone else feels the same way we do. Even if we imagine someone feels differently from us, our overconfidence can also take the form of mind-reading, where we believe we know what someone else is thinking or feeling without asking. Finally, even when we have asked about another person’s feelings, our overconfidence can take the form of a fixed mindset, in which we assume that things will stay the same. The truth is that an individual’s feelings about a particular subject can change. Attunement is an ongoing process, and assuming that someone feels the same way that they did previously about their dysphoria, transition, detransition, or anything else is a form of overconfidence that can interfere with true attunement.
What to do instead:
A quick trick to avoid the overconfidence trap: instead of assuming how the individual feels, wait to hear how they describe their feelings. And, again, it’s OK to ask: “How was that for you?” Another option is to share your guess about what the other person may be feeling and check to see in what ways you may be right or wrong: “I imagine that must be difficult for you. Am I right?”
One nuance here is that, if you turn out to be right, it can feel very attuned to express your impression about what the other person is feeling before they have explained it directly. Although this approach carries a risk, it can sometimes be even more meaningful than simply listening and asking. Fortunately, if you do happen to take this risk and get it wrong, repairing that rupture can be an opportunity for even deeper trust, intimacy, and healing.
The Agenda-Driven Pitfall
Similarly to all the other pitfalls described above, being agenda-driven is a form of centering oneself rather than the other. Many people concerned about the harms of medical transition of children feel an intense, overwhelming urgency to stop these harms immediately. While this is an understandable reaction, and may be useful when appropriately channeled, the goal of preventing children from being harmed by medical transition is distinct from the goal of supporting those who have already been harmed. In the same way that a detrans person may feel as if they have been told before how they are supposed to feel about their medical transition, they may also sometimes feel that they or their experiences have in the past been used as a tool to achieve a certain end, for example to promote or ennoble transition. When a detrans person with this history senses that someone is eager to use their personal story as a tool to achieve a goal, they may feel that their own needs and wellbeing are being overlooked, devalued, or misunderstood all over again.
What to do instead:
In describing the ideal state of mind for a therapist, psychoanalyst Wilfred Bion encouraged analysts to approach each clinical session “without memory or desire.” This beautiful and concise guideline perfectly encapsulates how having an agenda interferes with a therapist’s ability to listen and attune to what their client is saying in any given moment. While this ability is crucial for mental health therapists, anyone looking to hone their emotional attunement skills can benefit from incorporating Bion’s teaching.
Remember that each person is unique. This includes detrans people. Some may want to speak out about their experience or join the cause to protect other vulnerable youth. Some may need to heal in privacy. Some may want space and distance from the topic of transition altogether. And some may want something completely different from any of these options. Pay attention to what the individual needs, rather than prioritizing any specific agenda. And even for those who do want to join the movement, remember that this is more than a cause for this individual; it is a personal experience. Aim to be sensitive to what it might be like for this individual to be working on something that they have a personal relationship to. Sometimes it makes sense to set the agenda aside and center the human being in front of us.
Final Thoughts on Attunement
Effective attunement is scarce. And in the world of gender identity and detransition, despite the very best of intentions, it is often missed. This is not surprising when we consider how truly challenging it is to provide. The good news is that attunement is not about being perfect; it’s about recognizing when we fall short and repairing the rupture. Rather than berating ourselves for falling short, expect it. In the same way that we hold space for distressing emotions, we must also hold space for our own mistakes and shortcomings and for the distress they trigger. Humility and self-awareness are some of the most important elements of effective attunement.
Attunement is an ongoing process, and it’s easy for things to get in the way. The common underlying factors that contribute to the pitfalls described above (poor distress tolerance, avoidance of difficult emotions, accidentally centering our own perspectives, and making assumptions) will be encountered. So, when you want to provide emotional support, remember to practice the difficult skill of tolerating your own discomfort so that you can truly focus on the other person. Remember that attunement is ongoing, that mistakes are inevitable, and that the magic is in the repair. And when aiming to support someone you care about with their emotions, remember to attune, not assume.
Claire Blaze, LGSW, is a psychotherapist with a background in Gender and Feminist Studies based in the United States. Her clinical focus is on how culture, identity, and relationships shape clients' lives. In 2025, she facilitated Women’s Circle, a peer support group run by BeyondTrans for adult women who are questioning or ceasing medical transition.
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