ABSTRACT
Transgender, nonbinary, and genderqueer (TGNBQ) people are erotically marginalized in mainstream sex therapy treatment. TGNBQ clients represent a wide spectrum of individuals who experience diverse gender expressions, sexual practices, and varied sexual relationships. For some TGNBQ clients, gender dysphoria interferes with their sexual practices, expressions, and comfort in their bodies; for others, living in complexly gendered bodies is experienced as sexually exciting and something to celebrate-experienced less as dysphoria and more as gender euphoria. Sex therapy that is affirming for TGNBQ and their partners is built upon three interlocking theoretical positions: the first is understanding the developmental process of TGNBQ emergence, the second is a transfeminist clinical approach, and the third is a systemic, relational, and narrative approach with an emphasis on alliance building and attunement to both TGNBQ clients and their partners. This requires a three-pronged clinical orientation based on therapist self-awareness regarding their power and privilege, engagement in self-education and clinical consultation, and transparency with clients to engender trust and safety in the therapeutic relationship. The final section of this chapter is an exploration of these theoretical positions and clinical practices in the context of case vignettes.
