At Dayrise Wellness, one of the most common things we hear from teens and young adults exploring their gender identity is some version of this: “I’m not sure I’m ready for gender identity therapy. I don’t even know what to say yet.”
Here’s what we want you to know: you don’t need answers before you start. That’s exactly what therapy is for.
Gender identity exploration is deeply personal, often nonlinear, and almost always shaped by forces both inside and outside of you — your own feelings, your family’s reactions, your community, and a world that still has a lot of catching up to do. Therapy isn’t a place where you come in with your identity already defined. It’s a place where you get to figure it out, at your own pace, with someone who isn’t going to judge you for not knowing yet.
We heard from Rhealee Fernandez, LSW, a Clinical Therapist at Dayrise Wellness who specializes in supporting LGBTQ+ teens and young adults, to talk about what those early sessions actually look like — and what she wants every person exploring their gender identity to know before they walk through the door.
What Happens in Those First Gender Identity Therapy Sessions?
Before anything else, Rhealee focuses on building trust. “It’s really about rapport building,” she explains. “I want to know what their interests are. I try to connect with them so they feel safe — so we can create that non-judgmental space from the start.”
From there, she begins exploring what she calls a client’s gender history — not to label or diagnose, but to understand. When did they first start experiencing their gender? What life experiences have shaped how they see themselves? What has their family’s response looked like?
And crucially: she doesn’t assume anything.
“There could be a client who walks in whose parents are very supportive and have already started to give them Hormone Replacement Therapy (HRT),” Rhealee says. “And then there could be another client who is still struggling to get their parents to call them by their preferred pronouns. It’s a very individualized experience.”
This is one of the most important things to understand about gender identity therapy: it is not one-size-fits-all. Good therapy makes space for a client to tell their story the way they are experiencing it — once they feel comfortable enough to take up that space.
What Are the Questions That Actually Help?
Rhealee uses a set of questions early in the process that go beyond labels and focus on lived experience. Some of the most useful:
- What was the pivotal moment — the shifting moment — when you first started thinking about your gender?
- What feels comfortable about your gender experience? What doesn’t?
- How do you feel when others perceive you as your assigned gender?
- What are your internal desires — versus the external pressures coming from the people around you?
That last question is one Rhealee pays especially close attention to. A feelings wheel — a visual tool that maps emotions in granular detail — can be helpful here, giving clients language for what they’re experiencing as they work through these questions together.
Rhealee is also listening for signs of gender dysphoria throughout these early conversations — exploring whether a client has a strong, persistent desire to experience gender differently from the one they were assigned at birth. This isn’t about rushing to a diagnosis; it’s about making sure nothing important goes unaddressed.
In a world where being queer or gender-expansive still carries real stigma — social, political, and sometimes even within one’s own family — it’s easy for shame and fear to get tangled up with a person’s authentic sense of self.
“Due to that stigma, it can lead to a lot of shame and fear and avoidance,” Rhealee says. “So I listen for whether what they’re expressing is coming from inside them — or whether they’re carrying what other people think about them.”
She also pays attention to how clients answer, not just what they say. Whether someone is openly emotional or quietly holding everything in, both tell her something important. “That tells me this is a really significant area of their life,” she says. “That’s worth exploring.”
What If Someone Doesn’t Have a Support System?
Not every teen or young adult exploring their gender identity has people in their corner. Some are navigating this completely alone — no affirming friends, no supportive family, no community yet. For those clients, Rhealee says the most important thing she can offer first is validation.
“It’s okay not to know right now,” she says. “That’s why we’re here. That’s why we’re going to explore together — what parts of ourselves, deep down, we already know. It’s good to find it out in writing because then it helps us process it.”
There may also be shame present — shame around exploring their identity, or around not yet having a strong sense of self. Rhealee names that possibility gently, and works to normalize it before anything else.
From there, she uses a few specific tools:
Journaling with intention. Many clients already journal, but Rhealee has noticed that those without strong support systems often stay surface-level — “thought dumping” without really going deeper. She pairs journaling with a feelings wheel to help clients move beyond what happened and into what they actually felt.
Identity exploration through values and characteristics. Rather than starting with gender labels, Rhealee helps clients explore who they are at a deeper level — their values, their characteristics, the emotions they experience on a regular basis. “It helps us process what, deep down, we already know,” she says.
The Genderbred Person¹. This is one of Rhealee’s favorite clinical tools — a visual framework that breaks gender down into distinct components and helps clients see that gender is more nuanced than a simple binary. She says: “I use it with my clients regularly.”
Self-compassion. For clients who are exploring without a support system, Rhealee places particular emphasis on building inner reassurance. “It’s absolutely hard to lack support,” she acknowledges. “But if we can start to focus on self-compassion and self-reassurance — not needing that support from other people to know that we are worthy — that’s where real grounding begins.”
The Most Important Thing to Know Before You Start
If you’re somewhere in the early stages of exploring your gender identity — whether that means you have a lot of questions, a few quiet feelings you haven’t said out loud yet, or something in between — Rhealee wants you to hear this:
You do not need to have it figured out before you come in.
“You do not need answers before you start therapy,” she says. “You do not need to know who you are. You don’t need to have a firm sense of self. That’s why we’re here. That’s why we’re working together. It’s normal to feel uncertain.”
And there is no right or wrong answer waiting at the end of this process. Your identity is yours to define — on your own timeline, in your own words.
“You get to determine what is right in your identity,” Rhealee says. “No one else can shape that but you.”
If you or someone you care about is looking for affirming, compassionate support for gender identity exploration, Dayrise Wellness is here. Our clinicians work with teens, young adults, and families in the Chicago area to provide personalized, evidence-based therapy in a space that’s genuinely safe.
Learn more about our services or book a free consultation →