The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients

Nic Rider, Jennifer A. Vencill, Dianne R Berg, Rachel Becker-Warner, Leonardo Candelario-Pérez, Katherine G Spencer

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals. Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA’s therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired). Results: The core components of the GALA model are individualized to each client’s unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals. Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.

Original languageEnglish (US)
Pages (from-to)275-288
Number of pages14
JournalInternational Journal of Transgenderism
Issue number2-3
StatePublished - 2019

Bibliographical note

Publisher Copyright:
© 2018, © 2018 Taylor & Francis Group, LLC.


  • Genderqueer
  • LGBT health
  • gender affirming psychotherapy
  • nonbinary
  • transgender
  • transgender health


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