Therapy for gender dysphoria that moves at your pace
Affirming therapy for gender dysphoria in New York, offering space to understand distress around gender, ease its weight on daily life and explore what feels true for you, without pressure towards any particular path.
Gender dysphoria can feel like a constant low hum or arrive in sharp waves: in the mirror, in a name spoken aloud, in clothes, in how strangers read you. I offer a patient, affirming space to make sense of that distress and care for yourself through it. Our work may include talk therapy, somatic exploration and medication support for related anxiety or depression.
“Dysphoria is not evidence that something is wrong with you. It is information about the distance between who you are and how you are being seen.”
Our work is about listening to that information with care and responding in ways that feel right to you.
What gender dysphoria is, and what it is not
Gender dysphoria describes the distress some people feel when their gender identity does not align with the sex they were assigned at birth, or with how others perceive them.
Dysphoria is different for everyone. For some people it centres on particular parts of the body; for others it is social, sparked by pronouns, names or the way they are addressed in shops and offices. It can be intense and constant, or it can come and go, flaring during stress, puberty, hormonal shifts or moments of visibility. Some trans and non-binary people experience very little dysphoria at all, and that does not make their identity less real.
It is important to say clearly that being trans or non-binary is not a mental illness. The distress of dysphoria is real and deserves care, but the goal of therapy is not to talk you out of your gender or delay your choices. It is to support your wellbeing while you clarify what you need, whether that involves social changes, medical transition, both, or neither.
Therapy for gender dysphoria also recognises that distress rarely exists alone. It often travels alongside anxiety, low mood, social withdrawal, disordered eating, difficulty with intimacy or the strain of a hostile environment. Addressing these together, rather than in separate silos, can make daily life feel more manageable while bigger decisions unfold.
Body distress and the somatic dimension
Because dysphoria is so often felt in the body, purely verbal therapy can sometimes miss its texture. Somatic exploration offers gentle, consent-led ways to notice sensations, find moments of ease and build tolerance for being present, without forcing attention to areas that feel painful. Some people discover small sources of comfort or even euphoria in movement, breath or touch that they choose for themselves.
A clinician who understands the medical context
My earlier work as an LGBTQIA+ primary care provider means I am familiar with hormones, surgical options and the practical realities of transition. I am not here to gatekeep or rush you. Rather, I can help you think through the emotional side of medical decisions, understand how hormones and psychiatric medications may interact, and prepare for the changes, hopes and uncertainties that transition can bring.
When gender dysphoria weighs on you
You do not need a diagnosis, a clear identity or a transition plan to begin. If distress around gender is affecting your mood, relationships or ability to get through the day, therapy can offer support. These are some experiences people describe when they first reach out.
- Avoiding mirrors or photographs
- Distress when misgendered
- Discomfort with certain body parts
- Withdrawing from social situations
- Anxiety about clothing or presentation
- Low mood linked to gender
- Uncertainty about transition steps
- Fear of others' reactions
- Disconnection from your body
- Exhaustion from masking
Gentle, affirming care for gender distress
I combine psychotherapy, somatic exploration, mindfulness and psychiatric care. You decide what we focus on, how quickly we move, and which tools feel right to try.
Talk therapy
We explore your experience of gender, the history behind it and what you would like for your future. Psychoanalytic and feminist perspectives help us look beneath social expectations to what feels authentically yours.
Somatic exploration
Consent-led body awareness can soften the intensity of dysphoria, helping you find areas of neutrality or comfort and build a relationship with your body that feels less like a battleground.
Medication for co-occurring symptoms
If anxiety, depression or sleep problems accompany your dysphoria, I can assess and prescribe, considering any hormones you take. Adjustments are gradual, collaborative and carefully monitored.
Clarifying next steps
Whether you are considering a name change, coming out, hormones or surgery, we can think through options, timing, fears and hopes, so that your decisions feel considered and your own.
Coping in hard moments
DBT-informed skills offer practical ways to ride out acute waves of dysphoria, such as grounding, distress tolerance and self-soothing, so they feel less overwhelming when they arrive.
Space for euphoria
Therapy is not only about reducing distress. We also notice what brings gender euphoria, comfort and delight, and look for ways to invite more of it into your life.
Affirming care versus gatekeeping
Historically, many trans people met clinicians who saw their role as testing or delaying. My approach is different.
Gatekeeping model
- Identity must be proven
- Fixed narrative expected
- Delays framed as caution
- Distress seen as the identity
- Clinician decides readiness
Affirming model
- Identity respected from the start
- Every story welcomed
- Pace set by you
- Distress treated with care
- Decisions made together
Beginning therapy for gender dysphoria
Four gentle steps, each one taken only when you are ready.
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1
Free consultation 15 minutes
A short, private call to share your name and pronouns, describe what you are experiencing and ask any questions. You can find out how I approach gender dysphoria before deciding anything.
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2
Initial assessment
In our first full session we explore your history with gender, your current wellbeing, health, relationships and supports. If anxiety or depression are present, I assess them carefully and discuss options.
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3
Your plan, your pace
We agree on priorities together, perhaps easing daily distress, exploring identity, preparing for transition steps or managing co-occurring symptoms. The plan is flexible and revisited regularly.
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4
Continuing support
Regular 60 or 90-minute sessions offer steady ground as things evolve. Many people find dysphoria feels more manageable when they have consistent support and a clearer sense of direction.
Francesca Rome-Marie, PMHNP-BC
I bring together psychiatry, psychotherapy, somatic work and whole-body health, informed by years in primary care and further study in gender theory, feminist thought, culture and visual art.
I keep a deliberately small caseload so that every client receives consistent, unhurried and genuinely attentive care, held within one relationship rather than split across several providers.
Clear, upfront rates
I don't accept insurance. Modern Holistic Psychiatry is an out-of-network provider, so sessions are paid for directly. Depending on your plan, you may be able to claim reimbursement through your out-of-network benefits.
Find out how much your insurance may coverNeed urgent support? If you're in crisis or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline) or call 911.
Therapy for Gender Dysphoria FAQs
What does therapy for gender dysphoria in New York involve?
Therapy for gender dysphoria with me involves an affirming, unhurried space to explore your experience of gender, ease distress and support your overall mental health. Sessions may include talk therapy, somatic exploration, mindfulness and, if relevant, medication for anxiety or depression. There is no fixed programme. We focus on what is most helpful for you at each stage.
Do I need a diagnosis of gender dysphoria to see you?
No. Many people come to therapy unsure of how to describe their experience, and you do not need a formal diagnosis or a settled identity to begin. If a diagnosis becomes relevant for your own purposes, we can discuss that openly, but it is never a requirement for receiving care.
Will therapy try to make my dysphoria go away by changing my identity?
No. I do not practise any form of therapy aimed at changing or suppressing gender identity. The aim is to reduce suffering and support your wellbeing while respecting who you are. If you are questioning, we explore with genuine openness, with no preferred outcome on my part.
Can therapy help if I am not planning to transition medically?
Yes. Some people manage dysphoria through social changes, clothing, voice, movement or other forms of expression, and some choose not to transition medically for many personal reasons. Therapy can support you whatever you decide, helping you find ways to feel more at home in yourself.
How can somatic work help with dysphoria if my body feels like the problem?
Somatic work never asks you to love or focus on parts of your body that cause distress. Instead it is consent-led and invitational, often starting with neutral or comfortable areas, breath or the sense of your feet on the floor. Over time, many people find this helps them feel less overwhelmed and more able to inhabit their bodies with some ease.
Do you consider hormones when prescribing psychiatric medication?
Yes. With my background in LGBTQIA+ primary care, I take hormones and any other medications into account when recommending treatment. We review potential interactions and mood effects together, start carefully and monitor closely. I am happy to coordinate with your hormone prescriber if that would help.
What if dysphoria is making me feel hopeless?
Please let me know, because you deserve support with that. Hopelessness can ease with the right care and connection, and we can work on safety together. If you are ever in immediate danger, call 911, or call or text 988 to reach the Suicide and Crisis Lifeline at any time of day.
Take the first step, gently
Book a free 15-minute consultation to talk about what you are experiencing. There is no pressure, no timeline and no right answer.