Therapy for trans and non-binary people that centres your whole life
Gender-affirming therapy for trans and non-binary people in New York, combining psychotherapy, somatic care and psychiatric support. Your gender is respected from the first conversation, and your care is shaped around what you want from it.
Being trans or non-binary is not a mental health condition, yet living in a world that often misunderstands you can take a heavy toll. I offer a calm, affirming space to explore whatever you bring: anxiety, depression, transition questions, relationships, work, trauma, joy and everything in between. Sessions are unhurried, and I bring years of experience in LGBTQIA+ health to every one.
“You should never have to prove who you are in order to be cared for. Here, your identity is the starting point, not the subject of debate.”
Therapy works best when you can stop bracing yourself. My aim is to make that possible from the very first session.
Why trans and non-binary people deserve specialist understanding
Trans and non-binary people come to therapy for the same range of reasons as anyone else, and also for reasons shaped by living in a cisnormative world.
Many trans and non-binary people have had experiences in health care that left them feeling scrutinised, misgendered or treated as a puzzle to be solved. Some have been asked to explain their gender before they could talk about their depression; others have had every difficulty attributed to being trans. It is understandable if you approach therapy cautiously. That caution deserves respect, and it is something we can name together.
In our work, your name and pronouns are used consistently, your understanding of your gender is taken seriously, and there is no expectation that you fit a particular narrative. You might be early in questioning, many years into transition, uninterested in medical transition, or somewhere that no category quite describes. All of these are valid starting points.
My background as an LGBTQIA+ primary care provider and HIV specialist, together with further study in gender theory and feminist thought, means I understand both the clinical and cultural landscape you are navigating. I can talk knowledgeably about hormones, sexual health and the practical realities of transition, while keeping our focus on your emotional life and wellbeing.
Minority stress and its effects
Constant exposure to misgendering, discrimination, hostile politics and the threat of violence creates a kind of chronic stress that can show up as anxiety, hypervigilance, low mood, exhaustion or difficulty trusting others. Naming this as a reasonable response to an unfair environment, rather than a personal flaw, is often an important first step. From there we can work on reducing its grip on your body and mind.
Support for partners and families
Families, partners and close friends of trans and non-binary people sometimes need their own space to learn, process change and find ways to offer better support. I work with loved ones individually, always from an affirming stance, helping them move through confusion or grief towards understanding and connection, without placing that labour on the trans person in their life.
Joy, not only difficulty
Therapy is not only for crisis. Many trans and non-binary people use our time to deepen self-understanding, explore creativity and embodiment, strengthen relationships and build a life that feels expansive. Gender euphoria, play and pleasure are welcome topics here too.
Reasons trans and non-binary people reach out
There is no single reason to begin therapy, and you do not need to be in crisis. These are some of the experiences people bring to our sessions. You may recognise several, or none, and simply want a space where you can think out loud without having to filter yourself.
- Anxiety or low mood
- Exploring or questioning gender
- Decisions about transition
- Stress from misgendering
- Family rejection or estrangement
- Dating and relationship questions
- Workplace discrimination
- Past trauma or violence
- Body discomfort or disconnection
- Building community and belonging
Integrated, gender-affirming mental health care
I combine psychotherapy, mindfulness, somatic techniques and, where helpful, medication. Because I am both a therapist and a psychiatric prescriber, these can sit together in one consistent relationship.
Affirming psychotherapy
We talk about whatever matters most to you, drawing on psychoanalytic, feminist and relational approaches. Your gender is understood as part of who you are, not a problem to analyse, and you lead the direction of our conversations.
Somatic and embodied work
Living in a body that the world misreads can create tension, numbness or disconnection. Gentle somatic exploration, always invitational, can help you build a kinder and more trusting relationship with your body at whatever stage you are.
Psychiatric medication support
If depression, anxiety, ADHD or sleep difficulties are affecting you, I can assess and prescribe, and I take into account hormones and other medications you may be using. Changes are always gradual, collaborative and monitored.
Exploring identity
For those questioning or reconsidering their gender, we create space for curiosity without pressure towards any outcome. There is no timeline to meet and no correct answer, only what feels truest to you.
Resilience against minority stress
DBT-informed and CBT-informed skills can help with the practical side of coping: managing distress, setting boundaries with unsupportive people, and protecting your energy in hostile environments, without asking you to accept mistreatment.
Whole-person wellbeing
We look at sleep, nourishment, movement and connection. Supplements may support mood or energy, and I review them for safety and interactions with hormones or other medication. They work alongside medical care, never instead of it.
Starting affirming therapy with me
A clear, gentle process that respects your pace from the beginning.
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1
Free consultation 15 minutes
A short, confidential call where you can tell me your name and pronouns, what is bringing you to therapy and what you hope for. You are welcome to ask about my experience with trans and non-binary clients.
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First full session
We explore your history, current life, health, relationships and goals. You decide what to share about your gender and transition, and when. If medication may help, I begin a thorough psychiatric assessment.
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Your personalised plan
Together we decide what to focus on and how: psychotherapy, somatic work, skills, medication support or a combination. The plan reflects your priorities and can change as your life does.
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Ongoing support
We meet regularly in 60 or 90-minute sessions. Over time, many clients describe feeling less guarded, more connected to themselves and better able to meet challenges without losing their footing.
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 Trans & Non-Binary People FAQs
Do you offer gender-affirming therapy for trans and non-binary people in New York?
Yes. I provide gender-affirming psychotherapy and psychiatric care for trans, non-binary, genderqueer and gender-questioning people across New York State. Affirming means your gender is respected without question, your name and pronouns are used consistently, and you are never asked to justify who you are. We focus on what you want to work on, whether or not it relates to gender.
Do I need to talk about my gender in therapy?
No. Many trans and non-binary people want therapy for anxiety, grief, work stress or relationships, and simply need a clinician who will not make their gender the focus. You are welcome to talk about gender as much or as little as you like. Knowing that it is understood often frees you to explore everything else more fully.
Is this space for non-binary people who are not pursuing medical transition?
Completely. Medical transition is one path among many, and it is not a measure of how valid your gender is. Some non-binary and trans people choose hormones or surgery, some choose neither, and some are unsure or change their minds over time. In our sessions there is no assumed destination. We focus on how you want to live, how you want to be seen, and what helps you feel more at home in yourself and your relationships.
Will psychiatric medication interact with my hormones?
This is an important question, and I take it seriously. As a psychiatric nurse practitioner with a background in LGBTQIA+ primary care, I consider hormones and any other medications when recommending treatment. We review potential interactions and effects on mood together, start carefully and monitor closely. I also encourage coordination with your hormone prescriber where helpful.
I am not sure about my gender yet. Is this space for me?
Yes. Questioning is welcome here, and there is no pressure to reach a conclusion or label. Some people discover they are trans or non-binary; others find a different understanding of themselves. Our work is about giving you room to explore honestly, without anyone else's agenda shaping where you end up.
Do you work with parents or partners of trans people?
Yes. I see partners, parents and other loved ones individually to help them process change, understand gender more deeply and offer better support. This work is always grounded in affirmation of the trans or non-binary person. It gives loved ones a place to work through their own feelings so they do not place that weight on the person they care about.
What if I am struggling with thoughts of self-harm?
Please tell me. Trans and non-binary people face real pressures, and painful feelings deserve care rather than shame. We can work on safety together. If you are ever in immediate danger, call 911, or call or text 988 for the Suicide and Crisis Lifeline.
Care that sees who you are
Book a free 15-minute consultation to see whether working together feels right. Share as much or as little as you like.