When an adult child discloses that they are transgender or non-binary and intend to transition, families often experience a complex psychological process that clinicians increasingly recognize as a distinct form of adjustment, sometimes described in the literature as an "ambiguous loss” without a clear endpoint, in which the person is still present but the relationship as it was previously understood has changed.

Therapy is a professional relationship built on trust, competence, and a clearly defined set of ethical boundaries. Most clinicians practice within these boundaries conscientiously. However, a meaningful minority of clients report experiences with providers whose conduct falls short of professional standards sometimes due to poor training, burnout, or an incompatible therapeutic style, and occasionally due to genuine ethical violations.

Most clients withhold clinically significant material from their therapists at some point in treatment. Studies on "secrets in psychotherapy" and "client concealment" estimate that the majority of clients report keeping at least one significant topic hidden, and a notable subset withhold information they themselves rate as important to their treatment goals.