A client’s gender identity is how he/she feels inside and how he/she expresses those feelings, such as in the way he/she dresses, appearance, and behaviors. Most people feel that they are either male or female and some feel neither male nor female. These people may choose labels such as “genderqueer”. These feelings usually begin as early as infancy stage. On the other hand, some people’s assigned sex and gender identity are pretty much the same, or in line with each other. These people are called cisgender. Other people feel that their culturally or biologically assigned sex is of the other gender rather than their gender identity (i.e., assigned sex is female, but gender identity is male). These people are called transgender or trans.

Money (1973) was the first person to define gender identity as composed of three distinct aspects: gender role (the external presentation of gender), gender identity (the internal experience of gender), and core gender identity (the developmental process of the identity that begins at childhood). Gender identity is differentiated from biological gender (sex). Gender identity is a sense of awareness, usually beginning in early childhood, continuing throughout childhood, and reaching maturity in adolescence, of being male or female. Barker and Kuiper (2003) stressed that gender identity is “the degree to which an individual takes on the behaviors, personality patterns and attitudes that are usually associated with male or female sex roles”. What this means is that gender can be coherent with biological sex, but it does not necessarily have to be, as is the case with people who identify with the other sex. Eagly (2009) emphasizes that gender role beliefs are derived from the cultural context and provide a template for culturally normative behavior, and are internalized as gender identities that enact personal dispositions. That is, the prescriptive aspect of gender roles defines what is worthy of admiration within a culture. According to her, the descriptive aspects of gender role identify what is expected and are stereotypes about what is typical behavior for a specific gender.

In the past, psychiatry has considered gender identity when inconsistent from biological gender as pathology (deviation from a normal condition). However, it is accepted in psychological cliques that gender identity can vary from the defined biological gender, without pathology. Social justice psychological theorists do not accept the pathology assumption, and note that if there is any, it is not the result of a neurological or biological deficit, but the result of societal emotional abuse, and victimization due to not subscribing to cultural identity or perceptions of gender behaviors.

People may experience stress, trauma, and emotional abuse over the lifespan can lead to severe anxiety, depression, and other psychological problems associated with discordance between their gender identity and their sex assigned at birth. This analysis points to the need for understanding the issues clients may face in their primary cultural and familial contexts, it clearly shows how oppression and victimization of people can occur in their familial, social, and occupational worlds, creating a need for social justice on issues of hereditary, right and advocacy.