Although there is growing cultural awareness of transgender identities, transgender people continue to be marginalized and subject to identity-based discrimination and victimization resulting in disproportionate rates of psychological distress and particularly high rates of suicidality. Mental health clinicians can effectively support the mental health needs of transgender clients through the use of empirically supported, trans-affirmative interventions. This chapter focuses on transgender affirmative cognitive–behavioral therapy (TA-CBT), an evidence-informed intervention rooted in the unique needs and experiences of transgender individuals. TA-CBT is a version of CBT that has been adapted to ensure (1) an affirming stance toward gender diversity, (2) recognition of transgender-specific sources of stress and resilience, and (3) the delivery of CBT content within an affirming and trauma-informed framework. Clinical examples are utilized to elucidate affirmative delivery of several important components of TA-CBT: transgender affirmative case conceptualization, psychoeducation, and the development of coping skills to promote identity-affirming changes.