There is much more time given, there is no assumption that the client is an ill, mad, bad or sad individual. The key word is respect. There are many ways of being. The counsellor's task is to help the client to sort through the emotions, to assist a client to tell his or her own story, and having found a voice, to find her or has own way of being. Counselling is not a cure-all, but since isolation and rejection are such common themes among transsexual clients that listening is in itself empowering.
Uncertainty can cause great pain, but with certainty there are still many practical considerations.
We live in a real world and so a certain amount of pragmatism is important. Many gender dysphoric people can be seen as, or actually are, victims of society, with psychiatric and psychological backup lacking. They have to encounter a second puberty, without parental or peer group support in a society which seems suspicious or ignorant of their struggle. Until quite recently society the law and to an extent information has dis-enabled, even effectively disabled, most gender dysphoric people. In a sense I am uncertain whether it is the sufferer of gender identity conflict or society which is disabled.