‘You don’t have the luxury that your difference is going to be respected’: a Heuristic Inquiry into the training experiences of trans and non-binary person-centered psychotherapists

Tiresias and His Trouble with Ambiguity in Gender Marco Posadas (bio) To begin, I would like to identify my position as chair of the Sexual and Gender Diversity Studies Committee of the International Psychoanalytical Association (IPA). The IPA is the first, oldest, and largest international psychoanalytical association in the world. It was created by Freud with the help of Ferenzci, Jung, Eitington, Abraham, and Jones in 1910 with the purpose of organizing what started to be a body of theory and clinical mental health practice, and for the promotion of scientific activities at an international level. Today the IPA has almost fourteen thousand members and more than six thousand candidates within three consolidated regions—North America (including China, Korea, and Japan), Europe (including New Zealand, Australia, India, and South Africa), and Latin America—and a new, fourth region, Asia, which hopes to consolidate China, Korea, Japan, India, New Zealand, and Australia. It organizes a biannual international congress that is one of the largest psychoanalytic events in the world. The IPA has four official languages—English, French, German, and Spanish—and more than fifty languages among all its constituent psychoanalytic societies and institutes. A large part of its organizational and scientific work is divided, planned and executed by committees. Committees are appointed by the executive committee and ratified by the IPA board. The committee I chair was appointed by Stefano Bolognini's administration in June 2017. Our committee is fortunate to continue to be strongly supported [End Page 93] by Virginia Ungar, the first female president of the IPA, and Vice President Sergio Nick's administration. Before the creation of the Sexual and Gender Diversity Studies Committee, during its planning stages, there was already a lot of ambiguity around addressing issues of gender and sexual diversities in psychoanalysis. An important part of the committee's mandate is to create spaces for IPA-affiliated psychoanalysts and candidates and for non-IPA-affiliated psychodynamic clinicians and psychotherapists, among an increasing number of people interested in psychoanalysis, to discuss issues pertaining to psychoanalytic clinical theory and practice and to the intersection of sexual and gender diversity. Although our committee had anticipated the resistance that has been historically present when addressing these types of topics in psychoanalytic institutions (Drescher 2008; Roughton 1995, 2002), we were not able to identify and agree upon a specific point of contingence within psychoanalytic theory and practice that could cause the most resistance. This article is an initial step to engage with the resistance encountered in analytic spaces when we shift from a binary system to a non-binary way of thinking gender and sexuality. I will describe the experience in an attempt to provide models of understanding and working through these types of conflicts. Why am I calling it a conflict? This will be better answered with an example, in this case a non-clinical general vignette. I will disguise the participants' identities and will use a composite vignette to protect confidentiality. The Trouble with Ambiguity In 2016, I was delivering a workshop to strengthen clinical skills when working with racialized LGBTQ patients from a psychoanalytic perspective using an anti-oppressive approach. I was surprised to hear a senior analyst openly state from the back of the room that they preferred to hold on to their prejudices regarding trans and gender-creative patients. The audience mostly consisted of psychoanalysts, psychoanalytic candidates, training [End Page 94] analysts, and psychology graduates interested in psychoanalysis. Given the wide range of the audience and our shared interest in psychoanalysis, I usually clarify Freud's "progressive" perspective toward homosexual patients and the distortions of Freud's statements as the message got passed around through generations of culturally sanctioned homophobic clinicians (Socarides 1968; Roughton 2002). The questions from this particular audience led to a discussion about misconceptions in psychoanalytic literature about trans experiences and of trans bodies being misrepresented and misdiagnosed as psychotic (Millot 1989). Addressing misrepresentations of gender variance rooted in prejudiced formulations of trans subjectivities within psychoanalytic theory and proposing less-biased ways of approaching gender polymorphism from a non-pathological perspective can be a complicated task. This is not unheard-of in our field; in fact, queer theorists, Lacanian analysts, and transgender...

In Aotearoa/New Zealand, sexuality education is one of seven key areas of learning in the Health and Physical Education (HPE) subject area within The New Zealand Curriculum. Since 2015, sexual diversity (lesbian, gay, bisexual identities and perspectives) and gender diversity (transgender; non-binary gender) have been explicitly included in the curriculum guidelines for teaching sexuality education in schools. Based on survey data collected from a convenience sample of 73 participants aged between 16 and 19 years, this study focused on the prevalence of sexuality education provision, its content, and the inclusion of sexuality and gender diversity in the wider school environment. Despite sexuality education being a mandatory part of HPE, only around three-quarters of respondents remembered having been taught it at some point in years 9 and 10. When taught, sexuality education was reported to focus primarily on conventional content areas (e.g. heterosex; biological function) and was therefore not inclusive of sexuality and gender diversity. Inclusion in the wider school environment was also limited, being mainly restricted to easy to implement measures (e.g. allowing same-sex partners at school balls and having a rainbow ally group). The implications of these findings for the development, wellbeing and human rights of young people are discussed.

LGBTQA+ young people experience suicidal thoughts and behaviors at a much greater rate than their heterosexual and cisgender peers. This study explored firsthand accounts of the coping strategies employed by LGBTQA+ young people when experiencing suicidal thoughts and behaviors. LGBTQA+ young people (N = 27; ages 14–25) in Australia with a history of suicidal thoughts and/or attempts participated in semi-structured interviews. Using reflexive thematic analysis, four major themes were developed: (1) It’s about the journey, not the destination, (2) Connecting with others, (3) When I knew better, I coped better, and (4) Doing the best I can with what I have. LGBTQA+ young people reported utilizing a range of coping strategies, however these were limited by a lack of knowledge around mental health, gender and sexuality diversity, and available resources. Experiences of discrimination within support settings and limited access to clinicians with knowledge of sexuality and gender diversity were cited as significant barriers. Interventions to increase mental health literacy in LGBTQA+ young people and improvements to clinician knowledge of sexuality and gender diversity are needed to enhance LGBTQA+ young people’s access to effective coping strategies when experiencing suicidal thoughts and behaviors.

Background Both anxiety and depression have been identified as negative health outcomes associated with the distressing nature of the Covid-19 pandemic, especially among young people. Within this age demographic, trans and gender diverse people may be particularly vulnerable to pandemic-related mental health outcomes, such as anxiety and depression, due to the social challenges, gender dissonance, and poor mental health they experience. Furthermore, the social distancing measures impose several unique social and help-seeking challenges which may further contribute to the worsening of mental health. While there has been acknowledgment that vulnerable populations may be disproportionally affected by the pandemic, the experiences of trans and gender diverse youth have received very little empirical attention. Aims To explore the mental health impact of Covid-19 on the lives of young trans and gender diverse people in the UK. Method In total, 243 people took part in an online survey between May and July in 2020. Eighty-two people were removed due to providing insufficient data. The analyzed dataset therefore comprised of 161 respondents ranging from 16 to 25 years (M = 20; SD = 2.68). Participants were asked how social distancing measures had impact on their social lives, mental health and access to health services. They were also asked to complete validated measures of anxiety and depression. Results This study found that those who experienced a greater impact of the Covid-19 outbreak and its associated social distancing measures, reported poorer mental health. Lack of social support, negative interpersonal interactions, unsupportive and non-affirming living environments and the inability to access mental health support and gender-affirming interventions were all factors that were associated with poor mental health. Conclusion The findings provide specific direction for the tailoring of mental health service delivery to this population, noting the need for private, safe spaces in which young people can feel supported and have their gender identity affirmed.

PurposeThe objective of this proposal was to propose an educational innovation resource for the delivery of workshops with lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) themes aimed at students in high school and middle school to promote complex thinking as a necessary competency for understanding their continuously changing environment.Design/methodology/approachTraining for sexual and gender diversity challenges higher education institutions, some of which have bet on developing complex thinking to meet this need. Although not all universities have sufficient resources to create activities that foster relevant and diversity-sensitive competencies, some have implemented strategies ranging from modifying their curricula to designing specific classroom tasks that support student inclusion. In response to the challenges faced by higher education institutions (HEIs) to promote the acquisition of thinking skills for complexity, this paper proposes deploying a humanoid robot as an educational innovation tool in training initiatives that promote issues of sexual and gender diversity. The deployment model is described, considering design, delivery and evaluation. The value of this proposal lies in using humanoid robotics as a classroom resource within the framework of social robotics, considering its implications in the educational context to develop complex thinking competency and training for diversity in higher education students.FindingsThe data presented here highlight the importance of educational institutions integrating content into their plans, programs and activities (both curricular and extracurricular) that promote inclusion and sexual and gender diversity and attractive teaching strategies to reinforce this perspective. So, this proposal offers a support tool for implementing this content in everyday educational contexts where the objectives focus on triggering complex reasoning competencies.Research limitations/implicationsThe varied responses and perceptions of students towards robotics and sexual diversity, as well as the lack of clear methods to assess educational outcomes, may compromise the effectiveness of the intervention.Practical implicationsThe workshop proposed in this paper is configured as a series of iterations and repetitions in different educational fields, whether disciplinary (e.g. design or engineering) or transversal (e.g. entrepreneurship). The goal is to achieve educational strategies that generate a more significant impact at the institutional level. In this sense, the present proposal joins the actions implemented by other higher education institutions to make sexual and gender diversity visible to university students.Social implicationsThe overall aim is to bring awareness, understanding and education to students with an inclusive, respectful and equitable perspective.Originality/valueSocial robotics is an innovative and attractive tool for young people at the higher education level. We consider our study a pioneer in the area.

The South African Schools Act of 1996 inaugurated a new education system that confronts all forms of unfair discrimination and intolerance. South African schools remain heteronormative and heterosexist. We report on learners' attitudes and experiences towards the learning of LGBT issues. Using a case study methodology, semi-structured interviews were conducted with 11 high school learners. Findings reveal that sexual and gender diversity is not taught in schools due to a lack of knowledge, ignorance and stereotyping of gender and sexuality. We learned that gender and sexual diversity is a silent topic in schools and that silence perpetuate the compulsory heteronormative culture in schools. However, young people are exposed to and confront same-sex sexualities from different sources since many of the peers are disclosing their same-sex sexualities at younger ages. This study concludes that learners are positive and willing to learn about sexual diversity. If the learners are ready to be taught then we will have to revisit those who are charged with teaching, the educators. We conclude that the educators seem to be the barriers to the teachers and learning of sexual diversity and more research will have to look at in and pre-service teacher education.

In contemporary medical education, there remains a notable gap in effectively addressing the complex societal and cultural dimensions of healthcare, particularly regarding the LGBTQIA+ community. Medical students often receive limited exposure to the nuanced aspects of gender and sexual diversity, which is crucial for fostering an inclusive healthcare environment. This study aimed to bridge this gap by integrating queer museum arts into the undergraduate medical curriculum to promote reflective engagement and dismantling of biases among future healthcare professionals. In this mixed-method study 24 randomly selected final-year medical students underwent a four-week flipped-classroom program divided into three phases: an "Orientation phase" to train students in Visual Thinking Strategies (VTS); an "Exploration" phase, where students engaged with queer arts in small groups to identify and discuss discrimination and bias through a pessimistic lens; and a "Reinforcement" phase, which encouraged reflection on inclusive practices in healthcare through an optimistic perspective. Students were instructed to write a narrative report from a queer perspective in the first phase and a physician perspective in the second phase. Students' confidence before and after the program were collected and one-on-one semi-structured interviews were conducted. Then, a sequential analysis was performed, using quantitative results to drive qualitative analyses to explore student experiences and evaluate program effectiveness. Engagement with queer arts facilitated deeper emotional and intellectual connections, leading to a transformative shift in perceptions and attitudes towards inclusivity in healthcare. Participants initially exhibited low confidence levels in areas such as gender diversity, gender inequality related discussion, understanding multiple perspectives etc., largely due to fear of judgment, societal stigma, and a lack of prior exposure. However, by the end of the program, significant improvements were observed, with higher confidence across many areas driven by critical reflection and deeper engagement with gender and sexual diversity. The program served as a catalyst for challenging students to confront their biases through disorienting dilemmas and engage in critical reflection. This deep, internal shift not only broadened their understanding of gender and sexual diversity but also redefined their roles as advocates for inclusivity in healthcare. Program evaluation demonstrated its effectiveness in enhancing awareness, confidence, and equipping future medical professionals with the mindset necessary to create inclusive and compassionate care environments.

This chapter introduces the reader to the many issues schools are facing that relate to gender and sexual diversity. This chapter presents a brief overview of some of the main topics including bullying and harassment, diversity and equity, sexual and emotional health, positive school climates, and academic success. It also presents some related educational theories and situates how the theoretical foundations of each argue for inclusive discussions of gender and sexual diversity. The following educational philosophies are introduced: democratic, critical pedagogy, multicultural, social justice, feminist, anti-oppressive, and queer. Finally, the chapter gives examples from the curriculum, extracurricular activities, and school design to show how sexual and gender diversity are already present in schools, but generally not addressed in positive or inclusive ways.

This article explores Chilean teachers’ representations regarding gender, sexuality, and sexual diversity, analyzing the persistence of traditional sex education models and the presence of Comprehensive Sexuality Education (CSE) principles. Addressing a research gap in Latin America—where few studies explore teachers’ perspectives—this qualitative study analyses interviews with 16 teachers from diverse contexts. Structural discourse analysis revealed coexisting representations: biological, CSE-aligned, and transitional. Despite some openness, beliefs obstructing CSE remain prevalent. The study calls for curricular reform from early education onwards to counter prejudices in both official and hidden curricula. Findings inform future educational policy and research.

Previous research indicates that lesbian, gay, bisexual, transgender, queer plus (LGBTQ+) students feel marginalised and discriminated against in physical education (PE) and that teachers play a crucial role in establishing openness towards sexual and gender diversity in schools. Despite these findings, there is a lack of research that focuses on the topic of sexual and gender diversity in PE from the perspective of PE teachers. The paper addresses this academic void. Based on semi-structured interviews with 13 PE teachers from Germany, we explore the question of how PE teachers perceive sexual and gender diversity in PE and how they reflect on classmates’ interactions with LGBTQ + students. The analysis of the interview data is framed by the concept of school climate with regard to sexuality and gender diversity. Our data show that the interviewed teachers have different, partly divergent experiences with sexual and gender diversity in the context of PE. On the one hand, teachers notice that the socially propagated tolerance and openness towards sexual and gender diversity are manifested in the students’ interactions with each other, while on the other hand they observe a non-acceptance of certain LGBTQ + students and related problems in PE. The examination of the PE teachers’ experiences reveals central, partly overlapping patterns of argumentation with regard to the perception of (non-)acceptance of LGBTQ + students. Overall, it becomes apparent that the conditions of perceived (non-)acceptance of LGBTQ + students are determined situationally and subject-related. At the end of the paper, we discuss our findings in the light of current empirical knowledge.

A escassa literatura sobre ensino jurídico e diversidade sexual e de gênero indica que as faculdades seguem um padrão tradicional e tecnicista, não dialogando com questões sociais, necessárias para profissionais do Direito. Diante disso, o presente trabalho buscou investigar se futuros profissionais se sentem preparados para lidar com questões relacionadas à diversidade sexual e de gênero e quais relações eles estabelecem entre suas formações universitárias e seus graus de preparo/competência. Foi realizada, então, uma pesquisa empírica de cunho exploratório, através da aplicação de 200 questionários com estudantes do último ano da graduação em Direito de uma universidade particular de Recife. Os dados coletados foram tabulados e analisados através de uma abordagem quantitativa, demonstrando, sobretudo, que apesar de uma parcela significativa (40%) dos pesquisados se sentir preparada para trabalhar com demandas de diversidade de gênero e sexualidade na sua prática profissional, poucos deles atribuem essa preparação ao ensino universitário, ou seja, 76,5% apontam que a universidade não ofereceu (13,5%) ou ofereceu pouca (63%) formação em diversidade sexual e de gênero. Com isso, então, pode-se dizer que o pensamento jurídico brasileiro carrega raízes do modelo positivista e, por isso, se limita, muitas vezes, ao que está posto nas leis e códigos. É necessário repensar o modelo de ensino jurídico vigente, suas características e a atuação docente perante o mesmo e, assim, potencializar o Direito enquanto ciência que desempenhe um papel importante no combate à discriminação, ao preconceito, produzindo mecanismos que garantam, efetivamente, direitos fundamentais a populações vulneráveis.

Sexuality- and gender-diverse (SGD) young people experience substantial health disparities relative to cisgender heterosexual peers. Little is known about SGD adolescents younger than 15 years. To describe SGD prevalence and associated factors in a population-representative cohort of younger adolescents in Australia. This prospective cohort study was part of the Future Proofing Study, with enrollment of year 8 students at 134 Australian secondary schools from 2019 to 2021 and annual follow-ups for 5 years. Data were analyzed from June 20, 2023, to June 6, 2024. Outcomes of interest were baseline self-reported gender and sexuality identities, individual characteristics, and mental health and disability diagnoses, as well as school characteristics. Among 6388 participants, median (IQR) age was 13.9 (13.6-15.8), with a range of 10.7 to 17.5 years. Most participants attended school in a major city (76.0%), were born in Australia (91.4%), and spoke English at home (93.7%). Approximately half (3122 participants; 48.9% [95% CI, 45.2%-59.0%]) identified as female or girls, and 46.5% (2973 participants; 95% CI, 39.8%-53.4%) identified as male or boys. The overall proportion of transgender identity was 3.3% (95% CI, 2.7%-3.9%), with 23 participants (0.4%) identifying as transgender boys, 10 participants (0.2%) identifying as transgender girls, 117 participants (1.8%) identifying as transgender nonbinary, and 59 participants (0.9%) identifying as another transgender identity. The overall proportion of sexuality diversity was 12.0% (95% CI, 10.4%-13.8%). The proportion of cisgender participants who were sexuality-diverse (13.0% [95% CI, 11.4%-14.8%] of girls and 4.7% [95% CI, 3.7%-5.9%] of boys) was lower than the proportion among gender-diverse participants, which ranged from 30.0% (95% CI, 9.3%-64.1%) of transgender girls to 91.5% (95% CI, 81.3%-96.4%) of those with another diverse gender identity. Gender diversity and sexuality diversity were strongly associated (odds ratio [OR], 66.24; 95% CI, 38.23-114.80), and both were negatively associated with age (gender diversity: OR per 1-year older, 0.61; 95% CI, 0.49-0.76; sexuality diversity: OR per 1-year older, 0.78; 95% CI, 0.65-0.93) and positively with mental health diagnosis (gender diversity: OR, 2.41; 95% CI, 1.79-3.24; sexuality diversity: OR, 2.50; 95% CI, 2.10-2.98), and disability diagnosis (gender diversity: OR, 2.39; 95% CI, 1.68-3.40; sexuality diversity: OR, 1.96; 95% CI, 1.64-2.36). While there were significant associations between individual and school characteristics and responses to gender and sexuality identity items, patterns of association differed, with no consistent association with economic disadvantage. This cohort study of young adolescents found higher rates of SGD than among samples of older adolescents. The significant associations with younger age, poorer mental health, and disability underscored the urgent need for inclusive programs to promote a safe and welcoming environment in schools, health care settings, and communities.

Moving Dietetics Forward with Queer Pedagogy: A Post-Structural Qualitative Study Exploring the Education and Training Experiences of Canadian Dietitians for LGBTQ Care

While queer theology has foregrounded sexual and gender diversity in faith communities internationally, in South Africa, the emergence of a queer, African theology is necessary given that religion is often not a ‘safe space’ for sexual and gender minorities owing to theological violence. Advocacy for inclusion requires the development of theological capacity in queer communities so as to foster biblical, theological and interpretative resistance. There are a number of approaches available, including demythologising and reclaiming the Bible for queer communities, developing more redemptive interpretative options for queer inclusion and developing alternative discourses that challenge the heteropatriarchy of the Bible. Entry points for this work include Bible study; workshops and seminars for faith communities on sexual and gender diversity; the acceptance of a minimum pastoral threshold (or minimum levels of preparedness) for engaging with issues of sexual and gender diversity; and creating ecumenical spaces, cognizant of the local context, where such engagements can take place. This involves moving beyond a theology of compassion and essentialised notions of sexuality and gender so as to develop a queer, African, people’s theology that recognises the trauma experienced by sexual and gender minorities in faith communities.

Trans and gender diverse young people experience mental health difficulties self-harm and suicidality at markedly higher rates than the general population, yet they often feel isolated from mental health services. There is little qualitative research on the experiences of trans and gender diverse young people accessing mental health support in Australia. The objective of this study was to comprehensively explore the experiences of trans and gender diverse young people in Australia who have sought mental health support from therapists, counsellors, psychiatrists and/or inpatient care providers. We report on findings from the Trans Pathways study, which was a mixed-methods study to evaluate the experiences of trans and gender diverse young people accessing mental health services: specifically, therapy and counselling services, psychiatric services and mental health inpatient services. A total of 859 trans and gender diverse young people aged 14-25 years across Australia completed an anonymous online questionnaire. Therapy and/or counselling services (64.4%) were most frequently sought by trans and gender diverse young people in this study, followed by psychiatric services (43.0%) and mental health inpatient services (12.3%). The findings demonstrated that many mental health professionals lacked expertise in gender diversity, and that trans and gender diverse young people found it difficult to locate mental health professionals who were able to meet their needs in a timely manner. These findings indicate that training is necessary for all mental health professionals to improve their knowledge of gender diversity, enhance the support provided to trans and gender diverse young people and help to address the high rates of poor mental health. The findings outlined here provide insight into the areas in which clinicians could optimise their care of trans and gender diverse young people.