Transgender Clients Research Articles

Knowledge and attitudes toward transgender community among speech-language pathologists in India: A questionnaire-based exploration

Background: During the transition process, transgender individuals may require voice and communication services. Speech-language pathologists are increasingly involved in rendering clinical services and assisting transgender clients in voice and communication therapy. Previous studies in different countries have highlighted the lack of competence expressed by the speech-language pathologists toward serving the members of the lesbian, gay, bisexual, transgender, and queer communities. Presently, no such findings are available in the Indian context. Thus, a need was felt for identifying the concerns toward treatment for transgender individuals in speech-language pathology settings in India.Aim: The aim of the present study was to assess the knowledge, comfort levels and attitudes of speech-language pathologists practicing in India regarding the transgender community.Method: An online survey method was used to assess the knowledge and attitudes among speech-language pathologists working in India toward the transgender community.Results: The findings of the study revealed higher comfort levels as compared to self-rated knowledge levels in addressing issues related to transgender healthcare. Evidence-based practices toward transgender healthcare emerged as the topic needing more information. The study also helped to identify several moral beliefs and practices for voice therapy for the transgender population.Conclusion: There is a strong need to educate the speech language pathologists toward transgender healthcare in order to promote better cultural competence. The findings of the present study help to identify the lacunae in knowledge as well as to highlight the need to have continuing education programs in this area.

Addressing Needs of Transgender Patients: The Role of Family Physicians

There are approximately 1 million transgender and gender-diverse adults in the United States. Despite increased awareness and acceptance, they frequently encounter medical settings that are not welcoming and/or health care providers who are not knowledgeable about their health needs. Use of correct terminology, following best practices for name and pronoun use, and knowledge of gender-affirming interventions can create office environments that are welcoming to transgender clients. Health disparities faced by transgender patients that impact access to care include higher rates of mental health issues, substance use disorders, violence, and poverty. Transgender women are at greater risk for HIV acquisition and are less likely to achieve viral suppression compared with cisgender (nontransgender) individuals. Medical providers can facilitate HIV prevention efforts by offering pre- and postexposure prophylaxis to transgender patients at risk for HIV infection. Improving health outcomes requires attention to cultural competency and an understanding of lived experiences and priorities of transgender people.

Working with Transgender and Gender Diverse Clients in Emotion Focused Therapy: Targeting Minority Stress

ABSTRACT Our objective is to introduce therapeutic intervention, in an EFT framework, with gender diverse people. We review research outlining mental health comorbidity, and some of the unique needs of this population. We understand risk and protective factors and intervention targets through the lens of minority stress theory. Proximal minority stress variables – internalized transphobia, expected rejection, and concealment stress – are reviewed. We outline extant and emerging treatments tailored to members of the transgender and gender diverse population experiencing minority stress. We focus specifically on the utility of EFT as a model for treating proximal minority stress variables and their associated underlying emotion schemes. We focus on adapting central EFT chair tasks to meet the unique needs of transgender and gender diverse clients experiencing minority stress. An illustrative example of the implementation of such is provided in the case of a young transfeminine client experiencing minority stress.

The Psychometric Properties of the Competency Assessment Tool for Lesbian, Gay, Bisexual, and Transgender Clients

ABSTRACT This study introduces a new instrument designed to assess affirmative clinical practices with sexual and gender minority (SGM) clients, the Lesbian, Gay, Bisexual, and Transgender Competency Assessment Tool (LGBT-CAT). The LGBT-CAT has two unique qualities: Its design enables adaptation to measure practice competencies with gay, lesbian, bisexual and/or transgender clients, the latter of which has no existing measures regarding practice competencies, and it uses a qualitative collection method. Participants respond to 12 open-ended prompts; responses are then quantified by one or more raters based on a scoring rubric. In this cross-sectional study, practicing social workers (N = 357) were surveyed using the LGBT-CAT as well as measures of affirmative practices with SGM clients, knowledge, beliefs, self-efficacy skills, attitudes, and behaviors. The LGBT-CAT demonstrated good reliability, poor criterion validity, and adequate construct validity. These results support the potential integration of the LGBT-CAT into research on practice with SGM clients.

The Presenting Concerns of Transgender and Gender Nonconforming Clients at University Counseling Centers

There is a paucity of research on transgender and gender nonconforming (TGNC) students who present to university counseling centers (UCCs). Using national-level data from the Center for Collegiate Mental Health (2012 to 2015), the current findings indicate that TGNC students seeking services at UCCs are presenting with high acuity and more severe concerns than their cisgender peers. This severity is in nearly every clinical domain including suicidality, history of hospitalization, trauma history, mood disorders, and family distress. Comparing the transgender and gender nonconforming (GNC) collegiate clients, GNC clients have the highest levels of distress and clinical symptoms on nearly every indicator. Overall, these findings for both transgender and GNC clients provide important information for UCCs about treatment and outreach to these high-risk populations. Our findings also mirror the mental health disparities seen in noncollegiate community TGNC samples. We discuss treatment implications, limitations, and suggestions for future research.

Care of transgender individuals in India: A clinical perspective

India is making rapid strides in recent times in recognizing and providing legal supports to the transgender community. An increasing number of individuals are seeking medical assistance for gender-affirming medical interventions. Many medical and surgical practitioners working with transgender clients in the Indian subcontinent face clinical and social challenges. In this article, we highlight some of the common challenges experienced by healthcare professionals and the solutions adopted in providing care for transgender clients.

Transgender Experience of Mental Healthcare in Australia

Emerging global research suggests that transgender people experience poorer physical and mental health outcomes, as well as higher rates of discrimination in healthcare settings. To explore this in an Australian context, a qualitative research project was undertaken to explore the helpful and unhelpful therapy experiences of six transgender Australians. Using interpretative phenomenological analysis, four master themes emerged from the interview data, two of which are explored in depth. The research brings valuable insight into working towards positive outcomes with transgender clients with suggestions for changes in clinical practice for mental healthcare providers, education, training and future research.

Advocacy-in-Action: Case Portrait of a Helping Professional Pursuing Positive Social Change for Transgender and Gender-Expansive Youth

Transgender and gender-expansive youth experience discrimination and marginalization in the healthcare setting, school environment, their communities, and families. These experiences of rejection and adversity are correlated with higher rates of suicidality, depression, and other mental health concerns. Helping professionals play an essential role in mitigating experiences of oppression by advocating for positive social change for their transgender and gender-expansive clientele. Through the provision of a single case portrait, this article explores the advocacy-in-action of Craig, a helping professional and advocate, as he pursues positive social change for transgender and gender-expansive youth. Merriam’s (1988) interpretive case study was used to guide data collection and findings. Emergent themes provided concrete examples of how the American Counseling Association (ACA) endorsed an advocacy model, and the Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling Competencies for Counseling Transgender Clients apply to this population. Including the concepts of intrapersonal and interpersonal advocacy to the current advocacy model is critical to advancing the health of transgender and gender-expansive youth. Implications for counselors and counselors in training will also be discussed.

Transgender clients at a youth mental health care clinic: Transcending barriers to access

The current study investigated the service access pathways of transgender youth at a mental health clinic. Demographic and service information from youth (aged 17–25) at a Canadian mental health clinic (n = 1,504) was collected. Four separate chi-square analyses were conducted to measure potential differences in service access between cisgender and gender diverse clients (those identifying as transgender, gender queer, non-binary, or other). Compared to cisgender clients, transgender and gender diverse clients were significantly more likely to self-refer for treatment. These findings highlight the importance of a self-referral option for young gender diverse clients and provide needed data about the mental health service access of transgender youth.

A Self-Assessment Tool for Cultivating Affirming Practices With Transgender and Gender-Nonconforming (TGNC) Clients, Supervisees, Students, and Colleagues.

In the field of applied behavior analysis, professionals are likely to interact with transgender and gender-nonconforming (TGNC) people, either as clients, in a supervision context, in the university classroom, or in the workplace. This paper presents a self-assessment checklist tool that can be used to assess one's current behaviors of TGNC-affirming practices, along with guidance for using the tool to achieve growth in this area.

Supplemental Material for Blessing or BS? The Therapy Experiences of Transgender and Gender Nonconforming Clients Obtaining Referral Letters for Gender Affirming Medical Treatment

Supplemental Material for Blessing or BS? The Therapy Experiences of Transgender and Gender Nonconforming Clients Obtaining Referral Letters for Gender Affirming Medical Treatment

From Absence of Microaggressions to Seeing Authentic Gender: Transgender Clients’ Experiences with Microaffirmations in Therapy

Although mental health disparities for transgender individuals are well documented, a number of obstacles exist for receiving affirming therapy. To provide an understanding of transgender peoples’ help-seeking experiences, the present study aimed to investigate their positive experiences of identity microaffirmations within a therapeutic relationship. Sixty-four transgender participants answered an open-ended question online regarding their experience of gender identity–based affirmations in therapy. Using thematic analysis, responses were evaluated and four main themes were identified: (1) absence of microaggressions, (2) acknowledging cisnormativity, (3) disrupting cisnormativity, and (4) seeing authentic gender. Implications for therapeutic work with transgender clients are discussed.

A Bioethics Approach to Social Work Practice With Transgender Clients

Increased advocacy for the informed consent model of transgender health care specifies that patients should be in control of access to receiving medical interventions such as hormone therapy or surgery. However, in practice, mental health clinicians, including clinical social workers, are increasingly called upon by medical providers to serve as gatekeepers for these processes. It is frequently the role of social workers to assess transgender clients’ baseline mental health and their understanding of the consequences of treatment, and to forward recommendations to medical providers regarding the readiness of patients to transition. Therefore, social workers assisting transgender clients must be aware of the ethical standards that are particularly pertinent to their work with this marginalized and oppressed population. They must also be prepared to address unique ethical dilemmas that may be especially challenging to resolve. In this article we apply the most commonly utilized bioethical framework known as Principlism to describe the ethical standards and values that are particularly important to consider when working with transgender clients, namely autonomy; beneficence; nonmaleficence; and social justice. Because clinical social workers are frequently in the position of balancing client self-determination with their role as gatekeepers, a framework for resolving resulting ethical dilemmas is described (I CARE) and applied to three case examples.

Speech-language pathologists with a vocal music background: exploring impact on the training of the transgender voice

Speech-language pathology, vocal music, and music education literature reveal similar and complementary approaches to the transgender voice. The purpose of this qualitative pilot study was to explore what, if any, impact having a vocal music background has on how a speech-language pathologist (SLP) works with transgender and non-binary voice modification clients. Two SLPs were interviewed regarding their vocal music backgrounds, their work with transgender voice modification clients, and their thoughts on how music and voice modification training intersect. Results of the study indicate that a musical background may be beneficial to both the SLP and clients. Musical training provided the SLP with a broader range of tools for training clients in voice modification techniques, including the ability to model exercises, and manipulate timbre, resonance, and placement of the voice with great nuance. Both SLPs explicitly cite their vocal music background as being helpful in their practice. Further refinement of the interview protocol, as well as multiple interviews with a larger pool of subjects, will determine if the results of this study are generalisable.

Clinician and client perspectives regarding transgender health: a North Queensland focus

Background: Healthcare encounters are important in ensuring safe access to medical or surgical care for transgender people. Previous literature suggests many transgender people have had negative encounters with healthcare professionals. In Australia, there is limited research about this population and their healthcare, and less from regional locations.Aims: This study primarily aimed to explore both transgender client and clinician perspectives and experiences of healthcare interactions. A secondary aim was to investigate increased presentations to sexual health clinics in North Queensland by people wishing to transition.Methods: Semi-structured, in-depth interviews were used to gather data from 23 participants. Interview transcripts were inductively analyzed and themes developed. Results: Four themes emerged relating to healthcare encounters and the regional setting of North Queensland. These showed that support from family and peers is important for transgender mental health and wellbeing, and that person-centered clinicians who acknowledge a holistic approach to transgender care also form part of the support network for transgender individuals particularly in the regional setting. The internet was found to play a significant role in this study’s findings.Discussion: A collaborative holistic approach to transgender healthcare should be taken by client and clinician to best support the transgender individual during transition. The establishment of Australian guidelines and online peer support groups would facilitate this approach, particularly in rural or regional areas where specialist services are limited.

Resilience Factors and Suicide Risk for a Sample of Transgender Clients.

This study explored how individual- and community-based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross-sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens byway of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study.

Demonstrating Nursing Excellence Through Equality: The Relationship Between Magnet® Status and Organizational LGBTQ Client Services and Support

Introduction: Human Rights Campaign annually scores health care treatment of lesbian, gay, bisexual, transgender, and queer (LGBTQ) employees and clients among four measured dimensions in its Healthcare Equality Index (HEI). The purpose of this study was to determine if the score organizations earned on the 2018 HEI dimension measuring LGBTQ client services and support correlated with organizations' American Nurses Credentialing Center Magnet® recognition status, a distinction of nursing excellence. Method: Using a secondary data analysis approach, data obtained from Human Rights Campaign that specifically rated LGBTQ client services and support in 2018 HEI participating organizations (n = 626) were compared with the most recent inventory of American Nurses Credentialing Center Magnet health care organizations (n = 477). Results: LGBTQ client services and support HEI scores positively correlated with Magnet status (p = .0002). Discussion: Provision of LGBTQ client services and Magnet recognition is strongly related to higher quality nursing care, suggesting organizations earning Magnet recognition provide more equitable services to its LGBTQ clients.

Transgender clients at a youth mental health care clinic: Transcending barriers to access

The current study investigated the service access pathways of transgender youth at a mental health clinic. Demographic and service information from youth (aged 17–25) at a Canadian mental health clinic (n = 1,504) was collected. Four separate chi-square analyses were conducted to measure potential differences in service access between cisgender and gender diverse clients (those identifying as transgender, gender queer, non-binary, or other). Compared to cisgender clients, transgender and gender diverse clients were significantly more likely to self-refer for treatment. These findings highlight the importance of a self-referral option for young gender diverse clients and provide needed data about the mental health service access of transgender youth.

Living in the Margins: Intersecting Identities and Clinical Work with Black Women

Black women underutilize mental health services. Challenges to help-seeking and sustaining treatment relationships have been well-documented to include stigma, cultural disconnect, and mismanagement of race and racism in the therapy room. Certain marginalized identities are stigmatized both within the dominant culture and Black community. Case material from a Black transgender client and a Black woman who presents a complex mix of religious identification is presented. Giving visibility and voice to populations typically neglected in the clinical literature will contribute to the goal of culturally competent practice. Implications for training and clinical supervision are discussed.

The pathologization of trans-sexuality: Historical roots and implications for sex counselling with transgender clients

Summary Since sex reassignment surgeries (SRS) medical interventions for transsexual individuals were made available in 1951 (Meyerowitz, 2004), the need had emerged to identify candidates who could benefit the most from such interventions. This opened the way to the elaboration of very strict clinical guidelines for the identification of the typologies of transsexual individuals and for the emphasis on “differential diagnosis” between “true transsexuals” and the rest of the transgender population coming to clinical attention. These guidelines set the stage for a “pathologization” of the sexual life of transgender individuals in the eyes of mental health professionals. This review is intended to offer an overview of the historical roots from which such prejudices and biases have stemmed and draw the process of change that lead to gender confirming (GC) approaches.