Mapping gender affirming therapy experiences with transgender clients in Aotearoa
Research on transgender-specific experiences in therapeutic settings (psychology, counselling, psychotherapy and psychiatry) has typically suggested that trans* clients report mixed experiences, and has generally been conducted overseas or is embedded in more generalised LGBTQI enquiry. My research explores the unique and nuanced experiences of transgender clients in the therapy specific gender affirmation context of Aotearoa. Identifying and understanding these experiences will suggest ways service provision can be improved and to ensure clients can access and receive clinically relevant and trans-culturally appropriate therapeutic intervention moving forward.
I recruited twelve adult participants who identified as transgender or non-binary to take part in individual interviews regarding their experiences in therapy across a variety of settings, both publicly and privately funded, in Aotearoa. They were asked a range of questions to determine how they experienced therapy specific gender affirmation practices. A hybrid approach to reflexive thematic analysis was used to identify themes and patterns of meaning across the data.
My analysis identified four themes. Firstly, lack of basic trans* clinical and cultural expertise, exploring the ways therapists evidenced lack of understanding of cultural norms associated a trans* life experience or worldview and showed a lack of clinical expertise in basic gender affirmation therapy. Secondly Breadcrumbs, which refers to trans* clients tendency to exercise forced tolerance and endurance of sub-standard therapeutic experiences as this is predominantly all they can hope for. Thirdly, The therapy context as a purveyor of interpersonal and structural/systemic violence, where therapy itself becomes a harmful dynamic that mirrors violence and transphobia imparted by society. Lastly, an additional overarching theme of Imposition of cis-normative gaze was noted when trans* lives become co-opted and commodified by the normalising influence of cis-genderism.
Analysis highlights the urgent need for national guidelines to be conceptualised and expected from all therapists working in the specialised field of gender affirmation therapy across disciplines. Guidelines would ensure all clinicians meet professional body ethical expectations when working with transgender clients and possess the appropriate specialised knowledge and experience in order to protect and preserve their human and health rights.
