Abstract
People who are transgender and gender nonconforming (TGNC) have substantial disparities in mental health and thus rely on mental health practitioners like therapists to help address these disparities. However, little is known about therapist practices with TGNC people, and what research exists is often generalised from broader research on practice with people who are gay and lesbian. Because this research uses broad models to describe practitioner behaviour, it assumes all therapists approach practice with TGNC clients in the same way. The current study explores therapists' self-reported practices with TGNC people through a structured, qualitative, web-based survey of 95 practising social workers. From a thematic analysis of responses, five approaches to practice with TGNC people emerged: 1) A Low-Impact Approach, 2) A Fairness First Approach, 3) A Responsive Approach, 4) A Therapist Responsibility Approach and 5) A Pathological Approach. These approaches vary on three key dimensions: whose responsibility it is to broach client gender identity in treatment (therapist or client), the importance of gender identity (from low to high), and whether a TGNC identity is a disorder (yes, no or not addressed). The breadth of practice behaviours and undergirding assumptions participants described indicates that a single model may not fit practice behaviour with TGNC people. A discussion of the relationship between each approach and existing practice models suggests that the Low-Impact Approach, Responsive Approach and Therapist Responsibility Approach may be effective with TGNC people and that the Pathological Approach likely represents poor practice.