A Trauma-Informed Exploration of the Mental Health and Community Support Experiences of Transgender and Gender-Expansive Adults

Background and Purpose: Transgender and gender-expansive (TGE) adults face disparities in trauma exposure relative to their non-TGE counterparts.  Given that these traumatic experiences are often related to gender identity, feedback from TGE individuals about how to address gender identity concerns in a trauma-informed manner is needed.  The purpose of this qualitative study was to use trauma-informed care (TIC) as an analytical framework for exploring TGE adults’ perspectives on mental health and community supports.

Methods: Data were drawn from a cross-sectional, mixed-methods study that aimed to assess the mental health and community support needs of TGE adults (N = 100) recruited from online support groups.  Each participant completed a 20-minute online survey consisting of sociodemographic questions, previously validated instruments, and two open-response prompts that asked them to recommend ideas for improving the supportiveness of their communities and describe their best session with a mental health counselor.  These last two items yielded a considerable amount of data and became the sole focus of the current analysis.  Using ATLAS.ti, the first author conducted a few rounds of open coding and developed a preliminary coding scheme based on the principles of TIC after identifying this framework to be compatible with the full range of participants’ perspectives.  The Framework Method was utilized to apply the coding scheme to the data.  Categories and themes were identified using ATLAS.ti’s code co-occurrence tool and sorted into a Microsoft Excel spreadsheet as a means of summarizing and interpreting the data.  Finally, four representatives of the TGE community participated in member checking to enhance the trustworthiness of the findings.

Findings: The analysis yielded five themes that extended across settings: (1) trust and emotional safety (acceptance, validation); (2) environmental and physical safety (non-threatening atmosphere, access to accommodations and resources); (3) choice and collaboration (equitable relationships, collaborative decision-making); (4) empowerment (advocacy, community building, tools for self-improvement); and (5) cultural and gender issues (appreciation of subjectivities, community awareness).  Noteworthy findings included the role of TGE-specific knowledge, experience, humility, and open-mindedness in promoting safety within the therapeutic alliance; the preponderance of responses about within-group gender policing and mistreatment from providers; and the importance of resolving inequities in the greater community via advocacy and solidarity.  In addition, participants perceived access to identity-based accommodations to be a critical component of physical and environmental safety.   

Conclusion and Implications: This study was the first to apply a TIC framework to a qualitative exploration of TGE adults’ experiences with mental health and community supports.  Findings pointed to several recommendations for applying TIC to systems of care that serve this population, such as implementing strategies that help TGE adults undo the internalized transphobia that contributes to within-group gender policing or expanding public access to information about the availability of accommodations and resources (e.g., citywide directories of all-gender restrooms).  The extent to which participants discussed negative experiences when asked about positive ones suggests that there is a need for TGE-friendly providers and community spaces.  This research has laid the groundwork for future efforts to address this problem using a TIC model.