Transgender and nonbinary people experience a unique need for affirming mental health services due to social and environmental factors that marginalize their identities and experiences. In addition, research has shown that mental health providers consistently lack training, experience, or comfort in providing affirming mental healthcare to LGBTQ people. Further, there is little evidence that providers who identify themselves as “LGBTQ-affirming” are affirming of transgender people and, more specifically, affirming of nonbinary clients. This widespread lack of accessible mental health providers for transgender and nonbinary people is a barrier to providing mental health care that meets their needs and affirms their identities.
In order to address this gap in our understanding of how LGBTQ-affirming mental health providers engage in mental health services with transgender and nonbinary clients, this pilot study surveyed and interviewed mental health providers in 8 states who publicly identified themselves as competent or affirming in working with LGBT clients. The interviews explored participants’ clinical training and experience, their understanding of transgender and nonbinary identities, and their beliefs on what it meant to be LGBT-affirming and specifically transgender and nonbinary affirming.
Findings suggest that providers broadly conceptualize gender-affirming care in three main ways 1) environmental cues and support, 2) interpersonal behaviors, and 3) personal growth and accountability. Providers who described their clinical practice as affirming based upon environmental factors prioritized an emphasis on their availability of all-gender restrooms and the inclusive paperwork used in their practice. Those emphasizing interpersonal behaviors noted the use of conversations regarding client pronouns (though rarely did providers discuss their own pronouns with clients) and other ways in which they engaged in gender-inclusive conversations with their clients. Finally, those providers who centered their commitment to affirmation on their personal growth and self-awareness talked about intentionally deconstructing their own biases and internalized binaristic gender paradigms.
Conclusion and implications
The findings from this pilot study suggest the need for more explicit training in mental health services on the differences between environmental or overt affirmation and a recognition of the complexities of gendered experiences when working with transgender and nonbinary clients. Moreover, mental health providers who identify themselves as “LGBT-affirming” could better serve their clients by recognizing the distinct differences between LGB people and transgender and nonbinary people, and the differences between transgender binary experiences and transgender nonbinary experiences. Further, the fundamental importance of self-awareness of providers’ understanding and assumptions of gender is highlighted.