"These Are Clients of Ours and We Have a Duty and a Right to Serve and Honor Them": Therapists Experiences Supporting Transgender and Gender Expansive Clients within an Anti-Trans Political Climate

Background and Purpose:

Gender affirming care (GAC) is recognized as medically necessary and appropriate care for transgender, nonbinary, and gender expansive (TGE) individuals of all ages to reduce the effects of gender dysphoria and the challenges it brings to one’s psychosocial wellbeing (McGeough et al., 2023). Yet an overwhelming 93% of transgender youth ages 13-17 live in states that have passed or proposed laws restricting access to GAC (Redfield et al., 2024). Additional laws have proposed extending such bans to limiting the care trans young adults up 26 years old can receive as well as what will be covered by Medicaid. GAC includes medical interventions, including puberty blockers and affirming hormones, as well as mental health interventions that support and affirm people’s gender identity. Despite increasing state and federal restrictions on GAC, little research has examined how such legislation has impacted mental health providers who work with TGE youth. Therefore, this study aimed to understand the experiences of mental health providers working with TGE young people in the current sociopolitical climate. Our goals are to document their experiences during this unprecedented time in history and identify strategies for supporting social workers and other mental health providers who work to affirm TGE communities.

Methods

Utilizing a qualitative, exploratory design, we interviewed 25 mental health providers who provide affirming care to TGE youth across the U.S. (> 20 states). Virtual interviews lasted approximately 60 minutes and included questions about participants’ state contexts, current practices, challenges, advocacy efforts, support needs, and how their work has changed as a result of anti-trans legislation. We utilized thematic analysis (Braun & Clark, 2006) with multiple coders to explore for themes and patterns inductively.

Results

Findings revealed important and timely themes that highlight the strength and commitment of mental health providers, even in the direst of circumstances. Themes include 1) Navigating conflicts between professional ethics and state restrictions; 2) Committing to the health and well-being of TGE youth; 3) Engaging in advocacy to resist harmful legislation; and 4) Needs for professional support to do the work they do. Notably, we found that most mental health providers interviewed prioritized their ethical mandates to support TGE communities and their access to GAC even in the face of bans or restrictions on GAC in their states.

Conclusions and implications

Our findings point to the critical need to understand the experiences of mental health providers working with TGE communities during the current anti-TGE political environment. Implications from this work include working with professional organizations to provide concrete and ongoing support to providers, training mental health providers on navigating ethical versus legal mandates, and supporting the advocacy efforts of mental health providers. Additionally, given safety concerns expressed by participants, it is critical for professional organizations and GAC clinics or therapy offices to identify ongoing ways to support the safety of their therapists.