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This chapter examines the complex interplay of ethical and clinical considerations in psychotherapy, research, and supervision with sexual and gender minority (SGM) clients. Using ethical codes and “best practices” documents from mental health organizations throughout the Anglophone world, the authors explore topics such as clinical competence, nonmaleficence, non-discrimination, confidentiality, multiple relationships, using and conducting research, financial matters, advertising, assessment and diagnosis, and supervision through a feminist, queer lens. Ethical considerations are illuminated through brief vignettes grounded in affirmative clinical practices and a cultural humility approach.

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Research on transgender mental health has dramatically increased over the past decade. While initial studies were limited to small clinic-based or geographically limited convenience samples, larger internet and multi-clinic samples as well as increasing inclusion of gender identity questions in regional, national, and probability-based surveys have started to open new avenues for research. Broadly, disparities appear to exist across a broad range of mental health symptoms and diagnoses. However, significant variations exist across studies and intersectional and integrative approaches have started to shed light on some of these variations. This chapter provides an overview of studies examining the prevalence of mental health–related conditions within transgender samples followed by a synthesis of risk and protective factors that appear to underlie mental health disparities. Approaches to conceptualizing and measuring the size of the transgender population, ethical considerations, and implications and future directions are also discussed.

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