“Better issues to focus on”: Transgender Microaggressions as Ethical Violations in Therapy

Abstract

Negative experiences in healthcare settings have been linked to decreased treatment satisfaction and reduction of future help-seeking behaviors among transgender individuals. The present study used gender-identity based microaggressions as a model for understanding the client–therapist relationship. Using a qualitative approach, we investigated instances of microaggressions from mental health providers as experienced by 91 adults who identified as transgender or gender diverse. Participants completed an online survey and described instances of microaggressions directed towards them from mental health providers. Thematic analysis resulted in four therapy-salient themes: Lack of Respect for Client Identity, Lack of Competency, Saliency of Identity, and Gatekeeping. Our discussion of the results focuses on the examination of microaggressions as ethical guideline violations. We discuss methods to improve the practical application of ethical standards to counseling with transgender clients. Implications for practice, training, and future research are also discussed.

Microaggressions towards lesbian and transgender women: Biased information gathering when working alongside gender and sexual minorities

“…The main guidelines for psychological practice with LGBT clients promote understanding, respect, and support, recognizing the existence of minority stress as an essential factor affecting the mental health of LGBT individuals (American Psychological Association, 2012 , 2015 ; Coleman et al, 2012 ; Morris et al, 2019 ). Despite the guidelines that ensure care and protection for the LGBT population, some therapists continue to demonstrate bias when confronted with a member of the community as a client (Prunas et al, 2018 ).…”

“…Furthermore, therapeutic relationships are not immune to societal norms and values that pervade attitudes toward sex and gender (Anzani et al, 2020 ). Thus, although microaggressions that occur in therapy have been recognized as a violation of ethical guidelines, counseling interventions with people of marginalized groups often entail individuals being involved in a therapeutic relationship that places members in either the dominant or the marginalized social group (Morris et al, 2019 ). For example, if the therapist has a normative cisgender heterosexual identity, the client (by default) has a minority sexual orientation or gender identity (Sue & Sue, 2012 ).…”

“…Although a burgeoning area of research in recent years has been focused on microaggression towards LGBT individuals and barriers that prevent them from accessing health care, studies on microaggressions have mostly focused on the reported experiences of LGBT individuals, and no studies have investigated “in vivo” microaggressions directed toward sexual and gender minorities using a sample of experienced clinicians (Morris et al, 2019 ; Shelton & Delgado‐Romero, 2011 ). Furthermore, to the best of our knowledge, no study to date has measured psychotherapist microaggressions “in vivo” within a fictitious clinical scenario.…”

Examining the elevated risk of COVID-19 in transgender communities with an intersectional lens

“…Research widely documents that healthcare workers (including psychotherapists) are often ill-equipped to treat trans patients, even frequently abusing them and/or committing microaggressions (Grant et al 2011 ; James et al 2016 ; Morris et al 2020 ). Education and training (e.g., sponsoring workshops, engaging with resources created by trans people, hiring a trans person with experience in the medical or mental health industry to provide educational sessions) will be necessary to mitigate the abuse that trans people endure in healthcare settings.…”

Therapie mit transmaskulinen Klienten

“…Ich fühlte mich von ihr doppelt unverstanden und habe die Therapie deshalb abgebrochen". (S. 10 in [5])…”