Reluctant gatekeepers: ‘Trans-positive’ practitioners and the social construction of sex and gender

Abstract

The following study is based on 35 in-depth, qualitative interviews with licensed marriage and family therapists, counselors, clinical social workers, and professional psychologists who advertise their services as ‘trans-friendly’, ‘trans-supportive’, or ‘trans-positive’. We focus on cases in which practitioners denied clients access to body modifications for reasons related to gender identity in an effort to distill how practitioners' decisions are based on their working understandings of the appropriate relationship between gendered identities and sexed bodies. In the process of determining clients' access to body modifications, practitioners speak of the importance of the level of practice, as opposed to codified texts such as the DSM, in political and ideological constructions of gender and the materialization of sexed bodies. Instead of sharing one primary configuration of these ideological components, the practitioners we interviewed differed in terms of their assumption that gender identity is a product of biological, spiritual, or social processes. We conclude by considering the possibilities for the clinical encounter to subvert dominant gender ideology by authorizing more fluid gender identities and sexed bodies.

Keywords:

• transgender
• gender identity
• gender ideology
• body
• bioreductivism
• gender identity disorder

Acknowledgements

We are grateful for Sarah Uecker's expert research assistance and the insightful comments provided by the reviewers. We also extend our thanks to Sarah Phillips and John Hayes for their administrative support.

Notes

1. We use ‘hir’ as a gender-neutral pronoun.

2. World Professional Association for Transgender Health (WPATH) is formerly known as the Harry Benjamin International Gender Dysphoria Association.

3. Our participants often use the term ‘trans-positive’ to refer to their support for transgendered individuals' rights to self-determination. We use quotation marks because this is not our label and it is politically charged. We use the word ‘trans’ as an umbrella term to describe clients who are gender-variant and/or those who seek medical interventions to modify their sex characteristics.

4. We define gender as a socially constructed classification that can be a characteristic of individuals as much as institutions (Scott 1999) and gender as something that one ‘does’ (West and Zimmerman 1987), which is regularly interpreted as a finished product inherent and natural to the self. Borrowing from the work of ethnomethodologists (Kessler and McKenna 1978), historians of sex (Laqueur 1990, Meyerowitz 2002), and feminists of science (Fausto-Sterling 2000, Hird 2002, Fujimura 2006), we also see sex as a socially constructed classification whose current dominant logic organizes variations of nature into two ‘opposite’ categories of ‘male’ and ‘female’ based on primary and secondary sex characteristics.

5. We have assigned pseudonyms to all of our respondents to protect their confidentiality.