Transgender and gender diverse adults’ self-reported mental health diagnoses, engagement in mental health services, and perceptions of therapists

Abstract

Objective: Transgender and gender diverse (TGD) people face various challenges when seeking therapy. Given this, we wanted to understand more about TGD people’s perceptions of providers and how these compare to researcher ratings of providers on metrics of affirming practice. Method: The sample included 158 TGD adults (M_age = 33.06); 57.6% were in therapy. Participants completed measures about mental health, resilience, and therapy. We systematically coded provider websites and intake forms. Results: Participants in therapy were older, had higher depression, and lower resilience than participants not in therapy. Non-binary/genderqueer participants rated providers as less knowledgeable compared to trans feminine participants. Overall, participants appeared satisfied (71.4% extremely satisfied) and viewed providers as at least moderately knowledgeable (89.1%). Provider coding revealed variation across the markers of affirmation; 66.04% identified a TGD-specialty and only 26.42% shared provider pronouns. Higher frequency of inclusivity (via coding) was related to higher ratings of provider knowledge and more of a focus on gender, however, there was not a significant association with satisfaction. Conclusions: Providers who engaged in more affirming practices were more knowledgeable compared to those who engaged in fewer affirming practices. This may influence the content of therapy and whether clients feel comfortable discussing gender.

Keywords:

• transgender
• gender minorities
• mental health
• therapy
• therapists

Acknowledgements:

We deeply appreciate the time of all the participants who contributed to this study. We would like to thank the members of the community board associated with Trans Collaborations in Nebraska for their thoughtful feedback. This study also would not have been possible without the many dedicated research team members across all sites. We wish to thank Tian Walker, Makinna Miles, A. Capannola, Clove Tipton, Dr. Robert-Paul Juster, Geeta Eick, Bex Macfife, Holly Moulton, Lindsey Foltz, Kelsi Kuehn, Oliver Hoover, Jaden Haun, Beyla Geoffrey, Alex Jagielski, Julia Rohrabaugh, Lauren King Watt, Felix Hart, Rin Nguyen, Maryam Razzaq, Terra Dunn, Bella Andrus, Kalei Glozier, Rowan Giffel, Felix Brown, Taylor Anderson, Devon Kimball, Callie Harris, Megan Wertz, Heather Barnes, Sage Volk, Lex Pulice-Farrow, and Drs. Kirsten Gonzalez, Jennifer Jabson-Tree, Sarah Price, and Cindi StrutzStreetharan for their involvement in this work. Finally, Natalie Holt’s involvement was supported by the Office of Academic Affiliations, Department of Veterans Affairs, VA National Quality Scholars Program, and with use of facilities at VA Tennessee Valley Healthcare System, Nashville, Tennessee.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Authors Conflict of Interest Statements:

No authors have any conflicts of interest to declare.

Funding Statement:

Funding for this research was provided via the University of Oregon and Michigan State University.