Gender-affirming practices

For most people, sex is assigned at birth on the basis of genitalia. The majority of people assigned ‘female’ at birth will also experience their gender as ‘female’ in line with social norms about what constitutes this category. Similarly, most people who are assigned ‘male’ at birth will experience their gender as ‘male’. People whose gender is consistent with their sex as assigned at birth can be described as ‘cisgender’. For some people, however, this presumed relationship between assigned sex and gender is incorrect.

The term ‘transgender’ is widely used to refer to a diverse group of people. Compared to their cisgender peers, transgender people face a range of extra challenges including stigma, discrimination and social exclusion. This is often due to a lack of understanding and acceptance within their families and the community. So it is crucial that psychologists adopt an affirming approach when it comes to working with transgender people.

In 2017 the Trans Pathways report was released, documenting the experiences of 859 young transgender Australians and 194 parents of transgender children. The report contained quotes from some of the young people who completed the survey, including with regard to their experiences with psychologists. These quotes highlight what we as psychologists are doing well:

“My psychologist is incredibly understanding of my situation, as well as just a kind person to talk to who doesn’t seem judgmental of me, and seems like she genuinely cares about helping.”

Where we need to improve:

“My psychologist was lovely but I felt like I had to explain a lot of things to her such as what queer means. She was super accepting but I felt like she had no knowledge of gender diversity so it was just skimmed over.”

Situations where we are failing young transgender people:

“The service ended up making me feel worse than when I arrived. Also, there was a general tendency not to take my body dysphoria or my need to see someone who was actually knowledgeable about transgender issues seriously. People asked questions that made it clear they didn’t really know anything, and seemed to think they knew more about my problems than I did.”

The quotes from the report mirror research with transgender people more broadly, in which there is a clear divide between the skill sets of psychologists who are knowledgeable and understanding, those who lack knowledge but who are nonetheless welcoming, and those who fail in their duty of care to transgender people.

The Australian Psychological Society (APS) has been at the forefront of working towards ensuring the inclusion of transgender people on the part of all practitioners and researchers within the discipline. One example of this was the development of the APS information sheet on mental health practices that affirm transgender people’s experiences.

The information sheet recognises that affirming clinical responses are those most likely to result in positive outcomes for transgender people. Such positive outcomes include a reduction in psychological distress, reduced likelihood of suicidal ideation, and increased overall wellbeing.

A role for psychology

Psychologists have much to contribute beyond simply providing affirming responses. They also have a key role to play in advising and advocating to State and Federal Governments for the rights and needs of transgender people. Mental health professionals in general have made valuable contributions to state and federal inquiries that have sought to address inadequacies in legal and policy frameworks as they apply to transgender people. Such inquiries are likely to continue to occur, and psychologists have an important role to play in making submissions that endorse affirming approaches.

Researchers in the discipline also have an important role to play in terms of ensuring that affirming approaches are adopted. Unfortunately, psychological research has often been complicit with approaches that are not affirming of transgender people. Affirming research is best achieved through collaboration between researchers and community groups, and through attention to current best practice guidelines.

While the APS continues to make a considerable contribution towards ensuring that affirming approaches to transgender people are adopted in research and in practice, there is more work to be done. A key component of this work is to ensure the recognition of gender diversity beyond gender binaries. Many transgender people experience their gender as one of two binary categories (i.e., female or male). However many people experience their gender as not falling within these two binary categories (with the term ‘gender diverse’ or ‘non-binary’ often used to describe such people). See below for an overview of some of the categories that are reported in research and used by people to describe their gender.

Practitioners, researchers and the APS can make a significant contribution to recognising a diverse range of genders by ensuring that forms don’t simply include ‘male or female’. A list, drawing on the infographic opposite, can be one way of recognising many differing genders. Such a list, however, is unlikely to include all possible genders. As one option, forms may include the option ‘gender not listed here’ (rather than ‘other’, which itself can be marginalising).

In addition, communications should avoid phrases such as ‘men and women’, which serve to reinforce a binary understanding of gender. When welcoming a group of people to an event, for example, it would be more inclusive to welcome everyone, rather than the more standard ‘ladies and gentlemen’. Alongside recognising a diversity of genders, it is important to recognise the pronouns that accompany them. Increasingly, people whose gender is not described by the binary categories of male or female use the pronoun ‘they’ in the singular. Historically, ‘they’ as a singular pronoun was common, and thus its contemporary usage need not be treated as unusual.

As readers will no doubt be aware, negative messages about transgender and gender-diverse people are prevalent in the media. In order to ensure that transgender and gender-diverse people are affirmed, it is vital that researchers, practitioners, and the APS work towards challenging negative messages. As an evidence-based discipline, we have a strong and growing body of research from which to challenge negative messages.

Continued efforts

To date, the APS and Australian psychologists and researchers have made a positive contribution to ensuring the rights and wellbeing of transgender and gender-diverse people. The latest form this has taken is a webinar series by the APS Institute that aimed at ensuring that affirming approaches are adopted when working with young transgender and gender-diverse people. Psychologists across all settings and sectors should prepare themselves for working with transgender and gender-diverse people through increasing their knowledge and skill in employing affirming practices. The webinar series provides a clear framework for understanding the contexts in which transgender and gender-diverse people live, the ways in which such contexts can negatively impact upon people’s lives and affirming responses to working within such contexts.

But given ongoing discrimination, it will continue to be important that psychologists are outspoken about the need for affirming responses to transgender and gender-diverse people. This is especially true with regard to the most marginalised of groups: young children, those without access to services, those who experience poor mental health, older people, and those marginalised on the basis of ethnicity, faith and ability. Being outspoken requires not only that non-transgender practitioners and researchers speak from a place of knowing about what constitutes affirming responses, but that we also actively promote the voices of transgender and gender-diverse people within the discipline.

The author can be contacted at [email protected]