Knocking at the gate: Experiences of being a transgender client

I just moved to a new area, and I need to set up initial contacts with medical providers in my area. What might be a simple task for so many is a burden for me, even daunting at times. As a transgender woman, a barrier or proverbial gate looms over me, a gate that I am often powerless to open.

Just thinking about going to a new doctor or therapist or even just stepping into any new space can overwhelm me with a barrage of questions and concerns:

Is there a provider that understands me?
Is gatekeeping going to be an issue?
Will my provider think I’m not “trans enough” and deny me the care I need?
What will they require of me to “prove” that I am indeed transgender?
For what arbitrary length of time will I need to see them before they will provide the resources I need?
Will they know anything about letters, hormones, surgery, insurance coverage, etc.?
Will I have to educate my provider on all of these things?

These are just some of the many questions that might go through the mind of a transgender individual who is trying to find a mental health provider (or any medical provider). These are concerns that I have heard from countless individuals in my own transgender communities. As a transgender woman, these are all concerns that I experience every time I consider seeing a new provider.

Counseling psychology, as a discipline, has emphasized multicultural competence, but it has been only in recent years that a more affirming, open, social justice approach has been taken regarding transgender issues and clients. Few providers today are educated in transgender issues¹ and working with transgender clients². This makes that last question become especially salient. To dispel those fears and questions, I as the transgender person often need to educate my provider on the services I need from them. My experiences as a transgender woman and as a student in counseling psychology both make me very aware of this educational burden and the need to address it.

In my hometown of Gainesville, Fla., a town of over 120,000 people, I can count on one hand the number of providers I have encountered that have stated comfort and competency in working with transgender people. This problem is exacerbated in the many small towns³ and rural areas⁴ throughout the country. Therefore, a transgender individual such as myself encounters multiple barriers when trying to find a provider competent in transgender care:

Very few exist.
They often aren’t taking new clients due to demand.
They’re often out of network, making affordability an issue.
They often have limited to no training or experience working with transgender clients.

Due to a number of issues such as these, I was not able to work with a therapist who was especially competent in transgender care when I started going to therapy over four years ago. I had to take a risk and hope that the provider I saw would not only be helpful but would just be able to accept and affirm my transgender identity. Fears like these often prolong or even prevent transgender individuals from seeking out therapy in the first place.

This is where yet another concern rears its head: the onus of educating the provider⁵ can often then be placed on the transgender client on top of everything else.

We’ve seen research in recent years on best practices for working with transgender individuals but much of this research has resulted from mistakes⁶ and microaggressions that transgender clients had to then point out to their providers. Being misgendered⁷, deadnamed⁸ or having someone deny your identity understandably takes an emotional toll. After such microaggressions or outright discrimination occur, the additional emotional energy required to then confront and correct someone isn’t always there. When I have the courage to speak up, providers often don’t understand the emotional impact that confronting the situation has had on me or just outright deny having said anything incorrect. Unfortunately, gaslighting such as this⁹ is not uncommon. This causes clear discomfort, and in my experience, the client to be much less present and less likely to be as open about concerns, regardless of their relevance to my transgender identity. Unsurprisingly, these kind of incidences often weaken¹⁰ and sometimes even irreversibly damage¹¹ the patient-provider relationship.

As a current or future provider, there’s a good chance that you will have a transgender client at some point in your training or career. When that day comes, please open the gate. Transgender individuals deserve the same quality of therapeutic care as cisgender individuals without having to sacrifice their authenticity, educate their providers or be subjected to microaggressions and discrimination. With our current administration continually attacking the transgender community (i.e. the transgender military ban, attacks on workplace protections and proposing to define transgender individuals out of existence), advocacy, education and support for transgender clients and transgender communities as a whole is as important as ever.

Chloë Goldbach (she/her/hers) is a first year PhD student in the counseling psychology program at Southern Illinois University. She earned a BA in psychology, BS in mechanical engineering and MS in biomedical engineering from the University of Florida. Her research interests are in transgender-affirmative mental health care, providing more accessible mental health care for transgender populations, the de-stigmatization of transgender bodies and de-stigmatizing how society conceptualizes gender dysphoria.

Knocking at the gate: Experiences of being a transgender client

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