A Safe Bet? Transgender and Gender Diverse Experiences With Inclusive Therapists

Historically, the global mental health system has pathologized transgender and gender diverse (TGD) identities, imposing spurious diagnoses and nocuous "cures." Recently, the World Health Organization declassified "transgender" as a mental health disorder, and psychological organizations have acknowledged the harmful practice of conversion therapy and other culturally inept interventions. Some practitioners have begun to advertise their therapeutic services as "trans-affirming" or "trans-competent," but to date, there are no published studies delineating their efficacy. The following content analysis addresses this gap by considering the open-ended responses of 1,567 participants in the Trans Mental Health Survey. While inclusive mental health care is clearly needed, this study suggests that affirming providers are not axiomatically adroit: some providers inflate their expertise, conflate TGD experiences with sexual minority experiences, and manipulate their clients. Conversely, competent providers are identified by their helpfulness, trustworthiness, and understanding of TGD issues. In addition to promulgating best practices, this content analysis also acknowledges systemic barriers to quality care. The solutions to these macroissues include free or affordable mental health care and increased access to services. Public Policy Relevance Statement Little is known about the efficacy of trans-inclusive mental health care. This study is one of the first to suggest that many practitioners who advertise their services as inclusive may not be providing competent care. Standardized therapist training and increased access to affordable services may help to address some of these critical gaps in trans mental health care.