Research conducted by ICPPD Learner Jan O Sullivan as part of her thesis on L8 BA (Hons) in Holistic Counselling and Psychotherapy.

The purpose of this research was to identify pertinent information and knowledge that would enhance the therapeutic experience for transgender clients. Following a review of existing literature, which provided an overview of research to date and interviews with four practising psychotherapists to explore at a deep and personal level the experience of therapists working with transgender clients, the following themes emerged: understanding the terminology and language, non-binary view, non-pathological stance, discrimination and stigma, mental health, and the therapy experience.

Language and terminology: There is a lot of misunderstanding and confusion around language and terminology. Different transgender people use different words to describe themselves – she, her, hers, and he, him and his are the most commonly used pronouns, but the gender-neutral pronouns they, them and their, are preferred by some. Gender identity and sexual orientation are often misunderstood. Therapists who understand that gender identity and sexual identity are different concepts know that transgender clients can identify as straight, gay, bisexual or as another sexual identity. ‘Trans’ is another term of significance. There are many identities under the ‘trans’ umbrella and some do not refer to themselves as transgender as it does not sufficiently describe their identity. Not all terms fit universally for all people. Using the correct language and terminology is important.

Non-binary view: In many cultures throughout the world and particularly in the western world, gender is viewed as binary; you are either a boy or girl, male or female, man or woman and this gender is assigned to you at birth. This narrow notion of gender is not shared worldwide by all societies and in fact non-binary identities have been recognised for time immemorial by some cultures and societies. The research highlights that best practice for therapists is to hold a non-binary view of gender.

Non-pathological stance: The concept that transgender is a medical condition that must be cured is no longer real or relevant. The research suggests best practice is to recognise this non-pathological view.

Discrimination and Stigma: Many transgender people experience stigma and discrimination and are among the most vulnerable members of society. Discrimination can range from subtle to severe, explicit, or covert and can go from verbal abuse right up to physical abuse or even murder. Best practice in counselling and psychotherapy is for therapists to be cognisant of the impact of the societal intolerance and prejudice experienced by transgender clients.

Mental Health: Transgender people are members of an oppressed marginalised community which puts them more are at risk of mental health issues such as anxiety, depression, substance abuse and suicide. The stigma, discrimination, and harassment that transgender people are subject to, can have a significant impact on their mental health and wellbeing. It is important that those working therapeutically with transgender clients are aware of the prevalence of mental health conditions amongst the transgender community.

The therapy experience: Many transgender clients will present for counselling with concerns related to their gender identity or expression, but transgender people also seek therapy for issues other than being transgender; these can include depression, anxiety, problems with alcohol or drugs etc. Another aspect of the therapeutic experience that was highlighted was that very often a transgender person must educate their counsellor about being transgender. This ‘educator role’ can be challenging, frustrating and difficult for the client.

Taking the literature and the interviews into consideration the main findings from the research were twofold. Firstly, the research suggests that therapists have an empathic understanding of what it is to be transgender and secondly that therapists acquire specific information in relation to transgender education to support their work.

The recommendations I elicit from this piece of research are the need for

• Education and training for counsellors and psychotherapists supporting transgender clients.
• More articles to be written in this area to raise awareness of the importance of education information, when working with transgender clients, and to gain a better understanding of ‘being transgender’.
• CPD, and workshops for professionals who work with transgender clients – therapists, the medical community, social workers, teachers, and the local authority.
• Support for the transgender community through podcasts and documentaries.

The overall conclusion I drew from this research is that the core conditions of empathy, congruence, and unconditional positive regard that Rogers outlined, continue to be significant when working therapeutically with transgender clients, and a compassionate understanding of being transgender and the relevant education information unearthed in this research will positively impact and enhance best practice in counselling and psychotherapy.