Factors affecting mental health providers' competent care of transgender and gender nonbinary clients

Transgender and gender non-binary (TGNB) people face discrimination because of their gender identity. Well-meaning mental health providers (MHPs) may pose threats to their TGNB clients’ well-being by providing inadequate or harmful treatment. Many MHPs are unprepared to work competently with TGNB clients on a range of topics including gender-affirming medical care and gender-specific identity-based exploration. Exploration remains to be done on specific factors affecting competent care with TGNB clients, such as graduate training, self-reported competent practices, and performance-based affirming practices. Through the proposed investigation, the researcher used clinical scenarios to determine the specific ways MHPs may be prepared or unprepared when working with TGNB clients. The investigator recruited 108 participants through MHP electronic listservs. Participants responded to one of four clinical vignettes and completed three performance-based and self-report measures evaluating competence with TGNB clients and a demographic form. The researcher utilized the software program Linguistic Inquiry and Word Count (LIWC) to quantify themes and tone within participants’ responses to clinical vignettes. The researcher conducted regression analyses, moderation analyses, and ANOVAs to explore relationships between independent variables related to MHP identity and training and outcome variables measuring competence. Results partially supported Hypothesis 1, suggesting that MHPs with marginalized sexual orientations may demonstrate more competent practice with TGNB clients. Hypothesis 2 predicting between-group effects among MHPs based on gender and sexual orientation of a hypothetical client were not supported. Hypothesis 3 revealed mixed findings, indicating that some training variables may be positively related to competent practice. Degree type moderated some of these effects, such that participants with a counseling psychology degree demonstrated a greater difference in effects when evaluating number of post-graduate trainings and competence. Hypotheses exploring psycholinguistic differences between clinical vignettes did not yield significant findings. Finally, post-hoc exploratory analyses yielded noteworthy findings. MHPs with letter-writing policies in place for gender-affirming medical care demonstrated higher levels of clout and prosocial behavior than those without such a policy. The study contributes to existing literature by elucidating identity variables, training variables, and attitudes that may impact competent practice with TGNB settings among licensed providers.