For healthcare and mental health professionals, as well as students.

1. Affirming Social Work Practice with
Transgender Individuals: Health and
Mental Health
Leah Cohen, LSW

2. Essential Terms
➔ Gender Identity
➔ Transgender
➔ Gender Nonconforming
➔ Cisgender

3. Language is constantly
evolving. Everyone has
the right to self-identify.

4. How many
transgender
people are there
in the United
States?
1.4 million, 0.6% of population (Flores, Herman, Gates and Brown, 2016)

5. Barriers to
accurate data
➔ Large, national surveys have not
historically included questions that
captured the transgender population
➔ Fear of stigma and discrimination
➔ The way gender identity has been
measured has been limiting and has
not captured the diversity of gender
identities.

6. Guiding Assumptions
➔ Many therapists will see at least one transgender client during their careers.
➔ More therapists will work with family members of transgender individuals than
with transgender individuals themselves.
➔ Most practitioners have limited information about transgender clients and how to
work with them.
➔ A transgender identity is not synonymous with pathology.
➔ Transgender identity is not connected to sexual orientation.
➔ Transgender clients present for counseling services for the same reasons as the
general population.
➔ Gender reassignment surgery is not always of interest to a transgender individual
presenting for clinical services. (Chavez-Korell & Lorah, 2007)

7. ➔ 29% living in poverty compared to 14% US
population.
➔ 15% unemployment compared to 5% in US
population (2015)
➔ 30% of those who had a job in the past year
reported being fired, denied a promotion, or
experiencing some other form of
mistreatment related to their gender identity
or expression
➔ 53% reported verbal harassment in places
of public accommodation (hospitals, mental
health clinics, gov’t agencies); 22% reported
denial of equal treatment
Stigma &
Discrimination

8. 40%
of participants reported attempted suicide compared to 4.6% of the general population
with rates rising depending on experiences of harassment, discrimination, low income,
physical assault, and sexual assault.
(James et al., 2016).

9. TPOC are
disproportionately
affected by violence,
discrimination, poverty,
and health disparities
compared to White
trans people.
Trans people
of color
Artwork of Micah Bazant and
Edxie Betts

10. Barriers to
Health Care
Access
Primary care and transition care
➔ Fear of discrimination and
incompetent care
➔ Lack of competent health care
providers to administer
transgender-competent
preventative or transition-related
services
➔ Financial hardship

11. ➔ One third of the respondents in the USTS (2016) were refused
treatment, verbally harassed, physically or sexually assaulted, or had
to teach a provider about transgender people in order to receive
appropriate care.
➔ Despite the Affordable Care Act, trans people are less likely to have
insurance coverage than cisgender people and even when insured,
many insurance companies have denied coverage for
transition-related care that prevent trans people from accessing
necessary medical care (Cray & Baker, 2012).

12. Health care horror stories
bit.ly/transhealthstories

13. The benefit of
transition care
Studies indicate that competent
transition-related care for those who
desired it was associated with
increased overall mental health, greater
HIV medication adherence, and less
anxiety, depression, suicidality, and
substance abuse.
http://www.transequality.org/blog/hhs-issues-regulations-bannin
g-trans-health-care-discrimination

14. A model of competent
and affirming
healthcare
bit.ly/taffirmdoc

15. Mental Health

16. The importance of trans-affirming mental health care
➔ Transgender and gender nonconforming
individuals experience high rates of overall
psychological distress and high rates of mental
illness.
➔ Several studies have linked the effects of minority
stress to the psychological well-being of
transgender individuals.
➔ LGBTQ individuals utilize mental health services at
a high rate and many experience stigma,
discrimination, and non-affirming care.
➔ Mental health professionals report they often feel
unprepared to work with transgender individuals.
Mental health professionals’
lack of familiarity with gender
identity and gender variance is
deeply concerning given
transgender and gender
nonconforming individuals’
high rates of suicidality and
mental illness.

17. Consistent with the NASW Code of Ethics, it is our professional
mandate as social workers to “understand and appreciate the full
range of differences that exist among human beings and to explore any
and all prejudices that result in oppressive and unjust treatment.
It is incumbent upon the social work profession to embrace and explore
this domain of human variation and help educate the public in a manner
that mitigates stigma and supports the rights of transgender,
transsexual, and gender non-conforming individuals” (National
Association of Social Workers, 2008, p. 345).

18. The basics Do not assume that a transgender person is
seeking mental health services because of their
gender status. Transgender people seek mental
health services for the same reasons as
cisgender clients.
Always respect
clients’ identified
pronouns and chosen
name. If you do make
a mistake, apologize,
and move on.
Language matters!
Do not make assumptions
about anyone’s gender
identity. Use gender neutral
forms of address if unsure.
(Ex. folks, people, all)
Advocate for
changes in
clinic/agency forms
to be more
affirmative of diverse
gender identities.
Maintain confidentiality and do not “out”
someone as transgender without their consent.

19. bit.ly/totransdontsay

20. Trans Voices What transgender participants wanted mental
health and health providers to know.
“ …whatever I’m coming to you for, my
identity is not necessarily what my
problem is. That I could be a healthy,
full-formed person that just might
need someone to talk to, that might be
going through some other issues
unrelated to my identity – and that’s
not a problem….”
“I was thinking it’s kind of the same thing as
with the medical providers. I want the mental
health providers to assume that I know more
about who I am than they do when we meet.,
and to listen, when I feel like I can fill the
gap….and then have the competence to
reflect, again, to reflect language. Like don’t
use the wrong pronoun for me; I will walk.
That’s a baseline of respect. Baseline.
Language. “
“I think the reason [name of institution]
thus far has been the only healthcare
provider where I can feel completely at
ease is just from the first time I went
there and I went to fill out all the forms
that you have to fill out when you go to
a new doctor and I got to the gender
box and I didn’t have to play the eeny
meeny miny mo game. And I was very
excited that there was a gender that
can fill in and they would know what I
was talking about -- and that was
great.”
Responses from a 2008 focus group on
physical and emotional health needs of
transgender individuals in Philadelphia.
Public Health Management Corporation
Research and Evaluation, 2009
http://hivinsite.ucsf.edu/pdf/Health_Needs_of_
TGs_in_Philadelphia_2009.pdf

21. Trans Love
in the Black
Community
Trans people of color
demonstrate incredible
resilience in the face of
multiple minority stress
http://bit.ly/transblacklove