Following is my personal perspective , informed by working at clinics providing gender-affirming care .
Despite the statements and intentions of many treatment programs to provide genderaffirming care to transgender ( TG ) and / or gender-nonconforming ( GNC ) clients , such programs may struggle to actually show affirming treatment . Agencies may have no formal written policies , supervisors may not have experience , counselors may struggle with countertransference , and the agency may struggle to create effective community change . At any treatment center providing care to TG / GNC clients , I strongly recommend that those creating policies , supervisors , and all staff providing care fully read the WPATH Standards of Care , Version 8 , to familiarize themselves with the process of treatment for TG / GNC clients and also to identify the role of the mental health clinician in the treatment of the client .
The Agency Perspective
Those running community-based agencies may have their own areas of expertise and passions for serving marginalized populations . The needs of the clients being served , coupled with trends in client experiences , demand clinical focus and an official agency response . Many agencies are still responding to the post-COVID era while also attempting to support communities ravaged by the opiate crisis . While these needs are important , all agencies are encouraged to have formal , written policies indicating a commitment to the treatment of TG / GNC clients . To introduce such language , the agency policy must identify the systemic instances of racism , sexism , homophobia , and invalidation that many TG / GNC individuals have experienced in all forms of health treatment and recognize that these negative experiences have created barriers to these populations seeking care .
Furthermore , the policy should state the expectations of all staff to treat all TG / GNC clients from a perspective of validation , cultural humility , and a commitment of equity as they meet each client where they are at in their journey . Additional recommended policies include addressing instances of microaggression and overt aggression from all staff and other clients , and creating clear policies to address restroom concerns and agency operations , such as documentation . Providing flyers for agencies that affirm LGBTQIA + people shows a commitment to working with these populations .
Member Reflections
Trans-Affirming Care , From an Agency POV — Policy , Supervision , Treatment
Fredrick Dombrowski , PhD , LMHC , CASAC-M , LPC , LADC , NCC , CCMHC , MAC , ACS , BC-TMH , HS- BCP , ICADC , DCMHS , specializes in transgender clinical mental health counseling and has offered specialized training on mental health treatment of transgender clients . An AMHCA past president , he has directed several clinics for services for LGBTQIA + populations and has worked with adults and children living with co-occurring disorders . He has also been director of operations for the Westchester Medical Center and Whiting Maximum Security Forensic Hospital in addition to having been a full-time associate professor .
Supervision
The supervisor must show affirmation of the client ’ s identity and experience with culturally informed , person-centered care . The supervisory relationship must be based on respect and trust , allowing the Licensed Clinical Mental Health Counselor ( LCMHC ) to be honest about their own experiences . LCMHCs with limited experience may lack the in-depth education and training to work with TG / GNC clients , causing sessions to be impacted by aspects of countertransference . Using a supervisory framework based on respect and cultural humility , the supervisor works with the LCMHC to assess their own internal experiences , biases , and expectations so that they can provide equitable and affirming care . To enhance the skills of the LCMHC , supervisors work to address supervisee blind spots . This process must connect with the LCMHC ’ s own desire to provide effective clinical treatment to all clients . It is not enough to tell the supervisee what to do ; the supervisor must model and show the supervisee how to support TG / GNC clients .
Treatment
More on Gender-Affirming Care See the special section in this issue on pages 8 – 23 .
Mental health treatment of TG / GNC clients respects the full dignity of clients , along with their independence , strengths , values , and goals . LCMHCs don ’ t focus only on gender identity ; they also conceptualize it in the broader picture and the client experience . Regardless of the LCMHC ’ s own beliefs about working with TG / GNC clients , the LCMHC must allow opportunities for client self-exploration and create a treatment plan based on the client ’ s goals . It is unethical for the LCMHC to encourage or discourage any steps towards transition . The client is their own guide and voice . I recommend that all LCMHCs working with TG / GNC clients receive ongoing continuing education to enhance clinical skills .
The Full Commitment
Providing effective care to TG / GNC clients requires a full agency commitment that is visible and supported in all aspects of the agency . This full commitment is reflected in agency policies that show an understanding of historical factors that have impacted these populations , and in supervisors who have knowledge about how to treat TG / GNC clients and who then support their staff in doing so .
2 The Advocate Magazine 2023 , Issue # 3 American Mental Health Counselors Association ( AMHCA ) www . amhca . org