Date of Award

5-31-2022

Document Type

Campus Access Thesis

Degree Name

Master of Arts (MA)

Department

Clinical Psychology

First Advisor

David Pantalone

Second Advisor

Panayota Gounari

Third Advisor

Alice Carter

Abstract

Contemporary debates about access to gender-affirming care for transgender and gender diverse (TGD) individuals include whether this care can be provided on an informed consent basis or whether access should require mental health assessment (Bockting, 2009; Cavanaugh et al., 2016). Current standards of care which recommend mental health assessment are largely based upon the expert consensus of gender identity researchers and clinicians (Coleman et al., 2012; Levine, 2009). In this study, I aimed to explicate the historical and cultural context that informed this expert consensus, and to connect this historical context to current debates on access to care. Aim 1, a synthesis of the historical context regarding gender-affirming care, used Foucauldian Genealogy and Inductive Thematic Coding to analyze archival data on the criteria for access to care. Six themes emerged from the analysis. The first grouping of three themes (Cure vs. Medical Rehabilitation, Prevention of Transsexualism vs. Societal Acceptance, and Assimilation vs. Ambiguity) outline first the attempt to “cure” gender diverse identities, then the attempt to “prevent” these identities in youth, and finally the normative “assimilation” criteria used by clinicians and researchers to restrict access to gender-affirming care. The second grouping of three themes (Protecting Patients vs. Self-Determination, Reality vs. Fantasy, and Objectivity vs. Empathy) outline trans community perspectives on the criteria for access to care, the shift in access to care with the probationary “real-life test,” and the impact of trans community challenges and provider humility on changes in criteria. Aim 2 synthesized the current (2012-2021) academic literature on access to gender-affirming care using Qualitative Metasynthesis and Critical Discourse Analysis. Two major themes, the Assessment Model vs. the Informed Consent Model (ICM), emerged from the analysis. The criteria for access to gender-affirming care showed both continuity and discontinuity over time. Broadly, Assessment Model authors prioritized the prevention of post-transition regret, while ICM authors prioritized patient autonomy. To rectify historical and ongoing harm as expressed by TGD individuals, providers can center practices that support patient autonomy and center cultural humility.

Comments

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