I thought you knew: The need to raise awareness of transgender affirmative scholarship in medical settings

Despite the fact that transgender rights continue to be negotiated on the national stage, the American Psychological Association and the Society of Counseling Psychology have come down decidedly in favor of improving services and access for transgender people. This advocacy orientation has been taken up by other mental health organizations such as the National Association of Social Workers and the American Counseling Association. The World Professional Association for Transgender Health also offers guidelines for mental health care providers. Within these organizations, scholars have addressed ways that existing therapeutic models may be augmented by transgender affirmative interventions in an effort to improve psychological and physical health services for transgender people. This is important work, given that transgender people face high rates of discrimination and, as a result of minority stress, report elevated levels of depression and anxiety.

Despite the existence of handbooks and guidelines that have been offered to increase quality of care and to supplement training for helping professionals across disciplines, transgender individuals continue to report negative experiences with health care professionals. Given the preponderance of resources, it is puzzling that transgender individuals continue to report these negative experiences with such regularity.

One explanation for this dynamic is that a disconnect of some sort exists between those who produce the guidelines and those who implement them. Scholars have addressed the interaction between psychologists and physicians in primary care settings and a great deal of scholarship was generated on this topic in the mid to late 1990’s. Particularly useful for the present conversation was Pace and colleagues’ (1995) article on psychological consultation. Building on their work, I offer some possible reasons that the flow of information between psychologists and medical providers may break down when it comes to providing quality care for transgender people.

  1. Given that primary care physicians and other generalists are expected to possess a comprehensive knowledge of medical practice, specialized information regarding one small minority group may be deemphasized or overlooked in favor of broader, majority-focused training and practice.
  2. The fact that much of transgender scholarship comes from outside the mainstream medical community may impact receptivity within the medical field.
  3. Health care professionals may be skeptical about or lack confidence in applied psychologies and may be resistant to utilizing resources and guidelines from the mental health field.
  4. Psychologists may be timid or resistant to engaging with other health professionals for fear that they will not be taken seriously or will be disregarded.
  5. Training, values, and theoretical perspectives of psychologists and other health professionals may simply be different and these different orientations may impact responsiveness to and implementation of guidelines.
  6. Medical professionals may lack information about how to consult with psychologists and may be unaware of the fact that psychological science may benefit their practice.

Of course, this is not a comprehensive list. The items offered above are just one approach to understanding the apparent lack of crossover between scholarship and practice when it comes to transgender affirmative care. Whatever the reasons may be, it is troubling to think that we are generating the knowledge necessary to address and alleviate suffering, but that transgender community members continue to report subpar treatment and abuse at the hands of providers. It seems that, in our quest for social justice, it is not enough to conduct meaningful research and then to say, “The knowledge is out there. I thought you knew.” There must be ways to close the gap between research and practice.

Counseling psychology programs and counseling psychologists may be uniquely poised to address some of this disconnect between scholarship and practice. One of the strengths of counseling psychology is the discipline’s coequal emphasis on research, teaching, and clinical work. Some counseling psychology programs include training in interdisciplinary practice within medical settings that prepare students to dialogue with medical providers in constructive ways. As counseling psychologists continue to create inroads into medical settings, it is my hope that we will be guided by our social justice orientation to share our deepening awareness of transgender affirmative care and of the treatment needs of marginalized communities.


Douglas Knutson, Ph.D. (he/him) is an assistant professor in the Department of Psychology at Southern Illinois University at Carbondale. Douglas conducts research in LGBT health and his current focus is on transgender affirmative care.

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