Effects of Therapists Affirming and Non-affirming Reactions to Transgender Identity Exploration on The Therapeutic Relationship: An Analogue Study

Transgender individuals seek mental health counseling for a variety of reasons (Bockting, Knudson, & Goldberg, 2006). However, their experiences in therapy are not always positive, and some experiences are quite negative (Rachlin, 2002). The present study utilizes an analogue research design and video vignettes to investigate how a therapist’s response to transgender identity exploration affects participants' perceptions of the therapist and the therapeutic relationship. The study utilized a series of mock therapy video vignettes that vary the way that a therapist responds to the client including transition affirming, non-binary affirming, and non-affirming responses. Transgender participants were asked about their plan to transition or not transition and were then randomly assigned to watch one of three mock therapy clips. Participants then completed a series of questions about their perception of the therapist’s expertness, likability, trustworthiness, the session smoothness and depth, and their own feelings of positivity, and arousal. Results indicate that the non-affirming video condition had a significant negative effect on the participant’s perceptions of the therapist and the quality of the therapeutic relationship. No significant differences were found between the transition affirming and non-binary affirming conditions. However, there was a trend for those who were not interested in transitioning to rate the non-binary affirming video more positively than the transition affirming video and those who were interested in transitioning to rate the non-binary affirming video slightly less positively than the transition affirming video. This study provides a more nuanced understanding of the ways in which transgender individuals experience various affirming and non-affirming therapeutic approaches and how these perceptions may be different based on the participants plan to transition or not transition