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Chapter Ii: Review of Literature

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Chapter Ii: Review of Literature AVOIDING UNHELPFUL RESPONSES: A PROPOSED THEORETICAL MEASURE OF READINESS TO WORK WITH TRANSGENDER CLIENTS A Dissertation Presented to the Faculty of Antioch University Seattle Seattle, WA In Partial Fulfillment Of the Requirements of the Degree Doctor of Psychology By A. Ianto West November 2018 AVOIDING UNHELPFUL RESPONSES: A PROPOSED THEORETICAL MEASURE OF READINESS TO WORK WITH TRANSGENDER CLIENTS This dissertation, by A. Ianto West, has been approved by the committee members signed below who recommend that it be accepted by the faculty of the Antioch University Seattle at Seattle, WA in partial fulfillment of requirements for the degree of DOCTOR OF PSYCHOLOGY Dissertation Committee: _____________________________ Dana Waters, Psy.D., ABPP Chairperson _____________________________ Christopher Heffner, Ph.D., Psy.D. _____________________________ Jessye Cohen-Filipic, Ph.D. November 13, 2018______________ Date ii © Copyright by A. Ianto West, 2018 All Rights Reserved iii ABSTRACT AVOIDING UNHELPFUL STATEMENTS: A PROPOSED THEORETICAL MEASURE OF READINESS TO WORK WITH TRANSGENDER CLIENTS A. Ianto West Antioch University Seattle Seattle, WA When transgender people most need help, many face hostility and inadequate care from their health providers, including psychologists. This hostility is not surprising given widespread lack of familiarity with transgender issues or perspectives amongst clinicians. Even amongst those who hold the stance of openness to the other, most still have considerable difficulty working with transgender clients. Transgender training efforts vary in quality; some even appear to worsen attitudes towards transgender clients. Given these risks, it is crucial that clinical training directors and supervisors evaluate trainees’ abilities to facilitate respectful initial conversations with transgender clients. This project proposed an objective instrument for assessing a mental health clinician, or clinical trainee’s ability to discriminate between helpful and unhelpful responses commonly made in the initial clinical encounters with transgender clients. Development of the instrument is grounded in a combination of theoretical and empirical literature on the topic and is synthesized with the personal and professional experiences of the primary researcher as a transgender person and emerging clinician. This study utilized systematic expert review to examine the validity of this proposed instrument. This dissertation is available in open access at AURA, http://aura.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/etd Keywords: transgender, clinical training, multicultural competency, test development iv Dedication This dissertation is dedicated to all who desire to work with transgender clients in a beneficial and non-injurious way, and to the teachers making this possible. This dissertation is also dedicated to those brave enough to speak up on transgender issues—especially when doing so is uncomfortable. Special thanks to the scholars in my life for teaching me how to undertake this work, and to the rebels in my life for showing me why it is worth it. Thanks also to all who are brave enough to show up for accountability moments with grace. v Acknowledgments Thanks to Dr. Dana Waters for many hours carefully reading this project. The timeliness of your feedback made it possible for me to maintain momentum throughout the course of this project. Without it, I would have been ABD for certain. Thanks to my committee members. Dr. Christopher Heffner, you have listened to me talk about this project in several classes. You always seemed to ask the right questions to help me clarify my thinking. Dr. Jessye Cohen-Filipic, your presentation at APA came at just the right time. That workshop helped stretch my thinking on supervision to a new level. My analysis took another leap forward soon after. Thanks to my family for supporting me in this process. Special thanks to my love Carissa West for giving me many, many cups of coffee and being very patient on the many weekends and evenings I worked on this project. Thanks to my grandfather for giving me a chemistry lecture instead of being a normal babysitter when I was 8. This was one of many family interactions that helped launch my interest and capacity for science. Thanks also to the found family who listened to me talk my way out of my head and back onto paper. On the first class of the first year of this program, Dr. Jude Berkgamp addressed the “ghosts in the room”—the people not currently present who have brought us to where we are. Special thanks to the ghosts. vi Table of Contents Table of Contents ABSTRACT ................................................................................................................................... iv Dedication ........................................................................................................................................v Acknowledgments.......................................................................................................................... vi List of Tables ................................................................................................................................. ix List of Figures ..................................................................................................................................x CHAPTER I: INTRODUCTION .....................................................................................................1 Overview ...................................................................................................................................3 Terminology .............................................................................................................................3 Purpose of the Study ...............................................................................................................10 CHAPTER II: REVIEW OF LITERATURE ................................................................................11 Importance of Transgender-Specific Skills ............................................................................13 Social and Historical Context of Transgender Healthcare .....................................................25 Defining Unhelpful Responses ...............................................................................................37 Rupture Recoveries .................................................................................................................65 Approaches to Skill Measurement ..........................................................................................90 Test Development ...................................................................................................................93 The Current Study ...................................................................................................................93 CHAPTER III: METHODS ...........................................................................................................95 Overall Test Development, Steps and Progression .................................................................95 Pilot Project ............................................................................................................................96 The Current Study .................................................................................................................100 vii CHAPTER IV: RESULTS ...........................................................................................................108 Participation Characteristics .................................................................................................108 Quality and Completeness of Feedback ...............................................................................111 Quality of Open-Ended Expert Feedback .............................................................................116 Identified Items to Revise .....................................................................................................119 Tentative Revision and Second Review ...............................................................................123 Results Summary ..................................................................................................................127 CHAPTER V: DISCUSSION ......................................................................................................128 Quality of Feedback ..............................................................................................................128 Assessment of the Current Study ..........................................................................................133 Future Directions ..................................................................................................................140 References ....................................................................................................................................145 Appendix A: Recruitment Flyer...................................................................................................168 Appendix B: Informed Consent ...................................................................................................170 Appendix C: Phone Interview for Selecting Subject Matter Experts ..........................................172 Appendix D: Proposed Items to be Reviewed by Subject Matter Experts ..................................174 Appendix E: Summary of Flagged Items.....................................................................................206
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