Towards a transpositive therapeutic model : developing clinical sensitivity and cultural competence in the effective support of transsexual and transgendered clients

R. Raj

Traditionally, the research, assessment and treatment of 'gender dysphoria' (GD) and 'gender variance' (GV) has tended to pathologize transvestites/crossdressers, transsexuals and transgendered people, including 'transqueers'. This article will cite examples of clinical 'transphobia' to underscore the need to revolutionize our way of doing therapy with transpeople. To optimize the recent trend towards a more respectful, collaborative relationship between GD/GV clients and the mental health community, we must ensure that our clinical orientation is truly responsive to the changing real-life needs of a highly-diversified trans population, including the rights to self-determination and comprehensive health care. To help meet this goal, this paper will develop a generic transpositive therapeutic model, building from existing trans-affirmative approaches.A series of nine major guidelines to build the theoretical framework for a transpositive model of psychotherapy is proposed, with specific recommendations around: 1) clinical orientation/treatment philosophy, 2) assessment considerations, 3) treatment considerations (including psychotherapy, diversified subpopulations and marginalized subpopulations), 4) the therapeutic relationship, 5) comprehensive case management, 6) accountability/quality assurance, 7) advocacy/alliance building, 8) knowledge base/professional development, and 9) research.