Exploring clinicians' views about their roles when working with young people presenting with gender identity issues: a qualitative enquiry

Objectives: There has been a sharp increase of referrals to NHS child and adolescent mental services (CAMHS) in the UK for young people presenting with gender dysphoria. Little has been documented about how a range of clinicians understand their role when working with this clinical population. This study aimed to make an enquiry into how child and adolescent psychotherapists, clinical psychologists and family therapists understand their role when working with transgender and gender non-conforming (TGNC) young people. Method :I carried out semi-structured interviews with eight clinicians (three child and adolescent psychotherapists, three clinical psychologists, two family therapists) working routinely with TGNC young people. I transcribed the interviews verbatim and analysed them using Thematic Analysis. Results:Thorough analysis of the clinicians’ interview material produced the following five key themes: finding meaning; contextualising; containment; self-reflection; and practical support. Conclusions: All clinicians highlighted the importance of thinking, exploring, seeking meaning and deeper understanding in the face of the complex presentations of TGNC young people in their care. Key to this involved clinicians’ capacity to be able to contain anxieties within the young person, parents/carers and the wider professional networks. Child psychotherapists felt that close observation and monitoring of ones’ own response to clinical work with TGNC young people was key to their role. This was considered imperative to being able to manage personal prejudice/bias in a field of work that can provoke strong opinions, but also using it as a potential communication that might further our understanding of a TGNC young person’s state of mind. Confusion about role was an important finding that demonstrates that, for many clinicians, they still feel that they have a lot to learn about the most helpful ways in which they can support young people questioning their gender identity. This study highlights the pressing need for continued dialogue amongst professionals and academics in order for us to remain open and curious about the unique situation of each TGNC young person who comes into our care. Key words Gender dysphoria; role; clinicians; qualitative research