Providing occupational therapy services to transgender & gender-diverse clients: Power dynamics

Fostering a safe culturally safe environment

As occupational therapy practitioners, it is vital to understand the impact of historical and current social and political contexts on diverse populations. In addition, it is essential to foster an environment that is culturally safe (anti-racist, anti-oppressive, inclusive, and trauma-informed) (Curtis et al., 2019).

Physical, emotional, cultural, and spiritual safety is essential within practice settings and client-practitioner relationships for rapport and trust (Restall & Egan, 2021).

Improving practitioner inclusiveness recommendations

• Use affirmative and inclusive language in all communications
• Do not assume that the client is heterosexual and cisgender. For example when asking about the client’s relationship status ask: “What is your relationship style?” which is inclusive of married, committed relationships, polyamorous, single, etc.
• Asking open-ended questions allows the client room to provide relevant information (Capriotti & Flentje, 2018).

Openly and proactively express your gender and sexual minorities (GSM) affirmative stance

• Express your GSM-affirmative stance to improve rapport and trust in the client-practitioner relationship.
  • This is important because GSM can experience discrimination and mistreatment in health care and may be initially wary about working with a new practitioner (Capriotti & Flentje, 2018).
• Conduct background research (e.g., researching gender-affirming care, potential stress factors, potential resiliency factors, etc.) to assist with fully understanding your client's needs in order to provide the best client-centered care (Capriotti & Flentje, 2018).

Thoroughly discuss confidentiality and privacy policies

• Emphasize the client’s privacy and range of confidentiality during the initial session especially as GSM face societal discrimination and anti-GSM stigma (Capriotti & Flentje, 2018).
• Do not disclose information about the client’s gender identity, sexual, and romantic orientation (Capriotti & Flentje, 2018).
• Allow the client to ask questions about privacy (Capriotti & Flentje, 2018).

Understanding the GSM client's needs

• Understand that GSM clients generally experience more discrimination, stressful life experiences, rejection, and societal ostracism at a higher rate than their counterparts (Capriotti & Flentje, 2018).
• Use the Minority Stress Model (Meyer, 2003) and the Gender Minority Stress Model (Testa et al., 2015) to guide interventions and interactions with GSM individuals
• Realize that individuals who have a lot of support and community connectedness can still experience significant minority stress which can negatively impact their psychosocial functioning (Capriotti & Flentje, 2018).
• Do not assume that someone’s GSM status is linked to all or any of their health issues (e.g., someone may feel depressed due to a new job with increased responsibilities and workload and not due to identifying as transgender) (Capriotti & Flentje, 2018).

Cultural humility

• Cultural humility is an approach for providers that emphasizes perpetual learning and self-evaluation, developing mutually beneficial relationships with communities, and acknowledging the power dynamic between practitioners and clients (Tervalon & Murray-García, 1998).
• Cultural humility emphasizes the power dynamic practitioners hold over their clients through two methods (Agner, 2020).
  • Direct coercion— practitioner controls aspects of the client’s experience such as creating client goals without the client’s input.
  • Ideologic hegemony — practitioner pressures the client to make choices or changes based on what the practitioner deems good or necessary.