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A Conceptual Framework for Clinical Work With Transgender and Gender
Nonconforming Clients: An Adaptation of the Minority Stress Model
Michael L. Hendricks
Washington Psychological Center, P.C., Washington, D.C. Rylan J. Testa
Palo Alto University
In the last few years, transgender and gender nonconforming people have become more visible in our
society, which has sparked a marked increase in awareness, interest, and attention among psychologists.
Questions have emerged about the extent to which psychologists are able to work competently with this
population. This article presents a framework for understanding key clinical issues that psychologists
who work with transgender and gender nonconforming individuals will likely encounter in their clinical
work. This article does not address the knowledge and skills required to provide services related to gender
transition, but rather to provide other psychological services that these clients may need, in light of the
high levels of gender-related victimization and discrimination to which they are exposed. An adaptation
of the Minority Stress Model (Meyer, 2003) is presented and translated to incorporate the unique
experiences encountered by transgender and gender nonconforming individuals. In particular, we
examine adverse experiences that are closely related to gender identity and expression, resulting
expectations for future victimization or rejection, and internalized transphobia. The impact of Minority
Stress Model factors on suicide attempts is presented as a detailed example. Mechanisms by which
transgender and gender nonconforming persons develop resilience to the negative psychological effects
of these adverse experiences are also discussed. Recommendations for clinicians are then made to assist
psychologists in developing competence in working with this population.
Keywords: transgender, minority stress, suicide attempt, violence, resilience
In the last several years, the popular media have paid increasing
amounts of attention to people who present as transgender or gender
nonconforming, effectively raising the public profile of gender iden-
tity and gender nonconformity, at least in western societies. This
increased attention coincides with greater willingness of trans people
to publicly divulge their identity, and sometimes even share details of
their experience in public domains.
1
In turn, the increased attention
and visibility have resulted in a greater awareness of gender identity
issues, both by those who are trans and by society as a whole.
Concomitantly, mental health practitioners have been called
upon with greater frequency to render evaluation and treatment
services to people who make known that their gender identity does
not conform to the sex they were assigned at birth. Such requests
raise questions about whether psychologists are prepared and
competent to deliver these psychological services. This article
presents a framework within which psychologists may conceptu-
alize the unique stressors often faced by trans clients and how
those experiences are related to both vulnerability and resilience in
the mental health of trans people. Furthermore, we offer that these
experiences may also affect access to and engagement in mental
health services. Clinical implications of these issues will be dis-
cussed, aiming to inform provision of competent services for trans
clients.
In both anticipation of, and response to, this increased request
for psychological services, the American Psychological Associa-
tion (APA) has undertaken efforts both to help psychologists and
other professionals to improve their understanding of gender iden-
tity and gender expression and to ascertain what psychologists
need in order to competently provide services. The APA Task
Force on Gender Identity and Gender Variance (2008) published
its report, which included recommendations for education and
training. Subsequent to this report, the APA Council of Represen-
tatives passed its Resolution on Transgender, Gender Identity, and
Gender Expression Non-Discrimination (Anton, 2009), solidifying
the APA’s commitment to supporting the educational and training
needs of psychologists to work with this population (p. 443):
1
In this article, we use “trans” to refer to the range of persons who
identify or present as transsexual, transgender, or gender nonconforming.
This term was proposed by Lev (2004) and has met with broader accep-
tance than many other terms that have been previously proposed or used.
This article was published Online First August 13, 2012.
MICHAEL L. HENDRICKS received his PhD in Clinical Psychology from The
American University. He maintains a clinical and forensic practice as a
partner at the Washington Psychological Center, P.C., in Washington, D.C.
His areas of professional interest include suicidology, LGBT issues, and
forensic evaluation.
RYLAN J. TESTA received his PhD in Clinical Psychology from Temple
University. He is Post-Doctoral Fellow at the Center for LGBTQ Evidence-
Based Applied Research (CLEAR). He also serves as Program Manager of
the Gender Identity Program, within The Gronowski Center’s Sexual and
Gender Identities Clinic. His research and clinical work focuses on self-
destructive behaviors, including suicidal behavior, substance abuse, eating
disorders, and health risk-taking, in underserved populations.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Michael L.
Hendricks, Washington Psychological Center, P.C., 5225 Wisconsin Avenue,
NW, Suite 513, Washington, DC 20015. E-mail: mhendricksphd@gmail.com
Professional Psychology: Research and Practice © 2012 American Psychological Association
2012, Vol. 43, No. 5, 460– 467 0735-7028/12/$12.00 DOI: 10.1037/a0029597
460
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