Dialectics, power dynamics, and undercurrents of meaning: using psychotherapeutic strategies in primary care with trans and gender-diverse clients
Elizabeth Waldron A * , Lucy Solonsch B and Louise Stone CA College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA 5042, Australia.
B College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042, Australia.
C Social Foundations of Medicine, ANU School of Medicine and Psychology, Australian National University, Canberra, ACT 2600, Australia.
Australian Journal of Primary Health 29(2) 142-147 https://doi.org/10.1071/PY22156
Submitted: 23 July 2022 Accepted: 1 December 2022 Published: 23 December 2022
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Trans and gender-diverse individuals experience poor mental health, and face significant barriers when trying to access appropriate mental health care. Most seek treatment from mainstream primary care services, who have an ethical duty to provide care to all. Primary care practitioners can ameliorate traumatic harms by identifying helpful strategies and avoiding inappropriate or harmful strategies. However, there is limited robust, culturally sensitive evidence informing clinicians about the appropriateness and efficacy of psychological interventions for trans and gender-diverse clients. This forum article argues that the epistemological and ontological frameworks underlying psychotherapies can impact the therapeutic relationship, and are therefore important factors to consider in primary care practice with trans and gender-diverse clients. Our paper synthesises selected psychotherapies into four clusters. Each cluster is accompanied by discussion of the potential or demonstrated benefits and limitations of the underlying framework, in the context of primary care with trans and gender-diverse clients. We also explore power dynamics in therapeutic relationships with trans and gender-diverse clients, and the challenges these factors pose to developing a shared understanding of the client’s needs and preferences. The article concludes with some practical considerations for managing these issues in primary care.
Keywords: access, barriers to care, healthcare disparities, health services: needs and demands, mental health, minority health, primary care, quality of health care, transgender.
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