experience gender dysphoria (i.e., a feeling of distress when a person’s sex as assigned at birth does not align with their gender identity; How Discrimination Impacts LGBTQ Healthcare, 2021). Experiences of violence and victimization are frequent for LGBTQ individuals. The category of LGBTQ includes transgender individuals. Transgender is an umbrella term that describes people whose gender identity or expression does not match the sex they were assigned at birth. For example, a transgender person may identify as a woman despite having been born with male genitalia. They have long-lasting effects. According to the National Center for Transgender Equality, over 25% of transgender people have been victims of transphobic assault, and the percentage is even higher for trans women of color (How Discrimination Impacts LGBTQ Healthcare, 2021). Physician discrimination against the transgender population may be a combination of a deficit of knowledge and tolerance. Nevertheless, tolerance, bias, and competence continue to be present. If patients do not trust their providers, it is unlikely that they will return to see them in the future for medical care. Transgender patients are significantly more likely to be refused care than cisgender patients (Kattari et al., 2020). For this reason, interested patients must be connected to affirming providers who can adequately meet their needs; professional case managers can meet this demand. Underlying the discrimination faced by transgender patients in the healthcare setting is a fundamental lack of provider competency in transgender care. The failure to understand the transgender patient experience may not only contribute to healthcare practices perceived as discriminatory by patients. However, it may even perpetuate discrimination, as providers lacking adequate training in transgender healthcare issues may be more likely to perceive being transgender as deviant. Increasing provider education on the psychosocial aspects of being transgender and on healthcare screening, diagnoses, and treatments unique to this population may reduce the barriers faced by transgender patients in receiving quality care (Institute for Health Policy Leadership, n.d.). Few insurance programs cover transition treatments, and transgender people are less likely to have health insurance than heterosexual people (How Discrimination Impacts LGBTQ Healthcare, 2021). The complexity of individual diversity is inclusive not just of racial and ethnic identity but also of variables such as socioeconomic class, dis/ability, and LGBTQ status. While these facets of diversity are not exhaustive, they represent some essential diversity categories. Counselors must consider the unique array of diverse identities represented by each individual encountered in each counseling relationship. The complexity embodied within each client affects how the client understands and views the counselor and the counseling relationship, just as the complexity of the counselor’s diversity dimensions affects how the counselor understands and views each client. It is impossible to provide information that allows counselors to gain knowledge about categories of people and how they behave or view the world because not only is the Intersectionality Intersectionality is a concept that describes how these various dimensions come together to privilege or oppress individuals and groups. Intersectionality is defined as “multiple, intersecting identities and ascribed social positions (e.g., race, gender, sexual identity, class) along with associated power dynamics, as people are at the
variation within individual ethnicities and races endless, but the variation within each individual also is endless. Instead, clinicians should aim to understand the societal landscape that privileges and oppresses individuals. The experiences of oppression experienced by various diverse groups will likely provide them with a unique perspective on the larger
society and the counseling relationship. Transgender Isolation and Violence Transgender and gender-expansive youth face
heartbreaking levels of familial rejection, often from an early age. For many parents, their transgender or nonbinary child may be the first transgender or nonbinary person they have ever met (Dismantling an Epidemic of Violence, n.d.). Regrettably, fear of the unknown and stigma against transgender and nonbinary people lead many to reject or deny their children for who they are. This rejection can devastate individuals and isolate them from physical and emotional resources essential to their well-being. Most transgender people prefer to be identified with the pronoun that corresponds to the gender with which they identify. A transgender woman should be called “she” or “her” if that is what she prefers. Some transgender people do not believe in binary gender appellations and prefer “they” or a nongendered pronoun. Deadnaming refers to a transgender or nonbinary person by their birth, given, or former name without consent. Deadnaming can be harmful and can contribute to mental health conditions and violence. Many transgender people continue to face familial rejection and isolation, including being kicked out of their homes or physically harmed by family members (Dismantling an Epidemic of Violence, n.d.). In one of its most severe forms, grieving family members will misgender or erase the identities of victims of violence against transgender and nonbinary people after their deaths. When family members reject, deny, or disown transgender individuals, it can devastate their well-being and self-worth. It can also impact educational, economic, and housing stability and have long-term effects on mental health. Familial rejection of transgender and nonbinary people can be even more challenging for those who hold racial, ethnic, linguistic, religious, immigrant, and other cultural identities that appear to conflict with LGBTQ+ identities (Dismantling an Epidemic of Violence, n.d.). Evidence-Based Practice: Transgender individuals experience a dramatically higher prevalence of intimate partner violence (IPV) victimization compared with cisgender individuals, regardless of sex assigned at birth. IPV prevalence estimates are comparably high for assigned-male-sex-at-birth and assigned-female- sex-at-birth transgender individuals, and for binary and nonbinary transgender individuals. Note : From “Intimate partner violence in transgender populations: Systematic review and meta-analysis of prevalence and correlates,” by Peitzmeier, S. M., Malik, M., Kattari, S. K., Marrow, E., Stephenson, R., Agénor, M., & Reisner, S. L. (2020). American Journal of Public Health, 110(9), e1–e14. same time members of many different social groups and have unique experiences with privilege and disadvantage because of those intersections” (Rosenthal, 2016, p. 475). Kimberlé Crenshaw coined the term “intersectionality” over 25 years ago as a way to help explain the oppression of Black women. Today, the term “intersectionality” continues
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