Reluctant gatekeepers: ‘Trans-positive’ practitioners and the social construction of sex and gender

Abstract

The following study is based on 35 in-depth, qualitative interviews with licensed marriage and family therapists, counselors, clinical social workers, and professional psychologists who advertise their services as ‘trans-friendly’, ‘trans-supportive’, or ‘trans-positive’. We focus on cases in which practitioners denied clients access to body modifications for reasons related to gender identity in an effort to distill how practitioners' decisions are based on their working understandings of the appropriate relationship between gendered identities and sexed bodies. In the process of determining clients' access to body modifications, practitioners speak of the importance of the level of practice, as opposed to codified texts such as the DSM, in political and ideological constructions of gender and the materialization of sexed bodies. Instead of sharing one primary configuration of these ideological components, the practitioners we interviewed differed in terms of their assumption that gender identity is a product of biological, spiritual, or social processes. We conclude by considering the possibilities for the clinical encounter to subvert dominant gender ideology by authorizing more fluid gender identities and sexed bodies.