How Social Workers Serve Transgender Clients

According to the Human Rights Campaign, state legislatures will consider more than 300 anti-LGBTQ+ bills this year. That’s twice the already-extraordinary number they proposed in 2021.

Many of these laws specifically target transgender youth. From banning classroom discussions and books on gender identity following the Parental Rights in Education bill in Flodia, denying medical care for gender transitions, prohibiting trans youth from participating in sports, and restricting access to public restrooms, the ongoing discussions and outcomes of these laws weigh heavily on transgender and nonbinary youth. The Alabama Vulnerable Child Compassion and Protection Act makes it a felony for a doctor to prescribe gender-affirming medication or perform gender-transitioning surgery on a minor. In addition, Texas Governor Greg Abbott issued an executive order to criminalize gender-affirming medical care for transgender youth, calling it “child abuse.”

Faced with an onslaught of legislation targeting transgender and nonbinary youth, LGBTQ+ organizations and advocates emphasize the impact on mental health and increased suicidal ideations or attempts. The Trevor Project, a suicide prevention and crisis intervention organization for LGBTQ youth, released its fourth annual National Survey on LGBTQ Youth Mental Health. The survey collected responses from nearly 34,000 LGBTQ+ youth and young adults ages 13 to 24, revealing the following:

• In the past year, 45 percent of LGBTQ youth have considered suicide and 14 percent attempted suicide
• Nearly three-quarters (73 percent) of LGBTQ youth reported anxiety symptoms and more than half (58 percent) reported symptoms of depression
• During COVID-19, 56 percent of LGBTQ youth stated that their mental health was poor either always or most of the time

When considering only responses from transgender and nonbinary youth, key findings include:

• In the past year, 53 percent of transgender and nonbinary youth considered suicide, and 19 percent attempted suicide
• More than three-quarters (78 percent) of transgender and nonbinary youth reported anxiety symptoms, and nearly two-thirds (65 percent) reported symptoms of depression
• Fewer than one in three transgender and nonbinary youth considered their home gender-affirming, (i.e., respectful of gender expression and pronouns)

With this demographic’s mental health and legal protections at stake, how can social workers serve transgender clients?

With much on the line concerning the mental well-being of LGBTQ youth—and specifically in the lives of young people who identify as transgender or nonbinary— access to mental health care is crucial. Social workers and mental health professionals are essential assets in creating safe spaces and environments for trans youth to express their feelings and concerns under the current climate. This article explores how social workers serve transgender clients by discussing:

• The unique needs of the transgender community
• Services social workers provide transgender people
• Advocacy on the micro level and macro level
• How a Master of Social Work can prepare you to help transgender clients

How social workers serve transgender clients

Due to the sensitive nature of social work, the National Association of Social Workers (NASW) established a very detailed Code of Ethics that social work professionals must uphold. Section 1.05 of its ethical commitment to clients emphasizes cultural competence through continued education and understanding of social diversity, including sex, sexual orientation, gender identity, or gender expression.

The LGBTQ+ community is ever-evolving and educating oneself on the acronyms, terminology, and impact of current events is essential to work effectively to understand its needs. The Trevor Project survey revealed that 58 percent of transgender and nonbinary youth wanted mental health care in the past year and were not able to receive it, citing the following fears:

• Fear of discussing mental health concerns
• Fear of not being taken seriously
• Fear of being outed
• Fear of identity not understood
• Fear of mental care not working

Although these survey responses came from those ages 13 to 24, these feelings can carry into adulthood. Social workers can serve transgender clients by creating an LGBTQ+ affirming practice from adolescence to adulthood. This affirming practice includes learning about the community, not generalizing but instead respecting each client’s uniqueness and individuality.

Social workers who employ authentic dialogue, whether through psychotherapy or open, trusting conversations, can help alleviate any shame, make necessary diagnoses for treatment, or assist in managing possible outcomes when coming out to family or friends. For social workers, education and advocacy are ethical obligations.

What are the unique needs of the transgender community?

Transgender (or trans) is an umbrella term for individuals whose gender identity differs from the sex assigned at birth. This terminology includes trans men, trans women, transexuals, gender non-conforming, genderqueer, and other classifications that comprise the broad spectrum of transgender identity. Needing to feel seen, heard, and respected goes hand in hand with the current state of affairs regarding new and proposed legislation stripping away the legal protection of transgender individuals on a public stage. Additional challenges trans people face include:

• Stigma, bullying, and discrimination
• Increased rates of hate crimes, violence, and harassment
• Lack of health insurance coverage
• Inaccurate identity documents

While many surveys report the impact on minors and young adults, older adults are also affected, primarily around health care and medical care discrimination. In the 1950s and 60s, transgender health was considered a mental illness or “disease-based” identity. Although it has now shifted to an “identity-based” model, older adults can still experience discrimination from medical care providers.

Medical professionals and social workers often benefit from continued training in areas of gender identity and expression. The World Professional Association for Transgender Health’s Standards of Care (SOC) guides health professionals in assisting clients with their psychological well-being and overall health. Often, transgender clients seek care for their conflicting feelings around gender identity, gender dysphoria, or gender expectations and rely on therapeutic dialogue to sort through their emotions and self-discovery.

At times, transgender clients also seek clinical care as a prerequisite for medical care. Clinical care typically involves counseling or therapy performed by a psychotherapist, social worker, or psychologist to determine whether a client is eligible for medical care. This responsibility, unfortunately, places the psychotherapist in a “gatekeeper” position, which can discomfit clients aware they are under evaluation for medical treatment. Caregivers must maintain a careful balance, as psychotherapy is an essential step in irreversible gender-confirming procedures.

Services social workers provide transgender people

Social workers can serve in various capacities, including mental health professionals, clinicians, therapists, school social workers, and case managers, providing services or referrals to community resources. Transgender individuals face discrimination that can impact their mental and emotional health. These feelings can lead to lifelong issues, including harmful coping methods, youth homelessness caused by family rejection, substance abuse, hiding one’s identity, anxiety and depression, and suicidal thoughts or attempts.

To combat these issues, social workers must create safe environments and utilize affirmative counseling to move beyond a gatekeeping role. Although not all social workers practice in the clinical field, many social work professionals develop advocacy models embracing the principle that everyone has a right to their gender expression.

Advocacy on the micro level

Micro-level social work directly impacts individuals or families through one-on-one counseling or family therapy sessions. While social services on the micro level include treating substance abuse disorders, finding housing, providing psychotherapy, and addressing the client’s concerns about coming out, advocacy at the micro level can be as simple as asking what pronouns to use when greeting a client. That gesture, in itself, helps the client feel seen. Other ways social work advocates can show support at the micro level include:

• Accompanying your client to name or identification change hearings
• Avoiding microaggressions or misgendering your client
• Staying up-to-date about current events impacting transgender clients
• Having bathrooms designated as “family” or “all gender”
• Using your client’s chosen name instead of birth name

These methods can help transgender clients feel more at ease knowing their social work practitioner is supportive, aware of current events, and educated about the needs of the transgender community.

Advocacy on the macro level

While micro-level social work utilizes a more hands-on approach, macro-level social work seeks to get to the root of societal issues and inequities at the system level. This ties into another core social work value: social justice. Social workers operate at the institutional level by speaking out against injustices and promoting transgender equality. Examples can include:

• Advocating for health insurance to cover trans-specific care
• Joining marches or protests that promote transgender equality
• Developing or collaborating with safe, supportive community resources

Although macro-level social work does not involve direct interaction with clients, “behind-the-scenes” macro activity significantly impacts the transgender community through lobbying, public policy, and strategic planning.

How will a Master of Social Work prepare me to help transgender clients?

Like doctors and lawyers, social workers must accrue continuing education credits to stay licensed. A Master of Social Work (MSW) can help build the skills necessary for a more significant impact in roles at the micro level, such as a licensed clinician, or positions at the macro level, such as an administrator. However, no matter the career path, many MSW programs can equip you with the tools needed to make a difference. Some MSW programs offer hybrid or online options, allowing you to continue working so you can apply your learning in real-time.

The Tulane University School of Social Work offers a full-time program that takes 16 months and a part-time option that takes 32 months to complete. However, if you already have your Bachelor of Social Work (BSW), you can bypass the core classes and enroll in their Advanced Standing program, which takes as little as one-year to complete as a full-time student. The Virginia Commonwealth University School of Social Work provides a similar hybrid or online model, making it flexible for working professionals to learn at their pace.

The transgender community has unique needs that require specialized skills and lifelong learning to stay abreast with the ever-changing legislation negatively affecting the mental health and well-being of those targeted. Social workers must uphold core values, including service, social justice, integrity, and competence, to ensure their effectiveness, whether directly through client interaction or indirectly through system-level advocacy.

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