Pride vs. Prejudice: Contextualising Psychology’s Guidelines for Practicing with Trans and Gender Nonconforming People

Posted: Jul 14, 2021

Rainbow-Wrapped Amnesia

Every year in June, Toronto gets into the Pride spirit. Suddenly, Rainbows appear everywhere.

From the financial district to the suburbs and throughout the World Wide Web, various shapes, sizes, and palettes of Rainbows hang from balconies and splash across windows—within and beyond the historic “gaybourhood” where lesbian, gay, bisexual, transgender, queer, two-spirit, and otherwise non-straight and gender-non-conforming (LGBTQ2S+) folks have long celebrated their own existence, survival, and resilience. Companies that once openly fired (and still, albeit less openly, mistreat) LGBTQ2S+ employees now sponsor Rainbow-plastered Pride-themed ads and events. Their inclusive messaging appeals to previously untapped markets of consumers and just so happens to sell everything from credit cards to cruises to wedding registries. On my laptop, I click between open tabs: first scanning the American Psychological Association (APA) website, promoting its children’s publication Rainbow: A First Book of Pride (Genhart, 2019), then switching to a video/press release showcasing Toronto Police Services (TPS) Chief James Ramer raising the Progress Pride flag outside Toronto Police Headquarters.

University of Toronto Special Constable vehicles adorned with Pride symbols and slogans

Let’s face it, the Rainbow branding makes for feel-good marketing. And, amidst all the brightly coloured outpourings of support, it can be hard to remember, as the Stonewall reference goes: “The first Pride was a riot.”

It has not been so long since the dual forces of psychiatry and law enforcement worked overtly, in tandem, to pathologise and criminalise LGBTQ2S+ folks. The TPS infamously raided gay bathhouses and otherwise targeted marginalised LGBTQ2S+ people long after homosexuality was ostensibly decriminalised in 1969. Nonetheless, they marched in the Toronto Pride Parade for years—alongside others for whom their uniformed presence recalled this violence—until they were banned in 2017 following a 2016 Black Lives Matters (BLM) protest (CBC, 2021). Yet, only after Justice Epstein’s 2021 “Missing and Missed” report highlighted the TPS’s deeply-rooted systemic bias and discrimination did TPS Chief Ramer admit that “some mistakes” were made and commit to “change things for the better” (Masterman, 2021). Meanwhile, psychologists and psychiatrists—who also use(d) their professional authority to violently police gender and sexual “deviance”—are only just starting to publicly acknowledge the harm caused by their so-called treatments, even as they participate enthusiastically in Pride celebrations.

These tensions raise critical questions: When institutions position themselves as LGBTQ2S+ champions and saviours, how relevant are their past and ongoing infractions against the queer and trans folks they now fête with Rainbows? At what point does touting tolerance and acceptance—without at the same time acknowledging complicity in legacies of oppression—amount less to progress than hypocritical revisionism?

Going for Woke: Psychology Makes Efforts, If Not Amends

In his recent history of LGBT Psychology, Peter Hegarty (2017) describes how a gay psychiatrist dubbed “Dr. Anonymous” spoke on a 1972 “Lifestyles of Non-Patient Homosexuals” panel on behalf of closeted psychiatrists, wearing a literal hood, via a voice-disguising microphone. This account encapsulates the “strikingly visible… incompatibility between speaking about homosexuality from experience and speaking with psychiatric authority” at a time when homosexuality was a DSM diagnosis (2017, p. 7). In the next printing of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-II) in 1974, homosexuality, strictly speaking, ceased to be a formal diagnosis due to extensive efforts by gay and lesbian activists.[1] Subsequent amendments to human rights legislation have further protected individuals from discrimination based on sexual orientation (e.g., see Government of Canada, 2020), albeit less so for gender identity. Although these shifts have eased the way for many former Dr. Anonymouses to “come out,” Lesbian, Gay, Bisexual, and (especially) Transgender and otherwise gender non-conforming (together, TGNC) populations remain underserved, marginalised, and frequently unrecognised within mainstream Psychology, Psychiatry, and related platforms and institutions (e.g., see Hegarty, 2017; Tosh, 2015).

While attitudes about and understandings of sex and gender evolved substantially within and outside academia after I completed my undergraduate degree almost two decades ago, the texts and teachings presented in my Clinical Psychology courses did not reflect these changes. This discrepancy hit home recently when, after I had completed my interdisciplinary PhD coursework, my doctoral supervisor introduced me to the American Psychological Association’s 2015 “Guidelines for Psychological Practice With Transgender and Gender Nonconforming People.” I was surprised: not because the Guidelines were outdated or disconnected from TGNC perspectives, as I’d feared they would be; but because they weren’t. In taking a succession of graduate Clinical Psychology courses between 2016 and 2018, I had seen no evidence that these Guidelines had made their way into the training curriculum. The issue wasn’t that anybody did or said anything particularly homophobic or transphobic in the classroom; it was the surrounding silence.

For example, in one Assessment class assignment, we graduate students were given a generic intake form to have our participants fill in before we guided them through an intelligence test. This demographics form provided only two sex/gender options: male and female. I foresaw that such a forced choice might elevate pre-test anxiety beyond the low risk levels anticipated in the Research Ethics Board form for—and otherwise alienate—intersex and non-binary or trans-identified participants. Therefore, I improvised a quick intervention: verbally noting the binary item and offering my own participant the opportunity to fill in an “other” option if relevant—as had become normalised elsewhere, from the Canadian census through passport applications through medical intake forms. When my participant said she had no problem checking off “female,” we moved right along. To me, it seemed like the entire gender/sex box conversation, which took less than a minute in total, went quite smoothly.

However, when I received my mark breakdown later on, I saw my TA had noted that the gender binary issue “should not have been mentioned in front of the participant.” Rather than praise my on-the-fly queer-and-trans-competent modification, she deducted marks for my failure to “maintain a professional relationship throughout the entire assessment” because I had intervened as described above (while, at the same time, commending me for establishing rapport well and generally doing a “good job asking background questions”). Despite receiving an A on the assignment overall, I felt confused and disappointed—not so much because my attempt to gender-binary-bust was construed as unprofessional, but for the broader implications of this fact. To what degree might such a punitively-toned response discourage and disempower other Psychology students (and future clinicians) from making such interventions down the road?

It seemed a bit surreal to read the 2015 APA Guidelines after this incident took place. The first Guideline aspirationally states that: “Psychologists understand that gender is a nonbinary construct that allows for a range of gender identities and that a person’s gender identity may not align with sex assigned at birth” (p. 832). The sixth Guideline goes on to acknowledge the degree to which society’s adherence to the gender binary, and the emotional distress some TGNC people feel when being forced into it, are known to “adversely affect TGNC people within their families, schools, health care, legal systems, workplaces, religious traditions, and communities.” Suggesting that “[p]sychologists strive to recognize the influence of institutional barriers on the lives of TGNC people and to assist in developing TGNC-affirmative environments” (p. 840), it specifically outlines that:

Because many TGNC people experience antitrans prejudice or discrimination, psychologists are encouraged to ensure that their work settings are welcoming and respectful of TGNC people, and to be mindful of what TGNC people may perceive as unwelcoming. To do so, psychologists may educate themselves about the many ways that cisgender privilege and antitrans prejudice may be expressed… [and] consider making changes to paperwork, forms, or outreach materials to ensure that these materials are more inclusive of TGNC people…

It goes on to explicitly mention that demographic information collection “can communicate respect through the use of inclusive language and the inclusion of a range of gender identities” (APA, 2015, p. 840).

It’s possible that my TA’s response was a one-off fluke. Surely, rather than chastising my intervention, another grader might have praised my foresight in accounting, in advance, for the possibility of my random participant being TGNC-identified. It’s also possible that, as time elapses, Psychology/psychologists will have more chances to be influenced by the Guidelines and related materials and perspectives; that things will naturally change within Psychology in the TGNC-supportive direction the Guidelines envision.

APA website framing Psychology's LGBT history in a positive, Pride-ful light

Yet, it’s precisely this framing of Psychology—as conceding, from its newly “woke” position, to having “historically” been (but, implicitly, no longer really being) responsible for queer- and TGNC-exclusionary practices—that sits uneasily with me. For example, the “Research, Education, and Training” section of the Guidelines describes how:

Historically, in a set of demographic questions, psychological research has included one item on either sex or gender, with two response options—male and female. This approach wastes an opportunity to increase knowledge about TGNC people for whom neither option may fit their identity, and runs the risk of alienating TGNC research participants. (APA, 2015, p. 851)

Based on my own experiences, the above-cited paragraph reflects a contemporary status quo in at least some Psychology training milieus, not a long-past artefact. After all, the salient example I outlined above occurred more than a year after the Guidelines were published. Further, it was precisely within Psychology that I found myself, as an interdisciplinary visitor, risking punishment for my choice not to perpetuate non-TGNC-inclusive defaults.

The narratives of “diversity and inclusion” espoused by individuals and organisations who engage in discriminatory practices they fail to notice, let alone acknowledge, can be difficult to reconcile. If those authentically doing their best to engender safer spaces equally owned their past and present shortcomings, marginalised parties might be more inclined to give those in positions of power the benefit of the doubt in situations where their say:do ratio seems lower than ideal. Such admissions would also validate those who feel dissonance around claims, for example, that spaces where they still experience exclusion and barriers are already universally safe and welcoming.

[1] Albeit replaced in the new DSM-II printing by the residual “sexual orientation disturbance” (1974) that in future DSMs morphed into such classifications as the DSM-III’s “Ego-dystonic homosexuality” (1980) and the DSM-III-R’s (1987) “sexual disorder not otherwise specified” (which could entail “persistent and marked distress about one's sexual orientation.”)

Lessons and Legacies

I’m a strong proponent of individuals taking initiative to “be the change,” as the saying goes. I’m also aware, as are many psychologists, of how difficult it can be to act differently than expected in social situations, especially when hierarchies are involved. Yet, the Guidelines seem to take for granted that supervising psychologists as well as those in training, for whom such power dynamics are a daily reality, are on board with their TGNC-positive principles and aims. This optimism ignores both the prevalence and extremity of salient exceptions.

Tosh (2016) observes that “those who think they do not teach the topic [of gender] are in fact doing so” via spaces and texts in which “unquestioned assumptions about gender” abound (p. 11) and that “dominant and domineering perspectives within psychology regarding gender have been found to be cisgenderist and pathologizing” (p. 21). Tosh (2016) illustrates how this “hidden curriculum” (per Gofton & Regehr, 2006) of hegemonic gender and sexuality norm reinforcement influences teaching in psychology in “subtle but pervasive ways” that create an atmosphere wherein, for example, the widespread “delivery of pathological accounts of transgender people and the exclusion of their experience from mainstream theories and research” (p. 17) become normalised rather than problematized.

More alarmingly, Ansara and Hegarty found that “[m]ental health professionals are more cisgenderist than other authors” and that the language and concepts used by psychology’s predominant “‘invisible college’ structured around the most prolific author in this area are more cisgenderist and impactful than other[s]” (2012, p. 1). The latter’s chosen approaches, involving “behavioural modification techniques and aversive conditioning to ‘fix’ genders that do not match children and adolescents’ external gender assignments” (p. 3), “contrast starkly with the vision of nondiscriminatory leadership espoused by APA policy” (2012, pp. 11-12). Ultimately fired from his influential clinical day job in the wake of accusations that his ideology “caused profound harm to sex and gender minorities,” the most impactful author Ansara and Hegarty cite still consults widely on TGNC matters—to the chagrin of those who signed petitions and otherwise advocated for a change of guard. And he is not the only successful Toronto-based psychologist to leverage his academic and professional Psychology authority to widely promote non-gender-affirmative approaches—not only training and supervising aspiring psychologists, but influencing countless others as well.

However, the APA’s Guidelines neither acknowledge Psychology’s legacy of perpetuating a status quo that engenders, rather than combats, anti-trans sentiments nor any of the more overt violations committed against TGNC populations in the name of Psychology. In painting psychologists, at worst, as benignly reinforcing harmful norms—rather than as agents actively creating and upholding them—the Guidelines risk contributing to “modern prejudicial thinking that equality has been achieved” (Hegarty, p. 90), when the actual situation is quite different.

Certainly, as the Guidelines themselves point out, those pursuing psychological careers, whether focused in research, teaching, or clinical practice, are seldom adequately prepared by existing curricula to meet the minimal requirement of APA-accredited programs to “demonstrate a commitment to cultural and individual diversity” as pertains to gender identity (2015, p. 851). After all, a 2009 APA Task Force found that “[o]nly 52% percent of psychologists and graduate [student]” survey respondents “reported having had the opportunity to learn about TGNC issues in school” and only 27% of these “reported feeling adequately familiar with gender concerns” (APA, 2015). And, despite increasing opportunities for psychologists and trainees to develop competency around sexual and gender minority issues, both may over-estimate the degree to which their training has equipped them to engage sensitively with particular sub-populations. For example, they may “mistakenly believe that they have obtained adequate knowledge and awareness about TGNC people through training focused on LGB populations” (APA, 2015, p. 852).

I hope that future iterations of the Guidelines invite psychologists to accept collective responsibility for Psychology’s impact on society’s understandings of gender, including their ongoing pathologising, rather than welcoming, of those who don’t conform to the gender binary. Further, it might be helpful for psychologists to consider the degree to which those “whose gender identity does not match either their physical body, or cultural ‘norms’ of gender—who “have been the focus of much psychiatric and psychological theorizing, diagnoses, and treatment” (Tosh, 2015, p. 13)—may or may not benefit from having their experiences so-scrutinised under “psy” lenses. Critiques aside, however, in the absence of more community-accountable alternatives, the current Guidelines may help those wishing to become more specifically informed on TGNC issues in Psychology. And certainly, their wholehearted adoption, if seen as a starting point towards ongoing competency-building, would radically alter how the field of Psychology relates to relevant populations.

Improptu Pride gathering at the 519 Community Centre

After an intensive months-long lockdown, Toronto patios opened again this June. While most corporate-sponsored Pride events were cancelled or went online, smaller outdoor gatherings emerged spontaneously in city parks and streets. Instead of a Beer Garden, the 519 Community Centre hosted an LGBTQ2S+-focused vaccination clinic on Saturday, June 26, 2021, the day before the official Pride parade would have happened in a Covid-19-free multiverse. The queue, spanning several city blocks, convened a sober audience for the renegade grassroots Dyke March. Notably absent were crowd-managing uniformed officers and the usual gawkers (i.e., drunk Rainbow flag-waving tourists and loudspeaker evangelists preaching fire and brimstone to homosexual sinners doomed to Hell). The atmosphere was palpably low-key, the vibes more chill reunion than frantic glee. It made me wonder if we’ll ever see the day when society-wide queer- and trans-inclusivity feels like that: a broadly-felt given, neither superficial nor performative; something to be celebrated in its normalcy, like a cold drink with friends on a warm summer day.


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Tosh, J. (2016). The problem with ‘normal’: Teaching and learning about gender and trans psychology. In P. Karian (Ed.), Critical & Experiential: Dimensions in Gender and Sexual Diversity (pp. 10-24). Resonance Publications Ltd.

Author Bio

Cara Goldberg is a PhD candidate in the Gender, Feminist, and Women’s Studies department at York University. Her interdisciplinary research explores intimacy and accessibility (writ large) through critical mental health/madness, sexuality, and disability studies lenses. She has been involved with the Psychology’s Feminist Voices project since 2017.