Negative experiences in healthcare settings have been linked to decreased treatment satisfaction and reduction of future help-seeking behaviors among transgender individuals. The present study used gender-identity based microaggressions as a model for understanding the client–therapist relationship. Using a qualitative approach, we investigated instances of microaggressions from mental health providers as experienced by 91 adults who identified as transgender or gender diverse. Participants completed an online survey and described instances of microaggressions directed towards them from mental health providers. Thematic analysis resulted in four therapy-salient themes: Lack of Respect for Client Identity, Lack of Competency, Saliency of Identity, and Gatekeeping. Our discussion of the results focuses on the examination of microaggressions as ethical guideline violations. We discuss methods to improve the practical application of ethical standards to counseling with transgender clients. Implications for practice, training, and future research are also discussed.

中文翻译：

---

“更值得关注的问题”：跨性别微侵犯作为治疗中的道德违规行为

医疗保健环境中的负面经历与跨性别个体的治疗满意度下降和未来寻求帮助行为的减少有关。本研究使用基于性别认同的微攻击作为理解来访者-治疗师关系的模型。我们使用定性方法调查了 91 名被认定为跨性别或性别多样化的成年人所经历的心理健康提供者的微攻击实例。参与者完成了一项在线调查，并描述了心理健康提供者针对他们的微攻击实例。主题分析产生了四个突出的治疗主题：缺乏对客户身份的尊重、缺乏能力、身份的显着性和把关。我们对结果的讨论侧重于将微侵犯作为违反道德准则的检查。我们讨论了改进道德标准在跨性别客户咨询中的实际应用的方法。还讨论了对实践、培训和未来研究的影响。