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Abstract
Transgender and non-binary (TGNB) people continue to face marginalization within the mental health field. Such barriers include provider’s insensitivity, internalized cisgenderism, microagressive behaviors (e.g., misgendering TGNB clients), and lack of skills and knowledge to work effectively with the TGNB community. Scholars continue to find mental health providers report a lack of knowledge in their clinical training. This dissertation used a multi-method, multi-phase design to explore the state of TGNB affirmative therapy in mental health graduate education. In the Phase 1, data was collected from students (N =134) and faculty (N = 55) from nationally accredited clinical training programs. Non-parametric tests were used to examine mean score differences in student’s and faculty’s self-reported clinical competency and perceived level of affirmative training of their program. In addition, path analyses were conducted to examine associations between self-reported clinical competency and perceived level of affirmative training. Phase 2 used contextually-situated narrative inquiry to gather in-depth accounts from eight experts in TGNB affirmative therapy of their professional development, experiences in the field, and their recommendations for the future. Using the three interviews, narratives were constructed for each participant. These narratives were then used for a deductive thematic analysis within the pre-established categories: professional development, experiences in the field, and recommendations. Results indicated students and faculty self-reported limited clinical competency and affirmative training in their graduate programs. These findings were substantiated from the eight experts in the field who reported there have been minor changes in the field, but more work needs to be done in terms of providing adequate education to mental health providers. In particular, the effects of cisgenderism on the mental health field needs to be examined and cisgender mental health providers need to engage in their own gender work to be proactive against cisgenderism in their clinical practice. Implications for clinical training are discussed in light of these findings.