Date of Award


Document Type


Degree Name


Organizational Unit

Graduate School of Social Work

First Advisor

Susan S. Manning, Ph.D.

Second Advisor

Arlene I. Lev

Third Advisor

Jean East


Clinical relationship, Transgender, Transsexual


This phenomenological study was designed to gain insight into male-to-female transsexual clients' experience of clinical relationships. Transsexual clients who enter into a clinical relationship have an experience that is unique due to their transsexual status in society. Their circumstances warrant attention in research due to the following factors: 1) the nature of being transsexual 2) the gate-keeping requirements necessary for transition 3) their experience in society as a vulnerable and oppressed population, and, 4) the importance of understanding the transsexual individuals' experience of clinical relationships from the perspective of transsexual clients themselves. Twelve transsexual women were interviewed using semi-structured format utilizing open-ended questions regarding their experiences. Participants ranged in age from 30 to 64, and their year's post-SRS/GRS ranged from 20 months to 33 years. The data was analyzed using Moustakas' modified version of the Van Kaam method of analysis. The findings were grouped into four core themes: What the client brings to the clinical relationship, what the therapist brings to the clinical relationship, the experience of the clinical relationship, and the outcome of the clinical relationship. The essence of the experience is stated as fear driven self-preservation. It was found that participants feared rejection and expressed self-preservation initially by suppressing their transgender identity. After experiencing a crisis and/or catalyst, the participants changed their self-preservation focus to gender role transition, at any cost. The combination of this self-preservation for transition, and fear of clinicians' power in the gate-keeping process provided challenges for therapeutic alliance and trust in the clinical relationship. Participants expressed a change of attitude towards therapy, therapists, and the standards of care post-transition. Implications for social work research, theory, practice, education and policy are discussed.

Publication Statement

Copyright is held by the author. User is responsible for all copyright compliance.

Rights Holder

Karen M. Scarpella


Received from ProQuest

File Format




File Size

230 p.


Social work