Date of Award

Fall 2023

Document Type


Degree Name

Doctor of Philosophy (PhD)


Counselor Education and Counseling Psychology

First Advisor

Alan Burkard


The consensus approach for psychotherapy with transgender and nonbinary clients (TNB) has come to be known as trans-affirmative psychotherapy (TAP). TAP is influenced by a collection of guidelines and models (American Counseling Association [ACA], 2010; APA, 2015; Chang et al., 2017; Singh & dickey, 2017) and a small number of empirical studies related to psychotherapy with transgender clients (e.g., Elder, 2016; McCullough et al., 2017, Mizock & Lundquist, 2016, Morris et al., 2020). However, the limited empirical research and guidelines provide minimal direction to clinicians working in-session with TNB clients. This study sought to investigate the perceptions of exemplar clinicians’ in providing TAP with TNB clients and to inform future clinical work with this population. Psychotherapy research has previously examined the practices of expert or master therapists (e.g., Jennings & Skolvholt, 1999; Sullivan et al., 2005) and solicited their perspectives to better understand how they work with clients. Understanding the practice of highly skilled therapists can clarify what makes for exceptional practices and so was modeled for this study. A qualitative approach was taken to understand the rich perspectives and experiences of exemplar clinicians working with TNB clients. A sample of 12 clinicians, as nominated by experts in the TAP field, participated in a single, 60-minute semistructured virtual interview. Participants described motivations and training experiences for working with TNB clients, approaches to providing TAP, how TAP has impacted the participants, and advice for future TAP clinicians. Alongside the overlaps with existing research there were unique findings related to self-disclosure, termination, and training of clinicians. Recommendations for future research are centered on process-based research and research that can better understand the therapy dyad. Limitations and implications of the research are discussed. The study concludes with an exploration of future research directions to address gaps in the literature on TAP.