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A Phenomenological Study of Occupational Participation for People Who Identify as Transgender

2020; Volume: 3; Issue: 3 Linguagem: Inglês

10.3928/24761222-20200309-04

2476-1230

Vivienne Daly, Sinéad M. Hynes,

Sex work and related issues

Original Research freeA Phenomenological Study of Occupational Participation for People Who Identify as Transgender Vivienne Daly, BSc (Hons), ; and , BSc (Hons) Sinéad M. Hynes, PhD, BSc (Hons), , PhD, BSc (Hons) Vivienne Daly, BSc (Hons) and Sinéad M. Hynes, PhD, BSc (Hons) Annals of International Occupational Therapy, 2020;3(3):127–135Published Online:March 13, 2020https://doi.org/10.3928/24761222-20200309-04PDFAbstract ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinkedInRedditEmail SectionsMoreAbstractIntroduction:The challenges that transgender people face, which are caused by a multitude of factors, have been well documented. However, changes in occupational participation are less well known. This research explored changes in the occupational participation of transgender people.Methods:The study used a phenomenological research design. Data were collected through semi-structured interviews with five participants. Data were analyzed with an interpretative phenomenological approach.Results:Three themes were identified: work, self-presentation, and role change. Positive reports of transitioning were described as well as ongoing challenges in occupational participation. Various effects on work and life roles were reported. The study did not include either an emic perspective or member checking, limiting the usefulness of the findings.Conclusion:The findings showed that gender transitions can affect occupational participation both positively and negatively. A gender transition has the potential to foster a renewed sense of meaning and enjoyment in the everyday lives of people who identify as transgender. For clinicians, it is important to support people who are transgender and those undergoing a gender transition to maximize their occupational participation. [Annals of International Occupational Therapy. 2020;3(3):127–135.]IntroductionThere is a growing awareness among occupational therapists that identifying as transgender may affect participation in occupations (Beagan et al., 2012), in particular productive occupations, such as employment and education (Doan, 2010; McGuire, Doty, Catalpa, & Ola, 2016). In addition, identifying as transgender can negatively affect relationships with partners, family members, and peers (Beagan et al., 2012). After the disclosure of transgender identity, relationships with families, friends, and romantic partners are often strained, and in some instances, relationships may end (Dispenza, Watson, Chung, & Brack, 2012).Unique physical and psychological effects on health have been documented for the transgender community. Older transgender and gender nonconforming adults have significantly higher levels of depressive symptoms compared with older cisgender sexual minority adults (Fredriksen-Goldsen et al., 2014). This population of older adults has specific worries about future care, including use of the preferred name, recognition of gender identity, access to visitation, recognition of a culture of respect, and access to appropriate bathroom facilities. Discrimination and identity concealment also put this older adult group at increased risk for social isolation and loneliness (Fredriksen-Goldsen et al., 2014), factors that have been linked to poorer physical and mental health (Cornwell & Waite, 2009) and increased mortality rates (Steptoe, Shankar, Demakakos, & Wardle, 2013). Negative effects are not unique to older individuals. Within universities, students have reported adverse peer interactions, such as derogatory speech and physical attacks, that can negatively affect academic performance and can lead to social isolation (Pryor, 2015).The effects of multiple sources of stigma also can create barriers to routine health care. Shires and Jaffee (2015) surveyed 1,711 transgender people in the United States and found that more than 40% experienced discrimination, verbal abuse, physical assault, or denial of treatment when accessing health care because of their transgender identity. Likewise, Lindroth (2016) gathered data from 20 transgender people and found that they reported discrimination and disrespect when accessing health care, with estrangement from services occurring in some cases.Work-related opportunities and challenges include experiences of transitioning in the workplace, discrimination in the recruitment process, and disclosure of trans-gender identity at work. Brewster, Velez, Mennicke, and Tebbe (2014) conducted a large-scale qualitative study of the experiences of 139 transgender people with gender transitioning in the workplace. Participants found that gender-neutral uniforms facilitated negotiating the workplace during a gender transition. In addition, participants found that facilities that are divided into gender binaries, such as toilets and locker rooms, can foster conflict with co-workers and negatively affect work. Much research has been dedicated to the challenges that are specific to toilet and locker room facilities. The locker room has been found to be an intimidating environment for people who are transgender (Hargie, Mitchell, & Somerville, 2017), and discussions with management about which toilets and changing facilities employees are permitted to use can be very uncomfortable (Ozturk & Tatli, 2016).Discrimination in recruitment processes also has been reported, and transgender people sometimes choose jobs because the employer appeared supportive rather than based on competency, job aspirations, or experience (Ozturk & Tatli, 2016). Some people choose not to disclose a gender transition in the workplace because they fear losing their jobs or not being considered for promotions (Brewster et al., 2014; Budge, Tebbe, & Howard, 2010). Evidence also suggests that people who are transgender are willing to work harder and may accept less money in an attempt to gain acceptance in the workplace (Budge et al., 2010).The occupational experiences of people who are trans-gender are not well understood, and occupational therapists need to understand these experiences. This study explored occupational participation for people who identify as transgender and who have transitioned or are in the process of transition. It is important to note that the term "transition" that is used here is highly variable, and it is not something that all transgender people want or pursue. Transition can mean different things to different people. Examples include using a different name and/or pronouns, changing gender identification, using hormones or hormone suppressants, and/or undergoing surgical interventions. A person who identifies as trans-gender may undertake any or all of these steps or none of them. The participants in this study decided themselves whether they had transitioned or were still in that process; this determination was not made by criteria set by the researchers.This study attempted to answer the following questions: 1.What changes occur in the occupational participation of transgender people after or during transition?2.What is the influence of gender transition on daily life and roles?MethodsDesignThe study used a qualitative phenomenological design as the researcher (V.D.) gathered a detailed narrative of the lived experiences of the participants (Giorgi, 2012; Green & Thorogood, 2004) and the reasons for these experiences (Sutton & Austin, 2015). An interpretative phenomenological analysis (IPA) approach was chosen because it can facilitate an understanding of how individuals experience and attribute meaning to their engagement in everyday occupations (Clarke, 2009a; Smith & Osborn, 2008). An IPA approach encourages researchers to simultaneously document their own interpretation of the meaning of the phenomena for the individual (Pietkiewicz & Smith, 2014). An IPA approach is also appropriate when analyzing data from small populations (Smith & Osborn, 2008; Sutton & Austin, 2015). Ethical approval for the study was granted by the National University of Ireland, Galway, College of Medicine Nursing and Health Sciences Research Ethics Committee.ParticipantsPurposive sampling was used to select participants based on common qualities that are pertinent to the research (Etikan, Musa, & Alkassim, 2016). Participants were eligible for inclusion in the study if they (1) had experienced gender transition, irrespective of what that meant to the person, and (2) were older than 18 years at the time of recruitment. Administrators of transgender support groups and poster advertisements across the National University of Ireland, Galway facilitated recruitment. Prospective participants contacted the researcher if they were interested in participating. All participants provided written informed consent.Data CollectionData were collected through face-to-face semi-structured interviews (Figure A, available in the online version of the article)—an appropriate data collection method for use with socially marginalized groups (Hartey & Muhit, 2003; Mullen & Moane, 2013). Face-to-face interviews are suitable for exploring sensitive topics that participants may not want wish to discuss within a group environment (Gill, Stewart, Treasure, & Chadwick, 2008). An open-ended topic guide was used. Topics were chosen based on previous research in the area and guided by the research question. Although the questions acted as a guide, the open-ended format enabled flexibility in participants' responses. In accordance with the IPA approach, the researcher perceived the interviewees to be experts regarding their experiences (Geer, 1988). The topic guide was pilot tested with two cisgender participants (participants whose gender identity and gender expression are aligned with the sex assigned at birth). This may have caused normative bias and is a flaw in the design of the study but was done because of difficulty in recruiting participants from the target population. Pilot testing led to rephrasing of some of the questions to foster a broader discussion of certain topics.Figure A Interview GuideDuring the interview process, the researcher led continuous co-construction of the meaning of the data. Co-construction of data is considered essential in ensuring rigor in data collection, particularly in IPA studies (Guillemin & Gillam, 2004; Lietz, Langer, & Furman, 2006). A number of questions were used to ensure co-construction of experience, for example, "Am I correct in saying that [experience] has [the interviewer's interpreted meaning of the experience] for you?" The researcher also kept a reflective journal to record and reflect on observations and responses to the interviews (Clarke, 2009b). The journal was used during the entire research process as a method of exploring and analyzing actions and thoughts. The positionality of the researcher within the study was a key part of the reflective process. The research process was completed through critical reflection on positionality by responding to set questions, such as "How do my personal identity, views, perspectives, and experience fit within the context of my research?"Data AnalysisDuring data analysis, the researcher attempted to formulate an interpretive account of the individuals' unique experiences. After data collection, the researcher performed verbatim transcription of audio recordings of interviews. Pseudonyms were used during the transcription, analysis, and presentation of results and during the discussion.The researcher first immersed herself in the data by reading transcripts several times, as recommended in the literature (Pietkiewicz & Smith, 2014). This process is a key step in the analysis of qualitative data (Bird, 2005), and it enables the researcher to gain an overall understanding of the narrative accounts.The researcher then assigned codes and wrote interpretive summaries within the margins of each individual narrative (Braun & Clarke, 2006). In accordance with an IPA approach, the researcher did not impose a predetermined theory regarding the results (Smith & Eatough, 2006; Smith & Osborn, 2008). This approach introduced outcomes that the researcher had not considered previously. Smith, Flowers, and Larkin (2009) emphasized the need for researchers who use an IPA approach to analyze each interview individually.Once the codes were established, the researcher interpreted them to establish themes and corresponding sub-themes where necessary. The relevance of these themes and subthemes was consistently checked against the transcripts to ensure that they appropriately summarized the narratives within the data (Boyatzis, 1998; Braun & Clarke, 2006). The researcher adapted an etic position (Reid, Flowers, & Larkin, 2005; Smith & Osborn, 2008), which meant using verbatim quotes to make sense of the data and solidify interpretation of the narrative account (Clarke, 2009a).RigorA number of strategies were used to increase the rigor of the research process (Mays & Pope, 1995). The researcher used a reflective journal from the outset of the research process to identify and acknowledge her own views (Smith et al., 2009). The reflective journal provided a marker of development of the opinions and the decision-making processes to allow for auditability.Reflection and discussion of the data analysis is noted to increase rigor in qualitative studies (Pringle, Drummond, McLafferty, & Hendry, 2011), and the researcher engaged in this process with the co-author (S.M.H.). Moreover, rigor is enhanced through external auditing to ensure that the data analysis is credible (Pringle et al., 2011; Smith et al., 2009). The researcher provided the second author with sections of coded transcriptions from the data collection, and the second author ensured that the codes, themes, and subthemes reflected the narrative accounts gathered from the interviews.ResultsFive people were recruited for the study. Of these, three people identified as trans masculine and two as trans feminine. Four participants described themselves as having transitioned, and one participant reported still being in the process of transition. Table 1 shows the demographic characteristics of the participants.Table 1 Demographic Features of the ParticipantsCharacteristicParticipantEricMarianMikePaulRoseGender identityTrans masculineTrans feminineTrans masculineTrans masculineTrans feminineAge, years5866624447OccupationNot disclosed to maintain anonymityRetired—health service workerCurrently on sick leave—job not disclosed to maintain anonymityCurrently unemployed—previously employed in skilled office workCurrently employed in the railway industryTime elapsed since beginning gender transition, years20+61876Table A (available in the online version of the article) shows the themes, subthemes, and coding excerpts. Three themes were identified from the data: 1.Work2.Self-presentation3.Role changeTable A: Themes and Sub-themesThemesSubthemesCodeTranscript SegmentWorkParticipants' career choices as influenced by a gender transitionCareer choices"In an attempt to be as male as possible, I was a [lists three typically masculine jobs-not included to protect identity]". [Marian]"Every single aspect of life…even what job you apply for". [Eric]The impact of a gender transition on work performanceWork performance"When I go back…I'll just be another guy in the office." [Paul]"I think being trans made it better for me to do it, because you can see both sides of the coin". [Mike]"I worked as a lot of things. Looking back over my C.V., it tends to be every year I've changed jobs. I was always really hiding before which is why I moved jobs as well". [Paul]Consequences of disclosing or not disclosing transgender identity at workDisclosing Transgender identity"I've never told anyone in my work that I was anything other than what I am…"[Mike]"Mentally and physically I am totally fit for work, as I'm coming out the other end of the transition. It's just during the transition that its exceptionally difficult". [Paul]"I couldn't have friends…because if you started getting close to anybody, they might start asking questions". [Marian]"The guy who did the training himself he was making fun of trans people…you know, which I thought was really offensive. And I couldn't say anything". [Mike]Self-presentationUsing makeup and maintaining physical presentationValue of makeup"Nobody has ever seen me without my makeup." [Marian]"I feel duty bound to wear makeup…without it, I feel as though my femininity is almost stripped away." [Rose]Hair styling"I just looked like a woman with a short haircut." [Paul]Physical presentation"You can't just dress like a man. You will just look like a female wearing a man's suit". [Eric]"I've seen myself not going out on a night because I'm just too tired to go through the process of getting ready." [Rose]Dressing as impacted by a gender transitionDressing"When I'm off work. I like to feel feminine and I express that by wearing a skirt." [Rose]"Every single part of your life is coloured by that thing. From the clothes you wear, or could never wear." [Eric]Role changeRoles"I thought I was performing the surrogate father role in our family, protecting everybody, but now...I realise now that I was the mother hen, protecting her flock". [Marian]"I feel more confident, I feel more of the person, more certain of myself and my identity". [Rose]"You don't fit in anywhere…yeah you can go play snooker in the previous life, but not with your mates. It's just not the same". [Eric]Theme 1: WorkAll participants found that their gender transitions affected them at work. Participants described both negative and positive experiences. Discussions included the type of work that they chose to engage in, their performance at work, and the effect of disclosing or not disclosing their transgender identity.Some participants reported that their transgender identity affected their career choice. During the pretransition stage, some participants stated that they chose to work in particular fields in an effort to conform to the gender assigned to them at birth. Marian described how, before transitioning, she chose to engage in many leadership roles and was very competitive to maintain an image of masculinity."I always felt that, as a male, I always had to be competing against other men. . . ." [Marian]This was not the case for Mike, who stated that before transitioning, when he was presenting as female, he always pursued jobs that were typically male."I was pretty good at doing manual things, girly stuff was never for me . . . and before, I was a textile worker, and it was a manly job, you know. . . ." [Mike]Rose, who has always worked in what she describes as a masculine environment, never felt the need to change her career because of her transition."I'm still doing the same job. . . . It doesn't feel dramatically different in that respect." [Rose]Marian, who is currently retired, believed that her gender identity affected her ability to maximize her career potential. She was reluctant to get too close to co-workers or employers and thought that this was the reason why she did not achieve more at work."Even though I was quite successful, I never really achieved what I thought I was truly capable of." [Marian]Before transition, some participants put a lot of time and effort into their work, using it as a distraction from the stress they were feeling related to their gender identity."You fill up your life to divert you from the big thing . . . I was a workaholic . . . I kept my head down and worked. But on reflection . . . I didn't want to admit what the issue was." [Eric]Some participants found that disclosing or discussing their transgender identity at work was a challenge, largely because of the fear of adverse reactions from co-workers."Because . . . the males are very . . . bitchy. And I felt that if I was to come out as 'in transition,' I would've been isolated. . . . You're not going to last 5 minutes in that job." [Mike]Paul spoke about changing jobs frequently so that he did not have to deal with questions or comments from work colleagues."I was always really hiding before, which is why I moved jobs as well." [Paul]Rose was also guarded at work with regard to her colleagues. She did not try to make friends at work because she wanted to keep her work life separate from her life outside of work."I'd be a bit careful about what I'd say at my job. There have been issues. I've almost compartmentalized my life so much that I'm like two different people. There's the [Rose] of the workplace and the [Rose] who's off duty." [Rose]Some participants reported that during the transition period they found it difficult to look for work, and as a result, they were unemployed during this time."You can't go for a job interview, if you're in the middle of transition. . . . And transgender people are usually quite high achievers. . . . We are very high achievers who go from whatever to nothing." [Eric]Paul explained that he is currently unemployed because until he has completed all of the necessary surgeries to physically transition, he expects that having to explain to employers why he needs time off for recovery and dealing with the curiosity of co-workers would be too challenging."It would've been very difficult to work throughout this. . . . Mentally and physically, I am totally fit for work, as I'm coming out the other end of the transition. It's just during the transition that it's exceptionally difficult." [Paul]Theme 2: Self-PresentationAll participants noted that they modified their self-care routines after transition to ensure that their physical presentation corresponded with their gender identity in an effort to avoid being misgendered. Clothing and makeup were the main issues that participants mentioned.Most participants experienced considerable changes in their self-care routines. The two trans feminine participants incorporated the use of makeup into their self-care routines. Both noted that their everyday activities would be affected if they did not wear makeup, and they felt the need to incorporate makeup into their everyday routines before setting out to do anything else."Even if it's only to go and empty my bin or take something to the communal laundry or whatever, nobody has ever seen me without my makeup." [Marian]Rose discussed the importance of not being misgendered."I don't want anyone to mistake my gender. . . . I suppose I'm always being judged, and I think that transgender women are always being judged." [Rose]Rose stated that she felt "higher on the social sphere" if others did not mistake her gender. Rose and Marian identified financial and time commitments that went hand in hand with their new self-care routines."It gets quite tedious. . . . It causes me quite a lot of frustration, as a lot of time and effort has to go in to making me look like a passable female. At the very least, you're talking about 2 hours of head-to-toe body hair removal, makeup, clothing. . . ." [Rose]Most of the participants stated that they dressed differently after their transition. For Paul, dressing as what he would consider a typical male was imperative because it affirms his male identity to other people. It is important to him to maintain this appearance so that people do not call him by his previous female name."Once I started looking more the part, I started going to my local shop again. . . . If you see somebody who's now dressing how they feel . . . they're less likely to call me by the old name." [Paul]For most participants, this change toward dressing in a particular way was an important part of their transition, and dressing and style have become valued aspects of their daily routines."I never cared about clothes before, and all of a sudden I want to look smart when I go outside." [Paul]Knowing how to dress after initiating a transition was a challenge for some participants, as discussed by Rose."Color coordination, how to put on a pair of tights, what goes with what. You make mistakes, you face public ridicule, you know, in presenting properly." [Rose]Mike felt that he always presented in a masculine way growing up, with his current style of dress not changing very much compared with his style before he began his transition."I was always manly anyway, so for me it didn't make any difference. . . . I always wore something that wouldn't be showing anything." [Mike]Some participants found the type of clothing they were required to wear before transitioning uncomfortable. Mike, who was required to wear a skirt to school, detested going to school as a result."I hated school because you had to wear a skirt. I detested [wearing] a skirt." [Mike]Theme 3: Role ChangeGaining new life roles was a concept that most participants discussed during interviews, predominantly citing it as a positive aspect of a transition. The extent to which they gained new roles differed. Participants reported feeling responsible for taking on the role of advocate for other transgender people. They stated that they enjoyed and valued this role, which brought with it responsibilities."Taking a friend for a coffee . . . having a chat with someone who's having difficulties, helping someone who's having difficulties with a member of their family. . . ." [Eric]Paul reported going to training sessions and conferences and trying to make a difference to the people around him. He stated that he is "feeding back into the world in a way I didn't do before."This increased sense of enjoyment in activities was associated with an increased sense of confidence and authenticity in daily life, which participants attributed to their gender transitions."I've developed a strength and a confidence that I never had before. It extends into everything." [Paul]For Marian, although she supports and advocates for other transgender people, it is not her only role. It is important to her to be recognized as an individual and as more than a transgender woman."That's not my exclusive activism. . . . I try to be representative and engage myself in society as much as possible. I don't want or need to be recognized as a trans person.I am a woman. I am a woman of many, many different aspects." [Marian]Participants stated that they have not lost roles, noting instead that the roles that they have been enacting throughout their lives have been reconceptualized under different titles. Rose and Marian spoke about their roles within their families. Rose noted that she "should've been a son, a father," but instead is a daughter and a mother. To her, the roles felt the same; it was just the title that was different. She said, "My core sense of being is the same."For Marian, this was also the case. Nothing changed much within her role in the family, only her title. She stated, "I thought I was performing the surrogate father role in our family, protecting everybody, but . . . I realize now that I was the mother hen, protecting her flock."The detailed positive experiences associated with role change and transitioning, as recorded in the reflective journal, were surprising for the researcher. Experiences of occupational marginalization were noted, but not to the same extent as noted in the literature.DiscussionThis study described the effect of gender transitions on participation and engagement in the everyday activities and occupations of participants. Opportunities and challenges were discussed, particularly regarding participants' satisfaction in occupations since initiating a gender transition.Notably, work was affected in a variety of ways. Some participants noted that their career choices were influenced by their gender transitions, such as feeling obligated to choose specific jobs that they saw as matching with the gender assigned at birth. This finding resonated with previous research (Beagan et al., 2012; Panter, 2017) that showed that initial motivation to work in a certain field was often to conform with the gender assigned at birth. Nevertheless, the experiences of other participants in the current study contradicted these findings. Some participants worked in the same industries before and after transition. The support of management and the type of work involved appear to be important factors.Participants had differing opinions on whether disclosing their transgender identities in the workplace had an effect on their work. Some participants decided not to disclose or discuss their transgender identities at work to avoid creating uncomfortable or hostile situations with co-workers. People who begin gender transitions while remaining in their current role often face instances of transphobia (Mizock et al., 2017; Sangganjanavanich, 2009; Schilt & Connell, 2007). Other participants in the current study disclosed their trans-gender identities and did not experience instances of transphobia at work. The reasons for the different experiences are not clear, but factors may include different industry norms and cultures (Ozturk & Tatli, 2016), and some participants may benefit from a supportive workplace.Participants reported becoming completely preoccupied with their work when they were having challenges with their gender identity, with one participant choosing the label of "workaholic." Previous research found that gender transitions can lead individuals to increase their work performance (Budge et al., 2010; Mizock et al., 2017). Participants in these studies noted that they coped with challenges in the workplace by working harder and maintaining a strong work ethic, feeling pressure to validate their roles as workers. Evidence also suggested that some participants avoided work or disengaged from work during their transition. Because people who are trans-gender have an increased risk of loneliness compared with cisgender sexual minority adults (Fredriksen-Goldsen et al., 2014), support for those who are not engaging at work is especially important during this period.Research also has emphasized the importance that transgender people place