“Only the person can tell us who they are and we believe them”: Irish clinical and counselling psychologists’ perspectives on gender identity development and mental health in transgender and non-binary (TGNB) people

Background: Clinical and counseling psychologists have contributed to societal discourse regarding gender identity development and mental health in ways that have both validated and pathologized gender diversity. While transgender and non-binary people may seek the support of a mental health professional for many reasons, a readiness assessment is required to access gender-affirming care in Ireland; thus, clinical psychologists occasionally play a gatekeeping role in treatment access. Method: We conducted an online qualitative survey with trainee and practicing clinical and counseling psychologists in the Republic of Ireland (N = 36). Participants shared views on gender identity, its links to mental health, psychology’s role in the transition process, and their sources of TGNB-related knowledge. A reflexive thematic analysis rooted in social constructionism was used to analyze the data. Results: Five primary themes were identified: 1) gender identity development as self-exploration, 2) navigating expertise and uncertainty around transitude, 3) the functions of fence-sitting, 4) the sociopolitical structures shaping TGNB mental health narratives, and 5) role aspirations versus role expectations. Participants’ responses conveyed tension between person-centered, affirmative approaches and institutional practices rooted in cisnormativity. Conclusions: Findings underscore the need for comprehensive training which features transgender and non-binary voices, and an appetite for shifting away from gatekeeping gender-affirming care practices toward collaborative care models.