“ I Finally Felt My Identity Existed in Therapy ”: A Qualitative Study of Transgender-Diverse Patients’ Psychotherapy Experiences in Chile

Research on psychotherapy for transgender and gender-diverse (TGD) individuals remains limited, particularly regarding barriers to care and patients' own accounts of treatment. This study explored how TGD adults in Chile describe the contextual determinants, relational and procedural characteristics, and perceived consequences of their psychotherapeutic experiences. Eight TGD adults who had received psychotherapy in Chile participated in semi-structured interviews. Data were analyzed using Constructivist Grounded Theory, with the Generic Model of Psychotherapy as a sensitizing framework. Participants identified four contextual determinants of their therapeutic experiences: the sociocultural context, their experiences as TGD patients within the health system, varying levels of family support, and therapist characteristics. They described fragmented treatment histories marked by financial instability, discrimination, and frequent changes of therapist, which often left them feeling lost. In contrast, beneficial therapy was characterized by consistent validation of identity, including the use of chosen names and pronouns; a safe space to discuss gender experiences; regular weekly sessions; and trauma-informed, gender-affirming practices. Participants attributed improvements in body affirmation, emotional regulation, and self-compassion, as well as reduced internalized stigma, to trans-affirmative psychotherapy. They also linked positive therapy experiences to less perceived stigma from peers and greater acceptance from family members. These findings underscore the need for trans-competent psychotherapy that acknowledges personal histories and gender realities while addressing sociopolitical barriers to care. Clinicians should develop competencies in gender diversity and trauma-informed care. Future research should include more diverse samples across gender identities and age groups, as well as comparative evaluations of care models, to inform evidence-based guidelines for TGD-affirming practice.