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Abstract

To date, social work literature regarding transgender and gender diverse (TGD) individuals situates TGD individuals as objects of social work knowledge and intervention. While this existent work represents an important foundation, it may foreclose other positionalities for TGD individuals. Therefore, this feminist critical discourse analysis of social work literature utilizes professionalization and transnormativity as conceptual anchors to explore the phenomenon of “transgender lived experience” in social work literature in order to understand both the nature of transgender lived experience and who is permitted to have it. Ultimately, this project found that transgender lived experience within social work is a totalizing discourse centered on a wholly painful experience of othering that can only be ameliorated through medical intervention. While this experience can confer expertise upon some individuals, transnormativity and professionalization operate in concert with this discourse to situate TGD people as transgender in the first place, foreclosing any other subjectivity. Therefore, future inquiry into the experiences of TGD individuals in social work must be willing to embrace epistemic perspectives and methodologies that emphasize the nuance and diversity of individuals’ experiences and resist totalizing grand narratives.

Keywords

Discourse analysis social work transgender transnormativity professionalization

There is a strong foundation of scholarship on transgender and nonbinary (TNB) people and social work, primarily focusing on practice approaches to best support TNB people encountering social work services (Austin, 2018; Collazo et al., 2013; Morrow, 2004) and educational strategies to prepare future social workers for practice with TNB individuals and communities (Austin et al., 2016; de Jong, 2015; McCarty-Caplan, 2022). Within this context, social work scholarship has recently turned to emphasize the lived experience of TNB individuals as critical to equitable social work practice, education, and research with and on behalf of TNB clients (Harner, 2023; Holloway et al., 2021; Kia et al., 2022; Kia, MacKinnon & Göncü, 2023; Kia, MacKinnon & Coulombe, 2023). While this work argues that TNB individuals’ lived experience might allow them an important vantage point from which to inform social work practice (Kia et al., 2022; Kia, MacKinnon & Göncü, 2023; Kia, MacKinnon & Coulombe, 2023), by discursively situating TNB lived experience outside of the profession this perspective situates TNB people as objects of social work knowledge and intervention. This reflects a broader trend, wherein a growing body of literature acknowledges and explores the experiences of TNB social work students (Akapnitis et al., 2023; Austin et al., 2016, 2019; Greenwood & Paceley, 2023; Kinney et al., 2023; McCarty-Caplan, 2020; McCarty-Caplan & Shaw, 2023; Shelton & Dodd, 2020; Shelton et al., 2023); however, the literature exploring the experiences of transgender social workers is comparatively limited (Hansbury, 2011; Kahn, 2021; Lurie, 2014; Mathy, 2006; McCranor, 2022; Nealy, 2011; Shelton et al., 2011).

Dual forces of professionalization, which constructs the social worker as a particular, normative identity relative to their client's non-normative identity (Badwall, 2015; Ferguson, 2008; Hyslop, 2011; Mehrotra et al., 2019), and transnormativity, which constructs a particular TNB subjectivity (Bradford & Syed, 2019; Garrison, 2018; Vipond, 2015), coalesce in this construction of the TNB lived experience as external to social work knowledge. Therefore, employing professionalization and transnormativity as “conceptual anchors” (Leotti, 2020, p. 448) and starting from this turn in the literature toward emphasizing the importance of TNB lived experience to inform social work practice, this paper intends to critically analyze the construction of transgender lived experience within social work literature. In so doing, it aims to answer two primary questions: (1) What is the nature of transgender lived experience in the social work literature? and (2) Who is permitted to have lived experience in this literature?

Conceptual Anchors

Transnormativity

Social work literature has charted how social work is impacted by and reproduces cisnormativity, or the assumption that the only true gender experience is that of a stable binary gender (Kia, MacKinnon & Coulombe, 2023; Shelton & Dodd, 2020; Shelton et al., 2019), with comparatively little attention paid to transnormativity. Transnormativity represents the construction of an acceptable way to be transgender, enabling “some transgender people to be deemed culturally intelligible and, consequently, offered conditional acceptance within society” (McIntyre, 2018, p. 10). This cultural legibility flows from cisnormative assumptions: where cisnormativity rests on the basic assumption that everyone is cisgender by default and defined by relatively prescriptive gender roles (Shelton & Dodd, 2020), transnormativity takes up these cisnormative assumptions around gender and applies them to trans identities and experience (Boe et al., 2020). In this way, similar to how unpacking the cisnormativity inherent in social work education, practice, and research has allowed for clearer vision into how transgender people are excluded from or invisible to social work theory and practice, deconstructing the implicit transnormativity of social work practice and scholarship may allow us to see the ways social work scholarship and practice perpetuate a limiting construction of transness (Harner, 2023).

Transnormativity is created and maintained through narratives of trans identity that suggest a universal TNB experience. The transnormative experience is linear and teleological, marked by knowing that one was born in the wrong body from early in life, leading one to later seek medical intervention—despite the associated gatekeeping and victimization—to amend this embodied error (Bradford & Syed, 2019; Garrison, 2018, Vipond, 2015). There is an understanding that one's suffering is so deep that they must seek out medical intervention, regardless of how difficult it may be. Transnormativity has developed in concert with increased medicalization of TNB people and the hegemony of sexual reassignment surgery as determinative of transgender experience (Vipond, 2015). The centering of SRS as coterminous with transness grants power to medical discourse to create the positionality of the TNB person, constructing a particular regulation of gender and gender performance that fundamentally reinscribes a conservative understanding of gender as fixed and binary (Spade, 2006). Transnormativity serves to “privatize and depoliticize gender role distress,” (Spade, 2006, p. 321) obscuring the social nature of transgender oppression and the liberatory potential of radical transgender politic (Garrison, 2018; Vipond, 2015).

Professionalization

Professionalization is the process of demarcating the boundaries between social workers and others through establishing the field's scope of knowledge and by defining the positionalities available to both social workers and service users (Heite, 2012). Professionalization is a core part of social work education, as constructing boundaries between worker and client is key to social workers’ socialization into the profession (Heite, 2012). The Council on Social Work Education (CSWE) reinforces education as a process of professionalization, articulating a key learning objectives for students as the capacity to “demonstrate professional behavior; appearance; and oral, written, and electronic communication” (CSWE, 2022, p. 9). How one conducts oneself is key to maintaining the boundary of the profession.

Critical and radical approaches to social work have been skeptical of the usefulness of this process of professionalization and distance between worker and client. Ian Hyslop (2011) argues that professionalization creates a hierarchical relationship between worker and client that fundamentally forecloses social work's stated goal of “joining with” (p. 415) clients to create change through the imperative that social workers keep an objective distance from their clients, lest they suffer a “fatal loss of perspective” (p. 415). Similarly, Roy Bailey and Mike Brake (1975) are critical of how professionalization rewards social workers in managing and detaching from their emotions as core to the professionalization of social workers, leading to “businesslike career structures [that isolate] the social worker from the population at large” (p. 145). In this view, professionalization severs the social worker from their human experience in favor of a trained capacity to subtly influence change through the use of relational power masked by logics of care, service, and social justice that allow social work to continue to function under the guise of being a helping profession (Hasenfeld, 1987; Margolin, 1997).

This separation of social worker from lived experience is particularly potent for social workers from marginalized communities. Iain Ferguson (2008) notes that “social work has had the particular societal mandate of going amongst the poor, but with the clear injunction ‘not to go native’” (pp. 16–17), revealing the implicit assumption within the profession that social workers do not work with communities of which they are a part. For social workers who are not white, cisgender, heterosexual, or middle class, the injunction “not to go native” (Ferguson, 2008, p. 17) becomes an impossibility—they cannot deny their membership as part of the communities that social work services (Badwall, 2015). The implications for TNB individuals encountering social work services are clear: if they are a service user, they will be regarded as someone Other to the social worker; meanwhile, if they are a social worker, they lose their relationship with the community. This is illustrated in Rupert McCranor's (2022) account of being a transgender social work student where he observes this professionalized requirement of objective distance:
Being a social worker requires, on top of all of the other skills, knowledge and methods at our disposal, the skills of diplomacy, tact, and grace. We use these to maintain professional boundaries to preserve as far as possible the comfort, dignity, and safety of ourselves and the vulnerable people with whom we work. When you are a social worker who is visibly coded as ‘different’ or you are a practitioner who belongs to a protected characteristic, such as a person with a disability, a Black or minority ethnic practitioner, or a transgender practitioner, the effort that has to go into maintaining those boundaries can sometimes be insurmountable. (p. 83)
Distance or “professional boundaries,” per McCranor, requires practitioners to situate themselves apart from their community because of the nature of their role and professional training. The binary view of professionalization constructs – either social worker or trans person – serves to flatten both the identity of the social worker and that of the transgender community, erasing the intersectionality inherent in both. With respect to the professional social worker, this binary reveals the inherent whiteness of the profession, which implicitly situates the unmarked social worker as a member of the dominant group (Badwall, 2015; Mehrotra et al., 2019). Harjeet Badwall (2015) connects this to the inherent coloniality of social work, as colonialism requires the creation of a racialized other to be contained and assimilated. With respect to trans communities, this binary erases their own heterogeneity and assumes a transnormative notion of trans community and identity. As Jama Shelton, Gretchen Winterkorn, Heather Gay, Cooper Sabatino and Finn Brigham (2011) note in their panel discussion, just because one has an identity as a transgender or queer does not mean that one necessarily shares all experiences with other members of that community, regardless of professional training or lack thereof.

Methodology

Critical Discourse Analysis

As a “socio-historically located social practice” (Malson, 1998, p. 40), discourse mediates experience within the social context, engaging productive power to shape available subjectivities and realities. Critical discourse analysis then “aims to disentangle the giant milling mass of discourse, to chart what is said and can be said in a given society at a given time” (Jäger & Maier, 2009, p. 36) through engaging in a close analysis of texts. When taken up as a tool of feminist praxis, critical discourse analysis works to interrogate the ways in which gendered subjectivities are constructed and constrained by this speech, situating language itself as a site for the exercise of power (Lazar, 2007). Critically, this analysis is not seen as analyzing some core reality reflected in the text; rather, it seeks to discover the “regime of truth” constructed by these texts (Foucault, 1972; Malson et al., 2004, p. 477). In this critical analysis of the discursive construction of transgender lived experience within social work literature, I therefore seek to explore how these texts bound this phenomenon and construct particular TNB subjectivities in relation to social work. As a transgender nonbinary social work practitioner and academic, I have an embodied sense of how social work theory and practice approaches TNB subjectivities; this work represents an effort to systematically make explicit the implicit constructions of TNB lived experience that shape these subjectivities.

Selection of Texts

I selected the texts for analysis in January through March of 2023, based on the inclusion criteria of articles written in English, published in peer-reviewed social work journals and books, and focusing on the lived experiences of TNB people in the United States and Canada. Exclusion criteria included: dissertations, books, book reviews, a focus on a lived experience other than transgender experience (i.e. empirical studies about another phenomenon that happened to include TNB participants), and being written in a language other than English. Databases were selected for their relevance to the topic and availability to the author. The keywords used for all searches were “social work” AND “lived experience” AND “transgender.” Therefore, any work that did not explicitly situate itself as examining “lived experience” in those works was not included. Articles were screened using a sequential process. Articles were initially screened by a review of titles, narrowed by abstracts, and, finally, a full text review was conducted to arrive at the final collection of 13 articles.¹

Analytic Process

I engaged in detailed analysis of the texts beginning with a close reading of each included text to highlight both specific instances of invoking the concept of lived experience, as well as how this concept connected to overarching constructed meaning. I engaged in further close review of these passages highlighting lived experience to explore how this phenomenon was constructed within the text. This involved “questioning what was implied and assumed, as well as what was missing or left unsaid to gain a deeper understanding of the ideological work being accomplished in and through the texts” (Leotti, 2020, p. 456). I then grouped these passages into categories based on the type of lived experience being described as well as who was situated as having access to that lived experience, and then further refined these categories into four co-constitutive themes as well as three categories of individuals who, according to the literature, have lived experiences as TNB people.

Limitations

Given the nascent quality of this field, as well as the specific search terms used, this literature review has specific limitations. First, a literature review of an emerging body of work runs the risk of classifying this literature into a particular narrative and foreclosing other understandings. In employing a critical discourse analysis alongside an active acknowledgment of the discursive work this piece itself does, I hope to avoid this trap and instead broaden the possible areas for exploration within this field. Second, the specific keywords used—in particular, lived experience—served to create a useful narrowing effect for this review while simultaneously excluding a significant portion of the field. This further reinforces a reading of this literature review as a partial analysis of the field rather than a claim to absolute truth.

Results

My analysis of the nature of transgender lived experience in social work resulted in four overarching themes: (1) transgender lived experience as everyday experience, (2) transgender lived experience as marked by pain and difference, (3) transgender lived experience as inescapably medicalized, and (4) transgender lived experience as expertise. These themes interact with and build upon each other to create an understanding of transgender lived experience that overlaps significantly with a transnormative reality in which TNB people are given specific knowledge based on their daily experience of marginalization and medicalization. This analysis also revealed three occasionally overlapping categories of individuals who have lived experience: (1) TNB social service users, (2) children, and (3) social service professionals (defined here as social work students, researchers, and practitioners).

What Is the Nature of Transgender Lived Experience in Social Work?

Transgender Lived Experience as Everyday Experience. At its most basic, lived experience within the social work literature refers simply to an individual's day to day experience. Authors discuss how they attended to lived experience in their capacity as group facilitators (Botta et al., 2021), as researchers (Burdge, 2014; Capous-Desylles & Barron, 2017; Holloway et al., 2021), as students (McCranor, 2022), and as practitioners (Kahn, 2021), and, in so doing, reveal that the lived experience to which they refer is primarily the narratives and events that compose everyday life. Authors refer to TNB people as having “the lived experience of seeking or receiving social services” (Kia et al., 2022, p. 3176) or the lived experience of working on “cisgender-led research projects” (Holloway et al., 2021, p. 175), which can then be shared in a group setting (Botta et al., 2021) for the opportunity to be witnessed or to be invalidated by the “absence of social recognition” (Saltzburg & Davis, 2010, p. 99). These discursive constructions of lived experience acknowledge that TNB people participate in everyday experience, as they do their work, seek support, and engage in the messy experience of allowing other humans to respond with either support or invalidation.

Notably, however, this construction of lived experience as a daily experience coheres specifically around gender for the TNB individual. In their account of gender-queer youths’ experience, Susan Saltzburg and Tamara Davis (2010) write:
For those in the group who identified as transgender, there is the fear of not being authentically known for the ‘whole’ or ‘real’ person - the person whose memory bank carries the previous birth-sex experience as well. There is no public recognition or honoring of one's ‘whole’ life, the traversing of their gender journey. This absence of social recognition translates as invalidating and dishonoring of their ‘lived experience.’ (p. 99)
In this passage, the authors equate lived experience not only with day to day experience, but with those daily experiences across the span of a lifetime. It becomes a whole story, and for TNB people in particular, this story is about their gender and its change over time. Transgender lived experience is not just the experience of, for example, going to the store to buy a banana (D. Howell & G. Pappas, personal communication, 2022). Instead, it becomes about the gendered experience of one's daily life. In this we see the beginnings of a totalizing narrative as a TNB person's whole life is equated to the “traversing of their gender journey” (Saltzburg & Davis, 2010, p. 99). There is no opportunity for a lived experience outside of gender transition; instead, TNB people have daily lived experience of being a minoritized gender. This is echoed in the earlier accounts cited, as it is never simply the lived experience of accessing social services or working on a research project, for example. These aspects of transgender lived experience are instead about how a TNB person's experience of gender transition or minoritized gender impacts their research work in relation to cisgender researchers (Holloway et al., 2021) or social service access (Kia et al., 2022). Every lived experience is inflected by gender.

Transgender Lived Experience as Marked by Pain and Difference. Lived experience as inescapably gendered easily slides into gender being the totality of TNB people's lived experience. Transgender lived experience as wholly constituted by gender deviance is critical to understanding how social work literature makes sense of TNB people. What begins as a mundane experience becomes a wholly gendered daily experience that is marked by pain and difference. TNB people are discursively situated as fundamentally different from other identity categories. For example, in his case study examining Jay, a transmasculine youth, Russell Healy (2017) describes Jay's experience thusly: “Once Jay's knowledge about his lived experience was released and revealed to himself, there was no stuffing it back down, and no way to reseal the box” (p. 119). In this, lived experience refers to Jay's transmasculine identity, discursively situating the totality of Jay's experience as wholly equivalent to his gender identity. Transgender lived experience becomes an inescapable, individualized experience of gendered difference. This experience is deeply tied to the body:
Jay knew that living in a body that didn’t feel like it should be his was hard to bear. At times, it felt impossible. The opposite of euphoria, a feeling he rarely felt since adolescence began, was an accurate way of describing his lived experience. (p. 127)
Not only is the totality of Jay's lived experience equivalent to his identity as a transmasculine person, that identity is marked by pain—“the opposite of euphoria” (Healy, 2017, p. 127). To have lived experience as a TNB person is to be in constant distress because of one's gender, an inescapable experience that cannot be “[stuffed] back down” (Healy, 2017, p. 119), but instead it is a daily experience of an impossible to bear gendered pain because of the incongruity of one's body. This distress is inescapable in part because it cannot be addressed or controlled by the TNB persons themselves: “[Transgender minors’] distress is due to their dysphoria which is outside of their control” (Healy & Allen, 2020, p. 402). By situating dysphoria as beyond the control of the TNB minor, distress is made intractable and inseparable from the TNB experience. Critically, the race falls away as part of this totalizing discursive construction of gender. In foregrounding gender as the source of pain and difference, other aspects of TNB people's lived experience are omitted. TNB people are implicitly situated as white, foreclosing both an understanding of gender beyond a binary, Eurocentric formulation (Roen, 2001), as well as a full understanding of how intersectional factors may shape TNB people's lived experience of pain and difference.

Other authors engage this gendered difference as stemming from structural causes. Susan Saltzburg and Tamara Davis (2010) note how “the language used in everyday life leaves this minority population out of public discursive possibilities” (p. 94). Transgender lived experience, then, is not only fundamentally different from any other lived experience, it is also, to some extent, unable to be conveyed, as current norms around language fail to allow for the full expression of TNB identities and experiences. Moreover, the language available to them is marked by pathologization, as Erin Markman (2011) emphasizes:
The impairment in social, occupational, and other areas of life experienced by those diagnosed with [gender identity disorder] is indeed problematic, but it is due largely to the fact that those realms of life are often intolerant and hostile to transgender and gender-nonconforming people. (p. 320)
Pathologization and the pain that stems from it are a result of hostile social structures. What might be conceptualized as an internal problem worked up as a mental health diagnosis instead is better understood as an impairment because of a hostile world. Even though the source is discursively situated outside of TNB people in this account and not attributable to any innate pathology, the end result is still a transgender lived experience that is marked by difficulty.

There are some dissenting narratives, however. In her phenomenological account of transgender identity as a valued experience, Barb Burdge (2014) acknowledges that there are many accounts of transgender pain and struggle while seeking to expand on those with an account of “transgenderism as a phenomenon experienced as a valued aspect of life” (p. 356). Emerging from this is an account of transness as centered around an intimate connection with oneself, with others, and with the overall purpose that leaves people feeling “closely integrated with an authentic and distinctive sense of self, in which they [experience] profound wholeness and resilience” (Burdge, 2014, p. 365). In this account, uncovering one's gender identity is not something that leads to “the opposite of euphoria” (Healy, 2017, p. 127) and comes with a desire to “stuff it back down” (Healy, 2017, p. 119); rather, it opens the possibility for a more whole sense of self that is “authentic” (Burdge, 2014, p. 365). That is to say, rather than having one's gender identity remove oneself from the world by making one fundamentally other, transgender lived experience might include coming more fully into the world as a whole and resilient person. Someone who was previously neither integrated nor authentic can instead have a fuller and more present life because of their TNB identity.

The discursive construction of transgender lived experience as constant distress illustrates a further point of connection with transnormativity. Transnormativity is marked by a construction of transness as victimhood, as perpetual suffering and marginalization (Bradford & Syed, 2019), frequently engaging discourses of being born in the wrong body that also appear in the Jay case study (Healy, 2017; Vipond, 2015). In discursively situating transgender lived experience as purely tied to marginalization based on gender and pain deriving from gendered physical characteristics, social work literature on transgender lived experience reinforces a narrative of transnormativity. Moreover, because social work has a bias toward pathologizing TNB people (Markman, 2011; Shelton et al., 2019), this situation of trans people as other is inevitably cast as a manifestation of the victimization narrative of transnormativity (Bradford & Syed, 2019). This singular narrative of trans lived experience reinscribes the othering and marginalization of TNB people by reasserting that to be outside of the cisgender norm means that one's experience is irrevocably tied to their non-normative gender and the concomitant experience of pain and distress.

Transgender Lived Experience as Inescapably Medicalized. If transgender lived experience is marked by constant pain as a result of one's gendered embodied experience, it follows that transgender lived experience would also be marked by medicalization within the literature. Indeed, this experience of “the opposite of euphoria” (Healy, 2017, p. 127) as a result of the “paradox” (Healy, 2017, p. 129) of one's felt gender juxtaposed with one's embodied gender leads to an understanding of transgender lived experience as inseparable from medical transition:
Transgender clients embody a paradox. Their lived experience tells them that they are not ill, but they somehow have found themselves living in a body whose assigned gender feels wrong. This produces a profound dysphoria that can best be addressed through medical intervention. Transgender clients want to experience authentic life without feeling alien in their bodies. In order to access the treatment they need, the transgender client must accept various psychiatric and medical diagnoses. For many trans* persons, having to accede to being ill adds to their dysphoria. (Healy, 2016, p. 149)
The only possible way to resolve the “paradox” of trans lived experience and to free TNB people from their dysphoria-induced suffering is through medical intervention. The discursive strategy employed here situates “authentic life” (Healy, 2016, p. 149) as something only achievable through the creation of a normatively gendered body through medical technology. It calls back to Markman's (2011) understanding of pathologization as the root of trans suffering, while also positioning the distress as internal rather than socially caused. In so doing, it discursively constructs the solution as similarly individualized through medical intervention. Dysphoria, already connected to intractable and uncontrollable suffering, is now situated as something that can be controlled, but only through medicalization.

This demonstrates a further expansion into transnormative understanding of trans experience. Hasman (1992, as cited in Spade, 2006) writes, “transsexuals must seek and obtain medical treatment in order to be recognized as transsexuals. Their subject position depends upon a necessary relation to the medical establishment and its discourses” (p. 317). This represents a liberal, rights-based discourse around gender and transness that reinforces the idea that there is a proper way to be TNB and that is to engage with medical technologies such that one approximates a cisgender norm as closely as possible. While there are dissenting views toward this, including a more radical transgender politic (Roen, 2002), this approach coalesces with the social work imperative that “nonconforming bodies be assimilated into the mainstream” (Shelton et al., 2022, p. 179). Social work has been complicit in both cis- and transnormativity in reinforcing the pathologization of transness and situating the only correct transgender experience as one of painful, discordant embodiment and alleviation of this distress through medical intervention (Markman, 2011; Shelton et al., 2022).

Transgender Lived Experience as Expertise. Ultimately, the transgender lived experience of daily distress alleviated only through medicalization is situated within the social work literature as conferring a particular expertise not accessible through other means. As illustrated in Ariel Botta et al.’s (2021) positionality statement, an author “is a psychologist who is developing their group work skills. They are also a member of the TGD community and bring to the table invaluable lived experience as well as expertise in working with TGD youth” (p. 111). This author has expertise that comes from their lived experience as TGD person; however, this expertise is discursively situated as separate from their professional training and knowledge. This reflects discourses of professionalization that require the social worker to maintain distance from their client (Hyslop, 2011). If social work professionals are required to maintain a professional distance, but transgender lived experience is a totalizing discourse centered around pain and marginalization, TNB social work professionals must distinguish between their lived experience and their professional experience.

This is exemplified by the literature regarding TNB peers as critical informants for social work practice. In their work on “leveraging” lived experience for social work practice with trans- and gender diverse (TGD) individuals, Hannah Kia, Kinnon Ross MacKinnon and Kaan Göncü (2023) argue that “shared realities” (p. 197) among TGD individuals are core to expertise and cannot be replicated through education. As one of their participants shares: “I feel like there's an admiration that I have for all the other trans people in my life, that I think that's probably lacking amongst cis people. And I don’t think you can teach that” (Kia, MacKinnon & Göncü, 2023, p. 8). This situates transgender lived experience as conferring an expertise and perspective that cannot be replicated by formal training, further reinforcing how social work professionalization separates social workers from the capacity to engage their lived experience in their practice. TGD social workers can either be trans themselves and engage their lived experience as a peer in their connection with clients, or they can be social workers and have their credentials and professionalization shape the relationship between them and their clients. This reflects a growing neoliberal impulse within the social service field to center lived experience as “a commodity for exchange in neoliberal care and service markets” (Voronka, 2017, p. 334) and also highlights the implicit assumption that social workers are members of dominant social groups (Mehrotra et al., 2019). This emphasis on lived experience informing social work practice works in concert with professionalization to lead to an emphasis on peer workers, as professional distance and normative understanding of social workers’ identities foreclose the possibility that social workers themselves might have lived experience (Badwall, 2015; Hyslop, 2011; Mehrotra et al., 2019). This gives rise to a hierarchy of professionals, situating peer workers in between the professional social workers who work as their supervisors and their clients, as much as social workers find themselves situated between their client and the overarching systems they encounter (Epstein, 1999; Kia, MacKinnon & Göncü, 2023). This system of hierarchical professionals serving as various gatekeepers to care reinforces transnormative understanding of lived experience (Bradford & Syed, 2019) by implicitly asserting that TNB people are passive victims in need of services while simultaneously calling into question whether a worker can be positioned above a client in a hierarchical arrangement and still be considered a peer. Moreover, given that social work simultaneously constructs transgender lived experience as intractably distressing alongside this expertise, peer work ultimately means “embodying the tenets of normative citizenship: by managing ourselves and others, and most important, by getting back to work” (Voronka, 2017, p. 335). Once again, TNB people are subjected to the force of normativity, whether that be cisnormative understanding of gender or transnormative understanding of being distressed but not overcome by victimhood.

Who Is Permitted to Have Lived Experience?

If a hallmark of transgender lived experience is that it confers a certain type of expertise, it is important to understand who, then, is identified as having lived experience and how their positionality is similarly shaped by forces of professionalization and transnormativity. This section seeks to explore how the social work literature identifies TNB social service users, children, and social service professionals as distinct and overlapping categories, and how each is constructed to allow access to certain forms of lived experience.

Social Service Users. The most apparent category of individuals who are permitted to have lived experience is TNB social service users. This categorization emerges from themes of pain and medicalization. If transness is inherently painful and medicalized, then all trans people inevitably must encounter healthcare or social services. In their work on social work education on trans and gender diverse people, Hannah Kia et al. (2023) cite this inevitability of encountering social work services as the basis for improving social work education about TNB experience.

This, then, becomes the universal category for who has lived experience as a TNB person. Even TNB children, who sometimes cannot yet be service users themselves because of their age, have lived experience marked by the inevitability of future service use. For example, in their research into the lived experience of TNB children, Moshoula Capous-Desyllas and Cecillia Barron (2017) cite that the future is a primary concern of TNB children's parents:
As a whole, the parents expressed their concern with what was still to come with the onset of puberty and what this would mean for their gender variant child. They considered the potential need for puberty blockers and then cross-sex hormones. (p. 532)
With future concerns centered on medical interventions, TNB children are situated as future service users primarily. Even though prepubescent TNB children transition only socially (Capous-Desyllas & Barron, 2017), discourses of transnormativity appear in this narrative to situate their medical transition as inevitable and imminent. This serves to disrupt and obscure their current experience with transnormative discourses of TNB victimization and distress that can only be addressed through professional care. This makes us fundamentally unable to understand TNB children as they are rather than who they will become.

Similarly, TNB professionals are often seen as service users first and professionals second. In their account of their experience as a TNB social worker, Jesse Kahn (2021) explores the dynamics of self-disclosure noting that their disclosure of their TNB status often changes the therapeutic relationship between themselves and their clients. While this often can be a strength when working with TNB clients, Kahn notes that there are liabilities to this with clients of all genders. These liabilities leave them faced with a decision: disclose their gender identity and be subject to the totalizing discourses of transgender lived experience as foreclosing professional expertise or foreground their professional experience and be perceived as cisgender. This necessarily intersects with a TNB social workers’ other identities and also assumes that the TNB social worker is able to pass as cisgender, complicating this experience for nonbinary and transitioning social workers in particular. Additionally, this is likely felt differently across different relationships, as the influence of professionalization shapes how clients perceive social workers as well as how social workers relate with other professionals. Still, the intense relationship between medicalization and lived experience necessarily situates TNB individuals as service users first; therefore, it follows that this understanding of TNB social workers as always already service users appears in this literature.

Children. As noted above, TNB children also appear in the social work literature on transgender lived experience in a way that situates them as future service users. This account of TNB children as future service users is delivered solely through parents’ accounts despite being a part of a research project on the lived experience of TNB youth (Capous-Desyllas & Barron, 2017). While this likely reflects complications around research ethics in working with youth, it also serves to reinforce the notion that TNB children cannot speak for themselves and are instead constructed as passive becoming rather than agents able to meaningfully engage on their own behalf (Gill-Peterson, 2018).

When TNB youth are permitted to speak for themselves, their experiences are worked up as fundamentally different from other queer children's experiences (Healy, 2016; Healy, 2017; Salzburg & Davis, 2010). This reflects the medicalization inherent in accounts of transgender lived experience:
In vivo, however, the lived experience of transgender youth is very different from that of sexual minority youth. They are still subjected to a mental health diagnosis … and require medical treatment, legal assistance, and social adjustment in order to confirm their gender and alleviate the dysphoria they often experience. They cannot simply come out of the closet. (Healy, 2017, p. 113)
TNB youth are distinct from sexual minority youth because of medicalization. Sexual minority youth can simply come out of the closet, meaning that inhabiting their authentic identity is as simple as declaring it. This discursively positions coming out as TNB to be more complicated and onerous, involving not simply a process of disclosure but also a complex process of medical, legal, and social interventions. This further reinforces the transnormative understanding of transgender lived experience as fundamentally mediated by medical and legal interventions (Vipond, 2015) rather than the ability to flex with the politics and desires of the TNB youth (Roen, 2002).

Social Service Professionals. As illustrated above, TNB social service professionals are subject to a totalizing discourse of TNB identity that allows them access to either expertise granted through lived experience or through professional education, but not both. This is often experienced in academic settings as tokenization or being included primarily because of one's gender rather than other attributes (Holloway et al., 2021). In this case, being a TNB person forecloses both professional and lived experience expertise and instead situates the trans person as a sort of living virtue signal, affording cisgender researchers the credibility needed to support their projects without meaningfully changing their research practices or actively engaging with a conversation regarding expertise and positionality. Notably, this tokenization is not felt as intensely when multiple TNB individuals are included on a project (Holloway et al., 2021), indicating that there are ways to work beyond this totalizing construction.

In some cases, TNB researchers actively acknowledge the impact of professionalization on their work, reinforcing the discursive notion that TNB people can either have lived experience or professional expertise, but not both simultaneously. In their work on incorporating transgender lived experience into the social work practice, Hannah Kia, Kaan Göncü, Kelendria Nation, Jodi Gray and Darren Usher (2022) assert that TGD peer workers provide a perspective that TGD social workers cannot, arguing that “only TGD-identified workers could authentically support TGD individuals with accessing resistive discourses and counter-narratives” (p. 3184), a lived experience that cannot be substituted for formal education. This situates TNB lived experience as somehow more real than professional education and further reinscribes discourses of professionalization that argue that professional social workers must maintain professional distance to “preserve as far as possible the comfort, dignity, and safety of ourselves and the vulnerable people with whom we work” (McCranor, 2022, p. 83). Social workers are expected to join with their clients, but not to the extent that they embody the same characteristics (Ferguson, 2008). This creates a discursive construction of social work professionals as implicitly cisgender. The TNB social worker cannot access their lived experience while in their professional role because to do so would involve an elimination of the professional boundary that constructs the positionality of the social worker. Ultimately, TNB social workers must choose: will they be TNB and engage their lived experience, or will they maintain their status as professionals?

Key Implications and Contributions

Given that social work is a problem-focused discipline, it is reasonable that the social work construction of transgender lived experience is a totalizing discourse centered around a wholly painful experience of othering that can only be ameliorated through medical intervention. While this experience can confer expertise upon some individuals, its intersection with transnormativity and professionalization reinforces harmful understanding of gender. Clearly social work's focus on problems has shaped our research approaches, giving rise to this totalizing narrative of TNB lived experience (Harner, 2023). This intersects with discourses of professionalization that separate practitioners from their clients, implicitly situating the social work professional as someone who has not experienced adversity themselves. When this coalesces with the totalizing discourse of transgender lived experience, it serves to foreclose the experience of TNB social workers, situating them—as McCranor (2022) emphasizes—as always “trans first, social worker second” (p. 83).

Dean Spade (2006) asks, “…why should I engage this idea that my gender performance has been my most important difference in my life?” (p. 316). With that in mind, I wonder why scholarship must center on the idea that gender is always already the only thing to study when it comes to transgender people. Dorothy Smith (1987) has conceptualized and argued for a “sociology for women” (p. 46), noticing the ways that women's ways of knowing were consistently sidelined by the objectifying force of patriarchy. Women are not engaged as knowing subjects by sociological research in Smith's view; rather, the view from outside—what Donna Haraway (1997) might call the “god trick” (p. 285)—serves to objectify women, treating them as objects of study rather than subjects in communication. Smith argues that sociology can remedy itself by starting from the perspective of women themselves and seeing the world through their eyes.

Thinking about a sociology for women, I wonder about the possibilities of a social work for TNB people. Smith's (1987) analysis was that patriarchy structured—and therefore limited—sociology's capacity to engage women's experience. Similarly, Erin Markman (2011), Jama Shelton and S. J. Dodd (2020), and Vern Harner (2023) have demonstrated that pathologization, cisnormativity, and transnormativity limit social work's capacity to engage trans experience. Cisnormativity perpetually obscures the trans subject, and, when we are able to find them, objectifies them, turning them into an object of knowledge rather than a subject in their own right. Instead, if we start from the position of the trans person, how might we see the world? To say it otherwise, what would happen in our research if we looked out at the world through trans eyes rather than from the outside toward the trans person themselves?

It would be easy to interpret “looking at the world through trans eyes” as an exhortation to ensure that research with TNB people is done by TNB researchers exclusively. While this is clearly a powerful shift and intervention (Harner, 2023), it is not enough in and of itself. Just as cisnormativity erases and objectifies the trans person in a cisgender vision, transnormativity can easily structure the trans person even within our own vision. Moreover, the lived experience of a TNB researcher may only bear the shadow of a resemblance to the experiences of their research subjects, similar to how queer and trans social work practitioners’ lived experiences can diverge widely from that of their clients (Shelton et al., 2011). “Seeing the world through trans eyes” is not only about researcher positionality—it is also inseparable from epistemology and the methodologies that flow from that.

Part of this shift in vision also requires troubling the concept of ‘lived experience’ as an object in and of itself. Lived experience is, for the most part, taken for granted within social work as meaning “the knowledge [individuals] bring because [they] have firsthand involvement or exposure to particular events, occurrences or conditions that [they] have tried to make sense and construct meaning of” (O’Leary & Tsui, 2022, p. 1075). While rich and descriptive, this definition serves to equate people—particularly marginalized individuals—with their identities or a singular aspect of their experience, creating a totalizing narrative and foreclosing a more complex understanding of their humanity. Further, this view of lived experience represents a limited understanding of the depth and complexity of this phenomenon. In solidifying a narrative of “lived experience” as unitary and universal, social work literature has lost its capacity to engage the infinite varieties of lived experience and the acknowledgement that this is actually something that is universally possessed. Scholars in Mad Studies have long been problematizing the ways “lived experience” becomes Darby Penney and Laura Prescott's (2016) something other, held only by specific people who have suffered in particular ways, perhaps best exemplified by the quip: “‘lived’ experience as opposed to what—being deceased?” (p 37).

Similarly, the hermeneutic phenomenological research perspective understands “lived experience” as a foundational part of the human experience that is bound by affective and embodied experience and, to some extent, escapes language entirely (van Manen, 1997). As Hans-Georg Gadamer (1975/2004) argues:
Experience has a definite immediacy which eludes every opinion about its meaning…Thus, essential to an experience is that it cannot be exhausted in what can be said of it or grasped as its meaning…What we call an [experience] in this emphatic sense thus means something unforgettable and irreplaceable, something whose meaning cannot be exhausted by a conceptual determination. (p. 58)
This understanding of lived experience creates a space for a more expansive understanding of TNB experiences beyond the daily experience of gendered marginalization. Instead, the hermeneutic phenomenological tradition invites us to consider lived experience as a vivid, affective experience that, when carefully attended to, opens new possibilities for understanding the human experience.

Social work collapses “lived experience” in a totalizing discourse of marginalization. Phenomenological understanding instead allows us to expand outward into new possibilities, resisting discourses of professionalization and transnormativity and allowing instead for a multifaceted understanding of lived experience as intersectional, interconnected, and complex. As Karin Dahlberg and colleagues (2009) argue:
Entering the phenomenological realm we do not fundamentally find our lives as unrelated compartments such as ‘health’, ‘illness’, ‘emotional life’ ‘spiritual life’. Neither do we find mind-in-itself or body-in-itself. We rather find the seamlessness of everyday life and its qualitative character. (p. 266)
Whereas social work seeks to clearly define the problem so that it might be solved through professionalized pathways, hermeneutic phenomenological understanding seeks no such solution. This understanding allows for experience to be as it is rather than as it needs to be in order to be remedied. Incorporating this understanding into social work research, education, and practice may allow for a more authentic, multifaceted understanding of transgender individuals’ experiences, leading to a more robust form of support.

Further research is therefore needed to support a more robust understanding of transgender lived experience within social work and the experience of TNB social workers in particular. However, we must take care in the questions that we ask and the methodologies we engage to find their answers. We must carefully attend to the epistemological and discursive frames guiding our work to ensure that TNB people are captured in their full humanity, beyond the transnormative narrative of pain, difference, and medicalization (Holloway, 2023). Ultimately, social work scholarship on transgender lived experience would benefit from embracing epistemic perspectives and methodologies that emphasize the nuance and diversity of individuals’ experiences and resist totalizing grand narratives.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

A.P. Spoth

Notes

Author Biography

A.P. Spoth is a doctoral student at the Portland State University School of Social Work. Their research draws from trans theory, abolitionist perspectives, and Mad Studies to question taken-for-granted norms around lived experience in social work, with particular attention to the lived experiences of transgender social work practitioners.

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Transgender Lived Experience in Social Work: A Critical Discourse Analysis

Abstract

Keywords

Conceptual Anchors

Transnormativity

Professionalization

Methodology

Critical Discourse Analysis

Selection of Texts

Analytic Process

Limitations

Results

What Is the Nature of Transgender Lived Experience in Social Work?

Who Is Permitted to Have Lived Experience?

Key Implications and Contributions

Footnotes

Declaration of Conflicting Interests

Funding

ORCID iD

Notes

Author Biography

References