Protocol of Application and Phenomenological Exploration of Body Mapping in Transgender Population: An Art-Based Research Method

Abstract

This article is a methodological proposal for Body Mapping application in transgender population framed by a phenomenological approach and aimed at exploring the implicit and pre-reflective embodied cues of the experience of discordance between the felt body (the body I am) and the objective body (‘the body I have’) that opens a space in which words do not have easy access to. In order to describe our protocol of phenomenological exploration and application of Body Mapping, we detail the complete process in a single case. It corresponds to a female-to-male participant of 18 years old undergoing hormonal treatment with testosterone for 12 months before engaging in our study. Reflections about the potential of using art-based research methods for accounting of pre-reflective bodily experience of discordance in transgender population are detailed. The combination of the Body Mapping art-based research tool with a phenomenological approach for the study of experience seems promising for studies aimed at exploring experience from an embodied approach. It represents a radical first-person research method in which the images talk by themselves. Furthermore, including the researchers as beholders of the resulting artwork, assuming the role of inter-corporality of the aesthetic bodily resonance as part of the data collection procedure seems innovative but loyal and honest with what an Art-based research paradigm is.

Keywords

art-based methods phenomenology case study grounded theory methods in qualitative inquiry

The present article seeks to share a protocol of application and phenomenological exploration of the body mapping technique focused on rescuing the first-person bodily experience of transgender people. To do this, we will present the use of the Body Mapping (BM) technique as Art-Based Research (ABR) framed by a phenomenological comprehension of what the embodied experience is: the experiential flow that occurs mainly in an implicit or pre-reflective level. Our body has the experience of the world through its sensory-motor operations without the need for conscious control unless some event triggers our attention, bringing our bodily experience to the forefront to a level of reflective experience (Merleau-Ponty, 1945/1965). Therefore, the experiential flow unfolds through recursive cycles of pre-reflective to reflective, and pre-reflective awareness again with the development of narratives according to those cycles of experiences that in turn constitute our sense of selves (Fuchs et al., 2010; Gaete & Fuchs, 2016; Gallagher, 2006; Merleau-Ponty, 1945/1965).

As Langer (2016) proposes, there are aspects of gender that reside in a dynamic experiential flow, some of which have never even been named, such as the proprioceptive and interoceptive sensations of masculinity or femininity. This may result in a narrative gap that can make it difficult to distinguish which aspects of corporeality to modify for better integration of experience and gender affirmation.

Trans people suffer from a double trauma through their identity development and gender affirmation process: gender trauma, due to a bodily experience of discordance and incongruence, and everyday trauma due to rejection, discrimination, and violence (Langer, 2019). Taken together, this double trauma is associated with severe rates of psychopathology, including depression and suicidal behavior (Baams et al., 2013; Bockting et al., 2013; Connolly et al., 2016; Puckett et al., 2019). Experiencing violence and discrimination leads transgender people to direct negative social attitudes toward themselves while at the same time they try to resist the social stigma associated with gender identity (Testa et al., 2015). Stigma affects transgender people’s well-being at different levels: structural (e.g., social stigma), interpersonal (e.g., family stigma), and individual (e.g., internalized stigma) (Hughto-White et al., 2015; Reisner et al., 2016; Scandurra et al., 2018).

As with many traumatic experiences, the difficulty of articulating one’s own experience into words makes it even more difficult to deal with everyday experiences of self-affirmation and boundary-setting with one’s environment. This leaves the individual even more vulnerable to the cycle of traumatization and re-traumatization (Langer, 2019). In the present work, we are moved to develop a methodological tool that allows us to give voice to this experience of suffering from a first-person and embodied perspective. Beyond the verbal meanings that arise from the interpretation of the participants of their experiences, the phenomenological understanding of the embodied experience allows us to deeply access to how it is the very lived experience of bodily in an implicit or pre-reflective way. To this aim, the bodily experience of discordance of a transgender person will be described for exemplifying each step of the proposed protocol.

To bring the lived body to the present with all the richness of bodily signs, the evocation technique (Petitmengin, 2017; Valenzuela-Moguillansky & Vásquez-Rosati, 2019) was first applied to unfolding the implicit dynamic of a bodily experience of discordance for further express it by the BM technique. Then, we propose a protocol for data handling which we present as a phenomenological exploration of both the process of artistic expression and its resulting artwork. This protocol is developed based on the concepts of aesthetic bodily resonance, affective and emotional bodily resonance, atmosphere, and inter-corporality (Falvo, 2018; Fuchs, 2013b; Gallese, 2010, 2017a, 2017b, 2019).

The relevance of developing an embodied approach for the study of transgender experience has to do with the dynamic process of sex/gender identification that arises from lived experiences with one’s body over time (Fausto-Sterling, 2021; Moon, 2019). For transgender¹ youth, the development of their bodies accompanies their identity, not only through its effect on interactions with the world but also through the internal sensations that shape body awareness (Langer, 2019). In this regard, some authors (e.g., Durwood et al., 2017; Kozee et al., 2012; Olson et al., 2016) have raised the importance of understanding the bodily experience of transgender people, particularly from a phenomenological perspective and beyond the aesthetic or biological aspects. These authors have found that changes related to the affirmation of felt gender-concordant corporeality have an impact on deep psychological aspects, capable of sustaining one’s identity and regulating internalized stigma. By its part, Cooper et al. (2020) identified four key and overarching concepts within 20 reviewed phenomenological studies of the lived experience of gender dysphoria: “distress due to dissonance of assigned and experienced gender”, “interface between assigned gender, gender identity, and society”, “negative social consequences of gender identity”, and “internal processing of rejection and transphobia” (p. 5). Gender distress is described as experiences of conflict, confusion, and denial of their gender identity, along with body dysphoria and body disconnection (Cooper et al., 2020) sense of self or a total break between their sense of self and physical body. They also identified suicidal thoughts and preferring death to keep living in their bodies. Anyhow, the literature on what has been called ‘trans phenomenology’ is scarce (Baldino, 2015; Chu, 2017; Keegan, 2016), both within that frame or within the broader frame of the phenomenology of transgender lived experience (Parco et al., 2015), and to our knowledge, there are so far no phenomenological explorations of the lived body in transgender subjects.

It is our purpose here to contribute to the field with a better understanding of the bodily experience of transgender people, raising images that express their experiences and that can be seen and understood not only by the scientific community along by giving words that may account for their lived bodies. Therefore, the proposed methodological protocol is aimed at exploring the implicit and pre-reflective embodied cues of the experience of discordance between the felt body and the objective body that opens a space in which words do not have easy access to. In this regard, we hypothesize that the experience of discordance is featured by an incongruence between the interoceptive awareness, the body schema, and the body image which is likely to be expressed in difficulties in the senses of agency and bodily ownership, and in turn, in the sense of self (Fuchs et al., 2010; Gallagher, 2006). In other words, the whole experience of a bodily self must be colored by the feeling of lack of control over one’s corporeality concerning gestures, body posture, movements, erotic sensations, etc., and by the feeling of “estrangement” in not recognizing as my own the body I have that does not correspond to the one I feel that I am.

Considering that the embodied self operates in constant reference to one’s own body, such reference would correspond according to Langer (2016) to the “dark undercurrent” of the transgender experience as a place of discordance within one’s own body. This could be described as a real short circuit, which in this case is experienced daily every time ‘something happens' that accuses this discordance between reflective and pre-reflective levels of bodily experience. The flow of pre-reflective and reflective awareness is interrupted as well as the formulation of narratives and courses of action. Langer (2016) points out that in many cases this is not recognized until after the process of medical (hormonal or surgical) affirmation. The dynamic experiential flow is then interrupted by continuous breaks or incongruities that are difficult to integrate, resulting in what Langer calls a space of dislocation. Bodily dysphoria (as it has been called by the transgender subjects themselves instead of the so-called “gender dysphoria”) would be a symptomatic expression of the impossibility of an integrated and satisfactory bodily experience. The body would be experienced as problematic, unwanted, and in permanent conflict (Langer, 2016). The transgender person would experience their body as an object that is foreign and strange to themselves and their own identity. The body that I have would remain objectified and placed outside as an object that is rejected, and the body that I am would be dislocated from the object body that I have and that does not correspond to my identity. Therefore, the possibility of generating a consistent identity narrative would also be obstructed by this dislocated bodily experience. This represents the focus of our study corresponding to what is called here the experience of discordance. Nevertheless, our first-person methodological proposal is not restricted to any predefined focus of study but to any well-defined and situated bodily experience.

It is precisely the lack of narratives about the transgender bodily experience that makes it necessary to look for non-verbal tools as better methodological approaches for unfolding bodily experiences that are not yet verbally available. Art-based research as a qualitative but non-verbal method seems a feasible tool for accessing first-person bodily experiences in the transgender field, and thus breaks out of the trap of finding what we know how to look for (Eisner, 1997).

In sum, it is our commitment to the transgender community to give them a voice in facing this important but little-known topic, to contribute with novel ideas to better shape psychotherapeutic approaches, and to share a helpful research protocol for researchers interested in the study of embodied experience and the development of identity in different communities.

Art-Based Research

McNiff, one of the field’s pioneering along with artist, educator and art therapist, defines Art-Based Research (ABR) as “the systematic use of the artistic process, the actual making of artistic expressions in all of the different forms of the arts, as a primary way of understanding and examining experience by both researchers and the people that they involve in their studies.” (McNiff, 1998, p. 29). The use of the artistic process or artwork in the field of ABR goes further than the use of it just as data for research within academic disciplines that use traditional analysis but to the use of systematic experimentation to gain knowledge about life and experience (McNiff, 1998). The recognition of ABR methods has increased in research as new ways to engage with participants on an equal footing, as people who have something to offer, giving them the possibility to express themselves through other ways different from words (e.g., Baerg, 2003; Dew et al., 2018; Gastaldo et al., 2012; Skop, 2016), and opening the opportunity to access non-verbal accounts of experience that otherwise would not be available (Gaete, 2022). Therefore, our art-based methodological proposal seeks to postpone the narrative and representation of the experience through words and rather express it through the artwork as a form of phenomenological reduction in the sense of suspending reflections, judgments, and explanations and keeping sensory-motor patterns of the experience alive through the very creative and spontaneous gesture. This way, it is expected that what will appears in the artwork will be quite different to directly talk about the same lived experience as it is carefully situated in a plastic creative-expressive (PCE) work, avoiding as much as possible the figurative-representational artwork that we consider to be closer to verbal language than to the embodied meanings we seek to obtain (Gaete, 2022).

The plastic creative-expressive (PCE) process can be understood as an experience itself that follows the pre-reflective/reflective dynamism of any other experience, where the artist fluctuates between immersion in the creative flow and perspective-taking when decisions must be taken during the process, for example, changing the art materials or deciding that the artwork is complete (Gaete, 2022). The art-based exploration allows us to access an experience in the present moment (an experience that may or may not be referred to another previous one) along with its embodied meanings expressed in the resulting artwork. These different elements that appear during the artwork production offer two sources of information: (1) The process of creation itself, and (2) the resulting artwork expressing the embodied and non-verbal meanings (Gaete, 2022).

We propose that these two different sources of information resulting from the art-based exploration allow us to explore not only a real-time experience and its embodied meanings in the present moment, but at the same time open the door to explore a past or evoked experience.

Body Mapping

Body Mapping has been described as a process of creating life-size drawings of the human body that represent people’s identities in relation to their bodies within social contexts (Gastaldo et al., 2012; Gitau et al., 2022; Skop, 2016).

Body mapping was derived from Morgan and Thomas’s Memory Box project at the University of Cape Town, which helped South African women with HIV/AIDS document their lives (Devine, 2008). South African artist Jane Solomon modified the Memory Box project into an art therapy technique in which women with HIV/AIDS used words and images to share their life stories (Furman et al., 2019; Solomon, 2002).

BM has been highlighted by its potential to engage participants in a form of creative communication and as a form of participatory qualitative research tool (Gastaldo et al., 2012; Skop, 2016), however, to our knowledge it has been mainly used framed by a representational approach within health and education fields such as HIV/AIDS (MacGregor, 2008; Maina et al., 2014), sexual health (Ramsuran & Lurwengu, 2008; Senior et al., 2014), and gender-based violence (Sweet & Escalante, 2015), among others. The few reported studies that explicitly use the BM within a phenomenological approach don’t propose any well-shaped guide to accomplish a phenomenological exploration both of the PCE process and of its resulting image (Tarr & Thomas, 2011; Valenzuela-Moguillansky et al., 2021).

Anyhow, BM provides a non-verbal method for expressing experiences that are difficult to articulate verbally, such as pain, anger, and frustration, and has the potential to generate socially shared stories that become a collective experience (Gitau et al., 2022; Murray, 2000; Skop, 2016).

Body mapping draws participants' attention to their bodies and their bodily experience, encouraging awareness and reflection on that experience (Gastaldo et al., 2012; Solomon, 2002). It is therefore a particularly useful technique for studies that seek to reveal the bodily or sensory dimensions of the experience. That is, studies in which corporeality is considered as a dimension that defines how one is in the world (De Jager et al., 2016).

Body mapping has the potential to visually capture the bodily dimension of gender diversity, helping to examine thoughts, feelings, and vulnerabilities by drawing the physical contours of their bodies (Gastaldo et al., 2012; Lys et al., 2018). This allows for the examination of the nuances of embodied gender, medical transition, and the thoughts and affects of such an experience. Body mapping beyond its self-reflective feature promotes a creative process that allows participants a pre-reflective bodily awareness that would be safely available to further reflection and verbal expression or narrative through which participants could share their thoughts and emotional experience in a safe way (Furman et al., 2019).

Phenomenology and the Embodied Approach for the Study of Experience

The protocol that we are presenting here is framed by an embodied approach in which different phenomenological concepts and tools are applied to ensure rigorousness and respect for our first-person methodological design.

Emotional Bodily Experience

A first concept refers to the emotional bodily experience as it was defined by Gaete and Fuchs (2016) as a: “… multi-dimensional and dynamic phenomenon which includes affective and emotive aspects of bodily resonance along with implicit [pre-reflective]², explicit [reflective], narrative, and functional dimensions, and which conveys coherence and internal consistence to the self” (p. 26).

It is from this notion of emotional body experience that we came up with the idea of our four-step BM application protocol.

The first step is aimed at bringing an emotionally significant experience to the present by employing tools that allow us to obtain the greatest freshness and sensory vividness from it. This condition could be fulfilled either by exposure of the participants to the concrete experience as “laboratory conditions” or by “re-experiencing tools” such as mindfulness technics, imagery, or, as we did, through the evocation technique of the micro-phenomenological interview (MPI) that allows us to unfold the implicit dynamic of a bodily experience of discordance.

The MPI is a qualitative technique introduced for the first time by Pierre Vermersch (2011) and developed to be used in the field of cognitive science by Claire Petitmengin (2006). Is an interview aimed to guide the person to re-experience and evoke a specific experience to describe it in detail, with an emphasis on unfolding its pre-reflective and embodied contents (Gaete, 2019). The modality of using the BM art-based technique together with the micro-phenomenological tool of evocation was firstly used by Valenzuela-Moguillansky et al. (2021) for exploring the experience of the recovery process of women with fibromyalgia.

Bodily Resonance

This concept is applied from the conceptualization of affectivity by Fuchs (2013a, 2013b) which considers feelings as emerging from situations, persons, and objects with expressive qualities that lead to attract or repel us. Emotions exist due to our bodily sensations, resonance, and affectability. Fuchs states that we are emotionally related to the world through our feeling body which is a “resonance body”. Therefore, external objects with their special expressive qualities trigger a specific bodily resonance or “affection” that influences in turn the emotional perception of the object with a corresponding action readiness or “emotion”. Both forms of resonances “affective” and “emotive” have specific sensory-motor bodily configurations that allow us to perceive and name them as pleasure, rejection, anger, fear, etc. These specific sensory-motor bodily configurations, or a esthetic bodily resonance, of the beholder towards the resulting image are our interest to capture at the present guide for a phenomenological exploration of the BM (Falvo, 2018; Fuchs, 2013a, 2013b; Gallese, 2010, 2017a, 2017b, 2019).

Our protocol will use the term beholders referring to the researchers that observe the resulting images for the first time without any previous participation in the PCE process. In agreement with Gallese’s idea of embodied aesthetic experience (2017a, 2017b, 2019), beholder is a concept that its etymology suggests an active observer of a phenomenon, someone who “holds the sight”, “holding in view” being the observer someone who actively encounters to the work of art and involves in it in an embodied simulation manner. According to Gallese (2017a, 2017b), embodied simulation is conceived as a pre-reflexive functional mechanism of the brain-body system that can be triggered not just during the interaction with others, allowing inter-corporeality, but during the experience of spatiality around the body and the contemplation of objects. Bodily empathy, the outcome of embodied simulation, will be an important component of the perceptual experience of artworks by means of the mirror mechanisms that it evokes (Gallese, 2017a, 2017b). Therefore, the artwork mediates between two subjectivities as an inter-corporeal and intersubjective space of encounter.

Atmosphere

We refer to the affective atmosphere defined by Fuchs (2013a, 2013b) as a ubiquitous phenomenon with affective qualities of experienced spatial and interpersonal situations which are integrated into a unitary and dynamic gestalt. As with any other affective experience, the atmosphere is perceived by bodily resonance and can integrate both a personal atmosphere and an interpersonal one. Qualities as cold, serene, melancholic, relaxed or tense, familiar or fearful, among others, may be part of a perceived atmosphere. In our protocol, the researcher’s observation guide includes the perception of the atmosphere during the PCE process of BM.

Phenomenological Reduction

As with any experiential flow, during its participation in our protocol, the individual moves naturally between pre-reflective and reflective levels through its different steps. However, it is encouraged to sustain its pre-reflective level as a form of phenomenological reduction: first express and then explain could be called what is promoted by bringing the lived experience to be expressed first in the BM. This way, BM works as a form of postponing reflection by the immersion in the plastic creative expression of a given bodily experience of discordance.

The eidetic reduction or phenomenological reduction is a method that comes from the basic assumption made by Husserl about how our primordial experience is hidden behind beliefs and assumptions about the world, called by the author the “natural attitude” (Fuchs, 2004). The phenomenological reduction allows us to unfold the original underpinnings of the experience by suspending or “bracketing” all those basic assumptions about the world (Fuchs, 2004). The PCE process is assumed to be a form of phenomenological reduction of the expressed experience.

Therefore, our protocol comprises two moments of phenomenological reduction: (1) the participant’s expression of their live body at the BM, and (2) the beholder’s observation of the resulting image starting with a strictly perceptual description of it before unfolding any form of interpretation.

Methods

This protocol proposal takes part in a larger research project called “The Dreamed Body: Exploratory research on the embodied experience of Transgender and Gender Non-conforming (TGNC) persons” that was approved by the Institutional Review Board (IRB) of the Universidad Diego Portales, Santiago, Chile. All participants fulfilled the informed consent before start with the study.

The research team is made up of seven cisgender psychologists and two cisgender assistants, all of them from different work groups and a variety of approaches: phenomenology, psychoanalysis, humanism, and social constructionism. Two of the team researchers, M.I.G. and M.C., have a phenomenological background applied to clinical practice and research, between both M.I.G. with extensive experience as Art Therapist (Gaete, 2022). Other four members of the research team, C.M., A.T., F.C., and I.P., have extensive experience working with the transgender population through affirmative clinical care and have collaborative links with transgender civil organizations in Chile. The researcher assistant (J.C.) who conducted the micro-phenomenological interviews is certified by the Laboratory of phenomenology of the body, LAFEC (https://fenomenologiacorporal.org/) and with huge experience in that research tool.

As cisgender therapists, we have been faced with the challenge of understanding the embodied experience of transgender people, so we decided to be advised by a trans psychologist who could advise us from an embodied experience about this process.

This research has different interests: there is a commitment to the transgender community to give them a voice on a topic that is little known, to develop new ways of understanding and to share a research protocol of the bodily experience that will help other researchers to continue advancing in this topic that is so important for the development of identity.

Procedures

The Four Steps Protocol for the Application of Body Mapping

Our protocol proposes a four steps procedure for the body mapping application (Figure 1) aimed at a phenomenological exploration of the bodily experience of transgender people. The following description corresponds to a pilot application of this BM protocol, therefore each of the steps of application will be illustrated by our example piloting case.

Figure 1.

Four Steps Protocol of Body Mapping Art-Based Research. Note: PCE = Plastic creative-expressive process.

Step 1: Embodied Experience

The participant is invited to evoke a specific experience of disconformity with their body and describe it in detail. On a scale of 1–10 the chosen experience does not exceed a level of 7, warning to choose one that is sufficiently tolerable for the participant. The researcher assistant helps the participant to choose a moment of discordance that occurred not more than 2 weeks ago, bringing it into the present as follows: I invite you to close your eyes and bring that moment of discordance to the present, take the time to connect with all the bodily sensations that appear in that moment in as much detail as possible about the place where you are, who or what surrounds you, how your body feels, how you move, what sounds there are around you; and when you are ready you can begin describing it.

As can be seen, the evocation technique comprises a form of questioning in which the verbal tense is held in present, and the experience is unfolded in its embodied aspects by means of sensory-motor cues. It actively avoids questions about why by prioritizing the how over the what. In this way, the participant is prevented from moving away from the pre-reflexive embodied experience.

Step 2: Outline the Body Shape

We invite the participant to lie down on a white sheet of paper with closed eyes going back to the moment just evoked and adopting a bodily posture that better expresses it. Once the participant verbally notifies the researcher that the body posture of the evoked experience is ready, this is outlined by the researcher with a neutral and dark-colored pen, while the participant is still with their eyes close.

Step 3: Plastic Creative Expressive Process (PCE)

After outlining the bodily posture, the researcher invites the participant to look at the bodily posture and the art materials available, and then to choose the art materials that allow him to better express the bodily experience of discordance evoked. The participant observes the outlined body posture on the white sheet for a moment and chooses the art materials and colors (colored pencils, hard pastels, colored markers, dry tempera, colored crepe paper sheets, scissors, cola, and paper masking tape). The researcher plays the role of facilitator of the creative process and highlights that the importance of the exercise isn’t the aesthetic result, but that the artwork expresses the experience as it was lived, so it can be used all the available materials to freely create the body map. The researcher can also give some suggestions during the creative process about the art materials and the way to use them as guidance and support to the creative process, for example, “you can use the hard pastels as chalk and blur it with your fingers to make fades or combine colors”, “it is your work of art, so feel free to do whatever you want to better express your sensations”. Further, the researcher’s intervention is minimal, always behind the participant’s process and never ahead of it. Field notes are taken by the researcher as it is shown in Figure 2(B) with numbers indicating the order of appearance of images in the BM.

Figure 2.

(a) The PCE process. Note: The resulting image of the PCE process – Artwork made by the first participant of the study “The Dreamed Body: Exploratory research on the embodied experience of Transgender and Gender Non-conforming (TGNC) persons”. (b)Note: The fieldnotes of the PCE process – Fieldnotes taken by the researcher during the PCE process of the first participant of the study “The Dreamed Body: Exploratory research on the embodied experience of Transgender and Gender Non-conforming (TGNC) persons”.

Step 4: Artwork End and Final Questions

Once the participant decides that he finished the body map, a final interrogation is carried out about how the creative process unfolded and how the image emerged from it. The participant is first invited to take distance and observe his work. Then two aspects of the BM artwork are considered for requesting: (1) The Plastic Creative-Expressive (PCE) process, and (2) the resulting image itself. The interrogation begins by requesting the participant to describe what he or she did during his creative work and how the images appeared, how they felt during it, and how decided to use some colors and materials, etc. The researcher may also ask about some relevant moments of the process as pauses, spontaneous verbalizations, more intensive work, etc. The participant’s spontaneous description and narrative must be respected on the assumption that both the previous work of evocation in the interview and expression in the BM have sufficiently sustained the experience at its pre-reflexive and postponing verbalizations. Therefore, this final step corresponds to the reflective part of the BM application.

After the final interrogation, we took pictures of the body map made by the participant and saved the original image in a safe place, specifically in the Center of Study on Clinical Psychology and Psychotherapy (CEPPS) facilities at Diego Portales University. Figure 2(A) shows the body mapping made by our example case immediately after the MPI. The whole procedure is recorded in audio for further transcription.

The Case

Two researchers participated of the application of our BM protocol. The first corresponds to a certified micro-phenomenological interviewer for accomplishing Step 1. The subsequent three steps of application were conducted by a phenomenologist psychologist with the guidance of our art-therapist phenomenologist psychologist.

Participant Description

The participant is 18 years old and lives in the Metropolitan Region in Chile. Their sex assigned at birth is female and their gender identity is male. He has been undergoing hormonal treatment with testosterone for 12 months before the first interview. He uses a binder to compress his chest and says he doesn’t use any other type of object to reduce the feeling of discordance with his body. At the time of the interview, he had not undergone any medical-surgical intervention. However, in the future, he would like to have a mastectomy and a phalloplasty or metoidioplasty.

Step 1: Embodied Experience

By means of the micro-phenomenological interview, the participant evoked a situation during his birthday celebration with his family, where some of their aunts and his grandmother still used feminine pronouns to refer to him and highlighted parts of his body that caused his dysphoria. Regarding the evoked experience, the participant referred:

“The only ones who know are my aunts, my grandma doesn’t know, so she keeps treating me with incorrect pronouns. And my aunts too, despite of knowing… of knowing it and uh… what’s the name? That’s why I don’t really like family events. At least with that part of the family, because it’s stressful, because it’s as if everything I am… the process that I live and that I’ve lived will be invalidated in a few hours”.

About his experience of discordance with his body, he said:

“… like the chest, which is what stands out the most among them, or the legs too, which is like what usually causes me discordance, because they highlight it, and it is like a constant reminder”.

This first step lasted approximately 40 minutes, after a researcher assistant J.C. completed the entire micro-phenomenological interview by deepening the evocation of the moment. Then, we immediately proceeded to step 2 conducted by M.C.

Step 2: Outline the Body Shape

We invited the participant to lie down on the paper sheet, close his eyes if he feels to, and choose a bodily posture that represented the experience of discordance, he described during the MPI. The researcher gave the participant between two and 5 minutes to re-evoke the bodily sensations felt during the experience of discordance with his eyes closed, giving him indications to help him bring back those sensations to the present. For example, “try to remember the bodily sensations, starting from your feet and going up to your head, of how your body felt when your grandmom used the incorrect pronoun to refer to you. Then, find a posture that better expresses those sensations in your body”.

The participant chose a stiff bodily posture with straight arms and legs. His right arm was over his chest because he fractured his arm before the interview and was wearing a cast.

Step 3: Plastic Creative Expressive Process (PCE)

His creative process started in the chest and head of the humane figure, with more precise and detailed movements while he was talking about the difficulties during his affirmation process with his father and family and connected with his story and pain. Then he started to work on the shoulders, hands, and legs with wide and strong movements and moving in the space around the sheet. He finished his process by focusing again on the center of the human figure, drawing the figure in the abdomen, and then making precise details in the figure in the chest (an arrow and the curved line in the neck).

Step 4: Artwork end and final questions

In the chest, the participant made a blue heart with the trans flag inside: The heart “it is blue because I like it”, and the Transgender flag “Because it is part of me, and it is where it hurts the most”. He describes the elements around the heart as chains “that oppress it. And why is it in the center and surrounded by a black border? Because every time these things happen, those comments, are like they are rotting me.” The arrow he draws at the end “Is like… what it feels when they name me like, with another pronoun. With ‘her’, as who I am not. As if I were buried with something”. [Rough of the black paper in the heart]: “Because it’s rough, it’s like... it’s rough, it’s uncomfortable”…

Phenomenological Exploration

As can be seen in Figure 3 below, the information available for phenomenological exploration comes from two sources: (a) The plastic creative-expressive process (PCE), and (b) The final image itself.

Figure 3.

Data handling phenomenological exploration of both the process of artistic expression and its resulting artwork.

The following sources of information were considered for a first-order qualitative analysis with the corresponding triangulation criteria: the researcher’s direct observation, the participant’s description of their artwork, and the observations of a group of beholders (Figure 4).

Figure 4.

Researcher’s record of the creative process. Note: First-order analysis – Researcher’s record of the creative process.

Researcher’s Direct Observation

It corresponds to the researcher’s observations of the PCE process based on field notes recorded as Figure 1(B) shows, and a PCE observation guide. According to the assumption of art-based research as a form of phenomenological exploration of embodied experience (Gaete, 2022), we developed a guideline for the observation of the PCE process by the researcher for accounting for the procedural, sensorimotor, spatial, and different bodily cues involved in the process. This guide comprises four dimensions that give orientation to the researcher’s observation of the process:

The temporality of the creative process. This dimension refers to the rhythm of the creative process: fluid or broken, reflective pauses, tense pauses, doubts during the process, and the sequences of appearance of the images made during the creative process.

The spatiality of the creative process. How the participant used the space during the creative process: both the space of creation of the very sheet, and the physical space of the room while drawing and painting. Distinction between different areas of the sheet with more or less work, or qualitative significant differences.

The materials used during the creative process. Use of colors, textures, density, fading, and saturation of the colors. Intensity, direction, and movement of the traces.

The affective atmosphere during the creative process. Level of immersion or disaffection of the participant during the creative process, and the affective-emotional qualities emerging from the interpersonal-experiential space. It is perceived by intermodal features such as rhythm, intensity, dynamics, silent-noisy patterns, gestures, etc. It can be expressed as being warm or cold, calm, melancholic, relaxed or charged, familiar or threatening, and so on.

Participant’s Narrative

It corresponds to a participant’s narrative of their PCE process and the resulting image. After the PCE process is finished, the researcher conducted a final interrogation mentioned above in the fourth step. The researcher does this final interrogation aiming at getting the description of how the PCE process unfolded and the participant’s narrative of their final image. Examples of the data obtained in this stage of the process can be found in the case study described above.

Observations of Group of Beholders

A group of researchers observe the resulting image and fulfill a form that was specifically designed for this aim accordingly to the phenomenological framework named Artwork Observation Guide. We developed this observation guide grounded on the idea of the artwork as an intersubjective/inter-corporeal encounter between the author and the beholder in which aesthetic bodily resonance takes place (Falvo, 2018; Gallese, 2010, 2017a, 2017b, 2019). This guide is organized towards levels of observation as follows (see a more complete version of the Artwork Observation Guide in Supplementary Files).

Perceptual Level. For accomplishing the observational task, a phenomenological reduction is promoted. Thus, the first step is to describe at a very sensorial level: Describe what you see as if you were telling someone who is not looking at the image in as much detail as possible. Here you can find some examples of the data collected in this level: R.M.I.G: “I see a human figure with its right arm bent as if it were placed on its chest. On the chest a blue heart-like shape with black bindings and fastenings. Something like a black arrow in the center. A red arrow going from the outside pointing inwards (left-right). Blue and pink stripes on the lower right edge, and the whole figure surrounded by a thick black border and an outer red coloring. A kind of black necklace or cord around the neck with many loops”.

Level of Inter-corporeality and aesthetic bodily resonance. We ask the observer to describe and express what resonates with him/her physically and emotionally when he/her sees the image. Further questions are added for offering some tips for beholders’ observation task as follows: Which emotions does this image awaken in me? Do I identify any impulse of movement or action in my body when observing the image? Do bodily sensations appear when observing the image? Do I feel that the image touches/affects me in any way?

Here you can find some examples of the data collected in this level: R.C.M.: “Mutilated, wounded body, impacting on the stomach. Something monstrous that provokes rejection”. R.F.C.: “…it makes me feel tired, heavy, like it's taking away my energy, like I'm short of breath.”. R.M.I.G.: “It moves me backwards, especially my chest tightens. Also, a lump in my throat. It makes me want to cry to see the image of the pubis and the colored left hand moves me as if to strike with my fist...”. R.F.C.: “My neck distresses me. Like something choking it, like a wire, like something tangled… The navel is something I wouldn't go near, it looks like something dirty, like something wounded, putrefied. This creates a contradiction for me, because I want to feel empathy, but that particular part makes me feel rejection”.

Level of Body scheme and Body Image. The requirement is formulated as follows: The bodily position you see in the picture was the position adopted by the person in accordance with their lived experience (of the moment of bodily discordance). Describe the person's position on the sheet of paper. How do you think the person feels, sees, and thinks about their body? Further questions are added to guide the observation by means of clues such as qualities of the use of plastic material such as intensity, saturation, movement, use of space, etc., that are forms of sensorimotor expressions through the artwork useful for accounting for both body scheme and body image. Here you can find some examples of the data collected at this level: R.F.C.: “I think it is a subject that is in constant pain. A body that is like armor (thick, robust) but very ineffective…”. R.M.I.G.: “Stiffness, muscle tension, lack of mobility… Rejection of one's own body, shame, physical and emotional pain, disconnection, dislike of the thighs, the chest”. R.C.M.: “…He feels rejection, pain, oppression. He thinks of it as a constricted, bound, imprisoned body, and sees it marked, too visible and tormented”. R.I.P.: “That there are elements that make it impossible to move and that don't know how to go on. That has several thoughts that make him uncomfortable or clash with each other. That you find it difficult to incorporate the different elements of your body.

Level of Bodily Experience. The requirement is formulated as follows: Make a summary based on all that has been observed above that reflects the bodily experience of the author in this image (in our study a bodily experience of discordance). Here you can find some examples of the data collected in this level: R.C.M.: “Painful experience of rejection, with tormenting or overwhelming experiences of feeling a body imprisoned and sometimes feeling monstrous. With special rejection of the chest, genitals, and legs”. R.F.C.: “I think the main discordance of the body in the image is the lack of integration between the parts and the lack of harmony. I also sense the discordance between a wounded, gagged, marked body and a subject trying to survive”. R.I.P.: “Discordance with thighs, chest, abdomen, and thoughts”.

Reflections on the Process

Body Mapping Application

Our proposal replicates at some point the study of Valenzuela-Moguillansky et al. (2021) who used MPI in combination with the BM art-based research tool to explore in a pre-reflective manner the experiential means of a particular bodily experience. However, our proposal presents some variations from them: the first variation was the order of each phase of the study in which we start with the pre-reflective activities of MPI and BM before the reflective ones as the narrative interview that takes part in our broader research project. This decision makes the pre-reflexive exploration of the experience of discordance the first step of the whole data collecting process, allowing us to access the experience of the participants in a cleaner way preventing mental elaborations and representations from taking the place over direct lived experience.

Another methodological variation was removing the body scan//meditative technique before the MPI from the application procedure, because we consider that the evocation technique of the MPI by itself was a tool that allowed the participants both to evoke and connect with the bodily experience of discordance before the application of the BM. Further, the decision of using the evocation technique and desist from using the body scan was made due to that this interview takes part in the broader research project’s general aims. In this way, the entire research project gained parsimony and continuity in its development. Anyhow, our protocol proposal of application of the BM could be used with any other tool that leads to unfold and bringing to present a given embodied experience.

In this regard, a limitation we observed in our design had to do with the need to switch researchers between step 1 and step 2 of the protocol. While this was due to the need for an accredited researcher to conduct the MPI interview, it meant a small interruption to the process between evoking the experience and then expressing it. It is a recommendation for further studies to keep the continuity with the same researcher from the beginning to the end of the application of this protocol.

In relation to the induction and support given to the participant by the researcher M.C. in charge of step 2, it seems relevant to highlight the respectful and warm attitude towards the PCE process forming a creative-prone atmosphere giving careful suggestions and offers for the use of plastic materials that can improve the very creative process: as it was said always behind and never ahead of the participant. The diversity of plastic materials available seems to be of great relevance in supporting the PCE process giving the participant the confidence to create and express without significant material limitations.

Phenomenological Exploration

To our knowledge, this is the first protocol of phenomenological exploration within art-based research methods. The challenge of developing a protocol for phenomenological exploration of the experience of PCE and its resulting image arises from the assumption that artistic creation can function as a phenomenological exploration of experience. But how to extract the richness of a creative process and its resulting artwork without automatically moving on to interpretations was the challenge that moves us to apply phenomenological conceptualizations to keep the first-person experience of our participants alive, along with being honest with the fact that researchers’ observations are an unavoidable part of the observed phenomenon. This way, it can be said that what can have on hands with our proposal are first and second order data handling. First-order phenomenological data handling (which is what we have reported here): the very PCE process (that can be video recorded if further analysis is to be done) with the field notes of the researcher, and the resulting image with the narrative of its author and the beholders’ observations. And a second order qualitative data analysis (which its report is out of the scope of our article) can be developed using traditional qualitative categorization tools for verbal/narrative data (grounded theory, semantic analysis, content analysis, etc.) of the beholders’ observations, researcher field notes and the proper participant’s narratives of the process and its artwork.

Discussion on Ethics

Our proposal of application of the present protocol of phenomenological exploration of the transgender bodily experience and the complete research project of which it is a part are founded from its conception to its dissemination in the inclusion commitment of the stakeholders of the trans community. This commitment includes the participation of a consultant from the trans community, a psychologist and psychotherapist, who reviewed and made suggestions to the interview protocol. It also includes the future participation of other members of the trans community in Chile for data analysis and strategies for dissemination of the results at the end of the study. In fact, the resulting body map image “speaks for its own voice” and forms a fundamental part of the dissemination of the results. In this way we hope to build awareness and empathy about the transgender bodily experience and give an ethical meaning to the old slogan of minority activism: nothing about us without us, and, at the same time, we highlight one of the challenges of this research by making the first-person experience of our participants prevail.

Regarding the application of the BM technique some reflections emerged to be part of the initial setting questions about the participant’s physical condition at the time and the considerations that this may involve (e.g., need to eat something before starting the activity, need to go to the bathroom, considerations regarding physical limitations, etc.). Although this was done spontaneously by the interviewer, we believe it is relevant to consider it as part of the activity’s setting to ensure sufficient physical comfort and not to interfere with unnecessary discomfort the objective of the activity.

Another reflection that emerged had to do with the use of language: we believe it is relevant also to consider at the time of applying this protocol to spend some time at the beginning to check the particular way each individual refers to the different parts of his or her body. By this, a more respectful and closer way for the final questioning about the experience of creating body mapping could be ensured. In this regard, we did not observe any discomfort in our participants so far, however, we do not know if the collected material would have been even more genuine if we had access to the language that the person has to refer to his corporeality.

At the beginning of the present pilot application of our protocol proposal we decided to include at the second interview of the larger research project (a week after the BM) questions about how participants lived the former experience of BM and micro-phenomenological interview. In this way, we explored the acceptability and valuing of the lived experience to consider any observations or discomfort that participants might express. So far, the feedback has been very positive, even valuing some insights gained about their corporeality obtained during the micro-phenomenological interview and the BM.

Furthermore, as we state above, from an ethical and human rights perspective, our commitment with this study is to give a voice to all those TGNC people who usually do not achieve to put into words that which is felt in their bodies, and in this way contribute with novel ideas to better shape psychotherapeutic approaches.

Final Remarks

The combination of the BM art-based research tool with a phenomenological approach for the study of experience seems promising for studies aimed at exploring experience from an embodied approach. Including the researchers as beholders of the resulting artwork assuming the role of inter-corporality of the aesthetic bodily resonance as part of a valid “data collection” procedure seems innovative but loyal and honest with what an art-based research paradigm is. The resulting artwork is a different and challenging way of communicating results in which the participant is the owner of its own experience that is expressed by their firsthand. In our opinion, it represents a radical first-person research method in which the very images talk by themselves and the impact of the encounter with the beholders is respectfully and rigorously treated in order to include this information as part of the results of the study by means of our guide for beholders observations.

The idea of developing a protocol for the BM application has to do with the uncertainty about the results the body mapping process might bring. Further, following what Tarr and Thomas (2011) suggest about the need to isolate the body mapping from the qualitative interviews, it is our intention with this article to give a well-deserved space to the BM application protocol that risks of being absorbed by the rest of our broader research project in which words and narratives play the main role.

Finally, further research should consider a follow-up of the gender affirmation process through successive ‘snapshots’ that account for the changes in the bodily experience of transgender population through it.

Supplemental Material

Supplemental Material - Protocol of Application and Phenomenological Exploration of Body Mapping in Transgender Population: An Art-Based Research Method

Supplemental Material for Protocol of Application and Phenomenological Exploration of Body Mapping in Transgender Population: An Art-Based Research Method by María Isabel Gaete, Mariana Castillo-Hermosilla, Claudio Martínez, Felipe Concha, Isidora Paiva-Mack, and Alemka Tomicic in International Journal of Qualitative Methods

Footnotes

Acknowledgments

We thank Benjamin Silva for his advice on interview protocol.

Declaration of Conflicting Interests

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

Funding

This work was supported by the ANID – Millennium Science Initiative Program/Millennium Institute for Research on Depression and Personality – MIDAP ICS13_005. Also, this research received founding from Universidad Diego Portales, Chile (SG05 Investigación-Semilla).

ORCID iD

Felipe Concha

Supplemental Material

Supplemental material for this article is available online.

Notes

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