Emotional, Behavioral, and Cognitive Reactions to ... - PsycNET

Psychology of Sexual Orientation and Gender Diversity 2014, Vol. 1, No. 1, 72– 81

© 2014 American Psychological Association 2329-0382/14/$12.00 DOI: 10.1037/sgd0000011

Emotional, Behavioral, and Cognitive Reactions to Microaggressions: Transgender Perspectives Kevin L. Nadal, Kristin C. Davidoff, Lindsey S. Davis, and Yinglee Wong

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John Jay College of Criminal Justice, City University of New York In recent years, there has been an increasing amount of literature focusing on microaggressions, or subtle forms of discrimination, toward people of color; women; people with disabilities; and lesbian, gay, and bisexual (LGB) people. Despite this, there is a dearth of literature that describes the types of microaggressions experienced by transgender people as well as the ways that transgender people cope with, or react to, microaggressions. The current qualitative study (N ⫽ 9) used a directed content analysis to examine transgender people’s psychological processes and coping mechanisms when gender identity microaggressions occur in their lives. Participants’ perspectives are categorized into 3 major domains: emotional reactions, behavioral reactions, and cognitive reactions. Psychological implications for research and clinical practice are discussed. Keywords: transgender, microaggressions, discrimination

Statistics, crimes directed against individuals on the basis of sexual orientation are the second most frequent hate crime committed. There were 7,240 reported single-bias hate crime offenses reported in 2011, and 20.8% resulted from sexual orientation bias. It is possible that transgender people who are victimized by hate crimes might be targeted by the same type of perpetrator and might be aggregated into this statistic. However, the FBI does not collect data on hate crimes committed on the basis of gender identity; therefore, the number of hate crimes against transgender individuals remains unknown (Human Rights Campaign, 2012; Nadal, Rivera, & Corpus, 2010). Another report estimated that there have been approximately 1,123 murders of transgender people in 57 countries worldwide from January 2008 to December 2012 (TvT Research Project, 2013). However, this amount is also likely an underestimate because data on murdered transgender people are not reported because of the fear of retaliation, stigma toward transgender people, and police misconduct (Nadal et al., 2010). Finally, it has also been found that hate crimes toward transgender and gender nonconforming (GNC) people are especially violent and that transgender victims are targeted for violence for more complex reasons than their gender variance alone (Stotzer, 2008). For example, some perpetrators target transgender people because they were explicitly prejudiced toward transgender people; some perpetrators assumed transgender people to be easy victims of robbery; and some perpetrators assaulted transgender people (particularly transgender women of color) because of their multiple identities (e.g., gender identity, race, socioeconomic status; Stotzer, 2008). Transgender and GNC individuals experience several types of systemic discrimination and injustice from various sectors: the criminal justice system, health care, family, employment, education, and other public accommodations and service providers (Nadal et al., 2012). One qualitative study examined career-related discrimination with female-to-male (FTM) individuals, and participants identified microaggressions, health-care systems, government policies, housing, and educational institution as sources of

Although the term “transgender” is used to encompass a broad range of people who express their gender beyond the male-female binary, it is an umbrella term that can be used to refer to anyone expressing a gender that does not match their birth certificate (Nadal, 2013). American society (and most other societies) tends to emphasize that people identify with their birth sex, that people identify rigidly as either male or female, or both. As a result, people of transgender experience often encounter a spectrum of discrimination in their lives—ranging from hate crimes, systemic bias, and subtle forms of discrimination or “microaggressions” (Nadal, Skolnik, & Wong, 2012). Microaggressions are brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, which communicate hostile, derogatory, or negative slights and insults toward members of oppressed groups (Sue, 2010). The purpose of this paper is to describe the types of microaggressions that transgender people experience as well as the ways that these experiences affect transgender people’s psychological health. Before examining microaggressions, it is first necessary to understand how overt forms of bias and discrimination (particularly hate crimes and systemic oppression) affect transgender people. Regarding hate crimes and transgender people, there are several issues to consider. First, there are currently only 16 states (plus Washington DC) that have passed laws prohibiting discrimination on the basis of gender identity or expression (Transgender Law & Policy Institute, 2012). According to the U.S. Department of Justice Federal Bureau of Investigations (FBI) 2011 Hate Crime

This article was published Online First February 10, 2014. Kevin L. Nadal, Kristin C. Davidoff, Lindsey S. Davis, and Yinglee Wong, Department of Psychology, John Jay College of Criminal Justice, City University of New York. Correspondence concerning this article should be addressed to Kevin L. Nadal, 524 W. 59th Street, New York, NY 10019. E-mail: [email protected] 72


TRANSGENDER REACTIONS TO MICROAGGRESSIONS

discrimination (Dispenza, Watson, Chung, & Brack, 2012). The National Gay and Lesbian Task Force surveyed 6,450 transgender persons and 63% reported experiencing at least one type of discrimination (Grant et al., 2011). Of these individuals who reported discrimination, 90% reported workplace discrimination, 19% reported housing discrimination, and 53% reported public discrimination (e.g., verbally harassed or disrespected in a public place). Nineteen percent of the participants reported that they have been refused a home or an apartment, 22% reported harassment by police, 46% reported being uncomfortable seeking police assistance, and 19% reported being refused medical care. In a study conducted by the San Francisco Department of Public Health (The Transgender Community Health Project, 1999) surveying over 500 transgender individuals, male-to-female (MTF) and FTM participants reported verbal abuse (83%, 85%, respectively), physical abuse (37%, 30%, respectively), employment discrimination (46%, 57%, respectively), and housing discrimination (37%, 20%, respectively). A myriad of researchers have reported that transgender individuals experience high levels of physical and sexual violence, with rates of physical violence ranging from 43– 60% and rates of 43– 46% for sexual violence (Clements-Nolle, Marx, & Katz, 2006; Hendricks & Testa, 2012; Kenagy & Bostwick, 2005; Testa et al., 2012; Xavier, Bobbin, Singer, & Budd, 2005). Research has shown that transgender individuals experiencing discrimination reported increased levels of psychological distress, suicide ideation/attempts, substance abuse, rates of HIV infection, apprehension, and interpersonal difficulties (Bockting, Miner, Swinburne Romaine, Hamilton, & Coleman, 2013; Budge, Adelson, & Howard, 2013; Budge et al., 2013; Clements-Nolle et al., 2006; Dispenza et al., 2012; Testa et al., 2012; Xavier et al., 2005). Bockting and colleagues (2013) surveyed 1,093 MTF and FTM individuals; results indicated a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). In a study with a sample of over 500 MTF and FTM individuals, it was reported that 32% of participants had attempted suicide at least once in their lives and that 28% of participants were (or are) in alcohol or drug treatment (Clements-Nolle et al., 2006). According to Testa and colleagues (2012), transgender individuals who have reported physical or sexual violence were at higher risk of suicide ideation, suicide attempts, and substance abuse. Thus, it is imperative to understand and prevent discrimination to avert physical and mental health disparities for transgender individuals.

categorical taxonomy on lesbian, gay, bisexual, and transgender (LGBT) microaggressions. In this model, the authors identified and provided examples of the specific types of microaggressions that LGBT people may experience. Nadal and colleagues (2012) used a directed content analysis (DCA) with transgender participants (N ⫽ 9) to test the model and found 12 types of microaggressions that targeted transgender and GNC persons. Seven of these themes were included in the original model, and five themes emerged. Themes included the following: (a)

Use of transphobic and/or incorrect gendered terminology: Experiences involving the use of denigrating language, incorrect gender pronouns, or both (e.g., publicly questioning a person’s gender).

(b) Assumption of universal transgender experience: Interactions in which individuals assume that all transgender persons are the same (e.g., assuming that all transgender people undergo gender-affirming surgeries). (c) Exoticization: Encounters in which transgender persons are dehumanized or treated like objects (e.g., people treating a transgender person as a “token” because of their transgender identity). (d)

Discomfort/disapproval of transgender experience: Occurrences in which transgender persons are treated with disrespect or condemnation (e.g., a person becoming judgmental after learning about a friend’s transgender identity).

(e) Endorsement of gender normative and binary culture of behaviors: Statements and behaviors that communicate that a transgender person is expected to be or act in gender-conforming ways and is denied their transgender identity. (f) Denial of the existence of transphobia: Instances when cisgender individuals (i.e., nontransgender people) invalidate a transgender person by denying that transphobic experiences exist. (g)

Assumption of sexual pathology or abnormality: Incidents involving the treatment of transgender persons as psychologically abnormal or sexually deviant (e.g., beliefs that transgender individuals are all associated with HIV/AIDS or are sex workers).

(h)

Physical threat or harassment: Experiences in which transgender persons are teased, intimidated, or bullied because of their gender identity; although they are not physically abused, their aggressors create threatening, unsafe environments.

(i)

Denial of individual transphobia: Instances in which a cisgender person denies that she/he has transphobic biases.

Transgender People and Microaggressions Transgender individuals experience hate crimes and other forms of discrimination that are intentional and conscious by the perpetrator(s); however, some researchers have suggested that transgender individuals are also likely to be victims of more subtle forms of discrimination, known as microaggressions (Nadal, 2013; Nadal et al., 2010, 2012). Researchers have found that microaggressions may have detrimental effects on targeted groups, such as people of color (Sue, Bucceri, Lin, Nadal, & Torino, 2010; Sue, Capodilupo, & Holder, 2008); women (Nadal, Hamit, Lyons, Weinberg, & Corman, 2013); and lesbian, gay, and bisexual (LGB) individuals (Balsam, Molina, Beadnell, Simoni, & Walters, 2011; Nadal et al., 2011a, 2011b). Using Sue and colleagues’ (2007) taxonomy on racial microaggressions as a model, Nadal and colleagues (2010) proposed a

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(j) Denial of personal body privacy: Statements or behaviors in which cisgender people objectify a transgender

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person’s body (e.g., a stranger asking intrusive questions about one’s genitals). (k)

Familial microaggressions: Subtle or unintentional forms of discrimination that occur within the family.

(l)

Systemic and environmental microaggressions: Covert forms of discrimination that occur on an institutional or community level.

Under this theme of systemic and environmental microaggressions, there were four subthemes: (a) public restrooms (e.g., transgender persons must make a frequent decision when unisex restrooms are not available), (b) the criminal legal system (e.g., transgender persons experience dehumanizing treatment from law enforcement), (c) health care (e.g., offensive comments or the use of an inappropriate gender pronoun by health practitioners), and (d) government-issued identification (e.g., difficulty with changing one’s legal name and gender on legal documents to access public assistance).

Microaggression Theory and Coping Mechanisms In recent years, there has been a spectrum of empirical studies that support Microaggression Theory—a comprehensive model of framing contemporary discrimination in the United States and many other parts of the world (Sue, 2010). Microaggression theorists postulate that people of various marginalized groups experience microaggressive environments across life domains, including workplace settings, educational systems, the media, and the general community, which, in turn, has a negative effect on mental health and well-being (Sue et al., 2007). When describing racial microaggressions, Sue and colleagues (2007) proposed three major categories of microaggressions: microassaults (i.e., conscious, explicit derogations), microinsults (i.e., subtle and unintentional statements and actions that communicate bias or prejudice), and microinvalidations (i.e., statements that negate people’s lived experiences). Nadal and colleagues (2010) applied microaggression theory to capture the experiences of LGBT people, citing that LGBT people may also experience microaggressions, including microassaults, microinsults, and microinvalidations. Regarding the psychological effect of microaggressions, microaggression theorists have proposed that people who experience microaggressions will undergo several cognitive and emotional processes when deciding how to react or respond to microaggressions (Nadal, 2013; Sue, 2010; Sue et al., 2007). Furthermore, it has been hypothesized that although microaggressions themselves may seem innocuous and minimal, the accumulation of microaggressive experiences may lead to severe psychological distress (Sue, 2010; Sue et al., 2007). Previous studies examining perspectives of African Americans (e.g., Sue, Capodilupo, & Holder, 2008), LGB people (Nadal et al., 2011b), and cisgender women (Nadal et al., 2013) all contribute to Microaggression Theory by asserting three major domains of microaggressions responses: (a) emotional reactions, (b) cognitive reactions, and (c) behavioral reactions. The purpose of this study was to validate that transgender people respond to microaggressions in similar ways.

Research Questions Using Microaggression Theory as a model, we used a DCA approach to measure transgender people’s reactions to microaggressions. DCA is a qualitative method that is widely used to “validate or extend conceptually a theoretical framework or theory” (Hsieh & Shannon, 2005, p. 1281). Using a systematic procedure to classify, code, and categorize data, DCA is particularly useful when a particular theory or model has been proposed but has not yet been supported by empirical data. To ensure that researchers are not simply using data to fit into existing theories or models, the DCA approach also encourages new themes to emerge (Hsieh & Shannon, 2005; Zhang & Wildemuth, 2009). Because there are no known studies that investigate how transgender people react to, or cope with, microaggressions, we used DCA to extend on Microaggression Theory by exploring the emotional, behavioral, and cognitive processes that transgender people undergo when they experience microaggressions. Because of this, we asked the following research questions: (a)

What types of emotional reactions do transgender people have when experiencing microaggressions?

(b)

What types of behavioral reactions do transgender people have when experiencing microaggressions?

(c)

What types of cognitive reactions do transgender people have when experiencing microaggressions?

(d)

Are there other ways that transgender people react when experiencing microaggressions?

Method The current study involved secondary analysis of a previous data set that examined transgender people’s experiences with microaggressions. Whereas the original data investigated the types of microaggressions that transgender people experience (Nadal et al., 2012), the current study aimed to explore how transgender people cope with microaggressions. When conducted correctly, secondary analysis of qualitative data has been cited as an empirically sound research method because it permits researchers to use existing qualitative data to answer new research questions and build on existing phenomena (Gladstone, Volpe, & Boydell, 2007). Researchers who use this method are charged with task of avoiding the “reuse” of previous data (Heaton, 2008) by ensuring that original themes are extricated from the raw data and that previous participant quotes that were used in prior studies are not included.

Participants Nine transgender individuals participated in focus group sessions for this study. Three participants identified as transgender men, and six identified as transgender women. Two sessions were conducted, with each group being mixed in terms of gender. Participants ranged in age from 21 to 44 years (M ⫽ 29.2, SD ⫽ 6.46). Five participants identified as Latina/o, two identified as multiracial, one identified as White, and one identified as African American. Two participants identified their socioeconomic status as middle class whereas the remaining seven identified as working


class or struggling with poverty. Two participants held bachelor’s degrees, two had some college education, four had a high school diploma or GED, and one had not completed high school.


Recruitment All recruitment and data collection procedures were approved by the Institutional Review Board. Participants were recruited primarily through LGBT community-based organizations in a large metropolitan city in the Northeast. Researchers asked staff members of these organizations to share information about the study to their transgender constituents. If participants were interested, then they would contact the researchers, who would explain the purpose of the study; if the participant was still willing to partake in the group, they were invited to one of two focus groups. Participants did not receive any financial compensation, but they were provided with light snacks and refreshments.

Researchers A research team comprising four individuals conducted the focus groups; these included one professor of psychology, two graduate students of psychology, and one medical doctor finishing his psychology residency. The principal investigator is an associate professor with 13 years of experience in qualitative research; he trained the remainder of the team on various methods of collecting qualitative data. Although the researchers were not required to disclose their gender identities or sexual orientations, one researcher identified as transgender and three identified as cisgender. One researcher identified as heterosexual whereas the remaining three identified as queer or gay. The research team discussed their assumptions about transgender people before creating research materials and collecting and analyzing data. Openly discussing personal biases is a standard practice in qualitative research (Fassinger, 2005) to minimize the effect of any existing biases through all stages of the methodology and analysis (Hill, Thompson, & Williams, 1997). The research team identified and discussed several general assumptions before collecting data. Researchers discussed potential ways that their personal identifications (e.g., gender identity, race, perceived sexual orientation) could affect the research and the research participants. Researchers also discussed the need to be culturally competent in working with transgender participants so that participants did not feel marginalized or objectified while participating in the study. For the current study, a separate team of researchers analyzed the data. These researchers included the aforementioned professor and one graduate student from the previous team as well as two new graduate students who were not part of the data collection process. Of this new group of researchers, all identified as cisgender. Three researchers identified as heterosexual and one as gay. Similar to the team that collected the data, this new team identified how their personal experiences, biases, and worldviews would potentially influence the data; they also agreed to challenge each other whenever potential bias affected their coding or interpretations.

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Measures Each participant completed an open-ended demographic form in which the participant could self-identify gender identity, age, race, ethnicity, sexual orientation, level of education, occupation, and number of years in the United States. The research team developed a semistructured interview guide, which included open-ended and follow-up questions that were modified from previous studies on microaggressions (e.g., Sue et al., 2010). For example, one question asked participants to “think about a time when you may have been subtly discriminated against because of your transgender identity. Describe the scenario as best as you can.” This question was followed with additional probing questions (e.g., “How did you react in this situation?” and “How did you feel after the event?”).

Procedure Focus groups were conducted in two locations: (a) a reserved room at a public city college and (b) an LGBT community center in a large metropolitan city. In each group, there were two focus group leaders and an additional researcher who observed the group. Each participant was given an informed consent form to read and sign; participants were informed that the sessions would be audio recorded and explained how confidentiality would be maintained. Participants were allowed to ask questions before the group began and were informed that they could withdraw from the study at any time. Each participant was also given a list of local counseling resources in case they felt distressed after the group. The two focus group leaders introduced themselves and shared their preferred gender pronouns (PGPs) with the group; group members then did the same. This procedure was conducted to allow participants to self-identify and to prevent microaggressions from occurring in the session. The focus group leaders then began to ask open-ended questions about experiences with microaggressions. Participants were given time to respond freely, and facilitators probed further with follow-up questions when appropriate. The group observer noted the participants’ nonverbal behaviors (e.g., tearfulness, laughter) as well as group dynamics (e.g., verbal agreement). Each session lasted approximately 90 min. After each session, the researchers met without the participants to discuss their observations of the group’s dynamics and their own personal reactions to the session. Focus groups were audio recorded to maximize accuracy and were transcribed verbatim by the research team.

Analysis Data were analyzed using DCA (see Hsieh & Shannon, 2005) to extend on Microaggression Theory (see Sue, 2010). As aforementioned, DCA is used to authenticate an existing theory or model by examining qualitative data and coding content into hypothesized categories. In using DCA, it is encouraged for researchers to create new themes when appropriate to extend the conjectured model or theory (Hsieh & Shannon, 2005; Zhang & Wildemuth, 2009). Because previous studies with people of color, cisgender women, and LGB people (Nadal et al., 2013, 2012; Sue et al., 2008) supported that people who experience microaggressions reacted in different emotional, behavioral, and cognitive ways, the team of



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researchers began the analysis process with three domains: (a) emotional reactions, (b) behavioral reactions, and (c) cognitive reactions. For the current study, the DCA approach began with three researchers independently coding each statement into one of the three hypothesized categories: emotional, behavioral, and cognitive responses. Going through both transcripts in their entireties, these three researchers read each transcript individually and highlighted quotations that describe each type of reaction to transgender microaggressions. They agreed on a color scheme to which to categorize each category (i.e., they highlighted emotional reactions with the color red, behavioral reactions with the color yellow, and cognitive reactions with the color blue). If other quotes did not appear to fit in any of the categories, then they were charged with highlighting them with the color green. Researchers then reconvened to discuss their work; they addressed each quote and reached consensus about the most appropriate category for the given statement. By the completion of this meeting, the three analysts reached consensus on all of the quotes. They also agreed that all of the quotes either fit into one of the three proposed categories or were outliers and did not constitute the creation of a new theme. The researchers then provided an external auditor with preliminary list themes and examples of quotes under each theme. The auditor, a professor of psychology with extensive knowledge about microaggressions and LGBT issues, helped to minimize the bias that may occur through group conformity, groupthink, or power dynamics among the three initial researchers. The auditor reviewed the proposed themes and the associated quotes and provided feedback to the team, which included the reconceptualization of themes and the unsuitability of certain quotes. The team met again to incorporate the auditor’s feedback and choose representative quotations to illustrate the themes. The auditor reviewed the final analysis and approved the team’s work.

Results Three domains represented the different ways that participants reported as responding to microaggressions: emotional reactions, behavioral reactions, and cognitive reactions. In alignment with the best standards of secondary analysis of qualitative data, all quotes that are presented are original and have not been used in any previous study.

Emotional Reactions Participants described experiencing various emotions in response to microaggression, which were organized into five themes: anger, betrayal, distress, hopelessness/exhaustion, and feeling invalidated and/or misunderstood. Emotions were assumed to exist on a continuum, and each of these themes takes the range of intensity into account for each emotion (e.g., “distress” is represented in mild and intense forms within its theme). Anger. Participants reported feeling anger in response to microaggressions, with descriptions that encompassed feelings of irritation to aggravation to hostility. Often, participants reported anger in response to experiences of being disrespected. For example, a transgender female described an encounter with a cisgender woman on the street:

She said, “You know those are men,” to the woman standing next to her, and then I called her a bitch . . . I didn’t know what to do, but I reacted to it . . . if she wasn’t with her daughter, I would have punched her in the face.

Another participant described a more mild form of anger in response to having attention drawn to them: “I was irritated because you keep . . . you’re always looking at me, you’re always focusing on me . . . you’re always putting up a big show, but you know it bothers me all the time.” Betrayal. Another emotion that emerged from the analysis was betrayal. Participants described being betrayed by partners, family, or former friends upon finding out that they identified as transgender or because of transphobia in the community. One participant shared an experience in which they felt a friend avoided her in public because of her transgender status: I happened to walk down the same block he was and he moved to the left and I kept moving forward . . . but the way he moved, you know? He waved hi . . . but it was like he was ashamed . . . as if I was diseased. I felt very uncomfortable. I was definitely hurt.

Another participant explained that her cisgender male partner did not want to be associated with her on social media (e.g., facebook.com), and did not want her to meet his friends. She described an interaction she had with his friends on social media and having to tell him that it occurred and the discord that ensued: I felt hurt, unappreciated, unloved. I felt lied to . . . I felt like I was being revictimized because my own boyfriend is telling me this is my fault. It’s like saying you know what, it’s your fault for being who you are, for doing the things you’ve done, and it’s like . . . I believe if you care for someone, if you love someone, you accept them for what they’ve done because that’s who they’ve been . . . it made me feel very, very low and you know, I’m still dealing with that.

The participant explained that it was particularly painful to experience discrimination from someone she was close to. Distress. General feelings of distress were communicated by participants; “uncomfortable,” “nervous,” and “traumatic” were all words used to describe their emotional reaction to microaggressions. One participant described her discomfort at a situation and the actions she took to gain control in those circumstances, further explaining: “I put myself out there, yes I know I did, and I was still mortified.” Concerns about safety were not the only triggers of distress. A transgender male participant shared his feelings around assuming the privilege associated with maleness, saying: “It’s hard to figure out— how do you balance being between who you are and wanting to be respected?” Hopelessness and exhaustion. Participants also communicated feelings of hopelessness and exhaustion. They discussed feeling as though they were constantly struggling against microaggressions and sometimes reached a point where they did not believe their situation would improve or that they could not fight the discrimination any longer. A transgender male participant shared the emotions he deals with in determining how to respond to microaggressions: It’s really like, exhausting . . . emotionally, physically taxing to navigate through all these different things. Choosing your battles or when you choose to defend things . . . and let them call me a “she” because I don’t want to have another fight. Sometimes you choose to accept it

TRANSGENDER REACTIONS TO MICROAGGRESSIONS and sometimes you say, “Okay, this is wrong” and battle for it. So yeah it’s totally right that it is emotionally taxing.

race stuff, I’m like yeah you don’t really know me, you haven’t really earned that trust, you know? Why do you wanna know?

Another transgender female shared the following explanation of her mental state when individuals refer to her with the incorrect pronoun and the painful emotions that arise around her gender identity being questioned:

A transgender male participant talked about feeling pressured to act a certain way to be accepted as male and the discomfort he feels about the privilege his status as male affords him:

Well, it’s hard for me. I look in the mirror and see something and you keep saying “he,” . . . and then I have to deal with it outside. It’s going to [make me want] to get a thousand surgeries because I feel like I don’t look like them, I don’t want you to call me “he.”


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The degree of despondence felt by some individuals was evident in a transgender female’s response to a dangerous situation. When asked why she did not call the police for help, she replied: “Sometimes I feel it’s hopeless . . . that I’m not a person or a name.” Feeling invalidated and misunderstood. Participants also expressed feeling invalidated and misunderstood by others. This ranged from problems with people not understanding what it means to be transgender to expectations of gender roles in more traditional culture and LGBT culture. One female participant stated: “[People ask] ‘Oh, do you still have a penis?’ Why the hell do you need to know what’s in between my legs?” The participant went on to say that others are more interested in questions about her gender and sexual orientation than the reality of “who I am and how I want to live.” Another participant shared feeling annoyed when people ask microaggressive questions: “It’s to satisfy a curiosity you know, it’s like celebrity gossip, you know what I mean? They don’t really care.”

Cognitive Reactions Regarding cognitions, participants reported rationalization of others’ discriminatory behavior, the difficult situation of struggling with double-bind situations, engaging in cognitions around vigilance and self-preservation, and thoughts about resiliency and empowerment. Rationalization. One method used by participants was rationalization of others’ actions. Participants suggested that lack of education might be a reason why perpetrators say or do things that are hurtful. Others suggested that culture plays a role in that dynamic; one shared that because of her Latina family’s strict cultural background “they’re going to be ignorant for the rest of their lives.” Participants also talked about attributing microaggressions to some defect in the perpetrator: “But that don’t faze me . . . I kind of like push it to that side because that’s their issue.” Another participant remarked: “They’re going to say whatever they want . . . I’m the type of person to let people talk.” Double-bind. A second theme that emerged within the cognitive domain was participants feeling as though they were in a double-bind. This theme involved dealing with conflicts that seemed to emerge as a result of the transgender experience. For example, a participant discussed how striking a balance around disclosing personal information is difficult: People are like, ‘So like what are you?’ And I’m just like, that’s so [complicated]. I’m mixed. I’m Puerto Rican, I’m Mexican, and it’s far more complicated than that. . . . So in terms of gender stuff and also

It puts me in a position where I have to be like . . . if I want to get treated like a human being in this situation I have to grab all kinds of armloads of privilege that I’m not totally comfortable with if I want to be legitimized.

The difficult situations that arise in response to microaggressions constitute a kind of “balancing act” for people who identify as transgender. Vigilance and self-preservation. Cognitions about vigilance and self-preservation also emerged as a theme. Participants discussed their need to constantly be aware of their surroundings and how their gender presentation was being interpreted in different situations. One participant remarked: “Safety was my number one concern.” One example of this vigilance was described by a participant: “I need to be aware, like in public, around how I perceive my gender identity [and] how other people perceive it.” Meanwhile, an MTF participant spoke about the issue of emotional safety. Although his physical safety may not be threatened in some environments (e.g., in the workplace), he reports being aware of spaces in which disclosing or trusting others might be risky. A transgender female participant spoke specifically to physical safety, saying The initial reaction at the time when he asked me that was like, “Oh shit,” because I mean, I kind of prepared for it because of just the subtle kind of, not even subtle, the gestures and the way he looked at me. I knew what was going to come with that.

The vigilance exhibited by this participant proved to be selfpreserving because it heightened her awareness of a potentially dangerous situation, and in the end it helped her to avoid further confrontation. Resiliency and empowerment. The participants also discussed thoughts about resiliency and empowerment, such as engaging in positive self-talk and being confident as methods of coping with microaggressions. One transgender male participant explained: “I’m so not bothered by it . . . I’m so confident about myself that . . . it doesn’t faze me.” Participants frequently referred to the concept of “holding your head up high” in combating discrimination by others. A transgender female participant illustrated this when talking about being called names by strangers in the street: “Sometimes I get, I get a little nervous . . . but you know there are times when I just don’t bother and I just [hold] my head up high.” Another transgender female participant described the amount of work she has put into living life on her terms: All the years that I’ve put into living my life to a level where I can walk the street with my head up high and “Yes ma’am” and “How can I help you, miss?” and “mami” and “sweetheart” and being addressed in the proper pronoun in which I identify as.

She went on to describe that she does not make any apologies for who she is and the respect she demands of others, stating: “I’m very strong like, this is who I am, you accept me and you love me . . . period.”


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Behavioral Reactions The behavioral domain consists of different types of actions or inactions that were taken in response to microaggressions. Three themes emerged within the behavioral domain: direct confrontation, indirect confrontation, and passive coping. Direct confrontation. Participants described situations in which they used direct confrontation to address the microaggression or the perpetrator of the microaggression. This was usually accomplished through some verbal assertion and sometimes included providing education about what it means to be transgender. When addressing more obvious transphobic comments, participants described feeling an obligation to react. An MTF participant discussed this in terms of her cisgender male partner: “He was extremely, extremely transphobic when we first met and I kind of felt an obligation to break him out of that and through time and dedication I did where he then fell in love with me.” Correcting improper pronoun usage was also a common form of direct confrontation, and several participants described “always” having to correct others. More than one transgender female participant had even gone so far as to reveal their breasts in an attempt to justify her gender. A transgender female participant described constructively confronting the ignorance of a friend: I was like, “Umm, I’m not gay, I’m a transsexual and just because I like men, that’s my sexual preference. That [has] nothing to do with why I dress like a woman, there are women like me who like women.”

Others described having to directly address microaggressions by medical professionals. In a hospital emergency room, one participant explained that medical staff kept coming to look into her room after being informed of her transgender status. She confronted this intrusive, subtle discrimination by saying to a nurse: “You know what, I’m not here for you to look at me. I’m here for you to help me.” Another participant described being continually called by the name on her insurance card despite requesting to be called by her current name; she eventually addressed the technician’s behavior: “I said, ‘You know you didn’t call me by the name that I asked . . . you know that wasn’t right.’” Indirect confrontation. Forms of indirect confrontation used by participants were setting boundaries; contacting authorities; and, more rarely, displays of aggression used to preempt future harassment by others. A transgender male participant discussed his response to a stranger whose requests for information required firm boundary setting: “He was like, ‘So are you like a man, maybe? Or a woman maybe?’ . . . so I was like, ‘We have to be friends for me to answer that question.’” Instead of confronting the stranger directly in an assertive or antagonistic way, she simply opted to assert her ground and not answer the question. Other participants opted to contact authorities and allow them to handle the situation, from police and security to an authority figure in a specific institution. One transgender female participant learned more proactive ways to act in certain situations: I learned a lot of good things, like to take down people’s names, when you see them call the cops, you know. I always used to write down the date and times that it happened. I just had safety plans.

Participants also used indirect ways of informing others that inappropriate behavior would not be tolerated, similar to boundary

setting. A transgender female participant described her approach to going to jail for the second time: This time I knew I was going to go through it and I wasn’t going to allow anyone [to] think that I’m quiet or that they can just do whatever they want to me. I want them to know that I’m an outspoken person and that you know, I’m a hot box . . . That’s what I became and that’s what I was called, meaning that I bring attention to whatever [is] happening and I just wanted people to know that . . . for my own safety . . . . Like okay, let’s not mess with her. She’s going to get me in trouble.

In this way, she was able to indirectly communicate that she would speak up if conditions in jail were unacceptable to her. Passive coping. Participants also described methods of passive coping, which included diffusing, deflecting, avoiding, or appeasing other individuals; removing themselves from the situation; or purposely refraining from direct or indirect confrontation of any kind. One participant commented: “It’s always that moment like, how do I minimize the attention?” Another participant described having to appease well-intentioned people who may inadvertently microaggress when trying to be sensitive. She described her relationship with her mother “you don’t wanna be like harsh on your mom for like, you know, saying something that is really fucked up.” A more common method of passive coping was avoidance. Many participants described how they avoid public restroom debacles by either not using the restrooms in public or by trying to find disability-accessible restrooms. In a particularly salient example of avoidance, one participant stated that they avoid going to the doctor because of microaggressions by medical staff: “I haven’t been to a doctor since 2001. I go on WebMD. I go on the websites and see how to take care of myself.”

Discussion The current study aimed to examine the various ways that transgender people cope with, and react to, microaggressions. Similar to microaggression studies with African Americans (e.g., Sue et al., 2008), LGB people (Nadal et al., 2011b), and cisgender women (Nadal et al., 2013), it is evident that there are a myriad of emotional, behavior, and cognitive reactions that transgender people have to microaggressions. Emotionally, transgender participants responded with feelings of anger, betrayal, distress, hopelessness, and not being understood. Although these emotional reactions may not appear to have long-term consequences when they immediately occur, the accumulation of these emotions may have a significant effect on people’s mental health (and potentially even physical health). Cognitively, participants described many thought processes that occur when they encounter microaggressions. They sometimes rationalized others’ discriminatory behavior in that they could explain that perpetrators were uneducated or ignorant and that was the reason for their lack of sensitivity toward transgender people. They reported being extremely vigilant and cautious of their surroundings, and many participants believed that their experiences with discrimination led to feelings of resiliency and empowerment. Likewise, although previous microaggression literature claims that people of color, cisgender women, and LGB people assess potential physical and emotional consequences before making a decision



of how to respond to microaggressions (Sue, 2010), it appears that the transgender participants in this study are especially aware of the physical consequences that can occur if they confront their microaggressor. The facilitators and observers noted that all of the participants seemed to be knowledgeable of the history of antitransgender violence; thus, it appeared that all of the transgender individuals very cautiously made their decisions about reacting to microaggressions. Participants described being the recipient of microaggressions by all sorts of people in their lives—from systems (e.g., police officers, health care, etc.), from their families, and from their colleagues. It seemed that regardless of who was enacting the microaggression, participants were negatively affected; however, it appeared as if their emotional or behavioral reactions differed based on the source. For instance, one participant described the microaggressions she experienced from her lover; these experiences appeared to especially affect her because of their intimate relationship. As a result, she reported internalizing many negative emotions such as sadness and self-blame. Meanwhile, when a microaggression occurred from a stranger or a passerby, participants reported being upset, but they appeared better able to cope because these individuals were not significant in their lives. The current study supports previous literature that microaggressions are related to physical health and well-being. For instance, one participant explicitly proclaimed that she refused to go to a medical doctor because she does not want to be mistreated, harassed, or discriminated against. Although she may believe it to be a sensible coping strategy, it may actually have negative implications for her health. Not only is she not seeking help when she is physically ill, but it may also mean that she is not being medically supervised if she is undergoing hormonal treatments. It has been reported that many transgender people are acquiring hormones from the street; in fact, one study with a sample size of 248 transgender people of color found that 72% of those who were taking hormones obtained their hormones from friends or on the street (Xavier et al., 2005). Further, although the literature on transgender coping mechanisms is limited, the current study aligns well with previous studies that have examined transgender experiences and psychological processes. For instance, Budge and colleagues (2013) found that transgender people experienced various types of emotional and coping experiences when in different phases of transitioning (i.e., pretransition, amid transitioning, and post-transition). Researchers reported that transgender participants might engage in avoidant coping (manifested through cognitions and behaviors) and facilitative coping (manifested in cognitive behaviors). The current study aligns with these results in that participants reported cognitive and behavioral reactions that could be labeled as avoidant (e.g., “passive coping” under the behavioral domain) or facilitative (e.g., “resiliency and empowerment” under the cognitive domain). Furthermore, in examining the relationship between coping mechanisms and mental health for transgender people, one study found that avoidant coping strategies were related to psychological distress for transgender people (Budge, Adelson, & Howard, 2013). Results from the current study demonstrate that although transgender people do indeed engage in some avoidant coping strategies, they also report an array of facilitative cognitions. Given this, it might be beneficial for transgender people to develop these more

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affirmative cognitions to assist in decreasing psychological distress.

Implications for Psychology The current study has many implications for the field of psychology. Practicing psychologists must be knowledgeable of the types of microaggressions that their transgender clients may deal with on a regular basis and encourage open dialogues about these experiences to ensure that their clients are effectively coping with microaggressions. Educators, supervisors, and trainers need to ensure that they are teaching their students about microaggressions to prevent microaggressions from occurring in therapy settings, in the classroom, and in everyday life. Because it is very common for people to enact microaggressions without even being aware (e.g., participants report that others regularly use incorrect gender pronouns), it is important for psychologists to gain awareness of their own behaviors. Given the literature that proclaims how LGBT clients have reported that therapy is ineffective when their therapists were unsupportive, judgmental, or microaggressive (Israel, Gorcheva, Walther, Sulzner, & Cohen, 2008; Shelton & DegladoRomero, 2011), it is especially crucial for clinicians to be sensitive in their work with transgender clients. This study also yields implications for future research. First, because this study was exploratory in nature, we chose a qualitative method with a smaller sample size to answer preliminary research questions. For future studies, it may be necessary to use quantitative measures with larger sample sizes to understand how transgender people cope with microaggressions as well as how these microaggressions affect mental health outcomes (e.g., anxiety, depression, self-esteem) and physical health outcomes (e.g., cortisol levels, blood pressure, etc.). Second, future researchers may be interested in how other factors may serve as moderating or mediating variables that affect the relationship between microaggressions and coping. For instance, issues such as identity status (i.e., the level to which one is comfortable with their gender identity), internalized transphobia (i.e., a transgender person’s negative attitudes about one’s own gender identity), or appearance (i.e., whether one is able to “pass” as a male or female) may affect one’s experiences with, and reactions to, microaggressions. It may worthwhile for future studies to investigate transgender clients’ experiences in psychotherapy; whereas one study highlighted the types of microaggressions that LGB clients may face in therapy settings (Shelton & Deglado-Romero, 2011), researchers may be interested to know the specific types of microaggressions that transgender clients experience from their psychotherapists. Finally, studies with larger sample sizes may be used to look at within-group differences (i.e., whether or not microaggressions differ significantly between MTFs and FTMs, transgender people of color and transgender White people, etc.). Because the transgender community is just as diverse as any other community, it is important to understand how multiple identities may affect one’s experiences.

Limitations Although this study yields important findings regarding transgender people and microaggressions, there are limitations to consider. Although the participants in our study were diverse, the



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sample size was small and may not be generalizable to the entire population. Moreover, all of our participants identified as transgender men or women, without any participants identifying as genderqueer or GNC. Thus, experiences of individuals who identify somewhere along the gender spectrum might not be fully represented in this study. Furthermore, although we examined microaggressions due to participants’ gender identities, it is likely that other identities (e.g., race, appearance) may have influenced their experiences with microaggressions and thus may affect the ways that they cope with microaggressions. Thus, our study does not take into account how intersectional identities influence one’s experiences and coping. Furthermore, our participants were recruited from a large metropolitan city in the Northeast and may not be applicable to other parts of the country. Finally, although we took all precautions in conducting our qualitative research, there is still a potential that our biases may have affected the ways that the data were analyzed or interpreted. Using DCA could be limiting in that researchers approach phenomena with a theory or model in mind, which may disallow them from being open to other ways of analyzing the data (Hsieh & Shannon, 2005). Although researchers took precautions in using DCA (e.g., using an external auditor, openly discussing biases, etc.), perhaps a different qualitative analysis could have been helpful in examining the data. Despite all of these limitations, our exploratory findings help to elucidate how transgender people cope with microaggression experiences, and they can be helpful in advocating for bettering the world for transgender people.

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TRANSGENDER REACTIONS TO MICROAGGRESSIONS Sue, D. W., Bucceri, J. M., Lin, A. I., Nadal, K. L., & Torino, G. C. (2010). Racial microaggressions and the Asian American experience. Asian American Journal of Psychology, S(1), 88 –101. doi:10.1037/1948-1985 .S.1.88 Sue, D. W., Capodilupo, C. M., & Holder, M. B. (2008). Racial microaggressions in the life experience of Black Americans. Professional Psychology: Research and Practice, 39, 329 –336. doi:10.1037/0735-7028 .39.3.329 Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M., Nadal, K. L., & Esquilin, M. E. (2007). Racial microaggressions in everyday life: Implications for counseling. American Psychologist, 62, 271–286. doi:10.1037/0003-066X.62.4.271 Testa, R. J., Sciacca, L. M., Wang, F., Hendricks, M. L., Goldblum, P., Bradford, J., & Bongar, B. (2012). Effects of violence on transgender people. Professional Psychology, 43, 452– 459. doi:10.1037/a0029604 The Transgender Community Health Project. (1999). Retrieved on May 7, 2013 from http://hivinsite.ucsf.edu/InSite?p.⫽cftg-02-02 Transgender Law & Policy Institute. (2012). Non-discrimination laws that include gender identity and expression. Retrieved from http://www .transgenderlaw.org/ndlaws/index.htm

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Received September 21, 2013 Revision received December 8, 2013 Accepted December 14, 2013 䡲

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