‘Readiness as opposed to eligibility’- preliminary consensus amongst professionals regarding gender identity assessments employing the DELPHI methodology

Abstract

Purpose
Gender identity assessments (GIAs) have been criticized by practitioners and trans and gender non-conforming (TGNC) individuals alike. With the practice of exploring individuals’ gender identity for treatment pathway purposes being potentially invasive and inappropriate, the current study aims to explore explicit standards.

Design/methodology/approach
The current study used the Delphi methodology to survey practitioners familiar with GIA. Over three rounds, 14 international participants rated their agreement about six areas relating to the assessment: purpose; content; approach; forensic application; psychometric instruments; and wider issues. Statements that reached an 80% cut-off among participants were viewed as a sufficient level of agreement, while the remaining items were fed back for repeated ratings. Furthermore, participants had the opportunity to suggest additional items that the group could rate.

Findings
Overall, a consensus across 23 items was achieved. The findings indicate a practice emphasizing collaboration between clinician and client to facilitate an informed decision. Furthermore, participants advocated for a non-pathologizing version of the GIA. This is a departure from diagnoses like gender dysphoria toward an approach which encapsulates also positive aspects of the trans experience, for example, resilience and future plans.

Research limitations/implications
Limitations include sampling biases due to participants’ high specialization and challenges in recruiting TGNC individuals. Furthermore, findings appear restricted to adult services.

Originality/value
To the best of the author’s knowledge, this pilot is a first step to making current practice transparent and comparable, with the hopes to improve trans care. Furthermore, it is contextualized with the previously suggested application of the power threat meaning framework to GIA.