This qualitative study examines the healthcare provision for gender dysphoria patients by the National Health Service (NHS) in England. The thesis takes as its starting point the experiences of those providing and receiving care following the A, D & G vs North West Lancashire Health Authority court decision in 1999. The aims of the research are threefold: To examine what trans narratives tell us about individual understandings of gender, to explore what practitioner narratives tell us about the understandings of gender utilised in NHS treatment, and to determine what issues are important to consider when providing gender services. It undertakes an empirical thematic analysis through a triangulation of data sources - a literature review, qualitative interviews with specialists and focus groups with trans patients. The research is underpinned by three central questions: Do differences exist between the ways in which trans people and their doctors understand gender identity? Can the ways in which trans people formulate and express their gender identity map onto the notions of gender that practitioners employ? What are the wider implications for healthcare policymaking? The research questions were intended to investigate how trans people formulate and express their gender, whether and how those understandings differ from those that practitioners employ, whether trans narratives can map onto medicalised notions, and the implications for healthcare policymaking.

The overarching aim of this thesis was to explore psychological wellbeing among a treatment seeking population of trans individuals. Specifically, psychopathology and quality of life were studied as key dimensions of psychological wellbeing. The thesis begins with a proposed model of predictors of psychological wellbeing derived from a review of the literature, which includes social support, interpersonal problems, body dissatisfaction, self-esteem, experiences of transphobia, non-suicidal self-injury (NSSI), age and gender. Study 1 proceeds then to focus specifically on levels of perceived social support and its relationship to psychological wellbeing. Study 2 assesses interpersonal problems. Study 3 investigates prevalence rates of NSSI. Drawing on the findings from the previous three studies, Study 4 subsequently tests an amended model of predictors. In terms of the methodology employed across the studies, a cross-sectional questionnaire survey was conducted using standardised measures, a large sample of trans individuals recruited from a national gender identity clinic (GIC), and a matched control group of non-trans (hereafter referred to as cisgender) individuals. Throughout, consideration was given to differences between trans women and trans men as well as how trans individuals compare to cisgender individuals, with regards to each of the variables tested. The thesis concludes with a revised model of predictors, in addition to recommendations for preventing the development of poor psychological wellbeing and interventions for improving poor psychological wellbeing among the trans population.

Mixed race and African South African parents of children coming out as Lesbian, Gay, Bisexual, Transsexual, Intersex, Queer, Questioning and A-Sexual+ have a unique set of challenges within their cultural, religious and social contexts. The problem statement for the study entails that parents have to deal with familial and societal perceptions and reactions to their child coming out, face their own challenges and fears concerning their child’s sexual orientation or identity, and find coping strategies to deal with their coming out as LGBTIQA+. During my research in the UNISA library and online I found that there is a paucity of literature on this subject matter, especially within the South African context. The aim of this study was to obtain an in-depth understanding of these mixed race and African parents’ experiences, challenges and coping strategies in relation to a child coming out as LGBTIQA+. The Resiliency Theory of Family Stress, Adjustment and Adaptation, as linked to Hill’s Stress Theory and the Strength-based approach, were adopted as related theories within the theoretical framework of this study. A qualitative approach was employed, as I intended to gain insight into the lived experiences, challenges and coping strategies of mixed race and African South African parents in relation to a child coming out as LGBTIQA+, as well as to gain advice on social work support. A phenomenological and collective instrumental case study design, together with an explorative, descriptive and contextual strategy of inquiry, were used to explore, describe and contextualise how mixed race and African parents of LGBTIQA+ children experienced their children’s coming out, what their challenges were, and the coping strategies they employed to manage the challenges experienced. The sample of participants was selected by utilising purposive sampling. Semi-structured interviews, contained in an interview guide, were used to collect the data that was analysed using Tesch’s method of analysis (in Creswell, 2014:198). The data were collected by means of individual interviews and presented in a cross-person manner using selected narratives from the participants. Guba’s model, as espoused in Krefting (1991) and Lietz and Zayas (2010), was used and the four aspects of trustworthiness, namely credibility, transferability, dependability and confirmability, were applied. Ethical considerations were observed. The findings led the researcher to make recommendations regarding social work practice, education and further research into the phenomenon of parental experiences, challenges and coping strategies in relation to a child coming out as LGBTIQA+. In terms of parental experiences of their child coming out as LGBTIQA+, I found that parents were surprised and unhappy, disappointed, pained and shocked, and fearful for their child’s safety when they realised he or she was LGBTIQA+. When it came to their challenges and fears, the parents openly admitted that what the community, church and external family would make of their child being LGBTIQA+ caused stress for them. Lastly, the parents made recommendations to social workers based on their experiences, challenges and coping strategies, indicating that social workers should focus on sharing information and guiding parents; but firstly, social workers must have self-awareness and understand their own attitudes toward LGBTIQA+ matters. / Social Work / MA (Social Work)