Development and Validation of the Competencies in Sexual Health Counseling With Trans and Gender Diverse Clients Scale (CSHC-TGDS)

Abstract

Transgender and gender diverse (TGD) individuals have been underrepresented in research on healthy sexuality. It is crucial that mental health professionals (MHP) recognize the unique concerns and barriers faced by TGD clients in areas including access to healthcare, social support, and relationship issues. A previous Delphi study culminated in the initial development of a 54-item assessment of cultural comfort and professional competence among MHPs who provide sexual health counseling to TGD clients, the Competencies in Sexual Health Counseling with Trans and Gender Diverse Clients Scale (CSHC-TGDS). The current study utilized exploratory factor analysis to examine the factor structure of a briefer and empirically validated model. Three samples of participants were recruited through email listservs and professionally oriented social media groups: 1) graduate students in professional mental health programs, 2) MHP general practitioners, and 3) MHP practitioners with a self-identified specialty in gender and/or sexual health counseling/psychotherapy. Participants completed a 128-item online anonymous survey consisting of items from five measures assessing values of cultural humility, lifelong learning, competence working with TGD clients, and sexual intervention skill and comfort, followed by demographic questions. Principal factor analysis with a Promax rotation examined the CSHC-TGDS’s factor structure, reducing scale items from 54 to 30. The final model explained 61.39% of variance. Results from the EFA suggest that the CSHC-TGD is comprised of four factors: Professionalism, iv Research, Assessment, and Intervention Skills, Systems and Relational Care, and Supporting Gender Euphoria and Physical Pleasure. As predicted, the final scale was found to have sufficient- to good- internal reliability, convergent validity, discriminant validity, and construct validity with related measures (cultural humility, lifelong learning, competence working with TGD clients, and sexual intervention skill and comfort). Findings from this study suggest the CSHC-TGD is a promising tool with wide-ranging applicability for training, research, and self-assessment. The current study aims to support best practices for MHPs who work with TGD clients in sexual and intimate relationship health by enabling MHPs to critically evaluate their attitudes, biases, comfort, knowledge, and behavior when working with TGD clients in sexual and relationship therapy.