Dramaturgical Accounts of Transgender Individuals: Impression Management in the Presentation of Self to Specialist Gender Services

Abstract

Demand for gender dysphoria (GD) treatment has increased markedly over the past decade. Access to gender-affirming treatments is challenging for most people. For dysphoric individuals, much is at stake. Little is known about the specific needs, challenges, and coping strategies of this hard-to-reach group. We examined the experiences of treatment-seeking adolescents and adults using in-depth unstructured interviews with 26 people attending specialist gender services and 14 transgender people not referred to services. Patients with gender dysphoria distrust clinical services and describe considerable anxiety in sustaining their impression management strategies to obtain treatment. An authentic presentation is regarded by some participants, especially non-binary individuals, as inauthentic and emotionally difficult to maintain. Impression management strategies have partial success in accessing services. The presentation of “idealized” selves may result in unmet mental health needs of patients, and the receipt of interventions incongruent with their authentic selves.

‘Stuck in the System’: An Interpretative Phenomenological Analysis of Transmasculine Experiences of Gender Transition in the UK

“…Our results expand on this by demonstrating the 'sacrifice' and 'loss' transmasculine people endure throughout this process. The negative impacts on service-users has been explored by Lehmann et al (2021), specifically in relation to "impression management" (i.e., presenting oneself as the most compliant and expected version of a trans patient). Lehmann and colleagues argue that continuous impression management can lead to exhaustion and burnout, and causes service-users to feel they cannot disclose concerns about their mental wellbeing.…”

“…Our results expand on this by demonstrating the ‘sacrifice’ and ‘loss’ transmasculine people endure throughout this process. The negative impacts on service-users have been explored by Lehmann et al (2021), specifically in relation to ‘impression management’ (i.e. presenting oneself as the most compliant and expected version of a trans patient).…”