Development and Validation of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS)

Developing affirming interventions for transgender and nonbinary (TNB) therapy clients requires understanding their experiences with microaggressions in psychotherapy, yet no self-report measure of anti-TNB microaggressions in this context exists. Moreover, few studies have tested the associations between anti-TNB microaggressions and therapy processes. To better address the burden of unmet mental health care needs among TNB people, this three-study investigation designed and tested the psychometric properties of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS), a measure of TNB individuals' encounters with microaggressions in psychotherapy. Study 1 (N = 225) identified a four-factor model, comprising the themes of Educational Burdening, Lack of Affirmation, Inflation, and Invalidation. These subscales exhibited strong internal consistency reliabilities and demonstrated convergent and discriminant validity. The results of Study 2 (N = 435) replicated the four-factor structure through confirmatory factor analysis. However, bifactor analysis revealed that the Educational Burdening, Inflation, and Invalidation subscale scores were mostly accounted by a General Anti-TNB Microaggressions scale score-though Lack of Affirmation showed evidence of its independence. Also in Study 2, both scales were uniquely negatively associated with the working alliance. Study 3 (N = 151) found evidence for the test-retest reliability of GIEMTS scores over a 2-3-week period. Overall, the GIEMTS emerged as a robust and psychometrically sound instrument that captures the experiences of TNB individuals in therapy settings. The study concludes with valuable recommendations for training and clinical practice to bolster TNB mental health. Clinical Impact Statement Question: How do microaggressions against transgender and nonbinary (TNB) clients manifest in therapy, and is there evidence for their association with important psychotherapy process variables, such as clients' perception of the working alliance? Findings: The Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS) yielded two factors-General Anti-TNB Microaggressions and Lack of Affirmation-that showed evidence of construct validity, including negative associations with clients' perceptions of the working alliance. Meaning: The GIEMTS is a psychometrically sound self-report instrument that may inform TNB-affirmative training and may be used by therapists to assess and reduce th