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The campus environment

As a profession, we are just beginning to understand the needs of transgender students on college and university campuses. Without fully understanding their experiences, college counselling centre clinicians may struggle with how to best support students who identify outside a gender binary. This article explores emerging research and clinical observations to illustrate how transgender students experience life and support on campus as well as the unique challenges they face. It then provides recommendations to campus counsellors on how best to support their non-cisgender students.

Of great concern are the high rates of trauma and mental health concerns experienced by transgender students. In their study of over 26,000 college students from across the US, Swanbrow Becker and colleagues found that, compared with lesbian, gay and bisexual (LGB) students and their heterosexual cisgender peers, trans students reported considerably higher rates of trauma and suicidal experiences.¹ In particular, transgender students reported a higher lifetime history of trauma, suicidal thoughts and suicide attempts. Trans students also showed higher reactivity to stress through their reported higher rates of suicidal thoughts and attempts in response to a recent stressor. These results suggest that although trans students probably share some risk factors with LGB students, as the rates of their reported trauma and suicidal experiences are greater than those of cisgender heterosexual students, transgender students’ traumatic experiences and reactions to stress appear more severe (see table one). These issues appear to start before college: among LGBT youth in primary and secondary educational settings, 55 per cent reported verbal harassment, 23 per cent reported physical harassment, and 11 per cent reported physical assault based on their gender expression.²

Table one: A comparison of trauma and suicidal experiences between transgender, LGB and cisgender-heterosexual university students.

Source of statistics: Swanbrow Becker et al, 2006. ¹

In the UK, a large percentage of trans students face negative comments or conduct from university staff and students based on their gender identity.³ In addition, trans students report being physically attacked by other students or university staff because of their gender identity.³ Unfortunately, many trans students report not feeling confident in reporting bullying to university staff and hide their trans identity out of fear of discrimination. Many also report that they are actually encouraged by university staff to hide their gender identity ³ (see table two). Stieglitz reported that transgender youth are at risk of academic problems, isolation, unemployment, poverty, homelessness and substance abuse.⁴ In a national community survey of transgender adults, 15 per cent reported leaving educational settings prematurely, from kindergarten to college, as a result of harassment.⁵

In the US, the National College Health Assessment was used to gauge the 12-month prevalence rate of mental health conditions for trans students compared with other college populations.⁶ It showed that transgender students have approximately twice the risk for most mental health conditions compared with cisgender female students. For the three most common mental health concerns in the survey – anxiety, depression, and panic attacks – trans students experienced them about three times as frequently.

Table two: Transgender students’ experiences of discrimination, bullying and adverse conduct on campus

Source of statistics: STONEWALL ³

As the rates of mental health concerns are higher among transgender students, it is important to understand factors behind their stress. As with other students, academic concerns lead the list of stressors for transgender students. However, trans students report different primary stressors, along with higher rates of traditional student stressors, than theirÌýcisgender peers: concerns related to gender identity, emotional health, finances, life transition, family and friend problems, physical health, discrimination, sexual orientation concerns, substance use, traumatic experiences and relationship violence.¹ Other studies have identified financial and housing concerns as primary stressors.⁷ Examination of results from The National College Health Assessment in the US found that rates of violence experienced by trans students, including partner violence, sexual violence, and other types, were higher than both female and male students over a 12-month period.⁸

Clinical considerations

Based on the experiences of transgender students on campus, there are several considerations for clinicians and other university staff to take into account when working to support them. First, gender identity and sexual orientation are distinct, but interrelated constructs.⁹ While transgender students are often grouped with their LGB peers, they often report feeling excluded, different from and at times discriminated against by the LGB community.^10,11 Transgender students also appear to carry more fluid identities of themselves in other domains, and working with them requires a focus on the intersectionality of identities.⁹ For instance, 28 per cent of trans students identified with more than one race or ethnicity as compared with only five per cent of their cisgender peers.¹ In addition, when asked about their sexual orientation, 33 per cent of transgender students selected ‘other’ and 28 per cent of trans students identified as heterosexual,¹ suggesting some may not feel the same need to address sexual orientation concerns as their LGB peers.Ìý

While the transition to college can be stressful for all students, transgender students face additional challenges as they may find themselves changing in different ways from their peers. Complicating their ability to cope, trans students often face a lack of social support, including rejection by their family, religion, and friends. For those choosing to engage in gender reassignment treatment, their period of physical transition can be particularly difficult as they may project an outward appearance that is in transition, experience the impact of new hormones they are receiving, and potentially expend considerable financial resources during their transition due to seeking private care for their surgery and/or from their lack of access to resources from their families. This period of transition also puts them in a particularly vulnerable position, where risky behaviours may increase to secure financial resources and housing, such as engaging in sex work or ‘survival sex’ (trading sex for food), to generate income.^12,13

Considering the challenges faced by trans students, what can counsellors and universities do to support them? First, counsellors can help trans students by providing emotional support, sharing information, and building skills to allow them to cope with their challenges and environment. Secondly, campuses can look at their policies, processes, systems and culture and enact changes to support the inclusion of trans students on campus.

Counselling

Although transgender students are disproportionally impacted by health and safety concerns, they also endeavour to cope, with almost half using campus mental health services.¹⁴ While trans students may be less inclined to turn to peers and family for support compared with other students, an encouraging finding from research shows that transgender students are more likely to seek out counselling services than other students, where trans students have received support from counsellors, psychiatrists, counselling centres and clergy at higher rates than both LGB and cisgender students.¹

Stieglitz found positive social support, including areas of emotional, medical, mental health, housing, food and education support to be a major source of resiliency for transgender youth.⁴ Counselling centre staff can provide psychological assessments to help students understand themselves better, treatment for underlying conditions, information about supportive resources in the community, and advocacy to improve the campus environment. It is important to note that trans students do not require psychological treatment for identifying as transgender. Rather, they need support to explore their identity and cope with an environment that can be hostile towards them.

Group counselling is particularly recommended for transgender students in order to provide a forum for peer support. The counselling group can be structured as a theme group, which draws upon the benefits of interpersonal psychotherapy and psychoeducational groups.¹⁵ The group provides a safe space for expression of feelings, learning about issues transgender students face, building skills to manage stressors, and connecting with other transgender students on campus. Appalachian State University created one of the first counselling groups for transgender students.¹⁶ Psychologists supervise the group, which is structured as an open group, where membership changes as students enter and leave. New members benefit from the experience of longer-term members, both in terms of learning how to navigate the campus environment, cope with emotional challenges, manage the often difficult task of ‘coming out’ to family and friends, and hearing about how they sought changes to their legal status and physical attributes. The longer-term members also benefit by serving a role of helping others with their transition, giving them a sense of empowerment and agency. The group also serves as a forum for training students and clinicians on how to work more effectively with transgender students.

Individual counselling can help trans students form realistic expectations about the environment, including sources of support and building skills to help them access resources. Counsellors can also help trans students feel more visible and validated in their gender identity.¹⁷ The transition process can be difficult for trans students, where they may have faced rejection by their friends and family, but must also overcome emotional and financial challenges. They often have a strong desire to turn to their families and communities for support, but helping trans students decide when to ‘come out’ is critical because once they share their gender identity with others, they cannot pull the information back if they get a negative reaction.

Perhaps more than other students, transgender students come to the therapy room with a history of discrimination, rejection, and abuse associated with their attempts to express who they really are. Based on the high levels of trauma and discrimination experienced by transgender students, clinicians should practise trauma-informed care, by creating an environment that furthers safety, choice, collaboration, trust and empowerment to reduce re-traumatisation and promote healing.¹⁷ As time to develop rapport may be lengthened and challenges to their ability to cope continually pressed over time, working with transgender students often requires more counselling sessions over longer periods of time, compared with other college students.

While trans students utilise counselling at higher rates, they also engage in higher levels of risky behaviours than other students: having more sex partners, higher rates of sexually transmitted infections, and substance use.¹⁴ Part of counselling should include helping them learn harm reduction behaviours and alternative ways of coping. Oswalt and Lederer called for college health services andÌýcounselling centres to show increased sensitivity to the needs of gender non-conforming students, from intake through clinical experience, and making college health programmes more trans inclusive.⁶ This could include making sure intake documentation provides a space for them to state their gender identity and the ability to indicate the unique concerns they present with.

Policies, processes and systems

While transgender students work to gain clarity on their gender identify and undergo physical transition, they may not yet want to self-identify to others as transgender. As such, universities should provide ways for them to get support and information anonymously. University policies, processes, and systems may, however, make it impossible for them to control their expression of identity. For instance, lecturers can ‘out’ a student if the computer system relied on does not reflect the student’s current gender identity. Students have complained that lecturers, using university computer systems as their guide, call on them in class by their pre-transition name or with pre-transition gender descriptors. This leaves students having to explain to their peers who they are at a time not of their choosing. Although universities may have rules requiring that a student’s gender be recorded in the system, they could add a gender identity field, train faculty and staff to look for that and emphasise its importance in protecting students’ power of expression.

University policy must establish clear rules and guidance prohibiting discrimination and microaggressions. Unfortunately, many schools do not include gender identity and gender expression in their school non-discrimination policies; this leaves gender non-conforming youth without needed protection from bullying and aggression in schools.¹⁸

Grant and colleagues found that transgender students face housing challenges.⁵ Although, in the UK, discrimination on the grounds of gender reassignment is illegal,¹⁹ there may still be incidents of bullying or social exclusion. To address this, universities can examine admission processes, such as asking students on applications if they are open to living with trans students.²⁰ Krum and colleagues reported that transgender students preferred apartment-style housing and self-contained singles, which may support a more gender-inclusive housing community.²¹ In addition to creating housing options more conducive for transgender students, many campuses have created gender-neutral toilets and changing areas across campus.

People and culture

Many faculty, staff and students are not familiar with the needs of transgender students and may not consider them a population requiring support. Similarly, trans students may not feel comfortable turning to the campus community for help. As with other efforts to increase diversity and inclusion on campus, hiring transgender staff can help transgender students see others like them on campus. Lecturers, academics, administrators and students should also be trained to help them recognise their own biases.⁹ Counsellors and university staff should show visible support for trans students by, for instance, posting signs indicating that an office or location is a ‘safe place’. Further, universities should make resources for trans students visible, including listing resources on the university website advertising individual and group counselling, and outreach support for trans students.

Joining student organisations and gaining access to mentors helps college students feel connected to their institution and facilitates personal and professional development.²² Counsellors and other university staff can help trans students feel more a part of the university by encouraging their participation in academic and social student organisations. Counsellors might also collaborate with the student’s academic department and career services office to help trans students find mentors to support their academic and career exploration.

Outreach and prevention

Proactively creating a trans-inclusive environment on campus would signal to transgender students that they are welcome and promote their access to support. Displaying trans-affirming language on campus would create visible and tangible confirmation for these students. The campus LGBT student group serves as a primary source of support for non-gender-binary students, and their efforts to understand and support each student’s unique needs should be encouraged. Based on the high level of trauma, discrimination and suicidal experiences reported by transgender students, campuses should develop campus-based violence prevention and suicide prevention efforts specifically focused on gender identity.

Summary and conclusions

In summary, there are several ways clinical staff on university campuses can enhance their ability to help transgender students.

1. Reach out to the LGBT centre on campus, if available, or local LGBT centres or charities and learn about the experience of gender non-conforming students on your campus.
2. Provide needed services, such as group counselling, and advertise those services specifically to trans students and also to the broader university community.
3. Create a trans-affirming environment in the counselling centre by modifying intake forms and the intake process to allow trans students to selfidentify and articulate their unique concerns. Allow for confidential access to information and post gender-affirming signage.
4. Gain training on working with victims of trauma as well as working with the intersection of multiple identities.
5. Learn about supportive community resources that transgender students may need, such as access to food and shelter.
6. Engage in outreach and prevention activities to support transgender students and also help identify those in need of support. Suicide prevention outreach is particularly indicated considering the high rates of suicidal ideation and attempts among transgender students.

A common frustration among clinicians lies in helping clients, but then seeing them re-traumatised as they enter the very environment that triggered their need for counselling. This is especially true for transgender students. Counsellors can help trans students feel listened to, work through gender identity concerns, and build coping skills. Without changing the university environment, however, trans students may still struggle to thrive on campus. As advocates for the transgender community, university staff can enact policies to prohibit the discrimination of gender non-conforming students. They can also work to change the culture on campus towards one that is more gender inclusive. We are at an important time in the history of education as transgender students are ‘coming out’ in increasing numbers. Universities and their staff can seize this moment to stand out as leaders in adjusting their policies, processes, systems and culture to create a truly trans-affirming campus.Ìý

Dr Marty Swanbrow Becker is an Associate Professor of Psychological and Counseling Services at Florida State University. His research examines the influence of stress, coping, resilience, help seeking, and diversity of background on student mental health as well as the efficacy of suicide prevention interventions.Ìý

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