Research on evidence-based practice with transgender adults: A commentary on “A systematic review of recommendations for behavioral health services for transgender and gender diverse adults”.

Comments on the original article by Holt et al. (see record 2021-72420-011) regarding recommendations for behavioral health services for transgender and gender diverse adults. As it currently stands, much of the writing about clinical practice has been based on personal experience and professional opinions. These contributions are certainly important to the field. Also, there is still a great need for stronger research and science related to evidence-based practice with transgender and gender-diverse (TGD) populations. The article by Holt et al. (2021) provides an excellent overview of the current state of the literature on evidence-based practices with TGD clients and areas that need to be strengthened. Holt et al. (2021) reviewed 65 articles published between 2009 and 2018 and evaluated how well these articles integrated evidence-based practice (EBP) approaches. EBP was evaluated through the integration of the best research evidence, use of clinical judgment, and considerations of client characteristics, values, and contexts, as well as the integration of objective assessments. Notably, they found that only 9.2% of the articles (n = 6) were empirical reviews or studies. None of these publications were randomized clinical trials (RCTs). The other articles in their review were 40% case studies (n = 26), 32.3% summaries of recommendations for treatment (n = 21), and 18.5% reviews (n = 12). The most common purpose of the articles was to discuss transtheoretical factors in treatment (63.1%; n = 41). Only 16.9% (n = 11) of articles discussed how to adapt a specific theoretical orientation or intervention to be affirming of TGD clients, and only 20% (n = 13) of articles were about a specific presenting problem. There also was minimal focus on gender dysphoria or medical gender affirmation processes (e.g., guidance around hormones, surgery). The authors’ coding for how well EBP was integrated into these articles revealed that clinical judgment was integrated the most, and objective assessment was rated the lowest, leading to the conclusion that there is still much work left to be done to integrate EBP principles into clinical interventions, publications, and empirical evaluations of therapy with TGD clients. Another key takeaway was how dependent advancements in EBP are on other areas of research. For instance, the field needs more measure development and validation studies for the objective assessment component of EBP to improve. (PsycInfo Database Record (c) 2021 APA, all rights reserved)