Matchmaking Methodology for Humanizing Transgender and Gender Diverse Health Research

Abstract

Background: Current research on transgender and gender diverse (TGD) health focuses on a damage-centered approach to health outcomes, often further marginalizing and othering TGD individuals and their experiences. The Matchmaking Methodology is an approach that can be used to depathologizes and demedicalizes the TGD experience within research by decentering the cisgender gaze of TGD health research.

Objectives: This article aims to provide researchers a humanizing approach to TGD health and wellness research by outlining the process of the matchmaking methodology that connects individuals to co-create research and knowledge from multiple standpoints—those of scholar, practitioner, and community member.

Methods: Shaped by an approach to co-editing a book on TGD health and social service best practices, the Matchmaking Methodology can be applied to research projects as an intentionally engage method that allows for the centering of TGD voices, the integration of practitioner expertise as well as that of academic scholars with community members through collaborative partnership to conduct and disseminate research.

Conclusions: The matchmaking methodology for TGD health research can address some of the harmful and dehumanizing aspects that have historically dominated TGD-focused research. This approach focuses on the empowerment and critical consciousness of those participating in the collaborative partnership and centers their accountability to TGD individuals. Further, the involvement of practitioners and community members in the research process can translate to research that has a focus on real-life application and impact on best practices, interventions, and policy change.

I believe that telling our stories, first to ourselves and then to one another and the world, is a revolutionary act. It is an act that can be met with hostility, exclusion, and violence. It can also lead to love, understanding, transcendence, and community.

—Janet Mock

There has been a significant increase in transgender and gender diverse (TGD)-related research across various disciplines in recent years. Primarily situated within the cisgender (non-transgender) gaze, much TGD literature exemplifies Tuck and Yang's¹ damage-centered approach to research, which focuses on the pain and suffering TNB individuals experience daily. This approach, while often well-intentioned, further marginalizes and others TGD individuals by reinforcing a one-dimensional view with an almost sole focus on the lack of agency and power and, in doing so, fosters a distorted need for cisgender saviors. Connolly et al.'s² systematic review of the TGD youth health literature, which demonstrates an almost singular focus on the poor mental health outcomes of TGD young people, exposes the ubiquity of this damage-centered approach in the existing scholarship. The review's conclusion further reinforces this brokenness trope by locating the solution to mental health disparities as lying solely within the medical industrial complex rather than in TGD individual and collective agency. This damagecentered approach in health research is also demonstrated in the literature on TGD adults.³

There has been an expanding repertoire of TGD research exploring the resilience of TGD individuals and documenting how TGD individuals cope with or adapt to living in an anti-TGD society.⁴ While research has the unique power of telling stories that can cultivate liberatory changes in the systems that shape lived experiences, it must do so in a humanizing way. TGD-focused research means recognizing the complexities and nuances of TGD individuals as being more than ravaged by health disparities or idolized through "inspiration porn" by shifting to scholarship led by TGD researchers and supports TGD individuals as co-creators of both knowledge and solutions.⁵

Here, we explore the concept of a humanizing methodology that emphasizes the co-creation of research by centering the voices of TGD individuals, and intentionally bringing community members, scholars, and practitioners to a collaborative drawing board to conduct and disseminate research in a desire-centered approach.¹ While acknowledging the complexities that exist within anti-TGD systemic functions, this approach depathologizes and demedicalizes the TGD experience by decentering the cisgender gaze and focusing on the lens of TGD individuals themselves.¹ We outline a matchmaking methodology in conducting research or writing projects focused on TGD health that connects individuals to co-create research and knowledge from multiple standpoints—those of scholar, practitioner, and community member. In doing so, we argue that the proposed methodology increases the likelihood that multiple voices, positions, and experiences inform the research process, analysis, and narrative. This concept of a matchmaking methodology addresses many of the barriers that can arise in TGD focused community-based research and writing projects through an intentional pairing—matchmaking—of individuals whose expertise and experiences taken together in collaboration demonstrate the praxis of TGD research from reflection to action.

BEGINNINGS OF THE MATCHMAKING METHODOLOGY

In late 2017, a cisgender associate professor at the time (now full professor) was first approached by the publisher, who then brought on a nonbinary assistant professor. Then they recruited a nonbinary doctoral student (now graduated), and a trans community practitioner (now doctoral student) all housed primarily within the field of social work. In collectively agreeing to create the book,⁶ we committed to experiment with ways to deconstruct the traditionalist academic route of book development, and to intentionally engage methods that allowed for the centering of TGD voices, the integration of practitioner expertise as well as that of academic scholars, the incorporation of intersectional experiences, and the shift away from the sage on the stage approach to research that currently dominates knowledge production in the academy.⁷ Central to the project was not only the embrace of co-creation—that is, the "collaborative generation of knowledge by academics working alongside stakeholders from other sectors" (p. 392)⁸—but also recognizing the significance of the voice of lived experience⁹ and adopting the "nothing about us, without us"¹⁰ approach. By combining these aspects, the matchmaking methodology extends the various models of co-creation methodologies^11,12 and applies this approach to knowledge creation with TGD communities.

As co-editors of the book, all of us have experiences as community-based educational and social work practitioners, even though our current affiliations all exist within the academy. During the book writing process, however, two co-editors were community practitioners situated in TGD health care and health policy circles across the country. Additionally, from a racial identity perspective, we are all White. We recognized that the limitations of our collective standpoints and positionalities stood in tension with our vision of a comprehensive book on the experiences of various communities within the TGD community, including Black, Indigenous, and People of Color voices, disabled people, those from lower-income backgrounds, immigrants, and so on. To realize our goal, we knew we needed to bring in as many voices as possible into the book writing process—representing various backgrounds and experiences within the field of social work and health care related to TGD communities as well as the diversity of identities within TGD communities.

We committed to an approach whereby each chapter of the book would be co-authored by at least one academic scholar and one or more practitioners or community member(s). Additionally, we required that at least one author of each chapter must be TGD themselves. With some chapters, we reached out to potential authors in the fields of social work and healthcare, particularly to those TGD individuals whose experiences we desired to center. For chapters where we did not already have potential authors in mind, or where we only had a co-author who was an academic scholar, we initiated a call for authors under the framing of social work and health care for TGD communities, using our professional academic and community-based practitioner networks along with our personal networks to connect various individuals interested in writing about similar topic ideas. This matchmaking approach to co-authorship was time and labor-intensive, not only during the matchmaking, but also in supporting people new to academic writing to move through the entire process, and in supporting academic writers to co-author in a collaborative manner with community members. This intentional effort resulted in creating a book about TGD people and, we hope, truly centers the voices TGD people from a strengths perspective, rather than solely from a deficit perspective.

In the next section, we outline the matchmaking approach we used and how it can be adapted as a research methodology for TGD health research and writing projects. Through using the tenants of Nicolazzo's trans* epistemology, the matchmaking methodology acknowledges that TGD people are more than their experiences of oppression, hold complex and nuanced identities and experiences, and embody trans-formative capacities.¹³

METHODOLOGICAL PROCESS

The process of implementing the matchmaking methodology is straightforward and based on the context of the research or writing project. A lead coordinating individual(s), who can occupy any role or position, puts out a call for research or writing collaborators. This call should explicitly request collaborators with lived experience, with practice experience, and those who embody other minoritized identities, and should be worded in such a way as to indicate that the call is not for respondents or participants for a research study but rather for co-authors and co-creators of knowledge. Failure to explicitly communicate these critical aspects of desired collaborators can dissuade potential collaborators from expressing interest in participating as they may assume that the call is seeking only academic researchers. Additionally, the call should explicitly state that all collaborators have equitable decision-making power. This communicates to academic researchers that the expectations and goals of the project are to de-center the academy's voice in knowledge creation.

The call for collaborators should be shared widely and across different types of social networks to increase the likelihood of engaging diverse voices and perspectives in the project. Providing parameters and guidelines in this call for interest can be help seek information, such as interest area, capacity, learning interests, mentoring interests, funding/ financial needs, identities, and experience as a community member, practitioner, and/or scholar. It can be as formal or informal as the lead coordinator prefers, seeking to put the least amount of labor on potential collaborators at this point in the process.

Once the call for collaborators has been sufficiently met based on the criteria of the project goals, each submission should be reviewed by the lead coordinator(s). Individuals should be matched based on interests, positionality, opportunities for growth and mentorship, need, and other necessary criteria. Clearly, one person may hold multiple roles. The academic scholar role should be someone familiar with research methods and practices, and ideally someone affiliated with an educational institution. The practitioner can be a community practitioner practicing in the area being explored. The community member with lived experience represents the community voice for the project. The community member can be TGD themselves or a parent, partner, friend, or family of a TGD person. At least one person in the collaborative partnership should identify as TGD regardless of the three roles (academic, practitioner, or community member) they fulfill.

Once a match is made for the collaboration, the lead coordinator(s) supports the partnership in pursuing their research or writing goal(s). Depending on the needs of the collaborative partnership, this support can be either passive or active. A passive role might entail occasionally checking with the partners involved for a status update, offering support or resources, and answering questions that emerge. An active role might include having regular meetings to help engage issues that arise, providing writing and editing support, and consulting on the partnership goals. The contour of the support is dependent on time, capacity, and the goals of the collaborative partnership.

MATCHMAKING METHODOLOGY AS HUMANIZING RESEARCH

We argue that this outlined matchmaking approach is a humanizing methodology as it challenges the notion that academics are the sole knowledge creators by integrating practitioners and community members into the research and writing process.¹⁴ This allows for the praxis of research, as those who are most impacted are co-creators of the research as well as more likely to utilize the product in their personal and/ or professional life as community members, organizers, and/ or clinical practitioners. This praxis of research focuses on the various roles and positionalities pursuing the research project with critical consciousness and translatability to impact.¹⁵

While the matchmaking process itself is an important component of this approach and the product of the research is a primary goal, an essential aspect of the matchmaking methodology is the relationship-building among the collaborative partners. This relationship-building component aligns with the Project in Humanization, which centers learning through listening and dialogic engagements.¹⁶ Though the collaborative partnership is not a unit of analysis in and of itself, "the relationships we create and sustain and our human capacity to listen to, story with, and care about each other must influence the direction of…research for the next 100 years" (p. 391S).¹⁶ Similar to the dialogic process with research participants, the collaborative partners engage in their own dialogic process where everyone takes on the role of learner and teacher throughout the project period, thus creating an equitable collaboration.

POSITIONALITY AND CRITICAL CONSCIOUSNESS WITHIN THE MATCHMAKING METHODOLOGY

A powerful aspect of the matchmaking methodology and the collaborative partnership is the central concept that everyone holds both the role of learner and teacher. Ideally, there is fluidity among the interactions within the partnership, where everyone has a story to tell, everyone represents a specific experience, and where there may be paradoxes of multiple truths. For example, one paradox may be where a practitioner providing health services to TGD patients in an archaic system that marginalizes and dehumanizes TGD individuals in healthcare settings is collaborating with a community member who is actively working to dismantle the oppressive practitioner-reliant system within which the collaborating practitioner works. These contradictions may show up in the research itself and challenge the personal and professional boundaries that a traditional methodology may uphold. Having a critical consciousness¹⁵ of the social and political reality around us and the emotional responses we may have to our role in (de)humanizing TGD experiences "help us see and challenge norms, including those of professions and institutions that often value only objectivity and rationality" (para. 25).¹⁷ This grappling with emotions has the potential to build authenticity among the collaborative partnerships as well as with research participants.

While working with each other, the collaborative partnerships go through a process of "worthy witnessing" as part of the relationship building and sustaining process.¹⁸ Winn and Ubiles¹⁸ (2011) posit that there are four pillars to worthy witnessing: admission, declaration, revelation, and confidentiality. Admission begins the process of building trust and being trustworthy. Collaborative partners need to admit each other into the collective project and be admitted into each other's lives. Declaration is the process of being transparent with goals, agenda, and positionality. Being open and honest about the identities one holds—the areas where one may embody power and privilege, and one's epistemological view—allows the collaborator to show up fully and authentically and lets others fully consent to be part of that relationship. These unique power dynamics should be fully and openly discussed. This is especially important on teams where race, sexuality, gender, and role (for example) converge to give one person within the collaborative relationship more power across numerous axes.¹⁹

Revelation refers to the mutual respect and trust established within the collaborative relationships with the potential of leading "to the development of relationships that extend far beyond the project, characterized by mutual respect, caring, and, dare we say, friendship" (p. 9).¹⁸ Finally, confidentiality is the formal and informal practices, such as discretion in what does and does not get shared outside of the collaborative partnership and the research project.¹⁸ Within confidentiality, there may even be an act of refusal among the collaborative partnership that determines that "there are some forms of knowledge that the academy doesn't deserve" (para. 2)¹ based on the deteriorated trust of the academy rooted in the historic dehumanization, marginalization, and harm caused to TGD individuals in the name of research.

CHALLENGES

Matchmaking methodology is not without its own set of challenges and limitations. In our project, we opted to take on the labor of ensuring each chapter was written correctly in APA format rather than putting these expectations on community co-authors. This is an example of a domain-specific task and concomitant responsibility that fall within the academic member's expertise. While this takes substantial time and energy on behalf of the academic partner, removing this pressure is not only ethical but also enables the community member(s) to contribute in ways that are within their own realm of expertise without having to develop a skill that may not be useful in their daily life. This may translate to workloads that are not equally distributed across collaborators. However, we suggest that equitability should be understood within the context of the collaborators' various positionalities, strengths, knowledge, and skills.

Another challenge was that even a strategy of using a strengths and desires-based approach did not guarantee that co-authors and collaborators avoid the impact of transphobia as the book was coming together. One co-author lost their housing and therefore internet access, and several others experienced major mental health concerns in response to issues of societal transphobia. Further, as community member and practitioner contributions are typically outside the scope of their full-time jobs, it is important to recognize that the time and capacity of these collaborators may look different compared to the academic collaborators who utilize their regular work time on research and writing projects. This meant that we had to approach deadlines with flexibility, step in to put the finishing touches on some chapters, and practice holding a lot of grace and valuing relationships over the push for productivity—something rarely valued in academic settings.

We also had to navigate more traditional challenges of authorship and disagreements. These were more complicated than they frequently are in solely academic settings as many of the collaborators had never had to navigate these types of conversations before and, as such, needed more support in moving through them. This also means ensuring that meaningful contribution to the process is not solely measured based on academic standards but through honoring and valuing the contributions based on lived personal and professional experience. Further, we had to advocate for things like ensuring pronouns were included in authors' bios, making sure the publisher knew that they would not be provided with some authors' legal names, and supporting stylistic differences when the copyeditors sought consistency across chapters. These aspects are not as common in books that center the cisgender gaze and require providing education to and engaging in advocacy with the publisher.

CONCLUSIONS

The matchmaking methodology for TGD health research can address some of the harmful and dehumanizing aspects that have historically dominated TGD-focused research. The approach focuses on the empowerment and critical consciousness of those participating in the collaborative partnership and centers their accountability to TGD individuals. The collaborative partnership process provides an opportunity for a desire-centered approach to TGD research through exploring the resilience, resistance, and transformative capacity of TGD individuals and communities.¹ While the matchmaking methodology is not a replacement for participatory methodologies, it has the potential to work as a supplement when limited funding and engagement are barriers to community involvement. Further, the involvement of practitioners and community members in the research process can translate to research that has a focus on real-life application and impact on best practices, interventions, and policy change. Additionally, it diversifies and brings new voices to the academic literature and could present itself as a pipeline for TGD individuals into the academy as they learn the research process and build their individual and collective agency and efficacy as co-creators of knowledge.