Communicating While Transgender: Apprehension, Loneliness, and Willingness to Communicate in a Canadian Sample:

Matthew Heinz

doi:10.1177/2158244018777780

Communicating While Transgender: Apprehension, Loneliness, and Willingness to Communicate in a Canadian Sample:

Heinz, Matthew 2018-05-28 00:00:00 This mixed-methods study draws on quantitative and qualitative data on interpersonal communication measures and experiences of Canadian transgender people under the framework of Meyer’s minority stress model. Based on administration of three surveys (Willingness to Communicate; Personal Report of Communication Apprehension; and University of California, Los Angeles [UCLA] Loneliness scales), the participants in this study rated higher on communication apprehension and loneliness and were less willing to communicate than broader population means. The 44 participants identified key communication stressors in interactions with cisgender individuals and generated recommendations to facilitate less stressful communication climates. Communication climate, social isolation, and cisnormativity emerged as fundamental themes affecting interpersonal communication dynamics. Keywords transgender, Canada, social isolation, loneliness, communication apprehension, willingness to communicate, minority stress communication apprehension. In this way, this study builds Communicating While Transgender on previous work exploring communication needs of trans- Transgender communication is emerging as a field of inquiry gender Canadians (heinz, 2015; heinz & MacFarlane, 2013). in its own right (Spencer & Capuzza, 2015), and interper- sonal communication studies involving transgender studies Nomenclature is emerging as a field within this larger trend (e.g., Kosenko, Rintamaki, & Maness, 2015; Norwood & Lannutti, 2015). Scholarly, professional, cultural, personal, and political prefer- Social scientific scholarship on interpersonal communica- ences and conventions differ greatly when it comes to describ- tion involving transgender people is, as typical of emerging ing individuals who are not cisgender. Language use in this fields of study, still marked by somewhat incidental publica- area is also changing rapidly, and differs in national contexts tions and research projects. This particular project seeks to even when English is used as a common language. In this advance this area of inquiry by pursuing five objectives: (a) study, participants answered “yes” to the screening question of extending previous work on transgender communication whether they “identify as transgender,” so this study uses both dynamics, (b) contributing to the growth of interpersonal identity language and the referent “transgender” throughout as communication studies and transgender studies in a Canadian affirmed language. When other literature is cited, the language context, (c) extending traditional applications of communi- used in that particular work is maintained. cation scholarship to include transgender individuals, (d) generating recommendations to help address communication Interpersonal Transgender Communication needs and expectations identified by needs assessments, and (e) demystifying cisgender–transgender communication Spencer (2015) provided a succinct and first overview of the (Dixon, 2015). To these ends, this study offers quantitative emergence of transgender studies in communication. Spencer data on loneliness, willingness to communicate, and com- demonstrated the emergence of a field of study, notably munication apprehension in a Canadian transgender sample and qualitative data on communication dynamics experi- Royal Roads University, Victoria, British Columbia, Canada enced by Canadian transgender people. The immediate goal Corresponding Author: of the study was to explore communication experiences and Matthew Heinz, Royal Roads University, 308 Millward, 2005 Sooke Road, descriptors of Canadian transgender people, with a particular Victoria, British Columbia, Canada V9B5Y2. emphasis on loneliness, willingness to communicate, and Email: matthew.heinz@royalroads.ca Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open driven by publications since 2010, and noted the paucity of hide their gender identity. Herman (2013) surveyed transgen- studies in the areas of human communication (e.g., health, der and gender-nonconforming people about gendered pub- interpersonal, family, intercultural) that focus exclusively on lic restroom use in Washington, D.C., and found that 68% of transgender people. Such studies include examinations of participants reported at least once instance of verbal coming out processes (Meyer, 2003), relational management harassment. (Aramburu-Alegría & Ballard-Reisch, 2011; Nuru, 2014), Communication appears to be an implied but critical con- family communication dynamics (Norwood, 2012; Norwood cept in these and similar needs assessments, whether the & Lannutti, 2015), health communication (Kosenko, 2010, reported behavior involves verbal harassment, negative 2011; Kosenko et al., 2015), instructional communication experiences with health care providers, mismatching identity (Spencer & Capuzza, 2016), intercultural communication documents, avoidance of social contact, or nonverbal gender (Johnson, 2013; Yep, Russo, & Allen, 2015), and workplace identity expressions. For example, Holman and Goldberg communication (Dixon, 2015). To date, little is known about (2008) generated recommendations on social and medical the communication experiences of transgender people— transgender case advocacy and argued that often, “it is neces- despite consistent indications arising from studies that com- sary to actively advocate as part of making a referral, to edu- munication is key to the life quality of transgender people cate agency staff about transgender sensitivity protocols and and their families. Communication dynamics are still implic- trans-specific accommodations” (p. 199). Fraser (2012), past itly rather than explicitly studied in much research involving president of the World Professional Association for transgender people, likely due to the preponderance of clini- Transgender Health (WPATH), who advocated for the inclu- cal health research in this area. sion of etherapy in Version 7 of WPATH’s Standards of Care More than 27,000 respondents participated in the 2015 for the Health of Transsexual, Transgender, and Gender- U.S. Transgender Survey conducted by the National Center Nonconforming People, suggested that many transgender for Transgender Equality. The survey, which is the largest people worldwide could “benefit from the services of a survey of transgender people in the United States to date, knowledgeable, competent, and compassionate etherapist” demonstrated several themes, such as pervasive mistreat- (p. 258). Bauer et al. (2009) argued that cisnormative erasure ment and violence, severe economic hardship and instability, affects health care for transgender people, including “infor- harmful effects on physical and mental health, and the com- mational erasure” (p. 352) and “institutional erasure” (p. pounding effect of other forms of discrimination (James 354) such as exclusion on forms, texts, and applications. et al., 2016). The survey also demonstrated several positive Version 7 of the WPATH’s Standards of Care (Coleman trends, such as increased visibility and acceptance of trans- et al., 2012) contained concrete recommendations for voice gender and nonbinary people, and growing acceptance by and communication therapy “to help clients adapt their voice families and friends, colleagues, and classmates. The 2009 and communication in a way that is both safe and authentic, Canadian TransPULSE research project, which attracted 433 resulting in communication patterns that clients feel are con- participants from Ontario, found that 43% of trans Ontarians gruent with their gender identity and that reflect their sense had attempted suicide at some point in their lives and that of self” (p. 198). Each of these scholarly contributions 75% of trans Ontarians had ever seriously considered suicide emphasizes, indirectly, the role of verbal and nonverbal (Scanlon, Travers, Coleman, Bauer, & Boyce, 2010). With communication. regard to male-to-female (MTF) individuals, the Ontario sur- Intentional investigations that foreground communication vey findings indicated that 75% of MTF participants had concepts are now appearing, beginning to address a signifi- symptoms consistent with clinical depression (Rotondi et al., cant gap in the literatures of communication studies on one 2011). In addition, the survey found that disproportionately hand and transgender studies on the other. In their study on high numbers of trans Ontarians had avoided public spaces families’ experiences with transgender identity and transi- because of fear of harassment or being outed (Scheim, Bauer, tion, Norwood and Lannutti (2015) encouraged interpersonal & Pyne, 2014). In a large-scale study of the experiences of communication researchers to identify the communication trans people in the United Kingdom, Ellis, Bailey, and dynamics within resilient families to “develop specific com- McNeil (2016) found that social hostility, defined as “being munication strategies for easing the negative and increasing made fun of or called names; silent harassment” was the the positive effects of this family stressor” (p. 68). most frequent reported form of victimization (p. 9). Turner, Communication research has the potential to generate Whittle, and Combs (2009) found verbal abuse to be the applied recommendations that can be put to use by transgen- most common form of victimization of transgender people in der, nonbinary, and cisgender people alike. Repeatedly, a European Union context. A comparative analysis of recent research has demonstrated transgender people’s posi- European Union lesbian, gay, bisexual, and transgender tive accounts of interactions, such as Kosenko et al.’s (2015) (LGBT) survey data by the European Union Agency for online needs assessment of 152 individuals’ perceptions of Fundamental Rights (2014) found that trans respondents positive interactions with health care providers. These schol- reported frequent discrimination, victimization, disrespect, ars identified seven trans-positive recommended behaviors and maltreatment, leading many to avoid public spaces or for health providers: “communicating sensitivity to gender Heinz 3 issues, admitting ignorance, having a good bedside manner, Papadopoulos, & Randhawa, 2015). In a narrative literature curing the disease (and not the patient), protecting patient review on the theoretical foundations of loneliness, Tzouvara privacy, advocating for transgender health, and treating all et al. (2015) pointed to the negative health outcomes associ- patients equally” (p. 9). They suggested that their findings ated with loneliness, particularly when it affects humans “underscore the importance of communication skills and cul- long term and reinforces negative thoughts over time. tural sensitivity training for health care providers” (p. 13). Earlier work designed to assess needs of transgender people Communication and loneliness. Communication scholars con- on Vancouver Island in British Columbia, Canada, found that tinue to study loneliness. Communication-centered approaches the community and social belonging needs of the partici- to the study of loneliness focus on the effects of communica- pants were not met and that social needs ranked even with tion skills deficiencies; attribution-based approaches focus on health needs for these individuals (heinz & MacFarlane, loneliness as a result of stable and internal factors (Park, 2015). 2013). From a communication perspective, Segrin (1996) pointed out that loneliness has suffered from “conceptual confusion” and Loneliness. One area that appears particularly understudied in defined it as the “discrepancy between desired and achieved the realm of interpersonal communication involving trans- levels of social contact and interaction” (p. 226). Segrin gender people is the phenomenon of loneliness. Feelings of reviewed that loneliness has been consistently found to not be being alone and socially isolated are frequently surfaced in related to social network size, to be highly correlated with studies of and reflections on transgender experiences (e.g., depression, and to consistently emerge as the perception of Beemyn & Rankin, 2011; Bhanji, 2012; Brill & Pepper, being socially undesirable, not having a close friend, and not 2008; Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Gir- wanting to be a burden to others. Scholars have demonstrated shick, 2008; Hines, 2006; Lev, 2013; Rubin, 2003; Warland, that loneliness can be reduced by mediated communication in 2016; Witten, 2002), even for transgender people who posi- the form of parasocial interaction (Wang, Fink, & Cai, 2008); tively embrace their gender identities and/or feel affirmed they have demonstrated links between loneliness and willing- and supported in their gender identities (e.g., Greatheart, ness to communicate (Kirtley, 1999) and an individual’s level 2010; Waszkiewicz, 2006). Transgender needs assessments, of communication apprehension and loneliness (Downs, traditionally conducted from a public health perspective, Manoochehr, & Nussbaum, 2009; Zakahi & Duran, 1985). In tend to point to common experiences or perceptions of social a reciprocal relationship, depression and loneliness can create isolation, loneliness, and the perception and/or experience of or deepen interpersonal communication problems (Segrin, social exclusion as a result of stigma and discrimination, par- 1996). ticularly among transgender populations disproportionately affected by intersecting factors such as poverty, HIV status, Meyer’s Minority Stress Model race, class, culture, migration status, or ability status (e.g., Bauer, Travers, Scanlon, & Coleman, 2012; Hendricks & Meyer’s minority stress model (Meyer, 1995, 2003, 2007; Testa, 2012; Holman & Goldberg, 2008; Kenagy, 2008; Meyer, Schwartz, & Frost, 2008) has been widely used to Xavier, Bobbin, Singer, & Budd, 2005). Small-scale qualita- examine stigma, intersecting oppressions, and minority tive studies (e.g., Koken, Bimbi, & Parsons, 2009) often stressors in sexual minority populations (e.g., Marcellin, reflect a similar pattern. Logie, Lacombe-Duncan, Lee-Foon, Scheim, Bauer, & Redman, 2013; Otis, Rostosky, Riggle, & Ryan, and Ramsay (2016) conducted focus groups with Hamrin, 2006; Sandil, Robinson, Brewster, Wong, & Geiger, LGBT African and Caribbean newcomers and refugees to 2015). In essence, the model suggests that objective and sub- Canada and identified the benefits of targeted social support jective stressors unique to a particular minority group (e.g., groups to decrease social exclusion and increase community homophobia for gay, bisexual, and lesbian individuals) can resilience. Social support, Logie et al. argued, can reduce be identified within social structures; such stressors affect isolation and the impact of stigma, a position taken earlier by one’s physical and psychological health (Meyer, 2003). The Bockting, Benner, and Coleman (2009). Small-scale qualita- model has been predominantly applied to gay, lesbian, and tive studies involving transgender people often rely on bisexual populations (e.g., Gamarel, Reisner, Laurenceau, themes and patterns emerging from the data; although these Nemoto, & Operario, 2014; Kelleher, 2009), with fewer themes frequently encompass what individuals describe as applications to transgender or nonbinary individuals (e.g., isolation or loneliness, these are usually not a priori defined Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, or conceptualized. Scholars in a range of disciplines not only 2013; Hendricks & Testa, 2012; Levitt & Ippolito, 2014b; have established links between social isolation and loneli- Seelman, 2016). Meyer (2003) suggested that the “stress ness (Bernard, 2013; Hendricks & Testa, 2012; Shankar, model can point to both distal and proximal causes of dis- Hamer, McMunn, & Steptoe, 2013; Victor, Scambler, & tress and to directing relevant interventions at both the indi- Bond, 2009) but also pointed out the need to not use loneli- vidual and structural levels” (p. 692). Distal causes of distress ness as an interchangeable concept with social isolation, are external events such as an act of violence; proximal aloneness, or solitude (Bernard, 2013; Tzouvara, causes of distress are internal conditions such as an 4 SAGE Open expectation of rejection. Meyer conceptualized minority loneliness. The instrument, first introduced in 1978 (Russell, stress as an extension of social stress theory: Peplau, & Cutrona, 1980; Russell, Peplau, & Ferguson, 1978), has emerged as a highly reliable and valid measure, In developing the concept of minority stress, researchers’ and the second and subsequent third versions have further underlying assumptions have been that minority stress is (a) refined the scale. Russell (1996) encouraged researchers to unique—that is, minority stress is additive to general stressors use the scale to enable future updates and modifications. that are experienced by all people, and therefore, stigmatized people are required an adaptation effort above that required of similar others who are not stigmatized; (b) chronic—that is, Willingness to Communicate minority stress is related to relatively stable underlying social Willingness to communicate (WTC), defined as a “per- and cultural structures; and (c) socially based—that is, it son’s willingness to initiate communication” (Morreale, stems from social processes, institutions, and structures 2007, p. 8), has been studied since the late 1970s. It is beyond the individual rather than individual events or understood to be a stable personality trait. The WTC Scale conditions that characterize general stressors or biological, genetic, or other nonsocial characteristics of the person or the first developed by McCroskey and colleagues in 1985 con- group. (p. 676) sists of a 20-item questionnaire measuring WTC in public speaking meetings, dyads, and small groups with strang- Ellis et al. (2016) argued that feelings of vulnerability ers, acquaintances, or friends. Face validity and alpha reli- resulting from transphobic victimizations enhance minority ability of the instrument are strong (Morreale, 2007). WTC stress and are linked to negative health outcomes such as is related to communication apprehension (Donavan & internalized transphobia, anxiety, and low self-esteem. Levitt MacIntyre, 2004; MacIntyre, 1994). For this study, the and Ippolito (2014b) demonstrated “unexpected stressful most recent version of the WTC instrument was used issues arising both before after adopting” a gender identity (McCroskey & Richmond, 2013). (p. 61). Hendricks and Testa (2012) introduced an adaptation of Meyer’s minority stress model by offering a conceptual Communication Apprehension framework for clinical work with transgender and gender- nonconforming clients. This adaptation is of particular sig- Communication apprehension is defined as “the fear or anxi- nificance here because it offers an explanation of how trans ety an individual experiences as a result of either real or individuals’ experiences of victimization and discrimination anticipated communication with another person or persons” come to “have serious effects on the mental health of trans (McCroskey & Beatty, 1984, p. 79). Most frequently, the people” (Hendricks & Testa, 2012) in the context of Meyer’s Personal Report of Communication Apprehension (PRCA- model. Their work is particularly relevant because it focuses 24), developed by McCroskey (2005), is used to assess the on the experiences of social isolation, loneliness, and social construct given its high reliability and high predictive valid- disconnectedness and their role as predictors of suicide risk ity (Morreale, 2007). (Joiner, 2011; Van Orden et al., 2010). Herman (2013) also Emerging from the literature review and applied research argued that minority stress models are relevant to the life findings, the research questions guiding this study were as experiences of transgender people. Meyer’s model does not follows: isolate interpersonal communication as a phenomenon of immediate relevance to the creation and experience of stress- Research Question 1: What are the interpersonal com- ors, but many of the stressors and stress mitigators Meyer munication experiences of transgender people? (2003) provided as illustrations (e.g., concealing one’s iden- Research Question 2: How do transgender people rate tity, support groups, self-disclosure, talking to family, pre- on measures of communication apprehension, loneliness, vention programs) consist of interpersonal communication and willingness to communicate? processes. Research Question 3: Which communication recom- This study was, therefore, designed to explore commu- mendations can transgender people offer to cisgender nication experiences and descriptors of Canadian transgen- people? der people, with a particular emphasis on loneliness, willingness to communicate, and communication appre- Method hension, three measures that have been widely tested in other populations. Data Collection Six individuals assisted with gathering data in five Canadian University of California, Los Angeles (UCLA) provinces in 2015 and 2016; in addition, the author collected Loneliness Scale data at the Canadian Professional Health Association for The UCLA Loneliness Scale (Version 3; Russell, 1996) was Transgender Health Conference in Halifax in October 2015. chosen to assess transgender participants’ sense of Participants completed three long-established social science Heinz 5 Table 1. Descriptive Statistics. time. Participants were recruited via snowball sampling, an appropriate nonprobability sampling technique for studies Variable Categories N (%) surveying members of a rare population (Lavrakas, 2008). Assigned sex at birth Male 12 (27.3%) The Research Ethics Board of Royal Roads University Female 32 (72.7%) reviewed and approved the study, which was supported by an Age 19-24 8 (18.2%) internal research grant of Royal Roads University. 25-44 27 (61.4%) 45-54 4 (9.1%) 55-64 4 (9.1%) Participants 65+ 1 (2.3%) Descriptive statistics of the participants are provided in Table Aboriginal identity Yes 6 (13.6%) 1. A total of 44 participants between the ages of 19 and 65 No 38 (86.4%) years (M = 33.27 years) provided survey and questionnaire Visible minority Yes 7 (15.9%) responses for this study. Of these participants, 12 had been No 37 (84.1%) assigned to the male sex at birth, and 32 had been assigned to Population center size <1,000 3 (6.8%) the female sex. Seven participants identified as visible 1,000-29,999 6 (13.6%) minorities, a demographic category defined by Statistics 30,000-99,999 4 (9.1%) Canada as “persons who are non-Caucasian in race or non- >99,999 31 (70.5%) Province British Columbia 14 (31.8%) white in colour and who do not report being Aboriginal” Newfoundland 7 (15.9%) (Statistics Canada, 2017). Six participants identified as Nova Scotia 11 (25.0%) Aboriginal, defined by Statistics Canada as First Nations, Ontario 10 (22.7%) Métis, or Inuit. The majority of participants (31) lived in Quebec 2 (4.5%) large population centers, defined as communities with more Outness To no one 1 (2.3%) than 100,000 people by Statistics Canada. Participants Close family/friends (<10) 13 (29.5%) resided in the Canadian provinces of British Columbia (14), To most 18 (40.9%) Newfoundland (seven), Nova Scotia (11), Ontario (10), and To all 12 (27.3%) Quebec (2). For 38 participants, the time range from social Time from social and/ No answer 6 (13.6%) and/or physical transition to the date of the data collection or physical transition <1 year 6 (13.6%) extended from 4 months to 20 years. Six participants did not Between 1 and 3 years 8 (18.2%) answer the question on length of time from social and/or Between 3 and 5 years 5 (11.4%) physical transition. Most participants (18) were out to “most” Between 5 and 10 years 13 (29.6%) people, 13 were out to “close” family and friends, 12 were >10 years 6 (13.6%) out to all, and one participant was not out to anyone. The Age categories based on Grant et al. (2011). sample was limited by two considerations common to research involving transgender people: (a) the participants identified based on self-report and (b) the sample was based instruments (UCLA Loneliness Scale Version 3, PRCA, and on a convenience sample (cf. Rosser, Oakes, Bockting, & Willingness to Communicate) in paper-based format and Miner, 2007) as well as one limitation arising from the sam- provided answers to five field-tested open-ended questions. ple: the majority of participants had been assigned to the Basic demographic data were collected at the same time via female sex at birth. nine questions about age, sex assignment at birth, gender identity, ethnic identity, geographic location, size of popula- tion center, and time from social and/or physical transition. Instruments The question about transition simply inquired how much The UCLA Loneliness Scale Version 3 (Russell, 1996) is time had passed since “physical and/or social” transition designed to measure subjective feelings of loneliness as because transition itself was not a focus of this study, and the well as of social isolation. The 20-item scale includes items purpose of including this question was limited to determin- such as “How often do you feel alone?” and asks partici- ing whether the length of public identification was relevant. pants to rate each item on a scale from 1 (never) to 2 (rarely) For many transgender people, these processes are inter- to 3 (sometimes) to 4 (always). Nine of the items are reverse twined, contextual, and dynamic as their responses in this scored. First published in 1978, the scale has been revised study further illustrate. The surveys were submitted in anon- twice. The UCLA Loneliness Scale Version 3 was pub- ymous format; identification of the province in which the lished in 1996, and, as the most recent measure, was used in data were gathered was the only item tying data to their ori- this study. The instrument is considered internally consis- gin. Participants and the community members facilitating tent (coefficient α ranging from .89 to .94) and highly data collection received gift cards in recognition of their 6 SAGE Open reliable (Russell, 1996). Total scores can range from 20 to The qualitative data resulting from the answers to open- 80, with higher scores reflecting greater loneliness. ended questions were analyzed via two methods. First, a ques- The Willingness to Communicate (WTC) Scale contains tion-by-question analysis of the content provided by the 20 items, of which 12 are designed to measure an individu- participants’ responses followed standard procedures recom- al’s inclination to initiate communication and the remaining mended in the coding of open-ended survey responses (Fink, eight to distract attention from the scored items. Alpha reli- 2015). The author and a research assistant grouped the ability estimates generally range from .85 to above .90 responses by question and read the responses to each question (McCroskey & Richmond, 2013). Items such as “Talk with multiple times. Both marked key words and phrases used by a friend while standing in line” ask respondents to indicate the respondents to arrive at coding categories for each ques- the percentage of times they would choose to communicate tion. Using a spreadsheet, all responses were assigned to one in each of the 20 situations, with 0 representing never and or several coding categories for each question, and frequencies 100 always. In addition to the total WTC score, the instru- of appearance were tabulated; categories represented by three ment allows the generation of four context-type and three or more responses were reported. Labels for coding categories receiver-type scores. The context-type subscores pertain to were derived from language used by the participants. In the group discussion, meetings, interpersonal, and public descriptive analysis of the individual open-ended responses, speaking settings. The receiver-type subscores pertain to these coding categories were drawn upon to arrive at themes stranger, acquaintance, and friend. These subscores, how- representative of the responses to each individual question. ever, are not quite as reliable as the total score. All sub- Second, a qualitative analysis of the overall data (i.e., the scores and the total score will fall in the range of 0 to 100. text of the answers to all the questions) employed a tradi- To arrive at the total WTC score, the receiver-type sub- tional thematic analysis following the models articulated by scores are added and divided by 3. The norms for the total Braun and Clarke (2006) and applied by Fielden, Sillence, WTC are high if >82 and low if <52. For context scores, and Little (2011) and Olivari, Cuccì, and Confalonieri scores are considered high if >89 for group discussion, >80 (2016). This analysis consisted of multiple readings of the for meetings, >94 for interpersonal conversations, and >78 text, identifying clusters of meaning, extracting themes and for public speaking. Context scores are considered low if subthemes, and selecting representative participant quotes. <57 for group discussion, <39 for meetings, <64 for inter- To enhance representativeness of the data collected, partici- personal conversations, and <33 for public speaking. For pant quotations were checked to ensure that each participant receiver types, scores are considered high if >63 for was represented at least once, whether in direct or indirect stranger, >92 for acquaintance, and >99 for friend. Scores quotations, in either the content or the thematic analysis. are considered low if <18 for stranger, <57 for acquain- tance, and <71 for friend. Results The PRCA-24, developed by McCroskey (2005), consists of 24 items. It is highly reliable (α reliability typically Quantitative Survey Analysis between .93 and .95) and has high predictive validity. Items Descriptive results are presented in the form of short “I” statements, for exam- ple, Item 1 reads “I dislike participating in group discus- UCLA Loneliness Scale Version 3. Participant (n = 44) scores sions.” Participants select the degree to which each item ranged from 27 to 72 (M = 48.29, SD = 10.74). applies to them (ranging from 1 (strongly disagree) to 5 (strongly agree). The total PRCA score is the sum of the PRCA-24. Participant scores (n = 44) for the PRCA Group addition of all scores, which can range from 24 to 120. Scores Discussion composite ranged from 6 to 30 (M = 18.38, SD below 51 indicate very low communication apprehension; = 5.79; Table 2). Participant scores (n = 44) for the PRCA scores between 51 and 80 indicate average communication Meetings composite ranged from 6 to 30 (M = 19.18, SD apprehension; and scores above 80 indicate high communi- = 6.19). Participant scores (n = 44) for the PRCA Interper- cation apprehension. The instrument also allows for the sub- sonal composite ranged from 7 to 30 (M = 18.27, SD = 5.18). scoring of group discussion, meetings, interpersonal, and Participant scores (n = 44) for the PRCA Public Speaking public speaking settings. These subscores, however, are not composite ranged from 6 to 30 (M = 20.63, SD = 6.01). quite as reliable as the total score. Participant scores (n = 44) for the overall PRCA composite ranged from 47 to 76 (M = 69.06, SD = 5.15). Data Analysis Willingness to Communicate (WTC). Participant scores Quantitative analysis of the data resulting from the three sur- (n = 44) for the WTC group discussion composite ranged vey instruments involved descriptive statistics to provide a from 6.67 to 100 (M = 63.40, SD = 24.29). Participant scores snapshot of various statistics, most notably frequency, mean, (n = 44) for the WTC meetings composite ranged from 0 to and standard deviation. Correlation coefficients were run to 100 (M = 50.93, SD = 28.83). Participant scores (n = 44) examine the correlation of the scales to demographics. for the WTC interpersonal composite ranged from 0 to 100 Heinz 7 Table 2. WTC, PRCA-24, and UCLA-Loneliness Scale Scores (n = 44). Instrument Minimum Maximum M SD WTC_context-type subscore–group discussion composite: Items 8, 15, 19 6.67 100.00 63.40 24.29 WTC_context-type subscore–meetings composite: Items 6, 11, 17 0.00 100.00 50.93 28.83 WTC_context-type subscore–interpersonal composite: Items 4, 9, 12 0.00 100.00 61.04 25.52 WTC_context-type subscore–public speaking composite: Items 3, 14, 20 0.00 100.00 57.47 28.80 WTC_receiver-type subscore–stranger composite: Items 3, 8, 12, 17 0.00 100.00 39.52 27.47 WTC_receiver-type subscore–acquaintance composite: Items 4, 11, 15, 20 0.00 100.00 60.98 28.76 WTC_receiver-type subscore–friend composite: Items 6, 9, 14, 19 15.00 100.00 74.13 24.47 WTC–total score 8.33 100.00 58.21 24.86 PRCA–group discussion composite 6.00 30.00 18.38 5.79 PRCA–meetings composite 6.00 30.00 19.18 6.19 PRCA–Interpersonal composite 7.00 30.00 18.27 5.18 PRCA–Public Speaking composite 6.00 30.00 20.63 6.01 PRCA–overall composite 47.00 76.00 69.06 5.15 UCLA Loneliness Scale–total score 27.00 72.00 48.29 10.74 Note. WTC = Willingness to Communicate; PRCA = Personal Report of Communication Apprehension; UCLA = University of California, Los Angeles. Table 3. Comparison of Participant Means With Broader Population Means. Broader population Transgender study M SD M SD WTC Group discussion 68.1 16.4 63 24.29 Meetings 59.3 18.6 50.93 28.82 Interpersonal 72.9 15.8 61.04 25.52 Public speaking 52.2 20.4 57.47 28.80 Stranger 35.6 21.3 39.52 27.47 Acquaintance 69.9 18.25 60.98 28.76 Friend 83.9 14.0 74.13 24.47 PRCA Group discussion 15.4 4.8 18.38 5.79 Meetings 16.4 4.2 19.18 6.19 Interpersonal 14.2 3.9 18.27 5.18 Public speaking 19.3 5.1 20.63 6.01 Total score 65.6 15.3 69.06 5.15 UCLA Loneliness Scale Total score 40.1 9.5 48.29 10.74 Note. WTC = Willingness to Communicate; PRCA = Personal Report of Communication Apprehension; UCLA = University of California, Los Angeles. (M = 61.04, SD = 25.52). Participant scores (n = 44) for means of the transgender community with the broader the WTC public speaking composite ranged from 0 to 100 population norms. A population mean did not seem avail- (M = 57.47, SD = 28.80). Participant scores (n = 44) for able for the WTC; therefore, the broader population mean the WTC stranger composite ranged from 0 to 100 (M = used in Table 3 is based on a study of student groups in the 39.52, SD = 27.47). Participant scores (n = 44) for the WTC United States (Barraclough, Christophel, & McCroskey, acquaintance composite ranged from 0 to 100 (M = 60.98, 1988). The population mean for the PRCA is based on two SD = 28.76). Participant scores (n = 44) for the WTC friend separate samples: one of more than 40,000 college stu- composite ranged from 15 to 100 (M = 74.13, SD = 24.47). dents and another of more than 3,000 nonstudent adults Participant scores (n = 44) for the WTC overall composite with virtually the same results. A population mean did not ranged from 8.33 to 100 (M = 58.21, SD = 24.86). seem available for the UCLA Loneliness Scale; therefore, the broader population mean used in Table 3 is based on a Mean comparisons with population standard. The first sample of students (N = 487) used in a study testing the objective of the quantitative analysis was to compare the reliability, validity, and factor structure of the UCLA 8 SAGE Open (Russell, 1996). It is important to note that researchers participants, the research ethics protocol had intentionally have not established Canadian population norms for these assured participants that demographic data would only be scales. The results demonstrate that, in comparison with a provided in aggregate form and not linked to individual broader population of students, the participants in this open-ended survey responses. This addressed concerns about study were less willing to communicate in group discus- confidentiality and privacy expressed by some prospective sions, meetings, and interpersonal conversations as well participants. Results of the question-by-question analysis are as with acquaintances, and with friends. However, they summarized in Table 5; results of the overall analysis are were more willing to communicate in public speaking and summarized in Table 6 in a format modeled after that with strangers. This sample was also more apprehensive employed by Olivari et al. (2016). to communicate across all subgroups and reported more loneliness that the broader population norms. Question 1: Communication stress factors. Participants differ- entiated between communication with strangers and commu- Correlations. Correlations were run to assess relationships nication with individuals they know, between communication between the scales and the demographic variables (Table with cisgender men and cisgender women, and between 4). Because this data set has variables with data that are not communication with individuals who know that the partici- normally distributed, Spearman’s correlation coefficient pant identifies as transgender and communication with those (Spearman’s rho) was used rather than the Pearson correla- who do not. They stated that stress in interactions with cis- tion coefficient (Pearson’s r). No scales were related to sex gender strangers, particularly cisgender men, primarily arises assigned at birth, the size of the participant’s population from the fear of constant judgment, being belittled or not center, or the time from social and/or physical transition. accepted; apprehension about attitudes; fear of being mis- The overall PRCA composite was negatively correlated gendered, misnamed, and/or outed as transgender; the expec- with age, meaning that as participants’ ages increased, tation of having to educate others; and concerns about their scores on the PRCA overall composite decreased. The physical safety. They also reported a general lack of comfort correlation coefficient (–.335) demonstrated a moderate with conversations reflecting gender norms. effect. WTC–public speaking and WTC–friend scores were positively correlated to the degree that a participant I don’t know how they will react once they find out I’m trans. It reported being out as transgender. This means that the feels unsafe. At the same time, I don’t want to always have to more out participants reported being, the higher their “out” myself. But then there’s the fear that they will find out some other way. If I do “out” myself, I worry that I’ll be expected scores on WTC–public speaking and WTC–friend. The to educate them; I worry they won’t see me for who I am but just correlation coefficients of .329 and .316, respectively, get caught up in me being trans. (Participant 3) demonstrated a moderate effect. PRCA–meetings scores were negatively correlated to the degree that participants Participant 7 said that “feelings of being judged, not reported being out, meaning that the more out participants being listened to,” and “belittled, talked to as if I were a reported being, the lower their PRCA–meeting score was. child” cause stress in communication with cisgender people. The correlation coefficient of –.305 demonstrated a mod- Some noted that interpersonal communication stress can erate effect. affect all interactions, not just those with cisgender strang- ers: “It creates more distance between me and almost every- Qualitative Analysis of Open-Ended Questions one else” (Participant 44). Conversation about gender-related topics increases stress, participants observed, such as con- Five questions asked participants to (a) identify factors that versational partners’ “assumptions about my ‘stance’ on might make face-to-face interactions with cisgender people women” (Participant 26). Participant 25 responded with the stressful to them, (b) describe how such stress affects their observation that face-to-face interactions with cisgender these interactions, (c) identify cisgender communication people are not stressful: “If anything, I find it less stressful behavior most frustrating to them, (d) reflect on whether than interactions with trans people because I care more what being transgender affects the ways in which they communi- trans people think of me.” cate with other people, and (e) suggest recommendations to cisgender people who would like to make such interactions less stressful. These questions were exploratory, given the Question 2: Communication stress responses. All but six par- apparent scarcity of previous work on transgender communi- ticipants said that stress occurring in interpersonal communi- cation from a minority stress perspective. The responses cation encounters with cisgender people affects their were first analyzed question by question using standard con- communication behavior. Participants identified communi- tent analysis coding practice (Fink, 2015), then as one over- cation avoidance, withdrawal from interactions, silencing, all data set using thematic analysis (Braun & Clarke, 2006). and increased self-monitoring as direct responses to interac- Although linking demographic data such as age or time from tions. Some participants noted physiological responses such transition would provide a richer context for quotations from as a nervousness, stomach pain, muscle tension, conscious Heinz 9 Table 4. Correlation Between Demographics and Scales. Degree of out as Age Size of population transgender Time from transition WTC_context-type subscore–group discussion Correlation coefficient .068 −.100 .149 .004 WTC_context-type subscore–meetings Correlation coefficient .151 −.059 .046 .006 WTC_context-type subscore–interpersonal Correlation coefficient .129 −.151 .267 .006 WTC_context-type subscore–public speaking Correlation coefficient .065 .019 .316 −.007 WTC_receiver-type subscore–stranger Correlation coefficient .182 .032 .054 .060 WTC_receiver-type subscore–acquaintance Correlation coefficient .108 −.078 .271 −.046 WTC_receiver-type subscore–friend Correlation coefficient .015 −.172 .329 −.056 WTC total score Correlation coefficient .090 −.077 .227 .006 WTC–categorized high/moderate/low Correlation coefficient .109 −.085 .147 −.024 PRCA–group discussion Correlation coefficient .089 −.105 −.045 .130 PRCA–meetings Correlation coefficient .054 −.113 −.305 .066 PRCA–interpersonal Correlation coefficient −.003 .037 −.145 .190 PRCA–public speaking Correlation coefficient −.186 −.240 −.190 .079 PRCA–overall composite score Correlation coefficient −.335 −.048 .040 .087 PRCA–categorized high/average/low Correlation coefficient .181 −.097 −.204 .229 UCLA Loneliness Scale–total score Correlation coefficient .109 −.110 −.292 .059 Note. WTC = Willingness to Communicate; PRCA = Personal Report of Communication Apprehension; UCLA = University of California, Los Angeles. efforts to control one’s voice, stuttering, and facial flushing. I try to accommodate the other person. Causes internal anxiety. May talk less, avoid people, leave social situations sooner, go Others reported that stress made it difficult to organize their outside. Stick to more formal topics, do not discuss personal thoughts and spoke of an internal sense of stress building up. opinions or express my true feelings. (Participant 16) The most common behavioral responses participants identi- fied were withdrawal and avoidance, whether in the form of physical avoidance of public spaces or internal withdrawal. I find that I become anxious and stressed in some interactions. While I want to stand up for transfolk I lose confidence and struggle to communicate because my emotions get too involved. Generally, my body becomes tense, I may have a hard time (Participant 9) reasoning because I am so distracted by my stress. I may choose to not respond or end a conversation prematurely to end the interaction entirely. In the past I often held onto these situations/ One participant noted that although they experience stress, interactions and my stress sat in my body and manifested in tight that stress does not manifest externally: “The stress becomes muscles and soreness. (Participant 27) and stays internal,” Participant 1 wrote. For others, though, stress does manifest externally. “It can make me avoid Avoidance patterns the participants spoke of included not ‘straight’ ‘cis’ spaces. It can make me defensive or enraged, or speaking, or speaking less, keeping answers short, shutting embarrassed,” Participant 32 said. “It greatly affects my com- down, withdrawing from discussions, keeping people at arms’ munication because I will think it over before I can talk (i.e., length, and keeping conversational topics at superficial levels. make sure my voice is higher, etc.)” (Participant 34). 10 SAGE Open Table 5. Question-by-Question Content Analysis. Topic Coding category Number of mentions Communication stress factors Fear of constant judgment 14 Apprehension about attitudes 9 Discomfort with gender topic/norms 8 Fear of being outed as transgender 7 Fear of being misgendered/misnamed 7 Fear of not being accepted 7 Expectation of having to educate 6 Fear of being belittled 4 Concerns for physical safety 4 Communication stress responses Communication avoidance 16 Quietude/silencing self 9 Withdrawal from interaction 8 Increased self-monitoring 8 Internal stress build-up 6 Difficulty organizing thought 4 Physiological responses 4 Frustrating behavior Nonverbal distancing and disapproval 12 Dismissal 10 Lack of basic knowledge 6 Inaccurate assumptions 5 Enforcement of gender norms 5 Intrusive questions 4 Intentional misgendering/misnaming 4 Displays of pity or sympathy 3 Making big deal of mistakes 3 Defensiveness 3 Visible apprehension 3 Communication effect Increased caution and unease 11 Decreased self-disclosure 7 Increased emphasis on performance 6 Withdrawal 6 Increased monitoring of others 5 None 5 Increased effort, exhaustion 5 Anxiety and nervousness 4 Increased sensitivity to others’ gender 4 Desire to educate 3 Recommendations Follow communication cues 13 Signal warmth and openness 11 Display basic human respect first 9 Recognize/avoid cisgenderism 9 Use appropriate name and pronouns 4 Educate oneself on gender diversity 4 Display lack of judgment 3 Several participants who physically transitioned noted performance causes me to second guess a lot of what I say/ that transition stage made a difference: “As I’ve been passing do,” Participant 31 wrote. Participant 37 spoke of a vicious as cis more frequently it is less stressful” (Participant 28). cycle: “Stress can lead me to overanalyze/overthink and Many participants observed effects on speech production as therefore induce more stress.” a function of stress that communication encounters produce. “Alternately I ramble or end up mute and just don’t engage,” Question 3: Frustrating cisgender communication behaviors. Ver- Participant 14 noted. “Particularly with cisgender males I bal and nonverbal communication behaviors that reflect feel I have to perform masculinity. The pressure of transphobia, ignorance, or arrogance create frustration for Heinz 11 Table 6. Overall Thematic Analysis. assuming that I need to present as cis to be accepted fully as female.” Theme Subtheme Question 4: Transgender identity and communication. Five Communication climate Boundaries participants said that being transgender does not affect the Safety Self-disclosure ways in which they communicate with other people. For Self-monitoring the majority of participants, however, there is a noticeable Social isolation Isolation effect. Caution, unease, anxiety, and nervousness were Loneliness reported as common effects. Participants noted that they Social anxiety are more cautious and not at ease during interactions, such Unwillingness to communicate as Participant 3 who said, “I tend to be cautious when Cisnormativity Binary understandings meeting new people. I am ever vigilant, even with people I Expectation violation know, as I never entirely feel safe.” Participant 13 wrote “I Gender norms Uncertainty reduction find I’m more on edge and alert in social situations due to a general sense of danger.” Withdrawal from communica- tion and decreased self-disclosure were reported by par- these transgender individuals. Such behaviors most notably ticipants who contributed statements such as “I don’t talk include nonverbal distancing and expressions of disapproval about my private life much at all anymore” (Participant 5), and dismissal of the transgender individuals overall or of “I share less personal information” (Participant 16), and “I their attitudes, beliefs, and experiences. Some participants also have a harder time expressing my feelings/thoughts to identified staring, eye rolling, frowning, physical distancing, even close friends” (Participant 19). “I have trouble trust- bathroom usage glances, and loud and abrasive speech as the ing people,” Participant 15 wrote. This appeared especially most frustrating nonverbal communication behaviors they common when conversations turn to gender-specific experience. Participants articulated disappointment with the topics. experience of not being seen, listened to, or heard during I often find myself hyper-aware of conversation topics interpersonal interactions. “People who seem content to (especially with cisgender or hetero people) and mentally plan ignore your existence, even when they know you as an ways to end or leave a conversation if it becomes unbearable/ acquaintance,” Participant 16 wrote. It is frustrating when inappropriate. (Participant 27) others “won’t listen/correct me on my experiences,” Partici- pant 23 offered. Other cisgender communication behaviors So many things in life are so cis-centred that I don’t feel like creating interactional distance and conflict include displays talking about my experiences at all because it will require me to of lack of basic knowledge about gender diversity, inaccu- teach them, answer questions and deal with their own ignorance. rate assumptions, and enforcement of gender norms. Partici- (Participant 35) pants also identified being asked intrusive questions, intentionally using incorrect pronouns or names, displaying Some participants noted that they increase emphasis on pity or sympathy, making a big deal about mistakes, defen- gender performance to accommodate others, along with siveness, and visible apprehension as obstacles. increased monitoring of others’ communication responses. Inappropriate displays of sympathy or pity are frustrating, “I am nervous my voice will give me away. I’m nervous several participants noted, such as Participant 21, who wrote, people won’t get it,” Participant 29 wrote. Participants “Relax! And don’t use me as a way to prove you are an ally,” also commented on the increased effort and resulting or Participant 5, who provided the example “I can’t imagine exhaustion they experience as a result. Participant 41 said how hard it must be.” In a similar vein, overaccommodation being transgender has no effect on communication. “I try was noted as being a hindrance to positive communication to act myself 99 percent of the time and if people don’t encounters. “Frustrating? Stumbling over pronouns with like me for me I don’t surround myself with them unless I profuse apologies. When they treat me like I’m dangerous,” have to.” Participant 21 wrote. “Making a huge deal out of ‘screwing Three participants said that being transgender has posi- up’ my gender,” Participant 13 said. Participant 33 said it is tively affected their communication behavior, in that, it frustrating “when ‘allies’ try way too hard to look under- makes them more sensitive to the gender identities of others standing and it comes across as pity.” and has given them a greater appreciation for gender For some participants, normative assumptions about gen- dynamics. der-related preferences constitute the biggest challenge in interactions with cisgender people. Such communication On one hand, it allowed space to be vulnerable and share my behaviors include the assumption that transgender people experiences for education and advocacy work. On the other want to live up to normative ideals. “I dislike being compli- hand I feel like I always have to be “on” and as if I can’t mented only when I perform to the standards of any assigned communicate that I may need something different in the gender,” Participant 22 said. Participant 30 referred to “Just moment. (Participant 19) 12 SAGE Open Three responses also reflected that participants felt empow- conversations about gendered behaviors can bring about for ered to be more outgoing and to take the initiative to educate transgender people. “Learn about 2 spirit ones who do not fit others. in gender roles. Do not assume males to do male roles and females female roles,” Participant 2 wrote. “Make a habit of Question 5: Recommendations. The most common response using sex-neutral terms when interacting with people,” suggested that cisgender people need to follow the nonver- Participant 8 contributed. Such responses were related to bal and verbal communication cues provided by transgen- comments about the need to recognize and avoid cisgender der people, to follow their lead, and to be sensitive to their assumptions. communication needs by signaling warmth and openness. Two participants noted that they had no recommendations Many participants noted that nonverbal communication because they did not find interactions with cisgender people behavior contributes greatly to feelings of comfort and stressful. A few other individuals said they had no recom- safety during a communication interaction. Signaling mendations because they were not sure how interactions warmth, openness, and lack of judgment is essential, they could be improved or because they attributed stress to inter- suggested. Such communication behavior, they suggested, nalized anxiety. does not require special inventories of communication skills but a general genuine desire to acknowledge another’s Thematic Analysis of Overall Response Data humanity, to display basic human respect for an individual, and to have a basic understanding of gender diversity. The open-ended questions were interrelated, and respon- dents at times further articulated or elaborated on responses I would recommend that they make the effort to educate to preceding questions. To complement the question-by- themselves about trans issues and that they don’t just assume question analysis, an overall thematic analysis was con- that other people are cisgender. Also, I would appreciate it if ducted, based on the data set consisting of all open-ended they saw me as a human first and followed my lead on what I’m responses. This analysis yielded three overarching themes comfortable disclosing. (Participant 3) with four corresponding subthemes: communication climate (boundaries, safety, self-disclosure, self-monitoring), social Participant 20 recommended “open and welcome body isolation (isolation, loneliness, social anxiety, unwilllingness language. No questions about my body or gender that aren’t to communicate), and cisnormativity (binary understand- relevant to conversation.” Focusing on an individual’s appar- ings, expectation violation, gender norms, uncertainty reduc- ent gender variance creates an interpersonal distance that tion; see Table 6). In contrast to the content analysis of the creates stress in interactions, several participants noted. “Just open-ended questions, which drew directly from responses treat me like you would any other person and don’t bring up to arrive at coding category labels, this overall analysis me being trans unless I do first,” Participant 33 wrote. established conceptual themes and drew from interpersonal Participant 28 recommended to “not treat trans people any communication literature for appropriate labels. different than cis people.” Participant 6 observed that “as long as people are warm and respectful, then I’m not Communication climate. The dominant overall theme reflected stressed.” the significance of the interpersonal communication climate. Not surprisingly, participants remarked on the frustration, Participants said interactions in which mutual trust, respect, stress, and anxiety they experience when others use incorrect and safety are established early on tend to be positive and pronouns, assume pronouns, or argue when a pronoun is cor- enriching; interactions in which boundaries are violated, rected. They recommended, for their own practice as well as identity is reduced to being transgender, and judgment and that of others, to use gender neutral language where possible, dismissal are evident reinforce the need to avoid and with- until they have been given the opportunity to introduce them- draw from communication. Several participants noted antici- selves. “Let go of the judgment, don’t assume, don’t Sir? pating potential threats to their physical safety. The constant Ma’am? Sir?” Participant 10 wrote. Participant 24 suggested need to self-monitor one’s communication behavior increases to “not argue with a suggestion or request” because “it tends stress, reduces confidence, and requires a taxing amount of to invalidate the transperson’s voice.” People should not try energy, all but four respondents indicated. Participant 44 to guess pronouns if they are not sure about the appropriate said, “I enjoyed communicating with others before transi- pronoun, Participant 12 wrote. tion, now I dread it.” Participant 43 noted, “I self-censor a Other participants recommended that cisgender individu- lot!” Most participants raised the need to adjust and monitor als become sufficiently educated with gender diversity to self-disclosures depending on context, conversational part- understand “how exhausting it can be to be constantly mis- ner, and communication climate. understood” (Participant 38), to “be patient in conversation” (Participant 40), and to “stop dismissing my observations as Isolation. Nineteen participants made references to feeling if they’re not valid just because I’m transgender” (Participant alone, lonely, or socially isolated in their responses. In some 44). This includes being sensitive to the level of stress Heinz 13 instances, participants reported social anxiety exacerbating iso- The second research question sought to establish how lation; such an anxiety was attributed to negative experiences transgender people in this sample rate on measures of com- or expectations of negative encounters. Participants described munication apprehension, loneliness, and willingness to being isolated or isolating themselves by avoiding communica- communicate. In comparison with broader student popula- tion encounters, deflecting personal questions, restricting open tion norms (keeping in mind that this study used a nonran- communication to close or known others, and opting for dom sample), this sample was less willing to communicate silence. Participant 3 wrote, “I keep people at arm’s length.” in all settings other than with strangers or in the form of public speaking, reported higher loneliness, and reported Cisnormativity. Regardless of interpersonal intent of conversa- higher levels of communication apprehension. The degree tional partners, cisnormative expectations and norms pose to which participants were out appeared to have the greatest obstacles to open conversational exchanges, these partici- impact on their willingness to communicate and their lone- pants noted. Those who have physically transitioned, and/or liness scores. are recognized in their self-identified gender, and comfortable The third research question asked participants to offer with gender norms, reported greater ease in interactions recommendations to cisgender people. In sum, these recom- because of uncertainty reduction in interactions. However, mendations suggest cisgender people should follow the ver- for those who are not recognized in their self-identified gen- bal and nonverbal communication cues provided by der and/or those who are not comfortable with binary gender transgender people; signal warmth, openness, lack of judg- norms, casual participation in everyday conversations appears ment, and basic human respect; and acquire a basic under- marked by difficulty and safety concerns. Ten participants standing of gender diversity. expressed disappointment that cisgender individuals tend to expect gender conformity, whether in regard to one’s sex Discussion assigned at birth or one’s self-identified gender. “Most of the past year I’ve been presenting as male. It’s easier to get by, Meyer’s (2003) minority stress model and applications of and people find it easier to classify me and thus communicate that model to transgender populations (Hendricks & Testa, with me. I kind of hate myself then, however,” Participant 4 2012; Kelleher, 2009) suggest that cisnormativity, cisgender- observed. Three participants spoke of their commitment to ism, and transphobia contribute to chronic stress and nega- educating cisgender individuals about the range of gender tive health outcomes for transgender people. This study identities, with a particular emphasis on nonbinary identities. sought to isolate and identify specific interpersonal commu- Conversations that normalize cisgender assumptions may nication behaviors and experiences in which these stressors open up transgender participants to levels of disclosure not manifest. Such work is relevant to public policy and mental anticipated, lead to awkward withdrawals from communica- health service delivery (Alessi, 2014), educators (E. R. Green tion, or expose them to boundary violations. At the same & Maurer, 2015), family members, friends and allies of time, expectancy violation creates challenges for cisgender transgender people (Norwood, 2012), and the public at large. participants. Lack of knowledge or comfort with cisgender Three instruments were administered to gather initial data communication norms appears to contribute to feelings of on communication apprehension, loneliness, and willingness isolation: to communicate among Canadian transgender people. The results demonstrate relatively high degrees of communica- Being raised female and being introspective and valuing talking tion apprehension and loneliness and relatively low degrees about feelings makes me an atypical man. This can make my of willingness to communicate. The qualitative analysis of interactions with cis men strained (especially with strangers). the results suggested significant communication stress fac- (Participant 31) tors influencing individuals’ ability and willingness to engage in communication, a keen awareness of potential or perceived threats resulting from communication, a desire to Summary communicate in a welcoming communication climate, and a The first research question inquired about the interper- phenomenon of social isolation and loneliness. Participants sonal communication experiences of transgender people. generated specific recommendations for cisgender individu- In sum, participants emphasized the need for positive als wishing to contribute to a more welcoming communica- communication climates that are sensitive to the experi- tion climate. ences of loneliness and the effects of cisnormativity. These results offer a glimpse into the ways in which a Participants identified specific communication stress fac- sense of real or perceived social isolation and loneliness tors common to face-to-face interactions with cisgender might interact with communication behaviors and disposi- people, reported on their own responses to such stress, tions and vice versa. It is noteworthy that individuals who identified specific cisgender communication behaviors consider themselves to be more visible (out) score lower on that increase stress, and generated recommendations for loneliness and communication apprehension and higher on cisgender people. willingness to communicate. At the same time, 14 SAGE Open the qualitative data illustrate the stressful aspects of being recommendations. Such work could contribute to emerging visible. Cacioppo and Cacioppo (2014) argued that, gener- communication research on the ways in which individuals ally speaking, individuals who feel lonely experience a regulate communication anxiety (White et al., 2015). higher degree of sensitivity to social threats, a dynamic they titled “toxic effects of perceived social isolation” (p. 58). Acknowledgments Such work builds on earlier work in interpersonal communi- The author expresses sincere gratitude to Jayce Palmer, Stefan de cation, such as that of Segrin (1996), who observed that Villiers, Charles Paul Murphy, Zack Marshall, Stevie Gregg, and lonely people typically desire more intimate and meaningful Kinnon MacKinnon for assistance with the data collection. The relationships but hold negative views of others and expect author gratefully acknowledges the assistance of research assistants Tina Quade and Marie Claire Joseph in the data analysis process. others to hold negative views of them. In conversation, The feedback of two blind peer reviewers was most helpful in the Segrin noted, lonely people “behave in such a way, perhaps final revision of the article, as was the careful review by Dr. Runa as a result of deficient social skills, to virtually ensure a neg- Das, assistant professor at Royal Roads University. Most of all, the ative outcome” (p. 231). The results, therefore, stress the author expresses gratitude for the participation of the transgender need for family members, friends, allies, educators, and ther- individuals who made this study possible by thoughtfully sharing apists (Levitt & Ippolito, 2014a) to foster strong conversa- their time and perspectives with all of us. tional skills among transgender people. That, however, cannot happen unless the communication climate is condu- Declaration of Conflicting Interests cive to safe and welcoming conversations. Importantly, these The author(s) declared no potential conflicts of interest with respect are not necessarily conversations about one’s gender identity to the research, authorship, and/or publication of this article. or gender-related issues; they are conversations at large, which often contain cisgender and cisnormative, and some- Funding times transphobic, elements that make it stressful for trans- The author(s) received financial support in the form of an internal gender people to participate or further the conversation. research grant from Royal Roads University for the research and/or It is important to keep in mind that “not everyone who authorship of this article. experiences discontinuity between his or her sex and gender will experience distress about gender identity” as the WPATH References Consensus Project Human Rights Work Group pointed out in 2011 (J. Green, McGowan, Levi, Wallbank, & Whittle, 2011, Alessi, E. (2014). A framework for incorporating minority stress p. 4). 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DOI: 10.1177/2158244018777780
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Abstract

This mixed-methods study draws on quantitative and qualitative data on interpersonal communication measures and experiences of Canadian transgender people under the framework of Meyer’s minority stress model. Based on administration of three surveys (Willingness to Communicate; Personal Report of Communication Apprehension; and University of California, Los Angeles [UCLA] Loneliness scales), the participants in this study rated higher on communication apprehension and loneliness and were less willing to communicate than broader population means. The 44 participants identified key communication stressors in interactions with cisgender individuals and generated recommendations to facilitate less stressful communication climates. Communication climate, social isolation, and cisnormativity emerged as fundamental themes affecting interpersonal communication dynamics. Keywords transgender, Canada, social isolation, loneliness, communication apprehension, willingness to communicate, minority stress communication apprehension. In this way, this study builds Communicating While Transgender on previous work exploring communication needs of trans- Transgender communication is emerging as a field of inquiry gender Canadians (heinz, 2015; heinz & MacFarlane, 2013). in its own right (Spencer & Capuzza, 2015), and interper- sonal communication studies involving transgender studies Nomenclature is emerging as a field within this larger trend (e.g., Kosenko, Rintamaki, & Maness, 2015; Norwood & Lannutti, 2015). Scholarly, professional, cultural, personal, and political prefer- Social scientific scholarship on interpersonal communica- ences and conventions differ greatly when it comes to describ- tion involving transgender people is, as typical of emerging ing individuals who are not cisgender. Language use in this fields of study, still marked by somewhat incidental publica- area is also changing rapidly, and differs in national contexts tions and research projects. This particular project seeks to even when English is used as a common language. In this advance this area of inquiry by pursuing five objectives: (a) study, participants answered “yes” to the screening question of extending previous work on transgender communication whether they “identify as transgender,” so this study uses both dynamics, (b) contributing to the growth of interpersonal identity language and the referent “transgender” throughout as communication studies and transgender studies in a Canadian affirmed language. When other literature is cited, the language context, (c) extending traditional applications of communi- used in that particular work is maintained. cation scholarship to include transgender individuals, (d) generating recommendations to help address communication Interpersonal Transgender Communication needs and expectations identified by needs assessments, and (e) demystifying cisgender–transgender communication Spencer (2015) provided a succinct and first overview of the (Dixon, 2015). To these ends, this study offers quantitative emergence of transgender studies in communication. Spencer data on loneliness, willingness to communicate, and com- demonstrated the emergence of a field of study, notably munication apprehension in a Canadian transgender sample and qualitative data on communication dynamics experi- Royal Roads University, Victoria, British Columbia, Canada enced by Canadian transgender people. The immediate goal Corresponding Author: of the study was to explore communication experiences and Matthew Heinz, Royal Roads University, 308 Millward, 2005 Sooke Road, descriptors of Canadian transgender people, with a particular Victoria, British Columbia, Canada V9B5Y2. emphasis on loneliness, willingness to communicate, and Email: matthew.heinz@royalroads.ca Creative Commons CC BY: This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage). 2 SAGE Open driven by publications since 2010, and noted the paucity of hide their gender identity. Herman (2013) surveyed transgen- studies in the areas of human communication (e.g., health, der and gender-nonconforming people about gendered pub- interpersonal, family, intercultural) that focus exclusively on lic restroom use in Washington, D.C., and found that 68% of transgender people. Such studies include examinations of participants reported at least once instance of verbal coming out processes (Meyer, 2003), relational management harassment. (Aramburu-Alegría & Ballard-Reisch, 2011; Nuru, 2014), Communication appears to be an implied but critical con- family communication dynamics (Norwood, 2012; Norwood cept in these and similar needs assessments, whether the & Lannutti, 2015), health communication (Kosenko, 2010, reported behavior involves verbal harassment, negative 2011; Kosenko et al., 2015), instructional communication experiences with health care providers, mismatching identity (Spencer & Capuzza, 2016), intercultural communication documents, avoidance of social contact, or nonverbal gender (Johnson, 2013; Yep, Russo, & Allen, 2015), and workplace identity expressions. For example, Holman and Goldberg communication (Dixon, 2015). To date, little is known about (2008) generated recommendations on social and medical the communication experiences of transgender people— transgender case advocacy and argued that often, “it is neces- despite consistent indications arising from studies that com- sary to actively advocate as part of making a referral, to edu- munication is key to the life quality of transgender people cate agency staff about transgender sensitivity protocols and and their families. Communication dynamics are still implic- trans-specific accommodations” (p. 199). Fraser (2012), past itly rather than explicitly studied in much research involving president of the World Professional Association for transgender people, likely due to the preponderance of clini- Transgender Health (WPATH), who advocated for the inclu- cal health research in this area. sion of etherapy in Version 7 of WPATH’s Standards of Care More than 27,000 respondents participated in the 2015 for the Health of Transsexual, Transgender, and Gender- U.S. Transgender Survey conducted by the National Center Nonconforming People, suggested that many transgender for Transgender Equality. The survey, which is the largest people worldwide could “benefit from the services of a survey of transgender people in the United States to date, knowledgeable, competent, and compassionate etherapist” demonstrated several themes, such as pervasive mistreat- (p. 258). Bauer et al. (2009) argued that cisnormative erasure ment and violence, severe economic hardship and instability, affects health care for transgender people, including “infor- harmful effects on physical and mental health, and the com- mational erasure” (p. 352) and “institutional erasure” (p. pounding effect of other forms of discrimination (James 354) such as exclusion on forms, texts, and applications. et al., 2016). The survey also demonstrated several positive Version 7 of the WPATH’s Standards of Care (Coleman trends, such as increased visibility and acceptance of trans- et al., 2012) contained concrete recommendations for voice gender and nonbinary people, and growing acceptance by and communication therapy “to help clients adapt their voice families and friends, colleagues, and classmates. The 2009 and communication in a way that is both safe and authentic, Canadian TransPULSE research project, which attracted 433 resulting in communication patterns that clients feel are con- participants from Ontario, found that 43% of trans Ontarians gruent with their gender identity and that reflect their sense had attempted suicide at some point in their lives and that of self” (p. 198). Each of these scholarly contributions 75% of trans Ontarians had ever seriously considered suicide emphasizes, indirectly, the role of verbal and nonverbal (Scanlon, Travers, Coleman, Bauer, & Boyce, 2010). With communication. regard to male-to-female (MTF) individuals, the Ontario sur- Intentional investigations that foreground communication vey findings indicated that 75% of MTF participants had concepts are now appearing, beginning to address a signifi- symptoms consistent with clinical depression (Rotondi et al., cant gap in the literatures of communication studies on one 2011). In addition, the survey found that disproportionately hand and transgender studies on the other. In their study on high numbers of trans Ontarians had avoided public spaces families’ experiences with transgender identity and transi- because of fear of harassment or being outed (Scheim, Bauer, tion, Norwood and Lannutti (2015) encouraged interpersonal & Pyne, 2014). In a large-scale study of the experiences of communication researchers to identify the communication trans people in the United Kingdom, Ellis, Bailey, and dynamics within resilient families to “develop specific com- McNeil (2016) found that social hostility, defined as “being munication strategies for easing the negative and increasing made fun of or called names; silent harassment” was the the positive effects of this family stressor” (p. 68). most frequent reported form of victimization (p. 9). Turner, Communication research has the potential to generate Whittle, and Combs (2009) found verbal abuse to be the applied recommendations that can be put to use by transgen- most common form of victimization of transgender people in der, nonbinary, and cisgender people alike. Repeatedly, a European Union context. A comparative analysis of recent research has demonstrated transgender people’s posi- European Union lesbian, gay, bisexual, and transgender tive accounts of interactions, such as Kosenko et al.’s (2015) (LGBT) survey data by the European Union Agency for online needs assessment of 152 individuals’ perceptions of Fundamental Rights (2014) found that trans respondents positive interactions with health care providers. These schol- reported frequent discrimination, victimization, disrespect, ars identified seven trans-positive recommended behaviors and maltreatment, leading many to avoid public spaces or for health providers: “communicating sensitivity to gender Heinz 3 issues, admitting ignorance, having a good bedside manner, Papadopoulos, & Randhawa, 2015). In a narrative literature curing the disease (and not the patient), protecting patient review on the theoretical foundations of loneliness, Tzouvara privacy, advocating for transgender health, and treating all et al. (2015) pointed to the negative health outcomes associ- patients equally” (p. 9). They suggested that their findings ated with loneliness, particularly when it affects humans “underscore the importance of communication skills and cul- long term and reinforces negative thoughts over time. tural sensitivity training for health care providers” (p. 13). Earlier work designed to assess needs of transgender people Communication and loneliness. Communication scholars con- on Vancouver Island in British Columbia, Canada, found that tinue to study loneliness. Communication-centered approaches the community and social belonging needs of the partici- to the study of loneliness focus on the effects of communica- pants were not met and that social needs ranked even with tion skills deficiencies; attribution-based approaches focus on health needs for these individuals (heinz & MacFarlane, loneliness as a result of stable and internal factors (Park, 2015). 2013). From a communication perspective, Segrin (1996) pointed out that loneliness has suffered from “conceptual confusion” and Loneliness. One area that appears particularly understudied in defined it as the “discrepancy between desired and achieved the realm of interpersonal communication involving trans- levels of social contact and interaction” (p. 226). Segrin gender people is the phenomenon of loneliness. Feelings of reviewed that loneliness has been consistently found to not be being alone and socially isolated are frequently surfaced in related to social network size, to be highly correlated with studies of and reflections on transgender experiences (e.g., depression, and to consistently emerge as the perception of Beemyn & Rankin, 2011; Bhanji, 2012; Brill & Pepper, being socially undesirable, not having a close friend, and not 2008; Garofalo, Deleon, Osmer, Doll, & Harper, 2006; Gir- wanting to be a burden to others. Scholars have demonstrated shick, 2008; Hines, 2006; Lev, 2013; Rubin, 2003; Warland, that loneliness can be reduced by mediated communication in 2016; Witten, 2002), even for transgender people who posi- the form of parasocial interaction (Wang, Fink, & Cai, 2008); tively embrace their gender identities and/or feel affirmed they have demonstrated links between loneliness and willing- and supported in their gender identities (e.g., Greatheart, ness to communicate (Kirtley, 1999) and an individual’s level 2010; Waszkiewicz, 2006). Transgender needs assessments, of communication apprehension and loneliness (Downs, traditionally conducted from a public health perspective, Manoochehr, & Nussbaum, 2009; Zakahi & Duran, 1985). In tend to point to common experiences or perceptions of social a reciprocal relationship, depression and loneliness can create isolation, loneliness, and the perception and/or experience of or deepen interpersonal communication problems (Segrin, social exclusion as a result of stigma and discrimination, par- 1996). ticularly among transgender populations disproportionately affected by intersecting factors such as poverty, HIV status, Meyer’s Minority Stress Model race, class, culture, migration status, or ability status (e.g., Bauer, Travers, Scanlon, & Coleman, 2012; Hendricks & Meyer’s minority stress model (Meyer, 1995, 2003, 2007; Testa, 2012; Holman & Goldberg, 2008; Kenagy, 2008; Meyer, Schwartz, & Frost, 2008) has been widely used to Xavier, Bobbin, Singer, & Budd, 2005). Small-scale qualita- examine stigma, intersecting oppressions, and minority tive studies (e.g., Koken, Bimbi, & Parsons, 2009) often stressors in sexual minority populations (e.g., Marcellin, reflect a similar pattern. Logie, Lacombe-Duncan, Lee-Foon, Scheim, Bauer, & Redman, 2013; Otis, Rostosky, Riggle, & Ryan, and Ramsay (2016) conducted focus groups with Hamrin, 2006; Sandil, Robinson, Brewster, Wong, & Geiger, LGBT African and Caribbean newcomers and refugees to 2015). In essence, the model suggests that objective and sub- Canada and identified the benefits of targeted social support jective stressors unique to a particular minority group (e.g., groups to decrease social exclusion and increase community homophobia for gay, bisexual, and lesbian individuals) can resilience. Social support, Logie et al. argued, can reduce be identified within social structures; such stressors affect isolation and the impact of stigma, a position taken earlier by one’s physical and psychological health (Meyer, 2003). The Bockting, Benner, and Coleman (2009). Small-scale qualita- model has been predominantly applied to gay, lesbian, and tive studies involving transgender people often rely on bisexual populations (e.g., Gamarel, Reisner, Laurenceau, themes and patterns emerging from the data; although these Nemoto, & Operario, 2014; Kelleher, 2009), with fewer themes frequently encompass what individuals describe as applications to transgender or nonbinary individuals (e.g., isolation or loneliness, these are usually not a priori defined Bockting, Miner, Swinburne Romine, Hamilton, & Coleman, or conceptualized. Scholars in a range of disciplines not only 2013; Hendricks & Testa, 2012; Levitt & Ippolito, 2014b; have established links between social isolation and loneli- Seelman, 2016). Meyer (2003) suggested that the “stress ness (Bernard, 2013; Hendricks & Testa, 2012; Shankar, model can point to both distal and proximal causes of dis- Hamer, McMunn, & Steptoe, 2013; Victor, Scambler, & tress and to directing relevant interventions at both the indi- Bond, 2009) but also pointed out the need to not use loneli- vidual and structural levels” (p. 692). Distal causes of distress ness as an interchangeable concept with social isolation, are external events such as an act of violence; proximal aloneness, or solitude (Bernard, 2013; Tzouvara, causes of distress are internal conditions such as an 4 SAGE Open expectation of rejection. Meyer conceptualized minority loneliness. The instrument, first introduced in 1978 (Russell, stress as an extension of social stress theory: Peplau, & Cutrona, 1980; Russell, Peplau, & Ferguson, 1978), has emerged as a highly reliable and valid measure, In developing the concept of minority stress, researchers’ and the second and subsequent third versions have further underlying assumptions have been that minority stress is (a) refined the scale. Russell (1996) encouraged researchers to unique—that is, minority stress is additive to general stressors use the scale to enable future updates and modifications. that are experienced by all people, and therefore, stigmatized people are required an adaptation effort above that required of similar others who are not stigmatized; (b) chronic—that is, Willingness to Communicate minority stress is related to relatively stable underlying social Willingness to communicate (WTC), defined as a “per- and cultural structures; and (c) socially based—that is, it son’s willingness to initiate communication” (Morreale, stems from social processes, institutions, and structures 2007, p. 8), has been studied since the late 1970s. It is beyond the individual rather than individual events or understood to be a stable personality trait. The WTC Scale conditions that characterize general stressors or biological, genetic, or other nonsocial characteristics of the person or the first developed by McCroskey and colleagues in 1985 con- group. (p. 676) sists of a 20-item questionnaire measuring WTC in public speaking meetings, dyads, and small groups with strang- Ellis et al. (2016) argued that feelings of vulnerability ers, acquaintances, or friends. Face validity and alpha reli- resulting from transphobic victimizations enhance minority ability of the instrument are strong (Morreale, 2007). WTC stress and are linked to negative health outcomes such as is related to communication apprehension (Donavan & internalized transphobia, anxiety, and low self-esteem. Levitt MacIntyre, 2004; MacIntyre, 1994). For this study, the and Ippolito (2014b) demonstrated “unexpected stressful most recent version of the WTC instrument was used issues arising both before after adopting” a gender identity (McCroskey & Richmond, 2013). (p. 61). Hendricks and Testa (2012) introduced an adaptation of Meyer’s minority stress model by offering a conceptual Communication Apprehension framework for clinical work with transgender and gender- nonconforming clients. This adaptation is of particular sig- Communication apprehension is defined as “the fear or anxi- nificance here because it offers an explanation of how trans ety an individual experiences as a result of either real or individuals’ experiences of victimization and discrimination anticipated communication with another person or persons” come to “have serious effects on the mental health of trans (McCroskey & Beatty, 1984, p. 79). Most frequently, the people” (Hendricks & Testa, 2012) in the context of Meyer’s Personal Report of Communication Apprehension (PRCA- model. Their work is particularly relevant because it focuses 24), developed by McCroskey (2005), is used to assess the on the experiences of social isolation, loneliness, and social construct given its high reliability and high predictive valid- disconnectedness and their role as predictors of suicide risk ity (Morreale, 2007). (Joiner, 2011; Van Orden et al., 2010). Herman (2013) also Emerging from the literature review and applied research argued that minority stress models are relevant to the life findings, the research questions guiding this study were as experiences of transgender people. Meyer’s model does not follows: isolate interpersonal communication as a phenomenon of immediate relevance to the creation and experience of stress- Research Question 1: What are the interpersonal com- ors, but many of the stressors and stress mitigators Meyer munication experiences of transgender people? (2003) provided as illustrations (e.g., concealing one’s iden- Research Question 2: How do transgender people rate tity, support groups, self-disclosure, talking to family, pre- on measures of communication apprehension, loneliness, vention programs) consist of interpersonal communication and willingness to communicate? processes. Research Question 3: Which communication recom- This study was, therefore, designed to explore commu- mendations can transgender people offer to cisgender nication experiences and descriptors of Canadian transgen- people? der people, with a particular emphasis on loneliness, willingness to communicate, and communication appre- Method hension, three measures that have been widely tested in other populations. Data Collection Six individuals assisted with gathering data in five Canadian University of California, Los Angeles (UCLA) provinces in 2015 and 2016; in addition, the author collected Loneliness Scale data at the Canadian Professional Health Association for The UCLA Loneliness Scale (Version 3; Russell, 1996) was Transgender Health Conference in Halifax in October 2015. chosen to assess transgender participants’ sense of Participants completed three long-established social science Heinz 5 Table 1. Descriptive Statistics. time. Participants were recruited via snowball sampling, an appropriate nonprobability sampling technique for studies Variable Categories N (%) surveying members of a rare population (Lavrakas, 2008). Assigned sex at birth Male 12 (27.3%) The Research Ethics Board of Royal Roads University Female 32 (72.7%) reviewed and approved the study, which was supported by an Age 19-24 8 (18.2%) internal research grant of Royal Roads University. 25-44 27 (61.4%) 45-54 4 (9.1%) 55-64 4 (9.1%) Participants 65+ 1 (2.3%) Descriptive statistics of the participants are provided in Table Aboriginal identity Yes 6 (13.6%) 1. A total of 44 participants between the ages of 19 and 65 No 38 (86.4%) years (M = 33.27 years) provided survey and questionnaire Visible minority Yes 7 (15.9%) responses for this study. Of these participants, 12 had been No 37 (84.1%) assigned to the male sex at birth, and 32 had been assigned to Population center size <1,000 3 (6.8%) the female sex. Seven participants identified as visible 1,000-29,999 6 (13.6%) minorities, a demographic category defined by Statistics 30,000-99,999 4 (9.1%) Canada as “persons who are non-Caucasian in race or non- >99,999 31 (70.5%) Province British Columbia 14 (31.8%) white in colour and who do not report being Aboriginal” Newfoundland 7 (15.9%) (Statistics Canada, 2017). Six participants identified as Nova Scotia 11 (25.0%) Aboriginal, defined by Statistics Canada as First Nations, Ontario 10 (22.7%) Métis, or Inuit. The majority of participants (31) lived in Quebec 2 (4.5%) large population centers, defined as communities with more Outness To no one 1 (2.3%) than 100,000 people by Statistics Canada. Participants Close family/friends (<10) 13 (29.5%) resided in the Canadian provinces of British Columbia (14), To most 18 (40.9%) Newfoundland (seven), Nova Scotia (11), Ontario (10), and To all 12 (27.3%) Quebec (2). For 38 participants, the time range from social Time from social and/ No answer 6 (13.6%) and/or physical transition to the date of the data collection or physical transition <1 year 6 (13.6%) extended from 4 months to 20 years. Six participants did not Between 1 and 3 years 8 (18.2%) answer the question on length of time from social and/or Between 3 and 5 years 5 (11.4%) physical transition. Most participants (18) were out to “most” Between 5 and 10 years 13 (29.6%) people, 13 were out to “close” family and friends, 12 were >10 years 6 (13.6%) out to all, and one participant was not out to anyone. The Age categories based on Grant et al. (2011). sample was limited by two considerations common to research involving transgender people: (a) the participants identified based on self-report and (b) the sample was based instruments (UCLA Loneliness Scale Version 3, PRCA, and on a convenience sample (cf. Rosser, Oakes, Bockting, & Willingness to Communicate) in paper-based format and Miner, 2007) as well as one limitation arising from the sam- provided answers to five field-tested open-ended questions. ple: the majority of participants had been assigned to the Basic demographic data were collected at the same time via female sex at birth. nine questions about age, sex assignment at birth, gender identity, ethnic identity, geographic location, size of popula- tion center, and time from social and/or physical transition. Instruments The question about transition simply inquired how much The UCLA Loneliness Scale Version 3 (Russell, 1996) is time had passed since “physical and/or social” transition designed to measure subjective feelings of loneliness as because transition itself was not a focus of this study, and the well as of social isolation. The 20-item scale includes items purpose of including this question was limited to determin- such as “How often do you feel alone?” and asks partici- ing whether the length of public identification was relevant. pants to rate each item on a scale from 1 (never) to 2 (rarely) For many transgender people, these processes are inter- to 3 (sometimes) to 4 (always). Nine of the items are reverse twined, contextual, and dynamic as their responses in this scored. First published in 1978, the scale has been revised study further illustrate. The surveys were submitted in anon- twice. The UCLA Loneliness Scale Version 3 was pub- ymous format; identification of the province in which the lished in 1996, and, as the most recent measure, was used in data were gathered was the only item tying data to their ori- this study. The instrument is considered internally consis- gin. Participants and the community members facilitating tent (coefficient α ranging from .89 to .94) and highly data collection received gift cards in recognition of their 6 SAGE Open reliable (Russell, 1996). Total scores can range from 20 to The qualitative data resulting from the answers to open- 80, with higher scores reflecting greater loneliness. ended questions were analyzed via two methods. First, a ques- The Willingness to Communicate (WTC) Scale contains tion-by-question analysis of the content provided by the 20 items, of which 12 are designed to measure an individu- participants’ responses followed standard procedures recom- al’s inclination to initiate communication and the remaining mended in the coding of open-ended survey responses (Fink, eight to distract attention from the scored items. Alpha reli- 2015). The author and a research assistant grouped the ability estimates generally range from .85 to above .90 responses by question and read the responses to each question (McCroskey & Richmond, 2013). Items such as “Talk with multiple times. Both marked key words and phrases used by a friend while standing in line” ask respondents to indicate the respondents to arrive at coding categories for each ques- the percentage of times they would choose to communicate tion. Using a spreadsheet, all responses were assigned to one in each of the 20 situations, with 0 representing never and or several coding categories for each question, and frequencies 100 always. In addition to the total WTC score, the instru- of appearance were tabulated; categories represented by three ment allows the generation of four context-type and three or more responses were reported. Labels for coding categories receiver-type scores. The context-type subscores pertain to were derived from language used by the participants. In the group discussion, meetings, interpersonal, and public descriptive analysis of the individual open-ended responses, speaking settings. The receiver-type subscores pertain to these coding categories were drawn upon to arrive at themes stranger, acquaintance, and friend. These subscores, how- representative of the responses to each individual question. ever, are not quite as reliable as the total score. All sub- Second, a qualitative analysis of the overall data (i.e., the scores and the total score will fall in the range of 0 to 100. text of the answers to all the questions) employed a tradi- To arrive at the total WTC score, the receiver-type sub- tional thematic analysis following the models articulated by scores are added and divided by 3. The norms for the total Braun and Clarke (2006) and applied by Fielden, Sillence, WTC are high if >82 and low if <52. For context scores, and Little (2011) and Olivari, Cuccì, and Confalonieri scores are considered high if >89 for group discussion, >80 (2016). This analysis consisted of multiple readings of the for meetings, >94 for interpersonal conversations, and >78 text, identifying clusters of meaning, extracting themes and for public speaking. Context scores are considered low if subthemes, and selecting representative participant quotes. <57 for group discussion, <39 for meetings, <64 for inter- To enhance representativeness of the data collected, partici- personal conversations, and <33 for public speaking. For pant quotations were checked to ensure that each participant receiver types, scores are considered high if >63 for was represented at least once, whether in direct or indirect stranger, >92 for acquaintance, and >99 for friend. Scores quotations, in either the content or the thematic analysis. are considered low if <18 for stranger, <57 for acquain- tance, and <71 for friend. Results The PRCA-24, developed by McCroskey (2005), consists of 24 items. It is highly reliable (α reliability typically Quantitative Survey Analysis between .93 and .95) and has high predictive validity. Items Descriptive results are presented in the form of short “I” statements, for exam- ple, Item 1 reads “I dislike participating in group discus- UCLA Loneliness Scale Version 3. Participant (n = 44) scores sions.” Participants select the degree to which each item ranged from 27 to 72 (M = 48.29, SD = 10.74). applies to them (ranging from 1 (strongly disagree) to 5 (strongly agree). The total PRCA score is the sum of the PRCA-24. Participant scores (n = 44) for the PRCA Group addition of all scores, which can range from 24 to 120. Scores Discussion composite ranged from 6 to 30 (M = 18.38, SD below 51 indicate very low communication apprehension; = 5.79; Table 2). Participant scores (n = 44) for the PRCA scores between 51 and 80 indicate average communication Meetings composite ranged from 6 to 30 (M = 19.18, SD apprehension; and scores above 80 indicate high communi- = 6.19). Participant scores (n = 44) for the PRCA Interper- cation apprehension. The instrument also allows for the sub- sonal composite ranged from 7 to 30 (M = 18.27, SD = 5.18). scoring of group discussion, meetings, interpersonal, and Participant scores (n = 44) for the PRCA Public Speaking public speaking settings. These subscores, however, are not composite ranged from 6 to 30 (M = 20.63, SD = 6.01). quite as reliable as the total score. Participant scores (n = 44) for the overall PRCA composite ranged from 47 to 76 (M = 69.06, SD = 5.15). Data Analysis Willingness to Communicate (WTC). Participant scores Quantitative analysis of the data resulting from the three sur- (n = 44) for the WTC group discussion composite ranged vey instruments involved descriptive statistics to provide a from 6.67 to 100 (M = 63.40, SD = 24.29). Participant scores snapshot of various statistics, most notably frequency, mean, (n = 44) for the WTC meetings composite ranged from 0 to and standard deviation. Correlation coefficients were run to 100 (M = 50.93, SD = 28.83). Participant scores (n = 44) examine the correlation of the scales to demographics. for the WTC interpersonal composite ranged from 0 to 100 Heinz 7 Table 2. WTC, PRCA-24, and UCLA-Loneliness Scale Scores (n = 44). Instrument Minimum Maximum M SD WTC_context-type subscore–group discussion composite: Items 8, 15, 19 6.67 100.00 63.40 24.29 WTC_context-type subscore–meetings composite: Items 6, 11, 17 0.00 100.00 50.93 28.83 WTC_context-type subscore–interpersonal composite: Items 4, 9, 12 0.00 100.00 61.04 25.52 WTC_context-type subscore–public speaking composite: Items 3, 14, 20 0.00 100.00 57.47 28.80 WTC_receiver-type subscore–stranger composite: Items 3, 8, 12, 17 0.00 100.00 39.52 27.47 WTC_receiver-type subscore–acquaintance composite: Items 4, 11, 15, 20 0.00 100.00 60.98 28.76 WTC_receiver-type subscore–friend composite: Items 6, 9, 14, 19 15.00 100.00 74.13 24.47 WTC–total score 8.33 100.00 58.21 24.86 PRCA–group discussion composite 6.00 30.00 18.38 5.79 PRCA–meetings composite 6.00 30.00 19.18 6.19 PRCA–Interpersonal composite 7.00 30.00 18.27 5.18 PRCA–Public Speaking composite 6.00 30.00 20.63 6.01 PRCA–overall composite 47.00 76.00 69.06 5.15 UCLA Loneliness Scale–total score 27.00 72.00 48.29 10.74 Note. WTC = Willingness to Communicate; PRCA = Personal Report of Communication Apprehension; UCLA = University of California, Los Angeles. Table 3. Comparison of Participant Means With Broader Population Means. Broader population Transgender study M SD M SD WTC Group discussion 68.1 16.4 63 24.29 Meetings 59.3 18.6 50.93 28.82 Interpersonal 72.9 15.8 61.04 25.52 Public speaking 52.2 20.4 57.47 28.80 Stranger 35.6 21.3 39.52 27.47 Acquaintance 69.9 18.25 60.98 28.76 Friend 83.9 14.0 74.13 24.47 PRCA Group discussion 15.4 4.8 18.38 5.79 Meetings 16.4 4.2 19.18 6.19 Interpersonal 14.2 3.9 18.27 5.18 Public speaking 19.3 5.1 20.63 6.01 Total score 65.6 15.3 69.06 5.15 UCLA Loneliness Scale Total score 40.1 9.5 48.29 10.74 Note. WTC = Willingness to Communicate; PRCA = Personal Report of Communication Apprehension; UCLA = University of California, Los Angeles. (M = 61.04, SD = 25.52). Participant scores (n = 44) for means of the transgender community with the broader the WTC public speaking composite ranged from 0 to 100 population norms. A population mean did not seem avail- (M = 57.47, SD = 28.80). Participant scores (n = 44) for able for the WTC; therefore, the broader population mean the WTC stranger composite ranged from 0 to 100 (M = used in Table 3 is based on a study of student groups in the 39.52, SD = 27.47). Participant scores (n = 44) for the WTC United States (Barraclough, Christophel, & McCroskey, acquaintance composite ranged from 0 to 100 (M = 60.98, 1988). The population mean for the PRCA is based on two SD = 28.76). Participant scores (n = 44) for the WTC friend separate samples: one of more than 40,000 college stu- composite ranged from 15 to 100 (M = 74.13, SD = 24.47). dents and another of more than 3,000 nonstudent adults Participant scores (n = 44) for the WTC overall composite with virtually the same results. A population mean did not ranged from 8.33 to 100 (M = 58.21, SD = 24.86). seem available for the UCLA Loneliness Scale; therefore, the broader population mean used in Table 3 is based on a Mean comparisons with population standard. The first sample of students (N = 487) used in a study testing the objective of the quantitative analysis was to compare the reliability, validity, and factor structure of the UCLA 8 SAGE Open (Russell, 1996). It is important to note that researchers participants, the research ethics protocol had intentionally have not established Canadian population norms for these assured participants that demographic data would only be scales. The results demonstrate that, in comparison with a provided in aggregate form and not linked to individual broader population of students, the participants in this open-ended survey responses. This addressed concerns about study were less willing to communicate in group discus- confidentiality and privacy expressed by some prospective sions, meetings, and interpersonal conversations as well participants. Results of the question-by-question analysis are as with acquaintances, and with friends. However, they summarized in Table 5; results of the overall analysis are were more willing to communicate in public speaking and summarized in Table 6 in a format modeled after that with strangers. This sample was also more apprehensive employed by Olivari et al. (2016). to communicate across all subgroups and reported more loneliness that the broader population norms. Question 1: Communication stress factors. Participants differ- entiated between communication with strangers and commu- Correlations. Correlations were run to assess relationships nication with individuals they know, between communication between the scales and the demographic variables (Table with cisgender men and cisgender women, and between 4). Because this data set has variables with data that are not communication with individuals who know that the partici- normally distributed, Spearman’s correlation coefficient pant identifies as transgender and communication with those (Spearman’s rho) was used rather than the Pearson correla- who do not. They stated that stress in interactions with cis- tion coefficient (Pearson’s r). No scales were related to sex gender strangers, particularly cisgender men, primarily arises assigned at birth, the size of the participant’s population from the fear of constant judgment, being belittled or not center, or the time from social and/or physical transition. accepted; apprehension about attitudes; fear of being mis- The overall PRCA composite was negatively correlated gendered, misnamed, and/or outed as transgender; the expec- with age, meaning that as participants’ ages increased, tation of having to educate others; and concerns about their scores on the PRCA overall composite decreased. The physical safety. They also reported a general lack of comfort correlation coefficient (–.335) demonstrated a moderate with conversations reflecting gender norms. effect. WTC–public speaking and WTC–friend scores were positively correlated to the degree that a participant I don’t know how they will react once they find out I’m trans. It reported being out as transgender. This means that the feels unsafe. At the same time, I don’t want to always have to more out participants reported being, the higher their “out” myself. But then there’s the fear that they will find out some other way. If I do “out” myself, I worry that I’ll be expected scores on WTC–public speaking and WTC–friend. The to educate them; I worry they won’t see me for who I am but just correlation coefficients of .329 and .316, respectively, get caught up in me being trans. (Participant 3) demonstrated a moderate effect. PRCA–meetings scores were negatively correlated to the degree that participants Participant 7 said that “feelings of being judged, not reported being out, meaning that the more out participants being listened to,” and “belittled, talked to as if I were a reported being, the lower their PRCA–meeting score was. child” cause stress in communication with cisgender people. The correlation coefficient of –.305 demonstrated a mod- Some noted that interpersonal communication stress can erate effect. affect all interactions, not just those with cisgender strang- ers: “It creates more distance between me and almost every- Qualitative Analysis of Open-Ended Questions one else” (Participant 44). Conversation about gender-related topics increases stress, participants observed, such as con- Five questions asked participants to (a) identify factors that versational partners’ “assumptions about my ‘stance’ on might make face-to-face interactions with cisgender people women” (Participant 26). Participant 25 responded with the stressful to them, (b) describe how such stress affects their observation that face-to-face interactions with cisgender these interactions, (c) identify cisgender communication people are not stressful: “If anything, I find it less stressful behavior most frustrating to them, (d) reflect on whether than interactions with trans people because I care more what being transgender affects the ways in which they communi- trans people think of me.” cate with other people, and (e) suggest recommendations to cisgender people who would like to make such interactions less stressful. These questions were exploratory, given the Question 2: Communication stress responses. All but six par- apparent scarcity of previous work on transgender communi- ticipants said that stress occurring in interpersonal communi- cation from a minority stress perspective. The responses cation encounters with cisgender people affects their were first analyzed question by question using standard con- communication behavior. Participants identified communi- tent analysis coding practice (Fink, 2015), then as one over- cation avoidance, withdrawal from interactions, silencing, all data set using thematic analysis (Braun & Clarke, 2006). and increased self-monitoring as direct responses to interac- Although linking demographic data such as age or time from tions. Some participants noted physiological responses such transition would provide a richer context for quotations from as a nervousness, stomach pain, muscle tension, conscious Heinz 9 Table 4. Correlation Between Demographics and Scales. Degree of out as Age Size of population transgender Time from transition WTC_context-type subscore–group discussion Correlation coefficient .068 −.100 .149 .004 WTC_context-type subscore–meetings Correlation coefficient .151 −.059 .046 .006 WTC_context-type subscore–interpersonal Correlation coefficient .129 −.151 .267 .006 WTC_context-type subscore–public speaking Correlation coefficient .065 .019 .316 −.007 WTC_receiver-type subscore–stranger Correlation coefficient .182 .032 .054 .060 WTC_receiver-type subscore–acquaintance Correlation coefficient .108 −.078 .271 −.046 WTC_receiver-type subscore–friend Correlation coefficient .015 −.172 .329 −.056 WTC total score Correlation coefficient .090 −.077 .227 .006 WTC–categorized high/moderate/low Correlation coefficient .109 −.085 .147 −.024 PRCA–group discussion Correlation coefficient .089 −.105 −.045 .130 PRCA–meetings Correlation coefficient .054 −.113 −.305 .066 PRCA–interpersonal Correlation coefficient −.003 .037 −.145 .190 PRCA–public speaking Correlation coefficient −.186 −.240 −.190 .079 PRCA–overall composite score Correlation coefficient −.335 −.048 .040 .087 PRCA–categorized high/average/low Correlation coefficient .181 −.097 −.204 .229 UCLA Loneliness Scale–total score Correlation coefficient .109 −.110 −.292 .059 Note. WTC = Willingness to Communicate; PRCA = Personal Report of Communication Apprehension; UCLA = University of California, Los Angeles. efforts to control one’s voice, stuttering, and facial flushing. I try to accommodate the other person. Causes internal anxiety. May talk less, avoid people, leave social situations sooner, go Others reported that stress made it difficult to organize their outside. Stick to more formal topics, do not discuss personal thoughts and spoke of an internal sense of stress building up. opinions or express my true feelings. (Participant 16) The most common behavioral responses participants identi- fied were withdrawal and avoidance, whether in the form of physical avoidance of public spaces or internal withdrawal. I find that I become anxious and stressed in some interactions. While I want to stand up for transfolk I lose confidence and struggle to communicate because my emotions get too involved. Generally, my body becomes tense, I may have a hard time (Participant 9) reasoning because I am so distracted by my stress. I may choose to not respond or end a conversation prematurely to end the interaction entirely. In the past I often held onto these situations/ One participant noted that although they experience stress, interactions and my stress sat in my body and manifested in tight that stress does not manifest externally: “The stress becomes muscles and soreness. (Participant 27) and stays internal,” Participant 1 wrote. For others, though, stress does manifest externally. “It can make me avoid Avoidance patterns the participants spoke of included not ‘straight’ ‘cis’ spaces. It can make me defensive or enraged, or speaking, or speaking less, keeping answers short, shutting embarrassed,” Participant 32 said. “It greatly affects my com- down, withdrawing from discussions, keeping people at arms’ munication because I will think it over before I can talk (i.e., length, and keeping conversational topics at superficial levels. make sure my voice is higher, etc.)” (Participant 34). 10 SAGE Open Table 5. Question-by-Question Content Analysis. Topic Coding category Number of mentions Communication stress factors Fear of constant judgment 14 Apprehension about attitudes 9 Discomfort with gender topic/norms 8 Fear of being outed as transgender 7 Fear of being misgendered/misnamed 7 Fear of not being accepted 7 Expectation of having to educate 6 Fear of being belittled 4 Concerns for physical safety 4 Communication stress responses Communication avoidance 16 Quietude/silencing self 9 Withdrawal from interaction 8 Increased self-monitoring 8 Internal stress build-up 6 Difficulty organizing thought 4 Physiological responses 4 Frustrating behavior Nonverbal distancing and disapproval 12 Dismissal 10 Lack of basic knowledge 6 Inaccurate assumptions 5 Enforcement of gender norms 5 Intrusive questions 4 Intentional misgendering/misnaming 4 Displays of pity or sympathy 3 Making big deal of mistakes 3 Defensiveness 3 Visible apprehension 3 Communication effect Increased caution and unease 11 Decreased self-disclosure 7 Increased emphasis on performance 6 Withdrawal 6 Increased monitoring of others 5 None 5 Increased effort, exhaustion 5 Anxiety and nervousness 4 Increased sensitivity to others’ gender 4 Desire to educate 3 Recommendations Follow communication cues 13 Signal warmth and openness 11 Display basic human respect first 9 Recognize/avoid cisgenderism 9 Use appropriate name and pronouns 4 Educate oneself on gender diversity 4 Display lack of judgment 3 Several participants who physically transitioned noted performance causes me to second guess a lot of what I say/ that transition stage made a difference: “As I’ve been passing do,” Participant 31 wrote. Participant 37 spoke of a vicious as cis more frequently it is less stressful” (Participant 28). cycle: “Stress can lead me to overanalyze/overthink and Many participants observed effects on speech production as therefore induce more stress.” a function of stress that communication encounters produce. “Alternately I ramble or end up mute and just don’t engage,” Question 3: Frustrating cisgender communication behaviors. Ver- Participant 14 noted. “Particularly with cisgender males I bal and nonverbal communication behaviors that reflect feel I have to perform masculinity. The pressure of transphobia, ignorance, or arrogance create frustration for Heinz 11 Table 6. Overall Thematic Analysis. assuming that I need to present as cis to be accepted fully as female.” Theme Subtheme Question 4: Transgender identity and communication. Five Communication climate Boundaries participants said that being transgender does not affect the Safety Self-disclosure ways in which they communicate with other people. For Self-monitoring the majority of participants, however, there is a noticeable Social isolation Isolation effect. Caution, unease, anxiety, and nervousness were Loneliness reported as common effects. Participants noted that they Social anxiety are more cautious and not at ease during interactions, such Unwillingness to communicate as Participant 3 who said, “I tend to be cautious when Cisnormativity Binary understandings meeting new people. I am ever vigilant, even with people I Expectation violation know, as I never entirely feel safe.” Participant 13 wrote “I Gender norms Uncertainty reduction find I’m more on edge and alert in social situations due to a general sense of danger.” Withdrawal from communica- tion and decreased self-disclosure were reported by par- these transgender individuals. Such behaviors most notably ticipants who contributed statements such as “I don’t talk include nonverbal distancing and expressions of disapproval about my private life much at all anymore” (Participant 5), and dismissal of the transgender individuals overall or of “I share less personal information” (Participant 16), and “I their attitudes, beliefs, and experiences. Some participants also have a harder time expressing my feelings/thoughts to identified staring, eye rolling, frowning, physical distancing, even close friends” (Participant 19). “I have trouble trust- bathroom usage glances, and loud and abrasive speech as the ing people,” Participant 15 wrote. This appeared especially most frustrating nonverbal communication behaviors they common when conversations turn to gender-specific experience. Participants articulated disappointment with the topics. experience of not being seen, listened to, or heard during I often find myself hyper-aware of conversation topics interpersonal interactions. “People who seem content to (especially with cisgender or hetero people) and mentally plan ignore your existence, even when they know you as an ways to end or leave a conversation if it becomes unbearable/ acquaintance,” Participant 16 wrote. It is frustrating when inappropriate. (Participant 27) others “won’t listen/correct me on my experiences,” Partici- pant 23 offered. Other cisgender communication behaviors So many things in life are so cis-centred that I don’t feel like creating interactional distance and conflict include displays talking about my experiences at all because it will require me to of lack of basic knowledge about gender diversity, inaccu- teach them, answer questions and deal with their own ignorance. rate assumptions, and enforcement of gender norms. Partici- (Participant 35) pants also identified being asked intrusive questions, intentionally using incorrect pronouns or names, displaying Some participants noted that they increase emphasis on pity or sympathy, making a big deal about mistakes, defen- gender performance to accommodate others, along with siveness, and visible apprehension as obstacles. increased monitoring of others’ communication responses. Inappropriate displays of sympathy or pity are frustrating, “I am nervous my voice will give me away. I’m nervous several participants noted, such as Participant 21, who wrote, people won’t get it,” Participant 29 wrote. Participants “Relax! And don’t use me as a way to prove you are an ally,” also commented on the increased effort and resulting or Participant 5, who provided the example “I can’t imagine exhaustion they experience as a result. Participant 41 said how hard it must be.” In a similar vein, overaccommodation being transgender has no effect on communication. “I try was noted as being a hindrance to positive communication to act myself 99 percent of the time and if people don’t encounters. “Frustrating? Stumbling over pronouns with like me for me I don’t surround myself with them unless I profuse apologies. When they treat me like I’m dangerous,” have to.” Participant 21 wrote. “Making a huge deal out of ‘screwing Three participants said that being transgender has posi- up’ my gender,” Participant 13 said. Participant 33 said it is tively affected their communication behavior, in that, it frustrating “when ‘allies’ try way too hard to look under- makes them more sensitive to the gender identities of others standing and it comes across as pity.” and has given them a greater appreciation for gender For some participants, normative assumptions about gen- dynamics. der-related preferences constitute the biggest challenge in interactions with cisgender people. Such communication On one hand, it allowed space to be vulnerable and share my behaviors include the assumption that transgender people experiences for education and advocacy work. On the other want to live up to normative ideals. “I dislike being compli- hand I feel like I always have to be “on” and as if I can’t mented only when I perform to the standards of any assigned communicate that I may need something different in the gender,” Participant 22 said. Participant 30 referred to “Just moment. (Participant 19) 12 SAGE Open Three responses also reflected that participants felt empow- conversations about gendered behaviors can bring about for ered to be more outgoing and to take the initiative to educate transgender people. “Learn about 2 spirit ones who do not fit others. in gender roles. Do not assume males to do male roles and females female roles,” Participant 2 wrote. “Make a habit of Question 5: Recommendations. The most common response using sex-neutral terms when interacting with people,” suggested that cisgender people need to follow the nonver- Participant 8 contributed. Such responses were related to bal and verbal communication cues provided by transgen- comments about the need to recognize and avoid cisgender der people, to follow their lead, and to be sensitive to their assumptions. communication needs by signaling warmth and openness. Two participants noted that they had no recommendations Many participants noted that nonverbal communication because they did not find interactions with cisgender people behavior contributes greatly to feelings of comfort and stressful. A few other individuals said they had no recom- safety during a communication interaction. Signaling mendations because they were not sure how interactions warmth, openness, and lack of judgment is essential, they could be improved or because they attributed stress to inter- suggested. Such communication behavior, they suggested, nalized anxiety. does not require special inventories of communication skills but a general genuine desire to acknowledge another’s Thematic Analysis of Overall Response Data humanity, to display basic human respect for an individual, and to have a basic understanding of gender diversity. The open-ended questions were interrelated, and respon- dents at times further articulated or elaborated on responses I would recommend that they make the effort to educate to preceding questions. To complement the question-by- themselves about trans issues and that they don’t just assume question analysis, an overall thematic analysis was con- that other people are cisgender. Also, I would appreciate it if ducted, based on the data set consisting of all open-ended they saw me as a human first and followed my lead on what I’m responses. This analysis yielded three overarching themes comfortable disclosing. (Participant 3) with four corresponding subthemes: communication climate (boundaries, safety, self-disclosure, self-monitoring), social Participant 20 recommended “open and welcome body isolation (isolation, loneliness, social anxiety, unwilllingness language. No questions about my body or gender that aren’t to communicate), and cisnormativity (binary understand- relevant to conversation.” Focusing on an individual’s appar- ings, expectation violation, gender norms, uncertainty reduc- ent gender variance creates an interpersonal distance that tion; see Table 6). In contrast to the content analysis of the creates stress in interactions, several participants noted. “Just open-ended questions, which drew directly from responses treat me like you would any other person and don’t bring up to arrive at coding category labels, this overall analysis me being trans unless I do first,” Participant 33 wrote. established conceptual themes and drew from interpersonal Participant 28 recommended to “not treat trans people any communication literature for appropriate labels. different than cis people.” Participant 6 observed that “as long as people are warm and respectful, then I’m not Communication climate. The dominant overall theme reflected stressed.” the significance of the interpersonal communication climate. Not surprisingly, participants remarked on the frustration, Participants said interactions in which mutual trust, respect, stress, and anxiety they experience when others use incorrect and safety are established early on tend to be positive and pronouns, assume pronouns, or argue when a pronoun is cor- enriching; interactions in which boundaries are violated, rected. They recommended, for their own practice as well as identity is reduced to being transgender, and judgment and that of others, to use gender neutral language where possible, dismissal are evident reinforce the need to avoid and with- until they have been given the opportunity to introduce them- draw from communication. Several participants noted antici- selves. “Let go of the judgment, don’t assume, don’t Sir? pating potential threats to their physical safety. The constant Ma’am? Sir?” Participant 10 wrote. Participant 24 suggested need to self-monitor one’s communication behavior increases to “not argue with a suggestion or request” because “it tends stress, reduces confidence, and requires a taxing amount of to invalidate the transperson’s voice.” People should not try energy, all but four respondents indicated. Participant 44 to guess pronouns if they are not sure about the appropriate said, “I enjoyed communicating with others before transi- pronoun, Participant 12 wrote. tion, now I dread it.” Participant 43 noted, “I self-censor a Other participants recommended that cisgender individu- lot!” Most participants raised the need to adjust and monitor als become sufficiently educated with gender diversity to self-disclosures depending on context, conversational part- understand “how exhausting it can be to be constantly mis- ner, and communication climate. understood” (Participant 38), to “be patient in conversation” (Participant 40), and to “stop dismissing my observations as Isolation. Nineteen participants made references to feeling if they’re not valid just because I’m transgender” (Participant alone, lonely, or socially isolated in their responses. In some 44). This includes being sensitive to the level of stress Heinz 13 instances, participants reported social anxiety exacerbating iso- The second research question sought to establish how lation; such an anxiety was attributed to negative experiences transgender people in this sample rate on measures of com- or expectations of negative encounters. Participants described munication apprehension, loneliness, and willingness to being isolated or isolating themselves by avoiding communica- communicate. In comparison with broader student popula- tion encounters, deflecting personal questions, restricting open tion norms (keeping in mind that this study used a nonran- communication to close or known others, and opting for dom sample), this sample was less willing to communicate silence. Participant 3 wrote, “I keep people at arm’s length.” in all settings other than with strangers or in the form of public speaking, reported higher loneliness, and reported Cisnormativity. Regardless of interpersonal intent of conversa- higher levels of communication apprehension. The degree tional partners, cisnormative expectations and norms pose to which participants were out appeared to have the greatest obstacles to open conversational exchanges, these partici- impact on their willingness to communicate and their lone- pants noted. Those who have physically transitioned, and/or liness scores. are recognized in their self-identified gender, and comfortable The third research question asked participants to offer with gender norms, reported greater ease in interactions recommendations to cisgender people. In sum, these recom- because of uncertainty reduction in interactions. However, mendations suggest cisgender people should follow the ver- for those who are not recognized in their self-identified gen- bal and nonverbal communication cues provided by der and/or those who are not comfortable with binary gender transgender people; signal warmth, openness, lack of judg- norms, casual participation in everyday conversations appears ment, and basic human respect; and acquire a basic under- marked by difficulty and safety concerns. Ten participants standing of gender diversity. expressed disappointment that cisgender individuals tend to expect gender conformity, whether in regard to one’s sex Discussion assigned at birth or one’s self-identified gender. “Most of the past year I’ve been presenting as male. It’s easier to get by, Meyer’s (2003) minority stress model and applications of and people find it easier to classify me and thus communicate that model to transgender populations (Hendricks & Testa, with me. I kind of hate myself then, however,” Participant 4 2012; Kelleher, 2009) suggest that cisnormativity, cisgender- observed. Three participants spoke of their commitment to ism, and transphobia contribute to chronic stress and nega- educating cisgender individuals about the range of gender tive health outcomes for transgender people. This study identities, with a particular emphasis on nonbinary identities. sought to isolate and identify specific interpersonal commu- Conversations that normalize cisgender assumptions may nication behaviors and experiences in which these stressors open up transgender participants to levels of disclosure not manifest. Such work is relevant to public policy and mental anticipated, lead to awkward withdrawals from communica- health service delivery (Alessi, 2014), educators (E. R. Green tion, or expose them to boundary violations. At the same & Maurer, 2015), family members, friends and allies of time, expectancy violation creates challenges for cisgender transgender people (Norwood, 2012), and the public at large. participants. Lack of knowledge or comfort with cisgender Three instruments were administered to gather initial data communication norms appears to contribute to feelings of on communication apprehension, loneliness, and willingness isolation: to communicate among Canadian transgender people. The results demonstrate relatively high degrees of communica- Being raised female and being introspective and valuing talking tion apprehension and loneliness and relatively low degrees about feelings makes me an atypical man. This can make my of willingness to communicate. The qualitative analysis of interactions with cis men strained (especially with strangers). the results suggested significant communication stress fac- (Participant 31) tors influencing individuals’ ability and willingness to engage in communication, a keen awareness of potential or perceived threats resulting from communication, a desire to Summary communicate in a welcoming communication climate, and a The first research question inquired about the interper- phenomenon of social isolation and loneliness. Participants sonal communication experiences of transgender people. generated specific recommendations for cisgender individu- In sum, participants emphasized the need for positive als wishing to contribute to a more welcoming communica- communication climates that are sensitive to the experi- tion climate. ences of loneliness and the effects of cisnormativity. These results offer a glimpse into the ways in which a Participants identified specific communication stress fac- sense of real or perceived social isolation and loneliness tors common to face-to-face interactions with cisgender might interact with communication behaviors and disposi- people, reported on their own responses to such stress, tions and vice versa. It is noteworthy that individuals who identified specific cisgender communication behaviors consider themselves to be more visible (out) score lower on that increase stress, and generated recommendations for loneliness and communication apprehension and higher on cisgender people. willingness to communicate. At the same time, 14 SAGE Open the qualitative data illustrate the stressful aspects of being recommendations. Such work could contribute to emerging visible. Cacioppo and Cacioppo (2014) argued that, gener- communication research on the ways in which individuals ally speaking, individuals who feel lonely experience a regulate communication anxiety (White et al., 2015). higher degree of sensitivity to social threats, a dynamic they titled “toxic effects of perceived social isolation” (p. 58). Acknowledgments Such work builds on earlier work in interpersonal communi- The author expresses sincere gratitude to Jayce Palmer, Stefan de cation, such as that of Segrin (1996), who observed that Villiers, Charles Paul Murphy, Zack Marshall, Stevie Gregg, and lonely people typically desire more intimate and meaningful Kinnon MacKinnon for assistance with the data collection. The relationships but hold negative views of others and expect author gratefully acknowledges the assistance of research assistants Tina Quade and Marie Claire Joseph in the data analysis process. others to hold negative views of them. In conversation, The feedback of two blind peer reviewers was most helpful in the Segrin noted, lonely people “behave in such a way, perhaps final revision of the article, as was the careful review by Dr. Runa as a result of deficient social skills, to virtually ensure a neg- Das, assistant professor at Royal Roads University. Most of all, the ative outcome” (p. 231). The results, therefore, stress the author expresses gratitude for the participation of the transgender need for family members, friends, allies, educators, and ther- individuals who made this study possible by thoughtfully sharing apists (Levitt & Ippolito, 2014a) to foster strong conversa- their time and perspectives with all of us. tional skills among transgender people. That, however, cannot happen unless the communication climate is condu- Declaration of Conflicting Interests cive to safe and welcoming conversations. Importantly, these The author(s) declared no potential conflicts of interest with respect are not necessarily conversations about one’s gender identity to the research, authorship, and/or publication of this article. or gender-related issues; they are conversations at large, which often contain cisgender and cisnormative, and some- Funding times transphobic, elements that make it stressful for trans- The author(s) received financial support in the form of an internal gender people to participate or further the conversation. research grant from Royal Roads University for the research and/or It is important to keep in mind that “not everyone who authorship of this article. experiences discontinuity between his or her sex and gender will experience distress about gender identity” as the WPATH References Consensus Project Human Rights Work Group pointed out in 2011 (J. Green, McGowan, Levi, Wallbank, & Whittle, 2011, Alessi, E. (2014). A framework for incorporating minority stress p. 4). 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SAGE Open – SAGE

Published: May 28, 2018

Keywords: transgender; Canada; social isolation; loneliness; communication apprehension; willingness to communicate; minority stress

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Communicating While Transgender: Apprehension, Loneliness, and Willingness to Communicate in a Canadian Sample:

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Communicating While Transgender: Apprehension, Loneliness, and Willingness to Communicate in a Canadian Sample:

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