THE IMPACT OF SELF-ACCEPTANCE ON MENTAL HEALTH AMONG GENDER-DIVERSE INDIVIDUALS by Josephine Deschamps B.Sc, University of Victoria, 2021 THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF EDUCATION IN COUNSELLING UNIVERSITY OF NORTHERN BRITISH COLUMBIA March 2025 © Josephine Deschamps, 2025 ii Abstract The social context surrounding gender diversity influences how individuals shape their identity and experience the world. The increased prevalence of psychological distress in genderdiverse individuals is a concern, and this study focuses on the decisive protective factor of selfacceptance in an attempt to better understand how to mitigate adverse mental health outcomes for this demographic. By engaging in qualitative, semi-structured interviews and an exploratory qualitative approach, this research garnered rich data that reflected participants' perspectives and experiences. Through thematic analysis, powerful themes emerged. These included the holistic impact of mental health throughout one’s journey, the importance of connectedness and selfexpression and the need for authenticity in identity formation. The experience of self-acceptance was found to have a significantly robust positive impact on participants' lives, mental health, and overall well-being. This research contributed to deepening the understanding of gender-diverse individuals' journeys to self-acceptance by learning from their lived experiences and stories. iii Table of Contents Abstract .... ...........................................................................................................................iiii Table of Contents.... Acknowledgements .... ................................................................ ....iiii ..................... .......................................................................... vi Chapter One Introduction ....................... ...................................................................................... 1 Definition of the Terms .................................................................................................. 3 Rationale for the Research .......... ................................. . 8 Identity Formation ........................................................................................................ 13 Research Question ........................................................................................................ 15 Researcher Context ....................................................................................................... 15 Conceptual Lens . ....................................................................................................... 17 Summary of Chapter One ................. ...................... 19 Chapter Two Literature Review .............. .................................................................................. 21 Introduction .................................................................................................................. 21 LGBTQ Mental Health ................................................................................................ 21 Suicidality ........................................................................................................ 23 The Role of Systemic Barriers ..................................................................................... 24 Mitigating Adverse Outcomes ..................................................................................... 26 Support System .................................................................................................. 26 Self-Acceptance ................................................................................................. 27 Summary of Chapter Two ........................................................................................... 29 Chapter Three Research Process ....................................... ................................................................. 30 iv Exploratory Qualitative Approach ............................................................................. 30 Ethical Considerations ................................................................................................. 32 Participants .................................................................................................................. 35 Recruitment ....................................................................................................... 37 Data Collection .............................................................................................................. 38 Interview Structure .......................................................................................... 38 Approach to Analysis ....................................................................................................39 Evaluation Criteria ………............................................................................................ 41 Summary of Chapter Three ………............................................................................... 43 Chapter Four Findings …....................................................... .................................................. 45 Introduction .................................................................................................................. 45 The Coding Process ….................................................................................................. 48 Creating the Codebook .................................................................................... 46 Deriving Themes ............................................................................................. 52 Introducing Push and Pull ............................................................................... 55 Researcher Growth ....................................................................................................... 55 Theme 1: The Intersectionality of Mental Health ......................................................... 58 A Holistic Perspective ..................................................................................... 60 Theme 2: The Importance of Connectedness ................................................................ 63 Push and Pull: Isolation vs Belonging ............................................................. 66 Theme 3: The Role of Expression ................................................................................ 68 Push and Pull: Judgment vs Acceptance ......................................................... 72 Theme 4: The Exploration of Identity ......................................................................... 75 Push and Pull: Inauthenticity vs Authenticity .................................................. 77 v Theme 5: The Impact of Acceptance ............................................................................ 79 Meaning in Self-Acceptance ........................................................................... 82 Push and Pull: Suppression vs Validation ....................................................... 83 Summary of Chapter Four ............................................ .......................................... 85 Chapter 5 Discussion ........................................................ ......................................................... 89 Introduction ................................................................................................................... 89 Conclusions ................................................................................................................... 89 Thematic Conclusions ...................................................................................... 90 Connection to the Research Question .............................................................. 93 Integration with the Theoretical Framework ................................................... 96 Implications ................................................................................................................... 99 Practical Applications ..................................................................................... 99 Implications for Future Research .................................................................. 102 Limitations of the Study............................................................................................... 106 Strengths of the Study................................................................................................... 107 Reflexivity...................................................................................................... 109 Participants Messages .................................................................................................. 113 Summary of Chapter Five............................................................................................. 116 Thesis Conclusion ........................................................................................................ 116 References ................................. ............................................................................................ 119 Appendix A: Recruitment Post ............................................................................................... 127 Appendix B: Participant Information and Consent Form ....................................................... 128 vi Acknowledgement Many people have helped evolve the creation of this thesis, and it’s important to acknowledge their crucial contributions to this research. First and foremost, I would like to thank each participant for their willingness to share their stories with me. This research could not have occurred without their openness and bravery in sharing their experiences. I am profoundly grateful to each of them, and I truly hope I have managed to honour their stories as they deserve. Secondly, I would like to thank my mother for her ongoing support throughout this multi-year process and being my most significant source of encouragement. I would also like to express my gratitude towards my supervisor, Dr. John Sherry, for his valuable insights and guidance throughout this process. Additionally, I would like to express my appreciation to Dr. Linda O’Neill and Dr. Tess Healy for their support and guidance. Finally, I would be remiss not to mention how appreciative and grateful I am for the support of the LGBTQ community, and for every gender-diverse individual who has been part of my own journey of self-discovery and learning. Each of you has played a part in the culmination of this research and in developing my passion for this topic. I am truly honoured to be part of such an uplifting and supportive community. 1 Chapter One: Introduction Throughout history and across cultures, Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, Pansexual, Two-Spirit, Agender, and Asexual (LGBTQQIP2SAA+, subsequently abbreviated to LGBTQ to enhance readability) individuals have experienced life differently due to their identity. For some, this part of their identity can be imbued with shame or violence; for others, it can be a place of community and love. Every LGBTQ person has a unique story of how they came to acknowledge, understand, and accept this part of themselves: their journey to authenticity. In this thesis, I adopt an exploratory qualitative approach to examine the experiences of gender-diverse participants. By using semi-structured interviews, this research aims to increase understanding of that journey to self-acceptance and the impact that acceptance has on an individual's well-being. To explore those stories, it is essential first to understand the social context of being LGBTQ in North America, specifically in Canada. To contextualize these journeys, it is essential to understand the broader social and psychological factors influencing LGBTQ individuals in North America, particularly in Canada. One critical framework for understanding these experiences is the minority stress model, which describes the disproportionately high levels of stressors, including low socioeconomic status or increased exposure to discrimination, experienced by marginalized populations (Meyer & Frost, 2013). It incorporates both external and internal stressors, such as internalized negative beliefs and attitudes. The minority stress model uses a holistic approach to consider the factors that influence psychological well-being and mental health in the LGBTQ community (Meyer & Frost, 2013). By assessing for social determinants of health such as economic stability, community context, and environment, 2 Henderson et al. (2022) conducted a review that reiterated the impact of minority stress on mental health outcomes in the LGBTQ population. Subsequent research has considered the concept of minority stress when examining the social and psychological context in which LGBTQ and gender-diverse individuals exist. This is essential in understanding perspectives and experiences, particularly when exploring the mental health outcomes of this population. Shilo et al. (2015) noted that not all LGBTQ youth experienced adverse mental health outcomes, prompting an exploration of resilience factors within the social context. The authors found that social support and community connectedness were the most vital external resilience factors. Understanding resilience factors such as social support and community connectedness provides insight into how external resources can mitigate internalized cissexism, which is central to this study's exploration of self-acceptance. However, it was also noted that internalized negative social attitudes, namely internalized heterosexism or cissexism (also known as internalized homophobia or transphobia), were the strongest predictor of psychological distress (Shilo et al., 2015). Self-acceptance stands in opposition to these internalized negative beliefs, therefore leading to the thought that a strong level of self-acceptance is a mitigating factor in the psychological distress resulting from the cognitive dissonance of internalized heterosexism in LGBTQ individuals (Camp et al., 2020; Woodford et al., 2014). Additionally, according to Carson and Langer (2006), “self-acceptance is crucial to mental health. The absence of the ability to unconditionally accept oneself can lead to a variety of emotional difficulties, including uncontrolled anger and depression” (p. 1). The relationship between self-acceptance and mental health outcomes is clear. Still, to better understand the barriers to self-acceptance in genderdiverse individuals, we must consider the multifaceted influences of minority stressors. 3 Experiences of prejudice and discrimination, for example, can impact one’s self-perception, including the ability to accept oneself authentically. I hope to fill two main gaps in the literature. First, my goal is to be inclusive of the broad range of existing gender identities. Previous literature has been focused on cisgender LGBTQ or transgender individuals, which reflects a view that perpetuates the pervasive categorical approach to understanding gender through a lack of representation of those who identify outside of the gender binary. This research addresses a critical gap by including participants who identify outside the binary framework, such as genderfluid, agender, or non-binary, allowing for more representation in the academic literature of the true diversity of the queer population. My second goal is that the exploratory approach to the research enables participants to articulate their experiences in a manner that highlights the diversity and complexity of their self-acceptance journeys. This approach better captures the variety of challenges, resilience, communities, and overall experiences that have led them to embrace their authentic selves. Additionally, the perspective of the participants may offer insight into the relationship between self-acceptance and mental health outcomes with the overall goal of exploring factors that enhance psychological well-being. Definition of the Terms Before progressing further into an exploration of the nuances and uniqueness of gender, it is necessary first to have an understanding of some of the terminology used to describe different aspects of the topic. Language, our main communication form, is powerful and can impact one’s understanding and interpretation. Therefore, I will do my utmost to use appropriate language and terminology throughout this proposal. The definition of the terms derives from both my 4 understanding and lived experience in the community and outside resources including the Human Rights Campaign (n.d.) and the Pride Center for Sexual Orientation and Gender Diversity at Lehigh University (n.d). It is important to note that these definitions reflect current understandings but acknowledge that language and its usage evolve alongside societal perceptions. Sex This term refers to biological attributes, such as chromosomes, gene expression, hormone functions, and reproductive anatomy. Sex is often categorized as male or female, but there are variations in the biological attributes (see: intersex). Sex Assigned at Birth Sex assigned at birth refers to the label assigned at birth based on external physiological factors. Thus, people will be assigned female or male at birth. The sex assigned at birth may change throughout the individual’s life, and they may not always identify with the sex they were assigned at birth. Gender Gender is a term that describes the socially constructed roles, behaviours, and expressions of individuals. It can influence perceptions and interactions, and play a large role in one’s life experiences. Gender Binary 5 The social system which prescribes the view that human beings are comprised exclusively of women and men, dependent on the gender they were assigned at birth. Gender Identity This refers to the way people perceive themselves in relation to gender. There are a significant variety and societal structures and expectations that can play a role in identity formation. Gender identity is not confined to a binary but instead exists along a spectrum that can fluctuate for the individual over time. Gender Expression The ways that people choose to express their gender identity. This may not align with social expectations of their gender. Ways of expressing gender might include appearance, such as clothing, hair, or makeup, or might involve certain mannerisms. Gender-Questioning Individuals who are questioning their gender, or who may not know what their gender is. This can be a core part of establishing gender identity for individuals. Cisgender This is a term used for individuals who continue to adhere to the gender they were assigned at birth that falls within the gender binary. Cissexism 6 Personal, societal, and institutional beliefs or practices that promote the gender binary and denounce acceptance of those who do not fit within the set ideas of gender. Cissexism can result in prejudice and discrimination. It is also known as transphobia, but by using the term cissexism instead, the focus is on the oppressive systemic barriers as opposed to a “phobia,” which describes a person's irrational fears. Internalized Cissexism This is a phenomenon in which an individual’s perception of themself is through the lens of a social bias against gender-diverse people, it is internalized discriminatory views and negative attitudes towards the demographic. Internalized cissexism impacts mental health, wellbeing, and consequently self-acceptance. Sexual Orientation This term describes romantic or sexual attraction. It is separate from gender. LGBTQ This is an abbreviated acronym from LGBTQQIP2SAA, which is representative of Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Intersex, Pansexual, Two-Spirit, Agender, and Asexual individuals. This is meant to be as inclusive as possible to many individuals who do not identify with cisgender or heterosexual roles. It is an umbrella term for the community, commonly shortened to LGBTQ. For the sake of readability, I will use the abbreviated LGBTQ term throughout this paper. Gender-Diverse Individuals 7 Gender-diverse individuals are people who, quite simply, do not adhere to society's rhetoric of gender identity or expression; the sex they were assigned at birth is not congruent with their gender identity. Ultimately, gender-diverse individuals are those who do not sit firmly within the gendered binary. The following terms are examples of gender diversity but are not comprehensive regarding the variety of identities this term encompasses. Agender An individual who has no identified gender or might identify as genderless or gender neutral. Genderfluid Someone with no fixed gender. Instead, their gender shifts or changes over time, and they might identify as male, female, non-binary, agender, or a combination of gender identities. Gender non-conforming Individuals who do not comply with the established set of social norms and challenge the gendered expectations of their gender assigned at birth. Gender non-conformity can apply to anyone of any gender identity and can be exhibited through deviating in ways such as gender expressions, gender roles, or gender identity. Non-Binary Individuals whose gender identity does not fit the subscribed gender binary of “male” or “female.” These individuals might use they/them or other pronouns. Transgender 8 A term for individuals whose gender assigned at birth is no longer the gender they identify with or express. Trans-Masculine This term refers to individuals who are often assigned female at birth but have found they identify more with masculine traits or expressions in their gender identity. It is distinct from transgender in that trans-masculine individuals do not necessarily identify as male, despite aligning more with masculine gender identity. Intersex A term used to describe individuals who have a biological variation that does not fit into the typical binary of male or female anatomy. This can include variations in chromosomes, reproductive systems, or sexual anatomy. Pansexual A sexual orientation is when an individual is attracted to someone regardless of sex or gender and does not find sex or gender to be a determining factor. Queer Another umbrella term to encapsulate the LGBTQ community in addition to being used to describe those whose sexual orientation or gender identity is fluid. Two-Spirit 9 An Indigenous term that represents both masculine and feminine traits within an individual. Rationale for the Research The social lens in which the belief that human beings are comprised exclusively of women and men has been firmly implanted throughout the history of psychological research. Pleck (1981) conducted research that examined sex role paradigms while reinforcing the benefits of femininity and masculinity for the respective genders. The gender role strain paradigm reinforces the distinctions between genders through the binary lens (Levant & Powell, 2017), with psychological research consistently emphasizing the gender binary and reinforcing the gender ideology that rests on the subordinate role of the female psyche. Most of our understanding of the human psyche is through the binary lens, which lacks insight into the experiences of those who do not fit within rigid gender categories (Hyde et al., 2019). This contributes to an overall lack of understanding concerning this demographic and therefore poses a barrier to understanding stressors and providing appropriate mental health services. The minority stress model emphasizes the connection between the chronic stressors experienced by a minority group and its subsequent impact on said group's mental health (Camp et al., 2020; Meyer & Frost, 2013). These stressors can include objectively stressful occurrences, like the increased risk of exposure to violence and victimization, and internalized stressors, for instance, concealing a part of one’s identity from family or friends (Camp et al., 2020). These stressors and the adverse feelings accompanying them are potentially exacerbated by intersectionalities of oppression, including racism or sexism. Scheim et al. (2013) looked into the experience of transgender Indigenous participants. In addition to a high proportion of the 10 participants reporting poverty and housing insecurity, they found that 73% of the gender-diverse Indigenous participants reported experiencing violence due to their gender identity. Minority stress transcends a single piece of identity but instead integrates the various intersections of identity to understand one’s experience in the world better. Although the purpose of this study is not to examine how racism, for example, impacts the individual, it is necessary to understand how all these pieces of identity affect the participant and the role that intersectionalities, such as race or ethnicity, have on the journey to self-acceptance. As previously stated, the myriad of stressors experienced by gender-diverse individuals amalgamates and causes increased psychological distress for this population. Therefore, emphasizing specialized and accessible mental health services for gender-diverse individuals is essential. The socio-cultural and emotional distress experienced by individuals in this community impacts the integrity of their mental health and psychological well-being. Jones et al. (2019) found that the overall quality of life was better for cisgender individuals in comparison to transgender individuals. Both external and internal conflicts surrounding authenticity and acceptance of oneself perpetuate the use of coping mechanisms, for example, substance use. Other research has found that gender-diverse individuals experience a significantly higher rate of depressed mood, clinical depression, eating disorders, self-harm, and other challenges to their psychological well-being (Mak et al., 2020; Price-Feeney et al., 2020). In addition to this, gender-diverse individuals - and the LGBTQ community as a whole - experience significantly higher rates of both suicidal ideation and attempted suicide (Haas et al., 2010; Mak et al., 2020). It is important to reflect on the role that external stressors relating to a minority status have on mental health and distress. Consequently, it is necessary to have mental health services that are 11 cognizant of the role that gendered experience plays in one’s experience in life and how that consequently impacts the psychological well-being of gender-diverse individuals. Recognizing the adverse effects of minority stress underscores the need for mental health practitioners to adopt affirming and inclusive approaches tailored to the unique experiences of gender-diverse individuals. For practitioners, in addition to having mental health services that are sensitive to the adverse experiences their gender-diverse clients may have experienced, it can be beneficial to look upstream at what is causing the psychological distress and how it can be mitigated. Many of the stressors experienced result from the contextual social location of genderdiverse individuals. It is imperative to consider the societal influences that impact the well-being of both gender-diverse individuals as well as the LGBTQ community as a whole. During the time I have been writing this, North America has become progressively more hostile towards the queer community. I would be remiss not to emphasize the impact of harmful rhetoric and legislature. Bill C-4, legislation banning the dangerous practice of conversation therapy, was passed in January 2022 in Canada; however, there was significant opposition to this ban despite the evidence of its harm (Egale, n.d.). In March of 2022, the “don’t say gay” bill was passed in Florida, and a string of other states followed suit, such as Alabama and Tennessee (Coskun-Crabtree, 2022; Crafton et al., 2022; Strain, 2022). This bill, which inhibits discussion of sexual orientation and gender identity in schools, has a direct and negative impact on LGBTQ youth and youth overall by restricting access to education and resources imperative to their health and well-being. The legalized promotion of stigmatic rationalization only serves to alienate LGBTQ youth and foster an environment of hostility, isolation, and internalized heterosexism. 12 Less than a year after the “don’t say gay” bill, over 400 new anti-LGBTQ bills have been introduced in North America (American Civil Liberties Union, 2023; Choi, 2023). These bills target education, public accommodations, freedom of expression, access to healthcare, and even directly address queer artistry like drag events. In 2023 and 2024, the Canadian provinces of Alberta, Saskatchewan, and New Brunswick established new policies surrounding pronoun use in schools amidst rising anti-SOGI (Sexual Orientation and Gender Identity) sentiment. Tensions are increasing, and 2023 has seen protests both for and against SOGI education nationwide (Dickson, 2023). LGBTQ and gender-diverse individuals are losing their ability to find connection and community, their access to gender-affirming care, and even conversations surrounding gender identity are increasingly censored (American Civil Liberties Union, 2023; Choi, 2023). For many gender-diverse individuals in these areas, using a public restroom can be a source of fear and discrimination. The elevated likelihood of LGBTQ individuals with adverse mental health outcomes is well-documented; looking at the broader context is imperative to understand why. Living in an environment that denies and persecutes one's very identity through legislation and socialization causes inescapable harm to one’s well-being and identity formation. This adversity can be addressed to mitigate the impact on this population. Community, connectedness, authenticity, and self-acceptance can lessen the pressure or distress experienced by gender-diverse individuals due to their identity. Researching the resilience factors that can mediate the harmful impacts of minority stressors can help to benefit the community in a meaningful way, improving our understanding of how psychological distress can be reduced. While resilience factors have been studied in relation to mental health outcomes, there is limited exploration of how self-acceptance develops within the broader context of minority stress and its intersection with gender diversity. Pulling out patterns or themes in reaching self-acceptance 13 with the goal of increasing the beneficial influences and mitigating the harmful impacts, aims to continue to create a society that is safe and inclusive for all. Identity Formation Identity formation is a critical component of a person's development. Several identity formation models that have been developed will be discussed to explore and explain how individuals understand themselves and their identities better. Identity formation in and of itself is an exploratory process of determining one’s values and beliefs, of integrating an entire sum of experiences and thoughts into a cohesive identity. Intersectionalities of identity are unavoidable, of course, and there are minority identity models that consider aspects such as ethnicity and gender. One identity development model incorporating this intersectionality is the transgender people of colour (TPOC) model in which the individual self-identifies as transgender and validates this identity through education and learning (Beck & Simons, 2020). Subsequent steps include the display process and exploration processes, focusing on gender expression and how the individual chooses to present themselves, and the transition process where the consideration of hormones or surgery is explored. Other processes in the TPOC model include the proaction process, wherein the individual’s identity is evoked through behaviour; the intersection process, which includes learning to navigate adverse behaviours from other individuals (e.g. bullying) about an aspect of identity; and the passing process in which the individual engages in selective disclosure about their identity (Beck & Simons, 2020). The consideration of multiple facets of identity is integral and a component of benefit in this model; however, the processes are not sequential and instead flow with the individual's journey. The transient flow reflects how life can constantly change and influential circumstances (e.g. safety) that can impact facets such as gender expression. 14 While the TPOC model emphasizes a non-linear, intersectional approach, Bockting and Coleman (2007) present a sequential process, offering distinct perspectives on identity development. In their model of transgender identity development, Bockting and Coleman (2007) elucidate five stages: pre-coming out, coming out, exploration, intimacy, and identity integration. In contrast to the previous model, this one follows a sequential pattern of steps wherein the individual first experiences interest in feelings or behaviours that do not fit within society’s lens of the gender they were assigned at birth. This is the pre-coming out stage. In the coming out stage, the individual becomes more open about their authentic self, whether with themselves or others. The exploration stage is aptly named for being the part of the journey where the individual explores gender, relationships, and where they fit into the world. The intimacy stage follows this and concludes with the identity integration stage, where self-acceptance is achieved and they are at peace with this aspect of their identity. This model follows a series of steps that provide an overview of the process of self-acceptance. Participants' experiences surrounding their journey may be more cohesive following this model. Discussing self-acceptance, this can be congruent with the identity integration stage and explore how integrating this part of the participant’s identity into the other aspects of identity they possess enhances the experience of self-acceptance. These identity formation models provide a theoretical lens for understanding participants' self-acceptance journeys, offering a framework to analyze themes emerging from their experiences. While acknowledging the individuality of the process, a framework can be effective in enhancing understanding and may also be reflective of participants’ journeys. The research approach is a semi-structured interview, which leaves space for the participants to direct their 15 own sharing and create their own framework. Next, I will discuss the overarching research question that served as a focal point in guiding the interviews. Research Question What is the experience of self-acceptance in gender-diverse individuals? This open-ended question aligns with the exploratory qualitative approach by seeking to understand the participants' journeys to self-acceptance better and explore what it means to them. In discussing self-acceptance, the “self” is composed of constructs in which the individual has ideas of what consists of their authentic selves, for instance social roles or personal characteristics. Klussman et al. (2022) determined that critical components of this relationship with oneself must involve both an awareness and, consequently, the acceptance of oneself. Following this, a behavioural alignment congruent with self-awareness and acceptance is necessary. The authors posit that self-connection enhances one’s ability to lead a meaningful life with solid interpersonal connections and the pursuit of goals. Through gaining a deeper insight into the experience of self-acceptance in gender identity, I hope to explore the benefits of selfacceptance, particularly in psychological well-being, resilience, and improving mental health outcomes for this population. Researcher Context As a researcher, I enjoy exploring personally meaningful topics. The topic of selfacceptance as a resilience factor in gender-diverse individuals holds personal histories and meaning. I was assigned female at birth, but I never fully understood what this meant and consistently struggled with the associated gender roles, expectations, and expressions growing up. Figuring out my role and identity within the expected social norms was a constant challenge 16 that inhibited me from living authentically. Experiencing this inner conflict with who I was - or rather, who I am - caused a loss of confidence in my identity and self, which in turn impacted my mental health. My identity was this obscure concept that seemed just out of reach, or maybe I was hesitant to search for it - let alone embrace it - because I was afraid of the opinions of others. As I explored my identity, I began to find acceptance within the LGBTQ community. By learning from friends in the community, I found the concept of gender diversity and met others who could relate to the inner conflict I had been experiencing. My thoughts were validated as they had never been before. I heard the stories of many others in the community, and their struggles with acceptance from themselves and others. I was struck by the candour of my fellow community members as they shared their struggles with mental health and, for many, the history of suicidal thoughts and behaviours. I remember the story of a 13-year-old gender-diverse individual. They had recently attempted suicide, and I remember talking with them about the fear of rejection from family and friends that pushed them to a place of self-hate and internalized cissexism. At the young age of 13, the struggle to accept themselves and their identity created so much internal conflict, impacting their sense of worth to the point where they felt that suicide was the best option. This conversation showed me how important education and a sense of community support can be in understanding and accepting your identity. My own unique journey underscores the importance of reflexivity in this research. By reflecting on my positionality, I acknowledge how my personal experiences may influence the interpretative process. I reflected on the power of self-acceptance and how significantly it combatted internalized shame and therefore reduced psychological distress. My lived experience within the LGBTQ community informs my understanding of the participants' stories, providing a foundation for empathetic engagement while emphasizing the need for critical self-awareness. 17 Ultimately, being part of the LGBTQ community has encouraged me to advocate for improvement, and this research is part of a shift towards love, acceptance, and community for everyone. Conceptual Lens This thesis aims to gain a more in-depth understanding of the individualized experiences of gender-diverse participants. By focusing on the participants’ unique stories, I aim to enhance the knowledge of their journeys to self-acceptance. By grounding this inquiry in the context of psychological well-being, resilience, and mental health outcomes, the research aims to provide actionable insights for practitioners working with gender-diverse populations. The conceptual approach to understanding the singularity of each participant's story can also be used to reflect upon the socio-cultural context of these stories. It can be a powerful tool in exploring how each person experiences the world. As this thesis aims to better understand the socio-cultural impact on the psychological well-being of gender-diverse participants, an exploratory qualitative approach best supports this type of research. I am focused on learning from lived experiences and the insights that have been shaped by them. Consequently, the ideal approach allows the participants to engage in storytelling to communicate these experiences. The awareness of both the researcher and participant having a collaborative role is highly relevant, considering the highly subjective nature of the data collection process for this research. For example, participants' stories can be influenced by anything from their interpretation of past events to how they feel during the interview. Even during the interview, my position as a researcher and how skilled I am during the interview may influence what the participant shares. Therefore, it is paramount to be aware of my biases and unconscious behaviours, nonverbals, or 18 language use that might impact either the participant’s feelings of safety or willingness to share. Additionally, ensuring that I clearly expressed the aim of the interview is to hear their story instead of prescribing to an agenda helped to increase comfort while addressing response bias from the participant. Perceived power dynamics, a lack of safety, response bias, or other variables may influence what a participant shares. The researcher's interpretation of participants' stories plays a pivotal role in shaping the research outcomes, underscoring the inherently subjective nature of qualitative inquiry. By maintaining reflexivity and transparency throughout the analytic process, this study seeks to honour the authenticity of participants' experiences while acknowledging the interpretive lens through which they are analyzed. How I interpret the lives and experiences of participants will likely differ from another researcher's interpretation, as our perspective is influenced by personal aspects such as sociocultural position. Ensuring that I am aware of my biases and transparent in my analytic process can help to clarify the ambiguity of interpretation. I am cognizant of how my personal experience of self-acceptance influences my interpretation of the participants' stories. The approach to analysis is heavily contingent on the researcher's perception of the data, so my goal was to have as much transparency as possible in my interpretative process to ensure that I stay true to the participants' stories. Transparency is addressed through analytic transparency, which involves detailing coding and interpretive processes to allow readers to assess conclusions, and production transparency, which includes open documentation of methodological decisions and contextual factors influencing the study (Moravcsik, 2019). Symbolic interactionism is another theoretical element to integrate; its focus on the subjective meaning of social communications adds another layer of understanding regarding the stories shared by participants. Symbolic interactionism also aligns with the exploratory nature of 19 this research by examining how participants' interpretations of symbols, language, and interactions shape their experiences of self-acceptance. Therefore, it accounts for the participant’s unique perspective, looking at how they interpret and understand the world (Carter & Fuller, 2015). An element of this is the use of language and symbols for communication. For instance, the pink triangle symbolizes the LGBTQ community's resilience and reclamation of identity, reflecting the evolving meanings individuals and communities ascribe to their experiences. Previously used in World War 2 in concentration camps as a symbol of shame and punishment towards homosexuals, the pink triangle was later reclaimed by the LGBTQ community and used as a symbol of freedom and pride (Plant, 2011). The pink triangle is a symbol that underwent a socio-cultural shift and communicated powerful sentiments, including the community’s resiliency. Symbolic interactionism focuses on the meaning of the symbol, whether it is a symbol for a community or a symbol that only holds meaning for the individual (Carter & Fuller, 2015). Ultimately, meanings continuously evolve and are created through interactions between individuals and societies. Summary of Chapter One This thesis aims to contribute to the understanding of the lived experiences of genderdiverse individuals and to be more representative of the diversity within the community. The exploratory qualitative approach ensures that the research remains open to the diversity and complexity of participants' lived experiences, upholding the integrity of their stories. This research will explore how self-acceptance influences resilience, intending to examine how adverse mental health outcomes can be mitigated for this demographic. My context as a researcher was described by mentioning my personal story. A section clarifying terminology was included to provide more clarity to this research. A discussion occurred on the exploratory 20 qualitative approach and theoretical framework that best upholds the integrity of the participant's stories. Ultimately, this study seeks to fill critical gaps in understanding gender-diverse individuals' self-acceptance journeys, contributing to a more inclusive and nuanced academic discourse. 21 Chapter Two: Literature Review Introduction Historically, psychological research has focused on deepening its understanding of the cisgender psyche (Hyde et al., 2019). Chapter One explored some of the implications of this history. As the LGBTQ community fought for equal rights and recognition, a societal shift was sparked that is continuing to evolve. This shift resulted in increased awareness and compassion towards the marginalized community, drawing the attention of researchers and consequently leading to an increase in the research focus on the LGBTQ experience. I review the literature focused on LGBTQ psychological well-being, including the experience of being gender-diverse. Starting with a broad emphasis on LGBTQ mental health and narrowing down to examine the prevalence of adverse mental health outcomes and the factors influencing mental health, I then follow with a look at factors that mitigate adverse outcomes and elaborate on the topic of selfacceptance as a resilience factor. LGBTQ Mental Health The LGBTQ population faces discouraging barriers that contribute to the trend of high rates of adverse mental health outcomes, physical and sexual abuse, homelessness, and substance misuse. McConnell et al. (2016) noted that LGBTQ youth experience victimization at an elevated rate relative to their heterosexual and cisgender peers, which correlates with the increase in depression, anxiety, self-harm, and suicidality present in this demographic. Although research is more prevalent regarding the LGBTQ community as a whole, the studies that have been conducted focused on gender-diverse individuals have determined that this population is at an even higher risk for decreased psychological well-being (Price-Feeney et al., 22 2020). A survey comparing the mental health of cisgender LGBTQ youth with that of transgender and non-binary youth found higher rates of depressed mood (83% in gender-diverse compared to 71% of cisgender LGBTQ participants), serious suicide consideration (54% compared to the cisgender groups 39%), and suicide attempts (29% in gender-diverse and 18% in cisgender LGBTQ). The authors stated that the higher rates of mental health distress “have been linked to chronic stress stemming from the marginalized social status that minority individuals have in society” (Price-Feeney et al., 2020, p. 2). The authors note the experience of gender-based stressors, for instance, victimization and discrimination, which contribute to the mental health outcomes of LGBTQ and gender-diverse individuals. For example, the study determined that gender-diverse participants showed nearly double the rate of physical harm and threats compared to their cisgender LGBTQ participants. Additionally, 92% of the transgender male participants reported having experienced gender-based discrimination, an astronomically high prevalence that demonstrates the significance of societal context. A study conducted by Su et al. (2016) corroborates the findings of gender-diverse individuals experiencing a disproportionate amount of adverse mental health outcomes in comparison to the overall LGBTQ population. The researchers observed that, in contrast to the overall LGBTQ population, gender-diverse participants were over twice as likely to report experiences of above-average discrimination after controlling for variables like age and race. Participants who reported more discrimination were more likely to report depression symptoms as well, though identity acceptance mitigated depression. Similarly, Romani et al. (2021) evaluated psychological well-being in binary and gender-diverse individuals and assessed for differences. They found that gender-diverse individuals showed higher levels of anxiety and depression compared to the binary participants. 23 Suicidality Thomas Joiner studied suicide closely and developed the Interpersonal Theory of Suicide to explain the reasoning behind suicidal behaviours. Joiner posited that thwarted belongingness and perceived burden together fueled thoughts of suicide. Henricks and Testa (2012) explain how minority stress theory offers a further understanding of Joiner’s explanation by connecting it with the experiences of transgender individuals. Thwarted belongingness can also be considered as social disconnect or isolation, one of the strongest predictors of suicide risk (Joiner, 2010). Rejection from family and few social supports can contribute to social disconnect and can occur when people in a transgender individual’s life are unwilling to accept their gender identity (Henricks & Testa, 2012). Another critical predictor of suicide risk, according to Joiner is perceived burdensomeness, which, according to Joiner, is when one believes one’s death is more valuable than one’s life. Situations that can prompt these feelings of low self-worth could be homelessness or unemployment, both of which the gender-diverse population experiences at higher rates (Henricks & Testa, 2012). Internalized negative beliefs about one’s identity, such as internalized cissexism consisting of derogatory thoughts of gender-diverse individuals, and external negative experiences, for example victimization or rejection due to their gender identity, can contribute to one’s negative appraisal of self and ultimately lower perceived self-worth. Mak et al. (2020) identified that gender-diverse individuals have a higher likelihood of experiencing depression and other mental health concerns than the gender-conforming population. Moreover, the prevalence of suicide attempts for the gender-diverse demographic is thought to be between 32% and 41% in the U.S., which is contrasted by the 2% - 8% prevalence 24 in the average population (Mak et al., 2020; Haas et al., 2010). This disparity is not negligible. To better understand the variety of factors that impact suicidality and gain a more holistic perspective of what influences suicide attempts, Mak et al. conducted a longitudinal study, finding that participants aged 18-25 were at the highest risk of suicidality, with the risk decreasing as the participants aged; participants over 45 years of age had lower rates of attempting suicide. The Role of Systemic Barriers It is well documented that LGBTQ individuals, particularly those who identify as genderdiverse and have outward displays of non-conformity, are subjected to high rates of discrimination. These experiences of being in a hostile social environment are thought to result in a higher prevalence of adverse mental health outcomes in the LGBTQ population (Hendricks & Testa, 2012). Transgender individuals, for example, experience discrimination in areas like housing, employment, and healthcare; almost one in five transgender participants reported refusing medical care based on their gender identity (Su et al., 2016). These stressors contribute to an overall lower income among transgender individuals in comparison to the cisgender population, affecting socioeconomic status. Minority stress is a term that encompasses the disproportionately high levels of stress experienced by stigmatized minority groups. Often, it is chronic and can be societal (e.g. prejudice), interpersonal (e.g. rejection), and internalized (e.g. internalized heterosexism). These stressors can reduce resilience and harm one’s coping ability (Meyer & Frost, 2013). Microaggressions are daily subtle nuances that communicate negative attitudes towards a stigmatized group. They can be verbal or non-verbal, intentional or unintentional. Microaggressions can also be interpersonal or in a larger social context, including anti-LGBTQ 25 laws. Woodford et al. (2014) used the minority stress theory to build a hypothesis that microaggressions increase psychological distress and decrease self-acceptance in LGBTQ individuals. Self-acceptance was a mediator in the relationship between distress and microaggressions. The authors corroborated the minority stress theory, finding that heterosexism is chronic and reinforces one’s marginal societal status, potentially lowering the LGBTQ individual’s evaluation of self and identity. In other words, the link between psychological distress and heterosexism or other identity-related prejudice is evident. To expand on the minority stress model touched upon in the previous study, I looked at Bockting et al.’s (2013) article which looked at the dynamic relationships of stigma, mental health, and resilience in transgender individuals in the U.S. First emphasizing the role that systematic oppression plays in stigma while distinguishing between racial, employment, and economic discriminations, the authors apply the minority stress theory to explore the role of this prejudice in the psychological well-being of their participants. They concluded that stigma increases psychological distress, thus increasing the likelihood of mental health concerns, while self-acceptance, in addition to social support, can act as a buffer in which the minority stress is ameliorated. Stigma, in this case, was demonstrated through systemic discrimination in the employment and economic fields, both of which are crucial in evaluating socioeconomic status; improvements must be made to uplift marginalized populations. To further understand the relationship between minority stressors, mental health, and self-acceptance, I looked at Camp et al.’s (2020) systematic review of literature focused on the LGBTQ community. The authors identify how prejudice and discrimination can hinder accepting oneself, exacerbating the risk of poor mental health. Building on the minority stress theory, Camp et al. noted that chronic exposure to these minority stressors increases adverse mental 26 health challenges, exacerbated by the cyclical pattern of how those who struggle with poor mental health are often those with an increased vulnerability to the stressors. This creates a cycle of oppression and psychological distress that becomes difficult to eschew. Another topic discussed by Camp et al. (2020) was the internalization of prejudice and other negative social attitudes, a factor the authors noted diminished the level of self-acceptance in LGBTQ individuals. This stands to reason, as the dissonance that results from a conflict between one’s identity and beliefs poses a challenge in embracing authenticity. This is solidified by the inverse relationship between low rates of self-acceptance correlated to high rates of psychological distress found in the literature (Camp et al., 2020). Mitigating Adverse Outcomes Support System When looking at factors that can help bolster one’s ability to cope, it is essential to include an assessment of their support system. Family support is critical in mental health, particularly for gender-diverse youth, exacerbating either risk or resilience in these individuals. The reflection of stigma in the family of a gender-diverse youth can heighten stress levels and perceptions of rejection, increasing the risk of adverse mental health outcomes. McConnell et al. (2016) conducted a longitudinal study to assess mental well-being in relation to family support, noting that family support has been linked to increased well-being in areas such as depression, distress, and suicidality. They also observed that many LGBTQ youth turned to peers for acceptance, finding an alternate network of support. Despite peer acceptance, the study emphasized that a lack of family support in early adolescence has lasting impacts on mental health. 27 A study by Miller et al. (2020) found that family acceptance was a robust protective factor for LGBTQ youth participants, emphasizing the value of support and connectedness. Family acceptance benefits both the mental and physical health of LGBTQ youth, a crucial mitigating factor for a demographic with such a high prevalence of adverse health outcomes (McConnell et al., 2016; Olsen et al., 2016; Ryan et al., 2010). Ryan et al. (2010) note that although literature exists describing the relationship between LGBTQ and their family, its focus has predominantly been on assessing the negative impact of this dynamic as opposed to exploring the outcome of familial support. One of the results from their study was that participants who experienced acceptance from their family were half as likely to express suicidal ideation or attempt compared to participants who lacked that degree of acceptance or support. In addition to the resilience factor of family support, it is essential to acknowledge the impact of familial rejection. Durso and Gates (2012) found that LGBTQ youth were vastly overrepresented in youth homelessness agencies, comprising approximately 40% of the clientele. Of these youth, the most prominent reason for homelessness was reported to be family rejection. Therefore, in addition to the adversity of not gaining acceptance from family members, these LGBTQ youth were also subject to the negative mental health impacts of living in homelessness. Self-Acceptance Although external support, such as familial acceptance, is a vital component in mitigating adverse mental health outcomes, internalized thoughts, beliefs, and values bolster resilience. Feelings of shame, anger, confusion, or sadness resulting from one’s gender identity can lead to self-rejection, depression, and adverse mental health outcomes. A poignant and demoralizing example of this is internalized cissexism or transphobia. In this society, normative gender 28 expectations or anti-trans stigmas are internalized by the individual, creating discord between their identity and values. This can result in several mental health adversities, including selfdenial, self-rejection, or even self-hate. Self-acceptance can be a powerful antidote to these thought processes and Carson and Langer (2006) emphasize the influential role that selfacceptance plays in one’s mental health. To further the understanding of self-acceptance within the gender-diverse demographic, I looked at a study by Su et al. (2016) comparing mental health disparities between transgender and non-transgender individuals. They found that not only is the likelihood of depression and suicidality higher among transgender participants, but the transgender participants also reported having a higher exposure to discrimination. Discrimination and self-acceptance were the two variables with the closest relationship to depression symptoms in the study, with high levels of self-acceptance accompanying lower rates of depression. Other research corroborates the relationship between discrimination, self-acceptance, and depression. Woodford et al. (2014) noted the mediatory effect of self-acceptance on the discrimination-psychological distress relationship. This may be due to the impact of heterosexism on one’s evaluation of self and identity, with heterosexism lowering these internal evaluations and thus contributing to said psychological distress. Therefore, the researchers argue, heterosexism not only exacerbates psychological distress itself but reduces feelings of selfacceptance which also heightens psychological distress. Toscano (2022) found three main themes across the literature that impacted LGBTQ selfacceptance. These included themes of internalized negative feelings due to their LGBTQ identity, for example, internalized cissexism and beliefs of prejudice or devaluation due to 29 identity. The second theme was the increased risk of discrimination, harassment, or violence as a result of the individual's LGBTQ status. The third theme that impacted self-acceptance in the participants was the concern that friends, family, or communities would reject or isolate them based on their identity. The Factors of Self-Acceptance - Sexual and Gender Identities (FSASGI) aims to include these three most cited factors in qualitative literature, to connect internal struggles (i.e. self-acceptance) with external factors (i.e. safety and connection). Toscano (2022) emphasized that the myriad of barriers LGBTQ individuals face is not comprehensively accounted for in literature, and more research that provides a holistic overview is needed. Summary of Chapter Two LGBTQ individuals experience higher rates of discrimination, microaggression, and rejection than their heterosexual and cisgender peers. These experiences of minority stress stem from a social climate that, despite the ongoing improvement, still holds negative views and systemic barriers against individuals who deviate from the societal norm in North America. This is exacerbated for gender-diverse individuals with visible non-conformity within the gender binary. The impact of chronic stressors on LGBTQ individuals is significant, resulting in increased psychological distress, such as anxiety and low self-esteem. Depression and suicidality are two pressing concerns within the population that were discussed in relation to the high prevalence and possible contributing factors. Additionally, the internalization of stigmatizing beliefs can cause internal struggles with identity acknowledgement and acceptance. The literature has shown that a supportive environment and connections can bolster resilience, and higher self-acceptance rates mitigate psychological distress. 30 Chapter 3: Research Process The literature has emphasized the prevalence of adverse mental health outcomes in the LGBTQ+ population while noting that there are factors that can mitigate these adverse outcomes. By focusing more clearly on the resilience factor of self-acceptance, I aim to better understand the journey of gender-diverse individuals in understanding and accepting their own identities. Because it is such an individualized journey, using an exploratory qualitative approach provides the space to delve into the unique experiences and insights of the participants, how they came to a place of self-acceptance, and what it means to them. This chapter will explore the research design and process, including ethical considerations, participant recruitment, and data collection and analysis approach. Exploratory Qualitative Approach Qualitative research focuses on assessing non-numerical data, such as the interviews that compose the data in this study, and aims to deepen understanding of the topic. Qualitative research can be explanatory wherein the objective is to explain a phenomenon, such as assessing a cause-and-effect relationship, or qualitative research can take a more exploratory approach. The exploratory approach seeks to explore areas of research that are not well understood or have gaps in knowledge, looking to shed light on topics or areas that have not been studied in-depth and is effective at generating hypothesis (Mbaka & Isiramen, 2021). As this thesis seeks to understand the lived experience of gender-diverse individuals, a vastly underrepresented demographic in research, it aligns with the exploratory qualitative approach. The exploratory qualitative approach is particularly suited to addressing the underrepresentation of gender- 31 diverse experiences in research, as it provides an open framework to explore nuanced and multifaceted phenomena without imposing preconceived categories. An objective of this thesis is to amplify the voice of an underrepresented population, taking an approach that focuses on studying individuals' experiences and the meanings they attach to those experiences. In this study, I employ an exploratory qualitative lens to center participants’ narratives, emphasizing the role of storytelling as a means to uncover the meanings they attach to their experiences and identities. This storytelling approach is grounded in the belief that people's experiences are shaped by the stories they tell about themselves and the world around them. These stories are vital to how people make sense of their experiences and give meaning to their lives. As a researcher, I can gain insight into their perspectives, beliefs, and values by focusing on participants’ stories as the heart of the study. By focusing the exploration on the stories of participants, the research better demonstrates the true complexities and contexts of the human experience (Azzahrawi, 2021). While other research paradigms may seek to explain or predict, exploratory qualitative research aims to understand the topic; in this thesis it presents as interpreting the voice and perspective of the participant. Rather than imposing a predetermined set of categories or theories on the data, my approach encourages participants to define the meaning of their experiences in their terms, thus providing insight into their unique story. This allows for a deeper understanding of the participant's experiences and the cultural and social contexts in which they occur. The exploratory qualitative approach is a good fit for this research topic because it is particularly effective at exploring complex phenomena, topics that connect be fully conceptualized with numerical or quantitative data (Kalu & Bwalya, 2017). Therefore, this aligns 32 well with the complexity of gender-diversity and identity formation present in this thesis. Gender is a multidimensional social construct; it is something that humans have developed and perceive differently based on their experiences in the social context of gender (Sheppard & Mayo, 2013). Additionally, gender roles are strongly influenced by social norms and context. Different cultures, for example, have different beliefs and ideas about the roles each gender should have. This variation in beliefs leads to a shift in interaction patterns, consequently affecting our experience in the world. This exploratory research considers the role of intersecting identities in the shaping of one’s subjective perspective, thus is a valuable method for gaining insight into people's experiences and the meanings they attach to those experiences. By listening to and analyzing their stories, researchers can gain a deeper understanding of the world and its people. Ethical Considerations Ethical considerations are essential to the exploratory qualitative research method as it involves collecting sensitive information from participants while accurately and respectfully representing their experiences. Therefore, this research consists of several considerations related to collecting and representing participants' experiences. These considerations are necessary in ensuring that the study is conducted responsibly and respectfully, and that the participants' experiences are accurately and fairly represented. As a researcher, the utmost goal is to protect participants' privacy, dignity, and wellbeing. I am, in essence, studying the lives of these individuals as a way of contributing to the overall knowledge and understanding of the lived experiences and resilience factors of genderdiverse people. As the interview topic pertains closely to personal experiences, thoughts, and feelings at a potentially tumultuous point in their lives, it was important to consider the impact 33 that sharing these intimate details may have on the participant. With topics including mental health, adversity, and identity all playing a role in the journey of self-acceptance, I was mindful of the possibility that the participant may have negative memories resurfacing during the interview, potentially impacting their psychological well-being during or after the interview. Considering the possible discord caused by the interview subject, throughout the interviews, I was cognizant of the participants' non-verbal communication and diction in the event of distress and prioritized participants' well-being. My goal was to provide the necessary support services as needed, including having a prepared list of accessible resources to provide to participants. Reflecting on the interviews, although strong emotions arose, they often had a positive connotation, such as sharing the overwhelming familial support that touched the participant. I could gauge from the participants' openness, tone, and other nonverbals whether a participant was comfortable sharing about specific topics and if they were reluctant, I shifted topics to one that would likely feel more comfortable for the participant. Additionally, throughout the interview, I expressed that the participants have complete autonomy over what they share and can base it on their comfort levels. To enhance credibility, I engaged in member checking by inviting participants to review their selected quotes for accuracy and representation, ensuring their voices remained central to the research findings. I invited participants to give feedback and communicate with me if they had any feelings of discomfort from how their interview data was distilled in the findings, as well as ensuring that they felt my interpretation of their experiences was accurate and true to their stories. This also served to reinforce confidentiality as participants could note any potential points of concerns surrounding privacy in their quotes or stories. It’s also important to note the prevalence of ethical ambiguity. Consequently, I needed to continuously engage in critical subjectivity and reflexivity, self-evaluating to ensure that my 34 motives derive from a moral obligation to protect the participants and ensure their well-being. Josselson (2007) brings up the valuable discussion of the dual roles in research, namely the responsibilities of being a researcher in the academic community contrasted with the intimate relationship developed with the participant - an intimacy created by the nature of sharing personal experiences by the participant. Josselson (2007) writes that “interpersonal ethics demand responsibility to the dignity, privacy, and well-being of those who are studied, and these often conflict with the scholarly obligation to accuracy, authenticity, and interpretation” (p. 538). Both of these dual roles have differing responsibilities; thus, there was the potential for conflict to arise. However, Josselson notes that these roles have no solution. Instead, the researcher must recognize these obligations and consciously assess for conflicts throughout the research process. Upon reflection, I am grateful that no conflicts arose in recruitment, data collection, or subsequent processes. By actively reflecting on the dual roles of researcher and confidant, I remained vigilant in upholding professional boundaries while fostering an environment of trust and authenticity. However, the challenge of balancing the participants' voices with the researcher's data interpretation remains prevalent. The researcher must remain faithful to the participants' stories while providing a clear analytical framework for understanding. This is why a key feature of explorative qualitative research is that it is iterative and reflexive. This means that the researcher engages in critical subjectivity by actively participating in the research process, engaging in ongoing dialogue with the participants and reflecting on their biases and assumptions. Iterative indicates how the researcher adapts and evolves the approach and discussion, refining it as learning occurs throughout the research process. Reflexivity consists of awareness of my role in the research and questioning my assumptions and is applied through critical subjectivity. 35 Reflexivity was practiced through maintaining a reflective journal throughout the research process, where I documented my reactions to participants’ stories, identified potential biases, and evaluated how my positionality may have influenced data interpretation. This helps to ensure that the study is rigorously grounded in the participants' experiences and avoids imposing preconceived ideas on the data. Overall, the ethics of this research study require careful attention to the rights and wellbeing of the participants, and a commitment to conducting the research in a responsible and respectful manner. By adhering to these ethical principles, researchers can ensure that their qualitative studies provide valuable insights into the participants' experiences and perspectives. Participants This study utilized a purposive sampling method for participant selection initially, with participants intentionally chosen to ensure a robust representation of the diverse group of individuals who are gender non-conforming. However, due to a lull in participant recruitment, snowball sampling was also utilized to derive an adequate number of participants to provide enough rich data to analyze. Although existing research includes LGBTQ and transgender individuals, there is a lack of representation of the actual variety of gender identities and expressions present in the LGBTQ community. The present study aims to fill in some of that gap by ensuring inclusivity and representation to a broader sample of individuals who do not identify within the gendered binary. The inclusion criteria for participants were threefold: they must have English fluency to the degree of being able to express themselves in the interview; they must identify as gender-diverse in some way (e.g. non-binary, transgender, Two-Spirit, genderfluid, etc.), and they must be between the ages of 18 and 30. Incorporating a consideration of cohort 36 effects is crucial as the era in which formative years occur plays a significant and impactful role in identity development and social understanding. As time progresses, the awareness of the LGBTQ community has spread, resulting in different experiences of identity integration across age groups. Cohort effects are essential as social views, internalized prejudices, and external influences can play a role in identity formation and integration. Referring to the models of identity development, identity integration is akin to self-acceptance as there is peace with this aspect of their identity (Bocking & Coleman, 2007). Six participants (see Table 1) were recruited for this research to provide a holistic insight into various lived experiences. Participants varied in ages, respectively 20, 23, 25, 27 (n=2), and 29, which provided an excellent view into how one’s journey evolves throughout the 20’s, an age in which much self-exploration occurs while integrating the lens of a cohort effect that may also impact experience. Additionally, there was a range of gender identities, including non-binary participants (n=3), trans-masculine participants (n=2), and a Two-Spirit participant. This allowed for a deeper understanding of uncovering the layers of identity that evolve into gender identity and other contributing factors. Participants expressed that they use a variety of pronouns. However, they/them was a noted consistency so for this thesis, participants will be referred to by they/them pronouns to enhance clarity and legibility. Additionally, to preserve confidentiality, participants each chose a pseudonym by selecting a type of tree they felt was reflective of them. Trees were utilized for their symbolism in grounding, feeling rooted and a connection within an ecosystem much as the participants describe the power of community and connection. The pseudonyms are as follows: Aspen, Arbutus, Cedar, Cypress, Maple, and Willow. For this research, the participants may be at any point in their journey of self-acceptance and discovery of their identity. This may allow for an improved understanding of the internal and 37 individual process of self-determination involved in acknowledging and understanding a significant piece of one's identity. It is, ultimately, about listening to and learning from their story, and stories are constantly evolving. Pseudonym Age Gender Identity Aspen 20 Non-Binary Arbutus 23 Trans-Masculine Cedar 29 Trans-Masculine Cypress 25 Non-Binary Maple 27 Non-Binary Willow 27 Two-Spirit Table 1. Participant Demographics Recruitment I interviewed six participants in British Columbia, Canada, about their experiences. Participants were recruited through promotion (see Appendix A) at queer-focused events and agencies. Examples included agencies and service providers that cater to the LGBTQ+ community, including queer-focused health providers or gathering places for members of the community. Promotion included posting a designed poster (Appendix A) for potential participants to look at of their own volition. However, snowball sampling was also utilized to share the poster and information about the study. 38 Data Collection Data was collected through interviews with each participant. After participant recruitment, I reviewed essential information including informed consent, confidentiality, and the ability to withdraw from participation (see Appendix B), then arranged an interview with them that lasted approximately 60 minutes. Interviews were done online over a secured Zoom server and were recorded with participant consent. The recordings were used to create a transcript which I transcribed myself. I used an intelligent verbatim transcription method in which some editing was done to enhance legibility. However, it will be as true to the participant’s statement as possible. The editing consisted of the removal of filler words (e.g. “um”), removal of noises like coughing, and improving coherence in sentences where necessary (e.g. a long, run-on sentence may be divided into two sentences). Any identifying names or places that compromise anonymity were redacted. I did my utmost to preserve the meaning and words of the participant throughout the transcribing process. These transcriptions constituted the raw data of this research and were then analyzed. All data was kept confidential, and electronically stored on a password-protected drive, and the hard copies were kept in a secure area. Interview Structure The interview was designed to be semi-structured and utilize a collaborative approach. This encouraged the interviews to be open-ended and conversational, allowing the participants to tell their stories in their own words and to guide the direction and pace of the interview (Anderson & Kirkpatrick, 2016). However a challenge may arise from the participant-driven format is that the researcher, particularly one with a story related to the topic, may find it difficult to refrain from intervening when the participant is discussing something that emotionally or personally resonates. This speaks to how integral the acknowledgement of 39 personal biases is and continuing to be self-aware throughout the process. It was a source of mindfulness for me as the researcher. I relied on tools such as feedback and dialogue with my supervisor to maintain critical subjectivity. Reflexivity is critical to this ongoing awareness of the researcher’s influence. By engaging in this practice, I aspired to enhance the ability to uphold the integrity of the data collection and analysis. Building rapport and trust within the interviewee-interviewer relationship is an integral skill the researcher should possess. The initial interview question aimed to be open while remaining related to the research question (i.e. “What is your experience with self-acceptance?”) and allowed the participants to direct the conversation and determine how to respond, as their experience is unique to them. When participants required additional prompting or guidance during the interview, my role provided that. Further questions that were used to prompt deeper discussion included: Where do you think you are in your journey of self-acceptance? What does self-acceptance mean to you? Has accepting your gender identity impacted you in any way? Have you noticed any shifts in yourself and in your life? Has anything made it easier or more challenging for you to accept yourself? These questions retain the goal of providing guidance relevant to the research topic while still being open enough to give the participant the space and openness needed to share their story. Approach to Analysis The approach to analysis is grounded in the belief that people's experiences are shaped by the stories they tell about themselves and the world around them. We all tell stories of our lives; it is how we find meaning and make sense of life. By listening to and analyzing these stories, researchers can gain insight into their perspectives, beliefs, and values. As such, analysis aimed 40 to identify the themes and patterns that emerge, and to understand the meanings the participants attach to their experiences. This allows for a representation of the context and complexities in which these stories occur, providing a more holistic understanding. Building upon the exploratory qualitative approach wherein the aim is to broaden understanding of the experience of self-acceptance in gender-diverse individuals, the approach to analysis for this paper is most effectively construed as thematic analysis. Braun and Clarke (2012) outlined the practice of theme-building as a method of deriving meaning from the data. In inductive thematic analysis, researchers must develop a codebook beginning with open coding and continuing to refine these codes into an evolving codebook. Subsequently deepening the thought and concepts of initial insights can evoke themes. Braun and Clarke (2012) cited that the first step of thematic analysis is familiarizing oneself with the data, through iterative readthroughs of the transcribed interviews with participants. The following step is to generate codes by grouping topics and insights, considering contextual components. Afterwards these codes evolve into themes by being refined and sorted; these themes piece together insights, assumptions, and topics by exploring what links them. Following this, the themes that arose must be reviewed to ensure the data supports them and is justifiable. When working with these themes to define them, the researcher must determine that they are relatively conceptually parallel. Themes were developed to encapsulate the core narratives of participants, ensuring alignment with the research question while preserving the richness and authenticity of their experiences. This process is detailed and applied to the research data in the subsequent chapter. Identifying a story across the data set is critical in the analysis process (Anderson & Kirkpatrick, 2016). Analyzing and interpreting this data allows us to draw themes and patterns to capture the participants’ unique perspective better. The initial stage of analysis is familiarizing 41 and organizing the data. In the case of this thesis, it consists of transcribing the interviews, gathering additional notes and materials, and preparing the data for analysis. The subsequent stage was to familiarize myself with the data and then create initial codes. Codes helped organize data as I identified keywords, phrases, metaphors, or ideas in the data and assigned them to categories or themes. Coding can be top-down, deriving from prior knowledge of the subject, or bottom-up, from the data itself (Anderson & Kirkpatrick, 2016). Although my initial codes used prior research for the literature review, the end result of the codes was predominantly bottom-up and emerged from the stories themselves, reflecting an approach wherein meanings are grounded in participants own perspectives. This coding framework allowed me to identify the most common or prominent themes that emerged from the data and to compare and contrast the different perspectives and experiences of the participants. Effectively coding can increase trustworthiness by providing more structure and organization and help show any potential biases in the data analysis. Coding can also help enable transparency. In this research, the coding process involved iterative rounds of data immersion and refinement, beginning with open coding to identify initial concepts, followed by axial coding to explore connections between categories, ultimately leading to the emergence of coherent themes. This was the primary way the subthemes were conceptualized. Reviewing and revising the coding eventually led to grouping and distilling them according to the emerging themes. I engaged in thematic analysis by identifying patterns in the stories and then interpreting them. Thematic analysis is a more in-depth approach to analyzing and exploring qualitative data. It involves identifying and interpreting the themes from the interviews and examining how they relate to the broader social, cultural, and historical contexts in which the participants' experiences occur. This allowed the researcher to understand the meanings the participants attach to their 42 experiences and identify the underlying patterns and connections in the data. The themes evolve into the findings from the data. These findings lead to the final goal of cohesively presenting the themes and demonstrated in subsequent chapters. Overall, the analysis approach focuses on identifying the themes and patterns that emerge from the participants' stories and understanding the meanings that they attach to their experiences. By combining coding, thematic analysis, and dialogue with the participants, the researcher can gain valuable insights into the participants' experiences and perspectives. Evaluation Criteria To ascertain a degree of trustworthiness in the research, qualitative researchers must consider four essential criteria. These pillars of trustworthiness are credibility, dependability, confirmability, and transferability (Schwandt et al., 2007). In examining these, it is important to reflect on how the researcher and participant's interpersonal dynamics may influence the study's trustworthiness. The narration is contingent on the participant’s willingness to share their experiences; however, the complexity of storytelling is that humans may instinctually alter their stories. It is also important to note that language itself has limits. Participants may not have been able to truly express or reflect meaning within the confines of a language. Credibility is congruent with consistency in being able to trust the interpretation and perspective of the researcher. By engaging in activities such as member checking and triangulation, I have strived to increase the study’s credibility as an evaluation criterion. Dependability is another pillar of trustworthiness I have aimed to uphold throughout the research. This requires the research process to be clear and well-documented, allowing for the opportunity to engage in an audit of the research process (Schwandt et al., 2007). Transparency 43 throughout the entirety of the research process has been established in order to increase dependability and the ability to audit the research to assess for comparable conclusions. Transferability is another evaluation criteria applicable to the study, referring to the generalizability of the study (Schwandt et al., 2007). However, for qualitative research of this nature, it is essential to note that this is on a more specific case basis as opposed to the general population. Transferability in this research pertains to the applicability of findings within the context of gender-diverse individuals, acknowledging that the insights gained are most relevant to this specific demographic and may not generalize to all populations. The fourth pillar of trustworthiness is that of confirmability. Ensuring that my process and decisions as a researcher have been clearly documented and explained is integral. This allows the reader to ascertain that the findings are derived from the data and participants perspectives as opposed to the researchers’ innate biases. Confirmability has been evaluated throughout the research through the discussion of reflexivity and critical subjectivity. Critical subjectivity and reflexivity are integral to establishing trustworthiness, enabling the researcher to remain cognizant of their biases and maintain transparency in data collection, analysis, and interpretation. The very nature of qualitative research involves a connection between the researcher and the participant. This relationship balances intimacy by disclosing personal experiences and professionalism with a sense of mutual respect and boundaries. Fostering a mutual understanding of respect and trust is an essential foundation in developing this relationship and can be exemplified through authenticity in the research process and by the researcher. Because the researcher maintains an active role in the interpretation of the date, the researcher-participant relationship should be continually assessed. This occurred through reflection and self-assessment by the researcher; examples might be through an ongoing journal 44 and by connecting with colleagues. This reiterates the necessity of critical subjectivity in the approach, the researcher acknowledging their active role in the process in addition to predispositions that may influence the collection or interpretation of the data. Engaging in this relationship of reciprocity upholds a mutually beneficial approach for both the researcher and participant and can enhance the research data. Summary of Chapter Three This chapter outlined the exploratory qualitative approach employed in this research, highlighting its suitability for capturing the complexity of gender-diverse experiences. The ethical considerations, participant demographics, and rigorous data collection and analysis methods underscore the commitment to amplifying participants’ voices while maintaining trustworthiness and reflexivity. My approach aimed to center the individual's own perspectives about their experiences, considering the complexity and context of their lives. Ethical considerations of the research included prioritizing the participant’s psychological well-being and being cognizant of dual roles and biases. An overview of participant demographics was provided. Data collection consisted of a semi-structured interview and was coded to further undergo thematic analysis. 45 Chapter Four: Findings Introduction Engaging in the research process was an experience that evoked reflection and growth as a researcher. The first three chapters of this thesis provided an overview of the reasoning behind the research and why providing a platform in which gender-diverse voices can be amplified is so crucial. The literature review examined the barriers and supports for this demographic, and Chapter Three consisted of a thorough overview of what the research process entailed. In this chapter, the focus is on distilling and articulating the findings from the research itself. I review the coding process, including elaborating on the codebook and how themes were derived. I also speak to the necessity of reflexivity in the research process, namely how I worked with the concept around critical subjectivity in the interpretation and sharing of participants' experiences. The latter part of the chapter consists of delving deeper into each of the themes that arose from the data analysis, using the participants' words to reinforce the themes and findings. Each of the five themes will be explored in depth and participant examples will be used to highlight the push and pull concept from which the subthemes are derived. The Coding Process Thematic analysis was used to extract patterns and meanings from participants’ experiences. It is an open approach that can incorporate a broad spectrum of inquiry, thus making it a good fit for this research. However, the data must undergo an analytic process before being refined into themes. This process consists of transcribing and becoming familiar with the data; subsequently, it undergoes coding. The codes evolve into themes, then defined and named, and finally distilled into the findings and report (Braun & Clarke, 2006). The overarching research question “What is the experience of self-acceptance in gender-diverse individuals?” 46 remains a defining construct from which the analysis was considered. The codes were derived from experiences, thoughts, or feelings that all contributed to the experience of self-acceptance in participants. This corresponds well to the inductive approach used, which focused on the data and what it signified as instead of attempting to shape the data to fit any particular theory. Similarly, the interview aimed to understand the participants' lived experiences in their journey of acceptance. There were some consistent questions asked to participants, including “What does self-acceptance mean to you”, “How has accepting your gender identity impacted you?”, and “Has there been anything that has made it harder/easier to accept yourself?”. However, each participant interpreted these questions differently and gave unique responses, and much of the conversation flowed organically around experiences and thoughts shared and focused on deepening the understanding. During the transcribing process, I could add contextual layers to my knowledge of the data through nonverbals such as laughter, intonations, pauses, or emphasis that reinforced coding choices. As is necessary, I did my utmost to be mindful of any bias or influence I may have regarding how the data was interpreted concerning the role of critical subjectivity in this form of inquiry. My goal in coding was to remain authentic and representative of the participants' stories. Creating the Codebook After transcribing and getting familiar with the data, I pondered on the codes that could apply. As I read through the data, I maintained a notebook where I noted possible ideas for codes. Some of these stemmed from previous chapters in the thesis, for example mental health trends pointed out in the literature review, and others were thoughts that occurred while transcribing the data. I then reviewed the data to see if my initial codes were recurring or experienced across multiple participants. Some codes I first wrote down, for example anger, 47 hardly showed up and needed to be more varied compared to how frequently other initial codes appeared, for instance family. Refining these involved additional rounds of coding. Each code requires supporting data, along with quotes that exemplify the code. Through re-reading and emphasizing focus, the codes emerged from the data. The codebook shows shifts in codes and how they evolved through rounds and was a valuable system for identifying codes in the transcript. The codes were initially grouped in contexts, including emotions (e.g. love, joy, shame) or external factors (e.g. adverse experiences, representation), however, after examining them I noticed how they intersected and the themes that started to take shape. The codes began to be categorized by what they represented in a participant’s story: adverse experiences and selfworth connected to become a preliminary mental health theme; growth, self-discovery, and authenticity evolved into identity. Figure 1 below shows the five themes that emerged, each with codes that compose the thematic concept. The themes each present as a critical element in each participant's journey to self-acceptance. A broad overview of the coding process has been explained. Still, to further enhance transparency and allow the reader to make inferences about my interpretation of the data, we will explore some examples of how the codes evolved into themes. In this participant quote, Maple shares “[I fell] into some addictions myself after that period, in part because I felt so miserable because I felt like I had to hide . . . Feeling like I needed to keep up these appearances and not be authentic to myself was really hard and led me to a lot of bad places.” My initial codes for this included a clear experience, substance use, and emotions like sadness that felt strong in the participant’s story. As I progressed and looked beyond the surface, the experience of sadness and substances came from a feeling of isolation, as Maple describes this deep need to hide their authentic self. Similarly, suppression became evident as an impact on that isolation and a factor 48 in substance use and sorrow. For example, suppression and isolation also emerged in other participants' stories as a root of sorrow. Noticing the shared elements was how the initial codes of obvious emotions evolved to reflect the underlying experience. Additionally, this quote speaks to the intersectionality factor of the mental health theme, as in describing adverse mental health, Maple notes the connection it has to their identity and authenticity. The overlap between codes was one of the challenges in refining them and evolving distinct themes, particularly pertaining to mental health as it arose in conjunction with many of the unique codes. This can be seen in Willow’s quote “[d]iscovering who I am has been fun, because you learn to like yourself when you . . . stop living for other people. You realize that you never hated yourself. You hated the person that you were forced to be.” An initial code I used was self-hatred, and this tied into mental health. I originally thought of this more from a mental health perspective, but I then included codes for reflection and growth. In Willow’s quote, some elements represent an air of reflection on their journey, but they also speak to the growth that they experienced in realizing how self-hatred tied into a forced facade. What stood out to me as I refined this was the air of authenticity in this quote, how self-discovery paved the way for authenticity, and how that impacted their journey and psychological well-being. This became integrated into the theme of exploring identity after reflection and interpretation. Identity formation is a complex concept that cannot evolve independently of the myriad factors influencing and impacting life. Who we are, and who we become, is shaped by the lives we live, the experiences we have, our thoughts and our values. Much like mental health, identity was identified as it interwove throughout participants' stories. One significant element that contributed to identity formation - and influenced mental health and acceptance - was the concept of self-expression. Aspen discussed how their identity formation was inhibited by the 49 expectations placed on them, which meant they did not feel free to express themselves authentically. “It was a block of focusing on what somebody else saw, instead of what deep inside me was wanting to express and scream out.” Here they described that block, and I initially coded it as appearance-focused, as the context of the quote was surrounding how they dressed and looked. However, this quote has much more in it than simply discussing how Aspen appeared on the outside; only after seeing similar feelings across participants' experiences did I establish the code around perceptions of others. This code surprised me, and even more surprising was that it became one of the most frequently noted codes across participants. How others perceived them played a significant role in how participants expressed themselves. In Aspen’s quote, they describe how focusing on that perception held them back from authentic self-expression. This overlaps with the suppression code. However, perception of others arose in many different contexts and ways. Much of it connected to how participants expressed themselves, in this case, through appearance. Expression played a significant role in connecting and accepting oneself throughout the stories, so it became its distinct theme. Expression was very relevant to participants in their identity formation and, consequently, their self-acceptance. However, another one of the biggest influences that became evident in the coding process was the importance of connection. In speaking about what aided them in their journey to self-acceptance, Arbutus shared that “of course it was still hard to accept myself, but if I had parents that weren’t so accepting and kind then I don’t know if I would be where I am right now, accepting myself and loving myself just because they modeled that for me. And I’m really grateful for that.” This quote possesses some clear content that reflects the initial code, family. And while it is about family, it is also about love. Love became a refined code as it reflects the emotion and meaning behind why Arbutus shared this quote, and the role 50 that love played in their journey. Through love, Arbutus found a sense of belonging. This belonging co-exists with support, and Arbutus is clear about how their family provided the support they needed on their journey, and its impact on their self-acceptance. This coding process amalgamated to highlight how vital connectedness is for participants and its pivotal role in their journey. Therefore, connection became a key theme. All the codes, subthemes, and themes mentioned above are parts of the journey towards acceptance. Acceptance was the only theme I expected to arise, and that is simply because it is the focal point of the research and interviews. However, what emerged was how deeply and uniquely acceptance impacted each participant. Further in this chapter we will explore more about what it means to each participant and the impact acceptance had; however, for coding, acceptance in many ways was representative of a proverbial “end goal” for participants. When discussing their current assessment of self, Cedar articulates it as “I know who I am and I’m comfortable in who I am, and to me that is self-acceptance enough.” This quote summarizes their journey, and the initial, clear code of self-acceptance stands to reason. However, beyond acceptance Cedar also expressed a sense of internal validation and self-assuredness. I conceptualized the acceptance theme uniquely compared to the other themes, which arose to refine the codes and clarify. Acceptance and validation were both pivotal concepts, but to explore them more in the data, I separated the codes into self or internal, and validation or acceptance from others, or externally. This section aims to provide a clear understanding of the coding process, including the refinement of codes and how the codebook was utilized. Examples from the data were used to provide concrete and clear illustrations of the interpretation, eliciting themes and making sense of the data. It also enhances my transparency and reliability as the researcher. A more precise 51 outline of the codes can be found in the figure below, and we will explore how the themes were formed from these codes. Themes Subthemes Codes Example Quote Push and Pulls The Adverse Self-worth Example Code: Intersectionality Experiences, Shame Shame, Mental Health of Mental Mental Isolation Struggles Health Health Suppression “It just forced me deeper and Struggles Depression/Anxiety deeper down into that hole, Substance into that pit, and the only time Use/Trauma that I felt like I got air was when I was hurting myself.” (Willow) The Importance Belonging, Family Example Code: Relationships; Isolation vs of Support Relationships Support (including “My friend group has been a friendships) major help in figuring out who Love I am . . . [they] are incredibly Support supportive, and I don’t think I Connectedness Belonging realized how much so until I started my journey.” (Cypress) The Role of Appearance, Appearance: hair, Example Code: Appearance Judgment vs Expression Perceptions clothes (hair); Symbolism Acceptance Confidence “I adore my mullet, it is one of Symbolism my prize possessions at this Gender Roles point. I think my hair definitely Perception of Others has something to do with my gender.” (Aspen) 52 The Exploration Authenticity, Reflection Example Code: Authenticity of Identity Self- Growth Representation vs Discovery Representation “I think if I had grown up Inauthenticity Self-Exploration reading more literature with queer or diverse characters, it is something I probably would have pieced together sooner or earlier.” (Cedar) The Impact of Validation, Acceptance Re-affirming External Acceptance Validation Experiences Self-Acceptance Example Code: Judgment of Self “I don't need other people's Validation (internal validation to be valid in and external) myself. I now have enough Joy validation for myself.” (Maple) Suppression vs Validation Table 2. Codes and Themes Deriving Themes The purpose of coding cycles is to familiarize the researcher with the data and see nuances in it, deepening their understanding of the participants' experiences. Throughout the coding cycles, themes emerged by noticing the patterns that intersect throughout the stories (Saldana, 2021). I conceptualized the preliminary thematic concepts as focal points in each participant's experience, and shared commonalities reflected in unique journeys. After identifying these rough concepts, I needed to develop them into themes. This was done by assessing each thematic concept's role in the participants’ journey. In other words, how was this theme relevant to the participants and their stories? What I surmised was unique to each 53 theme but shared across each participant: the Intersectionality of Mental Health, the Importance of Connectedness, the Role of Expression, the Exploration of Identity, and the Impact of Acceptance. There was thought given to the eventual order as well, it being reflective of how these occurred in the participant stories. Mental health played a prominent role in the phase before the participant understood or embraced their identity. However, mental health is such a critical concept interwoven within experiences through reflecting on how each phase of the journey impacted mental health; no theme can singularly exist without the context of its impact on mental health, whether that be positive or negative. Despite being ordered first, this theme was the last to fully form as I felt stuck with how to conceptualize it. Only after developing the subsequent themes did I realize how big of a role mental health played in each theme and how vividly it intersected. Thus, the theme the Intersection of Mental Health evolved, a way of embracing just how interwoven mental health is with all facets of life, well-being, and acceptance. As we continue alongside the participant’s journey, the next theme that becomes clear is that of connectedness. Composed of codes involving love, support, belonging, family, and meaningful relationships, connection was vital to participants learning about who they are. Having a feeling of safety in connection was one of the first elements that facilitated participants in beginning to explore gender and identity. Additionally, connectedness was found to be a powerful antidote to escalating adverse mental health, which Arbutus emphasizes “it was such a hard time already that if I didn't have the acceptance from my parents and the support from my parents I don't know if I would have been able to make it.” Thus, the significance of connectedness cannot be understated and the theme of the Importance of Connection was born. 54 As connection became established, there arose a feeling of safety in those meaningful relationships. This signified in participants' experiences that they could explore self-expression without fear of judgment. Participants described how impactful it was to have their appearance, such as clothing and hairstyles, reflect their inner self-concepts. The freedom to try various forms of expression was essential in developing their self-awareness. Participants described arcs that evolved from focusing on how others perceived them to embracing self-confidence. Despite this shared arc in their journey, self-expression has a different role for each participant. Creating the Role of Expression theme was a way of honouring how self-expression was profoundly impactful and variable in how it was presented for each participant. The next theme, the Exploration of Identity, incorporates the different facets and areas of life wherein the participants engaged in self-discovery. Some participants described using tools like character creation in video games or Dungeons and Dragons as a way of testing the waters for what pronouns or appearance felt right to them, seeing what they could connect with in a safe environment. Codes that fit into this included authenticity, representation, self-discovery, reflection, and growth. All of these facilitate self-awareness and represent the deep dive into “figuring out the deep layers of who you are.” Aspen mentions the difficulty in authenticity, how you have to “find yourself to be yourself . . . and sometimes you don’t know who yourself actually is”. This theme reflects that deep inner work of self-exploration that must occur prior to acceptance - how can we accept ourselves if we don't know who we are? Throughout their journey, participants describe engaging in self-reflection and discovery to answer that pivotal question. The final theme is a culmination of the research and ties most closely with the initial research question “What is the experience of self-acceptance in gender-diverse individuals?” The 55 previously discussed themes were all critical factors in the experience of working towards selfacceptance for participants; however, this theme is the one that genuinely upholds the question of self-acceptance and the impact it has on the participant's lives. Thus, the Impact of Acceptance theme integrates the various ways self-acceptance has affected participants. The codes comprise several ways that acceptance shows up in the stories, such as experiences of joy, validation, or re-affirming. Each theme is interwoven throughout their journey to reflect the experience of striving towards acceptance, with this culmination emphasizing the result. Introducing Push and Pull As I conceptualized the themes above, I noticed a contrast between specific codes where each represented an opposing force that reflected the participants' arc. I categorized these opposing forces as a push and pull. These pushes and pulls are reflective of noticed subthemes across the datasets and codes: an adversity and its antidote. Isolation being overcome by belonging. Fear of judgement turns to embracing acceptance. Inauthenticity gives way to authenticity. Suppression becomes validation. Each of these reflect a push and pull experience for the participant's journey. To best exemplify how these subthemes arise in the stories of participants, later in this chapter, we will explore each push and pull as it appears in a participant’s journey. Researcher Growth Writing this thesis has been a multi-year journey and throughout that time I have grown as a person and as a researcher. Although I have deepened my understanding of the process of writing research, the most significant growth was during the data collection and analysis phase. Given the level of intimacy in the interviews, I initially struggled with the critical subjectivity 56 required for this field of research. Drawing on the counselling background, it was difficult for me to step out of the counselling role and into a researcher’s role. At the beginning of interviewing, I focused on connecting with the participant and needed to remember my role as a researcher. I was able to debrief this with my supervisor and create solutions for this internal challenge. It was very helpful for me to discuss and be mindful of in subsequent interviews, where I noticed an improvement in maintaining critical subjectivity while still demonstrating empathy. My supervisor also corroborated this improvement, and there was a shift throughout the six interviews. Much as the participants speak to the concept of continuous growth in their personal journey, I, too, experienced this growth concept and can speak to its continuity from a researcher's perspective. However, I would be remiss to not overlook how my growth as a researcher may have influenced the data collection and interpretation. Given the highly collaborative nature of the exploratory approach and the relationship of reciprocity, how I engage in each interview can play a role in how the participant responds and what they share. Based on participant feedback, concerns like perceived power dynamics or a lack of feeling of safety were not present in the interviews nor influenced their sharing. However, other variables such as ambiguity in storytelling and perception are difficult to avoid in this type of exploratory qualitative research. I did my utmost to use resources including my supervisor and ongoing reflection to note any biases or unconscious influences that may have arisen throughout the data collection process. This was where the inductive approach was advantageous, as I had no predetermined theory or idea with which I desired the participants to speak to, no set agenda when interviewing participants. My aim was to focus on simply listening to and learning from the participants' lived experiences, holding space for communication through storytelling. This focus remains true to 57 the exploratory qualitative approach, aiming to gain insights and deepen understanding of the participants’ perspectives, a focus on amplifying their voice. This approach allows participants to attribute meaning and perspective to their own experiences, which can provide insight into the complexities of their unique story. My interpretation of the data and stories may stem from personal experiences, reinforcing the need for reflexivity throughout all stages of the research process and striving to mitigate biases however possible. Transparency is one way to address this, and I spoke previously about integrating analytic and production transparency (Moravcsik, 2019). Production transparency incorporates my openness about the design and methodology of the research whereas analytic transparency is ongoing throughout this chapter. This is where I articulate how I interpreted the data and allows readers to make their own inferences about my analysis. I strive to be open about my process and thoughts as I underwent the research process and assessed the data. This can enhance trust in the process and add accuracy in representing participants' experiences. Overall, this research experience has involved reflection, transparency, and an openness to learn. Thus far in the chapter, we have looked at my growth as a researcher and focused on reviewing the coding process in detail. This has included a broad overview of how the initial codes emerged, such as ideas derived from previous research in the literature review, as well as a more detailed explanation through examples of participant quotes and how they were coded. We have examined how the initial codes were refined, and how the subthemes were developed. The push and pull conceptualization of the connection between themes was introduced and will be more closely examined in the next section. Participant stories will be used to exemplify the relationship between concepts. Themes have also evolved from the coding process, and these 58 themes will subsequently undergo a more profound analysis in the following section of this chapter. Theme 1: The Intersectionality of Mental Health One of the evolving themes that stood out predominantly was mental health. While the thesis explores mental health determinants, much of the interview was unstructured to allow participants to share what felt reflective of their experiences. As a result, my expectations were set aside as, instead of a clearly defined part of the interviews focused solely on mental health, the topic found its way again and again into the conversation in a myriad of contexts. When thinking about how best to reflect on how pervasive the varied influences are on mental health, the term intersectionality occurred to me. Intersectionality theory allows for the consideration of overlapping pieces of identity in an individual and emphasizes how each of these facets shape our unique experience in the world (Vu et al., 2019). The theory predominantly focuses on how each part of one’s identity, whether it be gender, ethnicity, age, class, or other factors, all overlap and contribute to experiences that are oppressive or empowering. Much as intersectionality has a place in areas of minority stress, as discussed in Chapter One, it felt correct to connect the concept to mental health as well. Vu et al. (2019) conducted a study that reinforced the negative impact of intersecting discrimination on mental health using the intersectionality theory as a launching point for their research. Including this perspective, mental health is an area that is heavily tied to intersectionality in participants' identities. However, the term intersectionality serves a dual perspective in this theme as it is also aimed at paying homage to how mental health intersects with every other theme. Mental health is a pervasive concept that consistently occurs in the coding and throughout the perspectives of participants; it plays a pivotal ongoing role in their journey and is also impacted by the proverbial “end goal” of self-acceptance. Consequently, 59 mental health has a clear and concrete intersection with each theme derived. To elaborate on this, I will explore not only the codes and subthemes noticed, but also hone in on the intersectionality by incorporating an approach that looks at both the push and pull of subthemes. The initial codes that created the theme surrounding mental health were of a more adverse focus: examining adverse experiences and identifying impacts of mental health struggles including depression, anxiety, trauma, or substance use. Many of these derived from what was noticed in the literature review in Chapter Two where it was identified that gender-diverse individuals are at an elevated risk for mental health distress including anxiety, depression, and suicidal ideation (Mak et al., 2020; Price-Feeney et al., 2020; Romani et al., 2021). Previous research set an expectation in my mind prior to coding, and while there were many adverse experiences pertaining to mental health the participants shared, there were also many positive aspects too. Familiarity with the data increases the ability to read beyond the surface, determine the feelings within the story, and observe the growth of the participants. This is where the push and pull concept became clear to me as a way of making sense of the data and distilling it into subthemes. I found antidotes in the data for many of the negatives I had initially identified. Isolation became connection. Shame turned to acceptance. Judgment became inundated with validation. Inauthenticity evolved to authenticity. Each push in the data found balance with a pull; each adversity transformed to resilience. In many ways, the very concept of the push and pull exemplifies the participants’ journey. While the ultimate end goal of this journey - if there ever is an end- is termed selfacceptance in this thesis, throughout the research I have found that self-acceptance is inherently holistic and incorporates so many specific areas of growth. To exemplify this growth in the push and pull, we will dive deeper into some specific arcs identified in the participants' stories throughout the chapter with mental health recurring as an overlapping theme. 60 A Holistic Perspective It is imperative to use a holistic perspective to better grasp the complexity of mental health and the variety of impactful factors. In other words, to look at the whole picture of someone’s experience. In this way, mental health is a unique theme in its robust integration in all areas of life. In Chapter Two, we established that socio-cultural distress can arise from identifying as gender-diverse, which has an elevated rate of depression, anxiety, substance misuse, self-harm, or other mental health challenges (Mak et al., 2020; Price-Feeney et al., 2020; Romani et al., 2021). Connecting this to the six participants' stories, each one spoke to their struggles with mental health. Every participant, to some degree, experienced psychological distress. Several participants connected that distress to feelings of dysphoria and internalized negative beliefs. “There were times where I just wanted to run, and I did not want to live. It was a struggle. It was definitely self-hatred.” Aspen’s openness shows how hatred can become internalized and its toll on mental well-being. These beliefs might derive from experiences of prejudice or disconnection they experienced, which relates to the holistic perspective toward mental health. The minority stress model, discussed in Chapter One, emphasizes how mental health is directly connected to stressful experiences that arise from facets of one’s identity (Camp et al., 2020). Similarly, Aspen brings up the inner conflict resulting from feelings of internalized cissexism, describing it as “being homophobic towards myself”. Throughout their share, Aspen opened up about mental health struggles which may have been exacerbated by their selfdescribed internalized homophobia. This is consistent with research that found that internalized homophobia was associated with an increase in experiences of psychological distress including depression, anxiety, and substance use (Yolaç & Meriç, 2021). Overcoming internalized negative beliefs, namely homophobic values, about themself was a barrier Aspen had to overcome as part 61 of their journey towards self-acceptance, and they shared that changing those beliefs resulted in improved mental health congruent with the protective factor of acceptance. Overcoming negative beliefs ingrained by societal expectations can be challenging, particularly when ongoing reminders and chronic stressors that reinforce those negative beliefs and hinder authenticity, expression, and acceptance. One prominent example of gender identityrelated stress that several participants discussed was simply the need to use a public restroom. Cedar highlights this concern: “Those were the most dysphoria-inducing moments, where I’m looking at a bathroom sign and thinking that neither of these [options] feel safe to me.” Cedar describes the unique fears that accompany either choice and how they cause significant emotional and psychological distress in both situations. Using a public restroom is an experience that several participants noted as being stressful, and for some it was the setting of adverse experiences like harassment. Restrooms are a poignant example of social construction pertaining to gender roles, and research has found heightened discomfort in individuals whose outward appearance is incongruent with the social expectation of the gendered restroom (i.e. male or female) (Platt & Milam, 2018). Having an essential need regularly evoke fear from feeling a lack of safety is one notable example in a series of chronic stressors. Participants also mentioned external factors such as fear of rejection from family members, lack of support from work colleagues, experiences of bullying and microaggressions. These were all found to contribute to psychological distress in participants in addition to exacerbating harmful internal factors, for example the aforementioned self-hatred. Internalizing negative beliefs can create significant dissonance within oneself, unable to reconcile it with the innate desire for authenticity. This inner conflict can be so difficult to experience that participants mentioned needing to rely on coping skills like substance misuse or self-harm. Willow explains their experience as “I was cutting myself or burning myself as a form of punishment, but also as a form of relief and safety. 62 Like that I had this autonomy over my body, and it was the one thing that I could control.” This quote directly demonstrates how feeling disempowered and lacking control over one’s autonomy leads to adverse mental health experiences. Self-harm was a way to cope, one of the only ways to feel relief and control. Connecting this with inner turmoil, it was a refuge from the feeling of pulled between authenticity and the expectations of others. The desire to punish themself may have arisen from internalized negative beliefs, reinforcing the earlier point about how it exacerbates psychological distress. Willow discussed their journey with mental health and how it corresponded to various factors in their life, as well as gender identity. They reflected on what changes they’ve noticed in themselves and their life since coming to terms with their identity as Two-Spirit. Since accepting my gender identity and changing my name, it's the first time in my life that I've gone without self-harming. It made a huge difference. And that's how I know that I made the right choice, is that it had such a huge impact. I used to constantly feel like there's something wrong with me, so I should be punishing myself. And now that I've accepted who I am, I no longer feel that. (Willow) Relating this to earlier in Willow’s journey, where they expressed the desire to selfpunish and felt uncomfortable in their own identity, we can clearly see the arc in which selfdiscovery and subsequent acceptance have influenced their mental health. Addressing their inner turmoil allowed for a sense of relief that they were previously trying to evoke from self-harm. Willow’s experience directly links acceptance of their identity to an improvement in their mental health, a powerful example of that relationship. It also corroborates findings from the literature review in which acceptance was found to mitigate adverse mental health (Carson & Langer, 2006; Woodford et al., 2014). As much as participants reported experiencing adverse mental health, they also shared how part of their journey has also been healing. Although this section of 63 the thesis has focused predominantly on the perspective of experiences of adverse mental health, it is important to acknowledge that this has been a representative portion of the participants' journeys. However, each of the participants reported experiencing love and resilience as key factors in overcoming this adversity. After exploring some of the barriers participants had to overcome, such as internalized negative beliefs, we can recognize the strength in the protective factors of participants' narratives. One of these powerful antidotes to adversity is connectedness. Connection, belonging, and support all strive to uplift the participants, boosting resilience and well-being. While it is important to note how mental health plays an ongoing role throughout the stories, we can turn our focus to explore the powerful way in which connection mitigates adverse mental health and bolsters acceptance. Theme 2: The Importance of Connectedness Connection serves as a mitigating factor in adverse mental health; it supports authenticity and expression. Having people in one’s life who provide unwavering support and external validation benefits the development of acceptance within oneself. That supportive feeling of belonging can consist of family, friends, peers, or community. In particular, family support has been found to be a strong protective factor that can bolster psychological well-being while decreasing depression and distress (McConnell et al., 2016; Miller et al., 2020). Some participants expressed extreme gratitude for families that have openly embraced them on their gender journey, and others experienced hesitation and disconnection. Arbutus had struggled with the adverse effects of repressing themself, however they have since found love in authenticity. “I wish that I'd known earlier in life that I would have been accepted with so much love.” In a message about love, Arbutus speaks remorsefully over the time spent being held back by fear. The sooner they embraced their identity the sooner they really connected that authenticity to the love and support of Arbutus’s network. Having a robust network of support and acceptance can 64 provide a protective quality over adverse mental health outcomes and experiences. Maple shared a powerful example of how family acceptance can establish support and connection: Family is a really big part of our lives, so the fact that almost the entire family unanimously decided to choose me over a different family member because he was acting badly. And the fact that none of the family talks to him anymore because they're like ‘no, that's not how we treat family.’ So it's the fact that they chose me and decided to support me and my gender and my mental health rather than this transphobic [person] . . . I can be me and be unafraid, and know that my family will stand by me. That, not necessarily fear, but apprehension, fades away a little more with each example of family, either by blood or by choice, sticking by you. (Maple) In this quote, Maple describes an experience with one particular family member who treated them in a discriminatory way. Having previously explained some hesitation on their family’s acceptance of their identity, Maple was overcome by love in this unanimous act of support from their family, really demonstrating how tangible actions of support play a big role in solidifying that feeling of belongingness. The support in this example stands out as a reaffirming experience of connection for Maple and encouraged them on their journey to selfacceptance. Having family stand beside Maple and providing a tangible show of trust and belonging strengthened their connection. This is a poignant example that reinforces the previous research about how demonstrations of support bolster mental health and reinforce it as a protective factor. Although family support can have a substantial impact, it is often the case where acceptance is not present in one’s family. Cedar speaks to the trust that breaks when that support wavers. “When you're a kid, you assume that that love is unconditional. And then as you grow up, you realize that actually the love of your parents can be conditional and something that you're 65 not even responsible for.” Here Cedar refers to the difficult experience of one’s identity as a source of disdain or shame. They spoke about how gender is not a choice; it is an innate part of who you are. To have that core part of your identity be a reason for parental conflict or familial ostracism has a deep impact on one’s well-being. The blow to self-acceptance that persists in having one’s family invalidate their experiences is significant and can exacerbate adverse mental health. In experiences of familial invalidation, individuals often turn to other options to fulfill that need for connection. McConnell et al. (2016) noted that LGBTQ youth often relied upon peer support and acceptance. Aspen discussed how important this peer support was for them in having a safe space to learn and explore their identity. There was no real information for me until I went to an LGBTQ youth group, actually . . . that was when I first realized what I was doing most of my life. The entire time I had known, but very subtly, that I didn’t really want to be just a woman . . . but it didn’t really kick in until the group. (Aspen) This group was a chance for Aspen to learn about themselves, and they described having opportunities to explore different forms of gender expression and having confidence in being uplifted and supported by their peers. This is a stark contrast to the distress caused by experiences of prejudice, harassment, or bullying - which several participants unfortunately mentioned experiencing. Combating adverse mental health derived from these negative experiences is having a feeling of belonging and connection, which is what Aspen described feeling in the group. “It helped with so much more than gender identity in itself. It helped with my mental health.” Creating communities of safe space allows individuals to feel empowered and supported by like-minded individuals, giving them a chance to explore their identity without fear of rejection. Many unpleasant emotions are fostered in isolation, leading to poor mental health. The antidote to that is connection, which allows for deep relationships and openness. This 66 emphasizes the link between mental health and connection. Willow speaks to how their journey of self-acceptance established intimate connections which provided an uplifting feeling. There was a portion of [time] where I felt very alone, but the more that I stayed true to who I am, and the way that I am, I found other people and I have a healthier connection that is sometimes more intimate. I can be more freely open with them. I can be myself, and they love me for who I am, which means I'm more secure in my relationships. And it's given me a freedom that I never thought I would have. (Willow) Here Willow expresses the power of connection and how it evolves into authenticity and freedom. They state how being themself in their relationships creates stronger bonds and deepens the sense of belongingness. It powerfully articulates how the strength in connection dissipates outwards, instigating positive experiences and meaningful relationships. This section has illustrated how the link between belonging, support, and self-acceptance is evident. Connection allows for increased authenticity. For some participants, their families were a big source of support, for others, finding friends and communities that uplifted them and validated their self-exploration was an essential part of their journey. Push and Pull: Isolation vs Connection The link between belonging and improved well-being has been clearly established. Isolation and connection materialize as a push and pull concept, existing in an inverse relationship. To explore this dynamic, we will look at how Cypress’s story highlights the push and pull of isolation and connection. Throughout their story, an inner conflict Cypress experienced was feeling torn between a desire to connect with their friends or to withdraw into themself. This conflict with self-isolation is exemplified as Cypress reflects on their experience. Part of it is nice because then I’m always comfortable. But then part of it is also hard, because I feel like I’m not really being the person I could be and it makes me feel a bit 67 like a turtle trapped inside my shell. If anything, I’m stuck inside and can’t get out. But I’m safe. (Cypress) As they explain this experience of feeling trapped in their shell, Cypress also shares the role that their avoidant personality plays in their life and how it can facilitate the withdrawal out of a need for a feeling of safety. They speak to how this impacts their comfort in going out into public or feeling confident in openly expressing themself, but also how it can be a hindrance in their social relationships. Cypress noted that they have had the same group of friends for the vast majority of their life, and how going through their journey has impacted those friendships. It has definitely made me feel like I would do whatever possible for these people, and it's made me a lot more present in their lives. I feel like before I was a bit of a backseat friend a lot of the time. And going through that, I definitely feel like I've put myself more in the forefront of playing an active participant in these friendships and less so just a bystander . . . which has been really, really comforting and really nice. (Cypress) Cypress spoke to how they struggled to fully integrate with their friends and show up presently and authentically but going through the experience of self-discovery and seeing how their friends supported them strengthened that connection immeasurably. There is a level of vulnerability that comes with authenticity, and in expressing the desire to self-explore, Cypress’s support network rose to meet their needs. Demonstrations of support like Cypress experienced bolster that feeling of belongingness and fortify relationships. Struggling with an urge to isolate and withdraw, Cypress was met with love and connection from their friends which directly impeded self-isolation. They summarize their sentiment about how their friend group encouraged the sense of belonging in their journey: “my friend group is incredibly supportive and welcoming and I don't think I realized just how much so, until I started my journey.” Cypress shared a deep gratitude for having people in their life that showed up for them during their self-exploration and 68 emphasized how essential their support was to them. Because they can often withdraw and retreat into themselves, Cypress said that having relationships that encouraged them to get out into the world and focus on connection was deeply impactful. Anxiety can become exacerbated in isolation, so friends that fostered belongingness was a direct counter to the anxiety becoming overwhelming and holding Cypress back from living their authentic life. A support network is hugely beneficial in the path to acceptance as well as identity formation. Not only does it increase psychological well-being, but it also creates a safe space to explore who you are within a pervasive sense of belonging. In other words, it creates a community where one can feel comfortable to try on different parts of identity or expression and see what they connect with, taking away the fear of vulnerability or judgment. A strong support network can establish an environment of unconditional acceptance, which fosters authenticity. A powerful way these connections support identity is through creating a safe space for authentic expression. Theme 3: The Role of Expression Before one can accept themself, they must learn who they are at their core. The development of one’s self-concept takes reflection and experimentation, being able to learn about themself - ideally in an environment or community that is safe and supportive, as discussed in the previous theme. A crucial component of self-exploration is being able to express oneself authentically. Expression is found to be an integral step in identity formation (Beck & Simons, 2020) and allows for one’s self-concept to flourish, in other words, having what’s on the outside match the feeling inside. This can greatly help self-image and esteem and are all contributors to self-acceptance. Our appearance can symbolize a lot about who we are, what we like, and what we feel connected to. Willow discusses how their journey has involved these external forms of 69 expression. “One of the best parts of my journey has been finding a way to represent who I am, through my style and the way that I dress.” Willow speaks to enjoying the process of trying on different clothes and finding outward forms of depicting their authentic self. They note how their appearance, through style and clothing, is a way for them to feel like they are representing their identity. Appearance can be a strong symbol for authenticity in identity. It allows us to represent ourselves through clothing, hair, accessories, mannerisms, or even expressions. These expressions take on a symbolic quality for participants, a beacon of self-acceptance. Aspen shared how they were not allowed to cut their long hair as a child, so as a way of pushing back against the suppression they “purposely let it mat three times” until they were taken to the hairdresser and got it cut short. “I had hair above my shoulders for the first time in my entire life and I felt happy.” Aspen described loving their hair and how liberating it felt to have their appearance match their self-concept. This connection is integral to identity. From a perspective of symbolic interactionism, Aspen’s story is an example of how their hair became a symbol with meaning for them. Previously, the short hair was a disconnect for them and incongruent with their self-concept; as their gender identity was explored, Aspen’s hair was a way in which they were able to find cohesion with their self-concept and their external expression. Gender expression is a way in which the symbolism of appearance has taken on meaning and is a way of communicating identity with others and can be perceived differently in various social interactions (Tabler et al., 2021). Thus, within the symbolic interaction lens, Aspen communicates their identity through the way they style their hair. However, authentic gender expression and how it is others perceive it can have a big impact on psychological well-being. The social perception of gender expression reiterates the concept of the influence of the sociopolitical context on acceptance and safety. This reinforces the point made in the previous theme, 70 about how a community of validation and support can be deeply beneficial, particularly regarding authentic self-expression. As much as authenticity in self-expression is something that can take time and effort to establish, being able to sense a discrepancy in one’s inner feeling and outward expression is innate for some participants. Cedar describes their sense of self as a young age: “I would cry every time my mom put me in a dress, and this is when I was 1 or 2 years old, right, too young to know any better.” Even from a very young age, Cedar felt a disconnect with an overtly feminine appearance. They contrasted this with how it was not until early adulthood that they put the pieces together about their gender identity, and most of their life until then they felt that disconnect with gender expression and their authentic self. Having a strong reaction of crying as an infant when put into a situation of gender disconnect speaks to the power of the early stages of identity development. This brings up the reflection on how gender can be a deep part of one’s identity. This innateness can be a reason why repression or internalized negative beliefs can be so deeply harmful. However, those harmful experiences often derive from an external source namely, the perceived negative perception of others. Perception of others was a code used when analyzing the data and was one of the most frequently noted codes. How the participants perceived judgment from others was often a topic that arose in the interviews, particularly pertaining to outward gender expression. There is a level of vulnerability that accompanies putting one’s authentic self on display through appearance. Cypress speaks about how they feel fully comfortable in their identity when they are alone but feels anxious when considering how they are perceived by others, and the impact it has on their outward self-expression. 71 When I'm in privacy, I can just be the person I want to be. Whereas being out in public . . . the concept of it is even more scary if I give them some sort of fodder, or some sort of ammunition to use against me . . . I know that people are always going to judge me somehow, some way, some shape or form but in my brain, giving them less to criticize and judge is better. (Cypress) Here Cypress is speaking to the vulnerability in self-expression, how putting oneself out there can be a scary concept because, to them, it can be used as a form of ammunition in judgment. To be authentic in expression is to open up to the potential of others not accepting that authenticity, particularly when it can be as stigmatized as gender expression. In particular, participants spoke about how challenging authentic expression was in their journey because of the expectations of others. Participants shared how, in their gender exploration, they experienced other people pushing their belief of what they “should” look like if they are transitioning or exploring gender. Maple speaks to how this resulted in multiple coming-out attempts because my mom wouldn't believe me, basically, until I actually started testosterone. She didn't believe me because I wasn't actually doing anything to change, in her words . . . 17 was when I tried to come out as non-binary for the first time to my mom. And her first words were ‘but you wear dresses.’ Presentation and identity don't necessarily have to line up . . . she would attempt to invalidate me using her perceptions of my experience. (Maple) Maple struggled with having their identity be believed - let alone validated - because of how their mother expected gender non-conformity to look, and if Maple didn’t subscribe to that expectation, then their identity was not considered valid. This reinforces the concept of symbolic 72 interactionism in relation to appearance and clothing, where expression becomes a symbol that is perceived uniquely by others. Maple notes the variation between identity and presentation, which acknowledges how presentation is communicative to others but may be influenced by the sociopolitical context. Maple's quote also speaks to the difficult experience of invalidation. Not only do gender-diverse individuals experience invalidation by society for not conforming to the gender binary, but even the attempt for authenticity can become dictated by the perception of others. If Maple is not going to conform to their gender assigned at birth, then they are pushed into their mother’s idea of what gender non-conformity “should” look like. The suffocation of those expectations can be a significant barrier to overcome in discovering what outward expression best aligns with one’s identity. While self-expression is unique to the individual, the social context can have a significant influence in shaping how that journey unfolds (Tabler et al., 2021). “As much as gender expression and identity is a self-searching thing, a lot of it, I've found, is also how people observe and respect you.” Cedar beautifully articulates the dynamic between the inner work of the acceptance journey and the role of external perceptions and interactions. As humans, we do not exist in isolation and are influenced by our surroundings and community. While the search for authenticity is a deeply personal journey, there are people who play a role in that journey and can either hinder it or support it. This ties into the theme of connectedness as well, speaking to how the people we are around have an inherent influence on us. Many participants speak to the dichotomy between being near people who suppress or invalidate their gender identity and the liberation and joy felt when surrounded instead by those who uplift them and provide that sense of unconditional support in their journey. Push and Pull: Judgment vs Acceptance 73 To exemplify the dynamics between self-searching and social influences in seeking authentic self-expression, we will look at Arbutus’s experience of overcoming judgment to embody acceptance. Their story also speaks to the importance of authenticity in expression. In describing their gender journey, Arbutus discussed pressure from others to be “trans enough” and struggled to adhere to what this meant in regard to commonly perceived gender expression. I would only buy things from the men's section, and I forced myself to stop liking pink and dolls and all the things that I really loved because I felt like if I'm going to transition, and if I'm going to be accepted as a man in this world, then that's just what I have to do. (Arbutus) This quote shows how Arbutus’s journey of expression was heavily influenced by the perceptions of others. They spoke of how they appreciate and enjoy things that are considered more feminine by society but felt like they had to suppress that part themselves as they figured out their gender identity. Arbutus shared experiences that led to this conclusion, predominantly judgment from others including peers at school and a harmful experience with a gender psychologist. This disconnect from authenticity was a way of searching for external validation of their identity. Consequently, Arbutus struggled with the inherent push and pull of seeking acceptance and eluding judgment however possible. However, suppression of inauthenticity was difficult to sustain, and Arbutus began to explore expression again, although with hesitancy in perceived judgment based on those adverse experiences. While I was re-accepting the feminine things that I love into my life, I was having a lot of doubts about myself. I was thinking ‘what are people gonna think of me if I start doing this again?’ If I start wearing dresses again, to a lot of people, my being trans is gonna become a lot less valid.’ (Arbutus) 74 Here we continue along Arbutus’s journey, and they have come to a place of realizing their gender identity and authentic self. However, they are now faced with the barrier of overcoming social perceptions and a fear of judgment. There is vulnerability in self-expression, particularly when it doesn’t align with socially present norms which, in this context, is gender. Arbutus’s arc is reflective of Bockting and Coleman’s (2007) model of identity development, where they have undergone exploration and intimacy stages, but are now working on the identity integration stage. In identity integration, the individual accepts themself and works on navigating how to integrate their identity into areas of their life, such as social situations and environments. Arbutus’s insight about how the perceptions of others influenced their gender journey spoke to the connection between external approval and self-validation. Part of the journey to selfacceptance is working through that conflict and overcoming the perceptions of others holding them back, which Arbutus speaks to. “I did a lot of healing, and I started to take back those pieces of myself, the feminine things that I love but also the masculine aspects of life that I love.” As part of the healing process, Arbutus describes reclaiming pieces of themself that was lost to fear and judgment. Embracing their authentic self through expression that simply reflected what Arbutus found joy in, regardless of gender stereotypes, was a key part of how Arbutus strived towards self-acceptance. They also spoke to the impact of the suppression of that joyful expression impacted their mental health and contrasted it to how they felt when overcoming perceived judgment. Once I started to present as myself, that gender presentation piece really made me feel more confident, and I became a lot like my old self before I started to go through my transition and depression and gender dysphoria and stuff. And now that I'm expressing myself the way that I feel comfortable doing so, in the way that I feel best, I've recovered a piece of myself that I think was lost along the way. I tried to force myself into that box, 75 and it didn't work, and I was miserable, and everyone could see that I was miserable. And now that I'm being myself, people love to see it and that makes me happy, and it feels nice to be able to put my true self out there and to have people appreciate me for what I really am. (Arbutus) As we continue to explore Arbutus’s arc, this quote is reflective of the achievement in identity integration. They worked through the conflict they were experiencing between authenticity and the perception of others, allowing perceived judgment to suppress their innate desires and likes. Here, Arbutus speaks to not only the culmination of their journey, but also the impact that identity integration, and consequently self-acceptance, has had on their life. One of these impacts is how, after overcoming judgment to embrace self-acceptance in their expression, Arbutus noticed a shift in their relationships and connections. Similarly, they also speak to the positive effect that authentic expression and acceptance had on their mental health. As we explore the distinct themes that arose in the data, it once again is essential to speak to the layers of overlap that exist within the stories and how no theme itself is inherently isolated. In particular, one theme that frequently arose in the discussion of self-expression was that of identity. Expression is a powerful way in which we can explore ourselves and our identity and figure out what feels authentic to us as individuals. Expression is a cornerstone of identity and that has been reiterated throughout this section. Identity is a complex concept that we will turn our focus to next. Theme 4: The Exploration of Identity Expression and connection are two integral components of the journey toward selfacceptance; they encourage self-exploration and facilitate the search for authenticity. Now, as we continue to examine the factors that lead to self-acceptance, I would be remiss not to emphasize the key prerequisite that acceptance necessitates: identity. How can we accept ourselves if we do 76 not know ourselves? Much of the participants' journey can be conceptualized as identity formation, which then precipitates self-acceptance as a final stage in identity integration (Bockting & Coleman, 2007). Identity formation requires exploration; it is how we determine our values and beliefs, our likes and dislikes, the sum of who we are. It is the culmination of all the parts of ourselves that we discover and define. Several participants compared the exploration of identity to a puzzle, with each of these identity facets likened to a piece; Aspen conceptualizes it as “putting that puzzle together to figure out who you are.” This metaphor highlights how multifaceted identity is; we are the sum of many experiences, thoughts, and connections. Although gender is a focus of this research and certainly is a large piece of the puzzle, it does not stand in isolation as a sum of an individual. Similarly, it might take putting together several other pieces before realizing gender identity - each person’s puzzle is unique to them. Putting together that puzzle is, in essence, the very concept of the journey to know and accept oneself. The exploration of self looks different for everyone, and in each participant the way in which they engaged in exploring identity was unique. Arbutus described wearing cosplay of characters of the opposite gender they were assigned at birth as a way of exploring how they felt connected to gender and presentation. Aspen described spending lots of time focused on video game character creation, a feature in games where the player can alter the appearance of their avatar in a way that they resonate with. They explained how they made their characters appear non-binary despite not being fully aware of their own gender identity at the time. Cypress noted that “an incredible tool for me to explore my gender was through the roleplay aspect in things like Dungeons and Dragons”, sharing how they would make different characters with different pronouns and try them out. Cypress said it was helpful to “get a gauge on different pronouns and how I felt being referred to by them.” Being able to have immersive ways to test out what feels right and connect it to themselves was useful for participants as they worked on figuring out who 77 they are. The experience of self-exploration is individually unique to each participant and aligned with facets of themselves that already felt more secure, for example an interest in video games. For participants, this allowed them to reflect on how they felt connected to gender. As previously mentioned, gender is a crucial piece of the puzzle for participants, one that is connected to their experience in life. Cedar speaks to the self-awareness and reflection that necessitated identity formation, discussing their self-perception and coming to understand their own experience. I just thought that being uncomfortable in your body was just what everyone experienced. And you think your life is normal because it's the only life that you're ever going to experience. But then you realize that actually, what you’re experiencing isn't normal. Other people don't feel this way. (Cedar) This realization was a puzzle piece for them, acknowledging that discomfort and reflecting on why. It was a piece that started a cascading reaction of putting more pieces into places by pursuing gender exploration. This discovery of their identity was crucial in their path towards self-acceptance, and Cedar expresses the sum of self-exploration as: ‘You're just becoming who you always have been.” This message powerfully encapsulates the theme of identity-exploration, how the journey is about becoming your authentic self. In keeping with the puzzle metaphor, I liken it to as we put the pieces together, we begin to see the image being formed. Similarly, in identity formation, as we put the pieces of ourselves together we begin to see the whole picture of who we are and what shapes our identity. In Cedar’s quote, they speak to how the image of authenticity emerges from self-discovery. This concept of identity formation is also congruent with identity integration being the final step of the identity journey and facilitates the experience of self-acceptance (Bockting & Coleman, 2007). Ultimately, identity 78 exploration is a gradual process that unfolds through subtle, exploratory ways as seen throughout participants' stories. Push and Pull: Authenticity vs Inauthenticity Identity and authenticity are deeply interconnected concepts. Authenticity is needed to be able to uncover identity. Therefore, feeling unable or unsafe to be authentic, or having authenticity invalidated, causes a significant barrier to identity formation. The inverse relationship of authenticity and inauthenticity has been conceptualized as a push and pull in identity formation. To exemplify this, we will explore Cedar’s arc. Family has consistently come up across all participants' stories as having a significant influence on their mental health during their journey. Reflecting on their experience of embracing identity through being open with their family, Cedar stated that “I think the thing holding me back the most was fear and the uncertainty of what would happen.” In this, Cedar eloquently summarizes a feeling that was shared among many participants in their own coming out journey. While a large part of the journey is sorting through one’s own emotions, another crucial component is how loved ones respond. There is vulnerability in authenticity, and Cedar shows their initial hesitation with opening up this way. However, there is an internal conflict that derives in the push and pull between authenticity and inauthenticity, an incongruence with one’s feelings and one’s fears. “It was that battle of, do I keep it secret because I'm scared of rejection? But also, this is who I am, there's no changing that. They can reject me, but it's not going to change that this is who I am.” Here, the conflict is apparent. Cedar is torn between living inauthentically and the vulnerability that comes with putting their true self out there. They speak to how a fear of rejection held them back, but through their own self-discovery came to terms with the truth of who they are. They accepted that rejection and invalidation from others does not diminish their identity. 79 Thus, authenticity ultimately overruled their fear but it took Cedar an inner battle to come to that place of self-validation in their identity. Cedar speaks to this conflict, elaborating on the toll of burying their identity “down deep” and how they reached a point where, “if I want to keep living, this is where I see my life going”, referring to candor and emphasizing the intimate connection between authenticity and mental health. The push and pull here is demonstrated between this link, with one’s mental well-being impacted by both authenticity and suppression. Ultimately, Cedar’s path led them to share the freedom they felt in authenticity. “[My family] can either support me as who I am, or they can pretend I don't exist anymore, but at least I can exist as my true self.” Here, we reached a pivotal point in Cedar’s arc. Contrasting this to earlier quotes, it is clear that Cedar was initially struggling with fear and hesitancy, but after an internal conflict they embraced authenticity. Fortunately, most of Cedar’s family members were relatively accepting and there was a positive outcome to their openness. Cedar’s journey reflects the role of self-discovery and authenticity in identity formation. They established who they were, but the fear of rejection was a barrier Cedar had to overcome in order to achieve identity integration. Throughout their arc we see how they came to terms with the realization and eventually used the power of self-acceptance to overcome the suppression of inauthenticity. Theme 5: The Impact of Acceptance The power of authenticity in the journey to self-acceptance is clear. The “self” is inherently derived from the search for what constitutes one’s authentic self, which, for the purpose of this thesis, aligns with one’s authentic gender identity (Klussman et al., 2022). Acceptance of oneself cannot exist without authenticity. Arbutus ties in how interconnected selfacceptance is with authenticity, as well as the impact it has on their mental well-being. 80 I'm definitely the happiest I've ever been right now, but I also feel like I'm close to the person that I've always been. I really shut myself off from the world, and kind of became a completely different person while I was really struggling. And now I’m back. (Arbutus) In this, Arbutus summarizes how their disconnection with themself was related to psychological distress, and the inverse relationship that has with authenticity and joyfulness. Coming from a place of self-reflection, this has shown Arbutus’s journey and how they are experiencing the world now from the perspective of self-acceptance. Similarly, in explaining pivotal themes on their journey of self-acceptance, they beautifully encapsulate how selfacceptance ties in with connection and authenticity. “I feel like it would be harder for me to accept myself if I didn't have the love of the people in my life, but also, I think that the people in my life love me even more because I'm living so authentically now.” For Arbutus, authenticity has brought love and joy; it paved the way for them to embrace acceptance. Additionally, in this quote, Arbutus demonstrates how several of the themes fit together: authentic identity is strengthened by connection and supports the journey of self-acceptance. As they share their story, this quote fits into a context of joyfulness. Joy was an initial code that I kept throughout the analysis process as it stood out to me as the opposite of the other emotions coded in the Intersectionality of Mental Health. Joy emerged as an impact of acceptance in participants, as a representation of the culmination of the journey. It also contrasts the adverse mental health described by participants at earlier stages of their selfexploration and identity formation. Corroborating this, participants often noted feelings of euphoria that came from accepting themselves in whatever shape that took. Cedar, for example, noted that “the first time I ever wore a binder and realized what gender euphoria was and could be.” Their experience of gender euphoria came from an acceptance of their identity in the form 81 of self-expression. Connecting the outward expression to what one feels on the inside is a direct antidote to the distress that arises from the dissonance of repressing one’s identity. Klussman et al. (2022) noted the necessity of a behavioural alignment that is congruent with one’s authentic self in order to embrace self-acceptance. Gender expression is one way in which this behavioural alignment can be achieved, as noted in an earlier theme. Similarly, another earlier theme emphasized the importance of connection; Toscano (2022) engaged in research that posited that fear of rejection or isolation from friends, family, and community was an inhibitory factor in regard to self-acceptance. Fearing rejection in relationships can pose a challenge in embracing authentic connection. Participants address this in their own way and how it influenced their own story. Willow discussed how their arc involved building confidence and self-validation, shifting their previous people-pleasing behaviours. I used to be a people pleaser. Now, I'm very outspoken. It's learning how to take up space and being okay with that. And taking up space despite the fact that it upsets other people, because I'm living my life for me. I get one life, and I'm not going to live it to please other people, and then secretly be miserable . . . because I can't stand who I see when I look in the mirror. (Willow) Willow reflects on their own growth in striving towards self-acceptance, identifying how the fear is related to people-pleasing tendencies. They express what acceptance looks like for them, and how unwavering it is despite negative perceptions of others. This shows how Willow’s journey included developing self-validity and a strong sense of self. Continuing their reflection, Willow contrasts their current state of acceptance with the impact that inauthenticity had on their mental health. “You learn to like yourself when you stop living for other people. You realize that you never hated yourself. You hated the person that you were being forced to be.” 82 This quote expresses how the perception of others and social context contributed to a state of suppression and inauthenticity. Living in that state fostered feelings of self-hate in Willow. Self-acceptance was a cornerstone of this shift and resulted in more positive feelings towards themself. Ultimately, Willow’s arc included struggling to understand their authentic self and consequently struggling with mental health, to embracing and accepting themself which has led to strong connections with others, empowerment, and self-validation. Additionally, joy was found to be a pervasive sentiment associated with acceptance. The experience of embracing authenticity and self-acceptance has been shared across participants and unanimously found to bolster mental health, strengthen connections, and enhance overall well-being. Meaning in Self-Acceptance Some shared impacts of acceptance across participants have been established. However, self-acceptance is also a concept that is unique to each person. In order to profoundly explore the subjective experience of this journey, each participant was asked, “What does self-acceptance mean to you?’ The variability in how this question was interpreted and responded to speaks to how unique the experience of self-acceptance is for each participant. Some participants related the question to their own journey and experiences while others considered a more generalized answer. Ultimately, each of these thoughts reflects their unique perspective. Arbutus connected the question to their own journey and experience, saying that “I think where I’m at now is self-acceptance. Living authentically is exactly how it feels. . . it’s unwavering.” 83 Aspen shared that “I think self-acceptance means to me, looking at something and thinking that it’s perfect with its imperfections. It has to have imperfections in it to be perfect.” Cedar’s insight was: “I think that self-acceptance is knowing yourself, who you are, and not being afraid to try and pursue that.” Cypress spoke to their own feelings of how “I am living my best life” in relation to selfacceptance, but also shared their perspective on it how variable and personal the experience of self-acceptance is: “it should not be expected that every single other person is going to want to have the same experience, or just straight-up express themselves and their self-acceptance in the same way.” Maple’s interpretation spoke to how “being able to celebrate those differences has played a large part in self-acceptance. Finding other people like me . . . and being able to be authentic with them is also a big part of self-acceptance because I don’t judge other people for these traits so why would I judge myself?” Willow painted a picture of joy: “it’s freedom for me. It’s happiness for me. It’s art and passion. And it’s scary. It’s so scary. And sometimes you feel unsure. But it’s so very liberating. It’s like this unseen force in your life that spreads love and positivity into everything else. It really starts from within you and bleeds out. And it can change everything you’ve ever known for the better.” Push and Pull: Suppression vs Validation Thus far, we have examined the various impacts that acceptance has on participants' perspectives. The detrimental impact of suppression has been noted throughout this chapter, and 84 in this push and pull, we take a closer look at the internal conflict that arises from feelings of shame and the need to hide or suppress one’s authentic self. Maple opens up about how their journey through shame and fear impacted them. “There were a lot of things I was scared about, and specifically being perceived as other.” A fear emerging from the perceptions of others presents itself in this quote as Maple expresses how this fear held them back from accepting themself and suppressed authenticity. Reaffirming this fear, Maple described how the reactions from people close to them continued to encourage that suppression. In particular, Maple opened up about their relationship with their mother and how she projected her own fear and shame about Maple’s identity onto them. “[My mum] felt like the world wasn't going to accept me, therefore she needed to quash it so that I wouldn't be othered.” Being unable to exist as themself in such an intimate parental connection was detrimental to Maple’s own validation of their identity; it is hard enough to find validity in oneself already, but to compound it with the active projection of shame exacerbates the difficulty immensely. For Maple, one of the only ways to cope with this feeling of being suppressed was with substances. Maple describes how this deeply impacted their mental health and led to using substances as a way of coping with this inner battle. I felt so miserable because I felt like I had to hide myself. No mentally healthy person would, I feel, voluntarily take substances that they know are detrimental. So to come to a point when you feel like those are necessary just to keep living day to day, there's obviously something else wrong. And what I know now is, that was a feeling of being lost, being insecure. Feeling like I needed to keep up these appearances and not be authentic to myself was really hard, and led me to a lot of bad places. (Maple) Suppressing one’s identity is difficult to sustain, and one of the only ways Maple described coping with it was with substances. Their reflection on their experience is profound, 85 showing the adverse impact of shame and suppression on mental health. Being unable to be authentic to themself was detrimental to their well-being and necessitated substances to endure this disconnection between who they felt they had to be and who they actually are. As we continue through Maple’s journey, there is a noticeable shift in how self-validation has influenced Maple’s well-being and mental health. Improving my mental health . . . has made it easier to not depend on other people's perceptions and validations of myself. When my mental health was really bad, it was easier to stuff those parts of myself away. But now that some of that has stabilized, it's easier for me to be authentically myself because I'm not so desperate for other people's validations of who I am. (Maple) Here we are seeing Maple’s growth and the evolving dynamic of mental health and validation. They had spoken about their gender journey and the process of beginning to embrace themself authentically, working through the shame to seek honesty in their identity. This evolved into self-validation which stood as an antidote to the shame and suppression that Maple had been living with. Strengthening that validation of self, Maple noticed a significant shift in their overall well-being and an improvement in their mental health. Finally, in contrast to their earlier experience being ruled by fear, Maple’s arc leads them to acceptance. They journeyed through adversity to come to a place of self-validation. “I don't need other people's validation to be valid in myself. I now have enough validation for myself.” Here, Maple beautifully articulates the capstone of their journey, how they fought the shame and fear holding them back and learned the power of self-validation. Being able to stand firm in their own validation of themself has allowed Maple to live as their true self, overall improving their wellbeing and mental health. Throughout this section we have explored the push and pull relationship between suppression and validation. Validation is a strong precursor leading to acceptance, and we have 86 also looked at various impacts that acceptance has had on participants. Some pervasive impacts of acceptance include strengthening connectedness and improving mental health outcomes. Selfacceptance is a subjective experience that is perceived differently by each participant, and we noted some participant interpretations of self-acceptance that provided insight into their stories. Ultimately, we have established that acceptance plays a pivotal role in the culmination of each of their journeys. Summary of Chapter Four This chapter has delved into the findings of the research. Thus far, we have been introduced to the topic and its importance, examined some relevant literature, and looked at what the research process entailed. In this chapter, we analyzed the data and developed themes. The analytic process was explained through an overview of the coding process and how the codes were shaped. How initial codes were applied and refined was described, with specific examples provided to ensure a thorough understanding and to enhance reflexivity and transparency. I reinforced these concepts when discussing my observations of my own growth as a researcher throughout the research process. Continuing the analytic transparency, the development and utilization of the codebook were reviewed as well, with exact codes specified. The data underwent thematic analysis in which patterns and meanings were derived from the participant’s stories. Consequently, this chapter discussed how the themes were derived from the data and the role they played throughout the participants journey. Each of the five themes that emerged was explored, both for their independent role in the participants' journeys as well as how they integrate with one another throughout the narratives. The themes flowed in a way that aimed to be reflective of how participants' stories unfolded. The initial theme centered around adversity to mental health, serving as a launchpad for the perspective-sharing. Most psychological distress was experienced prior to embracing 87 acceptance. We discussed factors that influenced participants' experience of mental health with respect to how holistically impacted mental health can be. Additionally, mental health was an ongoing point of discussion and was deeply intertwined with other themes throughout participants' stories, reinforcing the intersectionality terminology. Another theme discussed is the importance of connection. It was found to increase participant well-being and encourage authenticity. A sense of belongingness and a safe space to explore identity and expression helped participants in their journey toward self-acceptance. Building on this, expression was found to play a big role in exploring self-acceptance and facilitating identity formation. Ways in which identity exploration occurred were looked at, such as appearance like clothes and hair, as well as through role playing games and other creative outlets. Examining expression reinforced the necessity of identity formation and authenticity. These topics were looked at in the penultimate theme, where we further examined how selfdiscovery occurred in participants' stories and the role it played in their lives and relationships. Each of these themes culminated in looking at the impact that self-acceptance has had on participants. Acceptance has been found to have unanimously positive impacts on participants, encouraging self-validation, strengthening connections, and creating joy. Each of the themes discussed was reinforced with a push and pull conceptualization of the intersecting dynamics across stories and throughout themes. This push and pull is representative of inverse relationships between differing codes and concepts, and aims to emphasize the contrast between adversity and resilience. Each push and pull was explained through a participant example. Overall, this chapter has delved into the arcs that participants experienced throughout their journey. The findings in this chapter have been robust and provided a more in-depth understanding of the participant’s experience of self-acceptance. Many of the findings can be corroborated with existing literature, however this research allows us to gain 88 further insight into the lived experience of participants. Their stories highlight a powerful relationship between mental health and self-acceptance, and ultimately demonstrate how important acceptance is. 89 Chapter 5: Discussion Introduction Thus far, I have focused on the research process, understanding the coding process, and exploring the themes that arose from the data. In this section, I will be distilling the themes into concrete conclusions and, in essence, aiming to understand what the themes actually mean. I also assess what these meanings imply for both future research and for understanding the lived experience of gender-diverse individuals. Additionally, I infer how to create environments that foster psychological well-being and enhance self-acceptance in this demographic. I also note some limitations of the research and note ways that further research can aim to address these limitations, as well as contrast this with some of the strengths of the study. Finally, a section will include messages that participants wished to communicate and share with other individuals undergoing their own journey to self-acceptance, with the aim of upholding the intention of amplifying participants’ voices and ending the research on an uplifting note. Conclusions The themes that emerged from the data each contribute to a deeper understanding of the lived experience of gender-diverse individuals. In Chapter Four I discussed the process of how initial codes were formed, then refined. The themes that have emerged from these codes aim to address the research question and provide insight into the lived experience of gender diversity. Overall, much of what was discerned in this research reinforces the concept of the protective factors found by previous research, however the exploratory approach to this research allows for an expansion into comprehending the role and influences of these protective factors. This section will dive into key take-aways from this research and distill the thematic analysis into clear conclusions. Thematic Conclusions 90 Self-Acceptance Enhancing Well-Being. First, it is important to iterate the overarching research question: what is the experience of self-acceptance in gender-diverse individuals? This question was derived with the intent to explore the journey of self-acceptance and what it means to participants. However, it also involves a hypothesis that self-acceptance improves well-being. This is corroborated by previous research (Carson & Langer, 2006; Woodford et al., 2014). The theme that emerged from the topic of self-acceptance looked at the impact that it had on participants' lives, relationships, mental health, and overall well-being. In each area of life examined, self-acceptance was found to have a positive impact, consequently establishing the first conclusion. This conclusion directly addresses the research question by demonstrating that the experience of self-acceptance is transformative. Through participants' stories, accepting gender identity has been shown to improve psychological well-being and enhance connectedness. Identity Formation as a Pathway to Self-Acceptance. Self-discovery was found to be a key part of the search for identity and a necessary part of the road to self-acceptance. Each participant described the role that identity formation had in the development of their selfconcept, which is a necessary precursor to acceptance. This remains consistent with the Identity Formation Model, wherein participants' narratives aligned with the sequential pattern of identity development (Bockting & Coleman, 2007). Self-acceptance in this model is included as part of the identity integration stage and peace with self-concept is achieved. Prior to that is the exploration stage which involves self-searching and is congruent with participants' experiences. Finding authentic identity, then feeling secure in it, is a cornerstone of the journey to selfacceptance. Ultimately, self-acceptance cannot be achieved without authenticity. This clarifies the second conclusion: security in authentic identity is essential for the development of selfacceptance. This finding answers the research question by showing that self-acceptance is deeply 91 intertwined with the process of identity formation. Participants’ perspectives revealed that identity formation is an essential part of the journey to self-acceptance. Each individual discussed the importance of discovering and exploring their true identity as an integral part of their journey to self-acceptance. Self-Expression Facilitating Authenticity. In participants' stories, certain concepts were found to support and reinforce the development of authenticity, and consequently, the journey of self-acceptance. One of these essential concepts was that of self-expression. Participants described how important it was for their self-concept to be able to explore areas of appearance and symbolism with the aim of finding authenticity in their outward expression. This creates alignment with their inner self-concept and facilitates the journey of self-acceptance while allowing for improved mental health. It was found that perceived judgment or adverse expectations of others was one of the main inhibitory factors in the experience of self-expression. Countering this was the concept of validation, either self or external. The conclusion for this theme incorporated that finding and posits that safety and validation are integral in encouraging authentic expression. This theme answers the research question by revealing how self-expression plays a pivotal role in aligning outward appearance with their inner self-concept. The ability to explore their gender expression—through clothing, appearance, and behaviours—played a significant role in participants' journeys and encouraged a deeper understanding of their selfconcepts. Connectedness as a Protective Factor. Another concept that was found to encourage authenticity and acceptance was that of connectedness. This theme also allows for the feeling of safety in relationships that encourage expression and exploration. The conclusion is simply that connectedness increases well-being. It is an interesting positive cycle wherein participants noted that the more they engaged in authenticity, the stronger their meaningful relationships became, 92 which in turn served to encourage and reinforce more authenticity as well as acceptance. Although connection has been found to be a powerful protective factor in previous research (McConnell et al., 2016; Olsen et al., 2016; Ryan et al., 2010), the depth of the participants' perspectives demonstrated just how integral connection is to well-being and explored experiences that were reflective of how dynamic relationships can be. Similarly, it spoke to the myriad of influences that relationships have on the individual throughout their journey. Connectedness was found to be a powerful antidote to the adverse mental health experience of isolation as well as bolstering psychological well-being in participants. The theme of connection emphasized the importance of relationships in fostering authenticity and acceptance. Therefore, this conclusion contributes to answering the research question by highlighting the role of meaningful relationships and connectedness in the self-acceptance journey. Mental Health Shifts on the Journey of Self-Acceptance. The final conclusion derived from the findings speaks to how mental health is impacted throughout participants' journeys. Each participant’s story shared a similar flow pertaining to psychological well-being. At the start of their journey, before understanding or accepting their gender identity, participants experienced adverse mental health. As their journey progressed, this began to shift. Each participant discussed how their mental health vastly improved in the present as a result of the journey of self-acceptance and authenticity. They also spoke of various protective factors, such as belongingness, that aided them and their mental well-being throughout their journey. Thus, the conclusion here is that self-acceptance improves mental health. Additionally, protective factors including expression and connection play a beneficial role in relieving psychological distress and encouraging individuals in their journey. This conclusion directly addresses the research question by showing how the process of self-acceptance influences mental health. The improved 93 psychological well-being that participants experienced correlates with increasing acceptance towards themselves. However, it is important to note that this conclusion does not diminish the difficult struggles that participants experienced, including internalized negative beliefs. Many participants had to work through adverse mental health to achieve self-acceptance, and while protective factors can mitigate this to an extent, they do not entirely negate all mental health struggles. Although self-acceptance improves mental health, it cannot counteract all factors contributing to distress. For example, it is possible to accept oneself and still experience depressive symptoms. Throughout this research, I have aimed to emphasize how mental health is influenced by a wide range of factors and that should not be forgotten when considering the conclusions. Although self-acceptance can address many influential areas that contribute to decreased mental health, including self-hate or internalized negative beliefs, mental health can be severely impacted in other ways that are not intrinsically linked to acceptance, such as economic insecurity. Despite this, self-acceptance serves as an effective protective factor nonetheless. Overall, the conclusions of this thesis are clearly derived from the themes that arose in the analysis of the data. Participants’ stories were closely examined to draw findings that were distilled into conclusions. Overarchingly, self-acceptance was found to have a positive impact on participants' lives and well-being. However, it is important to note the role of limitations in this research. While self-acceptance was consistently linked to improved mental health, it is essential to note that the participants’ experiences may not fully represent the diversity of gender-diverse individuals globally or across all cultural contexts. Connection to the Research Question In the above section, I iterate and note the overarching question that has fueled this study: what is the experience of self-acceptance in gender-diverse individuals? Now I will revisit this 94 question and discuss how the research addresses it. This question upheld the core of the exploratory qualitative approach in its openness to the meaning of experiences while focusing it on the journey of self-acceptance. The findings of this research are profoundly connected to the question and directly address it through the presentation of the narratives and the creation of the themes. I have explored this research question throughout the study as I discuss what the journey of self-acceptance has looked like for each participant. These journeys have culminated in some key conclusions which serve to address the core research question. First and most relevant is the conclusion that self-acceptance has a positive impact on participants' lives and overall wellbeing. The experience of self-acceptance involves assessing what the impact is, and the analysis of this theme provides an in-depth perspective into what effects self-acceptance has had on participants, such as strengthening relationships. The theme surrounding connectedness focuses on the role that relationships and connection play throughout the journey of self-acceptance, concluding with its beneficial impact on well-being. Similarly, I explore how mental health has shifted throughout the course of the participants' journeys, relating the start of their stories to the present and how their psychological well-being has improved with the attainment of selfacceptance. Therefore, the conclusion about self-acceptance increasing mental health again has evolved from enhancing our understanding of the experience of self-acceptance. As I have explored the journey of self-acceptance, authentic identity formation has shown to be an integral precursor to acceptance. Identity formation and self-exploration are key contributors to understanding the experience of self-acceptance. This connects to the conclusion that security in authenticity promotes the development of self-acceptance. The thematic analysis explores how authenticity emerges from self-discovery. A component of the search for authenticity in participants' stories is self-expression, which is encouraged through safety and 95 validation. This works to create a more robust depiction of what the journey to self-acceptance looks like as well as how it is experienced, and what impacts acceptance has for participants. It is important to reiterate how the journey of self-acceptance is deeply influenced by one’s experience in the world. Our experiences are shaped by who we are, and these features of our identity all intersect. While gender identity was central to the participants’ stories, their experiences of self-acceptance were also influenced by a variety of intersecting identities, including geographic location, socioeconomic status, and disability. Intersectionality, as defined by Crenshaw (1989), helps us understand how overlapping identities contribute to unique experiences of marginalization and empowerment. Participants noted the impact of neurodiversity such as Attention Deficit Hyperactivity Disorder (ADHD) in their journey to accepting themselves and how it was an additional barrier but contributes to who they are as an individual. One participant shared that managing both ADHD and their gender identity often felt like balancing two complex challenges. Overcoming these hurdles ultimately strengthened their sense of identity. Participants also contrasted their experiences identifying as gender-diverse in rural settings compared to a larger city, noting an increased comfort in urban environments and less perceived judgement, thus making authentic self-expression less intimidating. One participant expressed how moving from a rural area to an urban setting gave them access to resources and communities that allowed them to explore their identity in ways that were not available to them before. They felt more confident and supported in expressing themselves. There are a variety of facets of identity that all contribute to the unique experience of each participant, and although these intersections can be a barrier, they are also integral in enriching the participants identities and our understanding of the experience of self-acceptance. Another section of this thesis that aims to specifically address the research question is where each participant is asked what self-acceptance means to them, and their quote is included. 96 This aims to expand the research question by honing in on the perspective of meaning in selfacceptance in relation to the participants' own unique narratives. While the conclusions provide a clearer connection and answer to the question of shared experience in self-acceptance, this section serves to address the subjective experience. All of these approaches amalgamate to provide a holistic depiction of what the experience of self-acceptance looks like for participants. Integration with the Theoretical Framework The conceptual framework that guided the research was centered around an exploratory qualitative approach. Focusing on an underrepresented population in research and aiming to formulate a deeper understanding of their lived experience throughout the research aligns with the exploratory framework. My perspective as a researcher involves looking at the experiences that the participants ascribe meaning to and allows for the storytelling aspect of the data collection to unfold organically. When asking participants similar questions (e.g. how has accepting your gender identity impacted you?), each participant responded in a unique way which reflects their own experiences and perspective, for example through anecdotes that are personally meaningful and symbolic in their journey. This is demonstrative of how the participants make sense of their experience and derive meaning from it, and it fits seamlessly within the conceptual framework established for this research. This approach also aligns well with my own goal for this thesis, wherein the core of the research is centered around participants' stories and insights. This centering encourages a more grounded understanding of the contextual influences and various factors in participants' lives that have shaped their perspectives (Azzahrawi, 2021). An example of this is how participants all discussed the role that validation in self-expression played in their journey. There were no prompting questions surrounding appearance or gender expression, but participants each integrated anecdotes, experiences, and feelings surrounding expression into their stories nonetheless. The consistency in meaning- 97 making surrounding self-expression throughout participants' stories was evident in the analysis and prompted the development of the aforementioned conclusion. While the exploratory qualitative approach provides a meaningful way to understand the lived experiences of gender-diverse individuals, it is essential to revisit the theories and models that guided this research and explicitly connect them to the study’s conclusions. The Minority Stress Model (Meyer, 2013) and Identity Formation Theory (Bockting & Coleman, 2007) offer key insights that help contextualize the experiences of self-acceptance explored in this study. The Minority Stress Model aims to be representative of the various chronic stressors that are present in the experiences of minority groups, which, in this context, are gender-diverse individuals (Meyer, 2013). In participants' experiences, minority stress was a recurring theme, particularly in relation to societal rejection, discrimination, and internalized negative beliefs. Examples of these stressors include fear that evolved from using public restrooms, exhaustion from having to explain and justify their gender identities, hesitation surrounding how to be able to be authentic in situations like work, fear of rejection from family members, and bullying or harassment in settings like school. Participants opened up about how this chronic stress exacerbated psychological distress and was a barrier to both authenticity and acceptance. These stressors and subsequent consequences directly align with the Minority Stress Model’s assertion that experiences of chronic stress detrimentally contribute to individuals’ wellbeing. However, participants who experienced strong support systems, validation, and a sense of community were more resilient to the harmful impacts of these chronic stressors, highlighting the protective role of connection—a key finding in this study. This is demonstrated in participant stories such as when Arbutus speaks to how the support of their parents was a defining factor in their ability to persevere through difficult times or when Maple’s family stood by them in an experience of discrimination. By engaging in the exploratory qualitative approach, the stories 98 that unfolded ended up aligning with the minority stress model’s conclusions. Using the minority stress model as a framework for understanding, the research was better able to express how various life factors impact mental health holistically and were a core concept in deriving the conclusions and themes of intersecting mental health. The findings highlight how protective factors such as connectedness can mitigate the effects of minority stress, suggesting a need to refine the model to incorporate these dynamics more explicitly. Another core model that has been referenced and applied throughout the research process has been the Identity Formation Model (Beck & Simons, 2020; Bockting & Coleman, 2007). Identity formation has been a pivotal part of participants’ journeys and an integral precursor to achieving self-acceptance. Participants’ journey toward self-acceptance clearly follows the stages of identity exploration and integration. We first analyzed some models of identity formation, and throughout the data analysis, these models were applied to participants' stories. They align with how participants have learned about gender, explored it for themselves, utilized expression as a way of seeking authenticity, began to open up about their identity with people in their lives, and strived for identity integration and, thus, acceptance. These correspond closely with the thematic conclusions, particularly surrounding the role of expression and exploration in identity formation. Much of the journey we see throughout their storytelling aligns with models of identity formation, corroborates the previous research, and strengthens the framework. By linking participants' experiences of gender identity formation to these stages, we can see how the findings contribute to a broader understanding of identity development, particularly for genderdiverse individuals navigating societal pressures. Applying this to an exploratory qualitative approach, this research was able to explore more thoroughly how identity formation flows and evolves, as well as improve the understanding of the dynamic influences that impact how identity forms and acceptance develops. 99 Implications I have established the meaning behind the findings, drawing conclusions from the data and thematic analysis. To strengthen the understanding of the underlying meaning in these conclusions, I will assess some of the implications this indicates within the social context. Practical Implications Having a greater understanding of the journey of self-acceptance in gender-diverse individuals allows for more insight into their lived experiences. The findings of the research demonstrate a clear correlation between acceptance and mental health. They also support the role of protective factors in mitigating adverse mental health outcomes. Thus, to apply these findings one must explore how to bolster protective factors for gender-questioning and gender-diverse individuals. One prominent example centers on the theme of connectedness. Reinforcing a conclusion from this study, connection and belonging are seen as effective protective factors for gender-diverse individuals. While this can come from familial relationships, there are unfortunately circumstances where families are not supportive or accepting of the LGBTQ population. In difficult situations like this, one can explore other avenues in which connectedness can be achieved. Aspen discussed how helpful they found an LGBTQ youth group in their journey. As reiterated in the findings, having a safe space to engage in self-exploration and receiving support and validation in their identity formation was pivotal on their journey towards self-acceptance. An application implication here might be to increase facilitation and access to LGBTQ groups or to provide more community-oriented spaces for LGBTQ individuals who are seeking a sense of belonging. This would also work to combat isolation in this demographic. Additionally, this implication is quite transferable; a sense of belonging and feeling of safety benefits more than the target demographic of this study. It is safe to ascertain that, across ages and geographical contexts, belongingness and safety increase mental health and combat 100 isolation. For instance, fostering community spaces in rural areas or smaller towns, where access to LGBTQ resources may be more limited, could significantly reduce feelings of isolation and provide essential support to individuals. School staff, for example, can create youth groups in their schools that aim to provide that safe space. It may also be noteworthy for mental health professionals, to encourage ideas such as LGBTQ-oriented support groups to facilitate a sense of belonging. Connectedness has been shown to increase well-being. It also amplifies experiences of validation, which encourage self-exploration and expression, contributing to an increase in mental health. Mental health professionals can aim to integrate these concepts into a therapeutic setting and explore how to enhance these experiences in gender-diverse or gender-questioning clients. Examples may include focusing on gender-affirming therapeutic practices, for example ensuring the use of the client’s preferred name and pronouns. Specific approaches such as cognitive-behaviour therapy may be useful in addressing internalized negative beliefs, or expressive arts therapy as a way of encouraging the exploration of gender identity in a safe way. Other implications can include promoting validation and encouraging authentic expression, which may also be accomplished through peer groups or community spaces. This is connected to the conclusion stipulating the necessity of safety and validation in self-expression and authenticity. Similarly, increasing the representation in authentic gender expression can facilitate more acceptance and exploration. Representation is a transferable finding where it benefits more than the participant demographic; various marginalized communities have vocalized the benefits of representation in ethnic diversity, for example. Representation is being addressed to an extent as we see an increase in LGBTQ characters and role models in media, but continuing that upward trend is essential. Media representation of LGBTQ individuals, particularly in roles that normalize and celebrate diverse gender identities, may help reduce stigma and encourage self- 101 acceptance among viewers who may be struggling with their own identities. Finding other ways to increase representation on a more localized scale can continue to reinforce the concept of freedom in authentic expression. An example of this for educators may be increasing the focus of gender-affirming curricula, such as gender-diverse role models that exist in literature or history studies to increase representation. This might look like reading books by gender-diverse authors, or critically reflecting on the dynamics of gender in a socio-cultural context. Learning and increasing exposure to diversity in gender can help address bullying and harassment while also boosting validation in gender-questioning students. Similarly, having school staff trained on gender inclusivity, including using a student’s preferred name and pronoun, can also help create a safer environment for students to explore their identity. Having a safe space for gender-diverse students to go to, gender-neutral options for bathrooms or changerooms in schools, and community-building events such as workshops or art displays that encourage student leadership are all ideas that can contribute to a stronger feeling of safety and comfort for individuals exploring their gender identity. One way this might address mental health is by combating internalized negative beliefs about gender-diversity in gender-questioning individuals. Internalized cissexism, for example, was found to be quite detrimental to participants’ psychological well-being and reinforcing ways to address this is paramount. Mental health professionals should be trained to address internalized negative beliefs. Similarly, it is worth noting that training professionals who may work with gender-diverse individuals to validate and support their identity through ways like proper pronoun usage is an important part of creating a culture of safety and belonging. Congruent with establishing a supportive environment, healthcare professionals and policymakers may look at the process of gender-affirming services like hormone therapy or surgeries, for example, and how they might remove barriers to access these integral services. 102 Building on this, we discussed earlier in the thesis various harmful legislation and policies that contribute to experiences of minority stress and have a negative impact on LGBTQ mental health. A practical implication from this research that would enhance psychological wellbeing is for politicians and policymakers to abandon their pursuit of harmful condemnation of gender-diverse individuals. Replacing the vitriol with support and validation of identity would create an environment of belongingness instead of isolation. Therefore, an important recommendation stemming from this research is to instead enact policies that address discrimination for this demographic, such as anti-harassment policies in environments like healthcare, schools, or workplaces. Policymakers might also focus on creating incentives for workplaces and schools to adopt gender-affirming practices, such as inclusive restrooms and pronoun training. Additionally, focusing on increasing funding to enhance current successful programs or future ones that are planned; in essence, will not allow funding to be an obstacle in creating a safe environment. In the thematic analysis, we have seen the influence this shift has on mental health. What would be of additional benefit is more insight into the myriad of factors that impact mental health in gender-diverse individuals. Future interventions should consider the compounded barriers faced by gender-diverse individuals from marginalized racial or economic backgrounds. Similarly, future research further examining the various influences that shape mental health would be useful in further determining how to apply protective factors and establishing additional ways to mitigate adverse mental health outcomes in this population. Implications for Future Research As noted above, this thesis includes implications that may aid in directing future research and highlighting gaps in the literature. Broadening the scope of the research would be of immense benefit to deepening the understanding of the topic. What this might look like is having a larger sample size that has the capacity to include more diversity in gender identities, as this 103 thesis was unable to obtain a sample size that was as representative as possible; ideally, research would include as many gender identities that exist on the gradient to be able to fully explore the dynamic overlaps. Additionally, engaging in longitudinal research that assesses participants’ ongoing throughout their self-acceptance journey would be another interesting way to deepen the examination of what that journey looks like and how mental health and life shift during their journey. Participants in this study were already accepting of themselves, so they narrated their experiences with a reflective lens, whereas in a longitudinal study that interviews them over the course of their unique journey would provide valuable ongoing insights of the fluidity of identity formation instead of a reflective snapshot at a specific moment in their journey. This might evoke different meanings attributed to experiences and result in interesting findings, and perhaps more specific interventions and approaches tailored to different stages of their journeys. Thus, a longitudinal study tracking participants over a decade could illuminate how self-acceptance and mental health evolve in response to life transitions and external societal changes. Another way of engaging longitudinal research can be in relation to cohort effects and the age experience. This thesis focused on the experiences of individuals aged 18 to 30; more research focused on the journeys of individuals of a different age range (e.g. 40 to 60 years) would provide valuable insight into how the shifting socio-cultural context and attitude around gender diversity plays a role in their journey. It would be of interest to apply the concept of cohort effects to this area of research, which would further facilitate understanding of influences in one’s journey. One way this might deepen understanding is through assessing the role that social media plays in shaping identity, or how virtual spaces and online communities can impact an individual's selfexploration. Additionally, research that incorporated a more in-depth assessment of a variety of factors in identity formation would be helpful in further understanding the complexities of 104 identity. This might look at differing experiences and opportunities for exploration in various socio-economic groups as one example. Research focused on the intersection of socio-economic factors and gender can provide incredibly valuable insights into how elements like access to resources and quality of education influence and shape gender identity. For example, how would economic disparity impact access to healthcare for gender-affirming surgeries? How would having the financial capability to afford ongoing counselling to explore and debrief gender influence mental health and identity formation? One participant explained how financial constraints made it difficult for them to access consistent mental health care, delaying their journey toward self-acceptance. This underscores the role socioeconomic status plays in identity formation. Another example noted in this study was participants in this study who grew up in more rural settings noted a significant shift in their identity exploration when they moved to a more urban environment. Both the access to resources and exposure to more diversity allowed participants to feel more comfortable in self-expression. One participant who moved to an urban environment shared how being exposed to a more diverse population helped them feel validated and accepted, which contributed significantly to their self-acceptance process. Another participant mentioned how the diversity of urban environments allowed them to explore their gender expression without constant fear of judgment. Contrasting rural and urban upbringings in identity formation for gender-diverse individuals would be an interesting direction for future research. Alternatively, research could explore how multiple intersecting identities, such as race, disability, and class, uniquely shape the experiences of gender-diverse individuals as they navigate self-acceptance. Another poignant example of the influential role of intersecting identity is that of culture. Although culture did come up at times in the interviews with participants in this study, the focus 105 on gender identity did not allow for a deeper exploration into the role culture played in identity formation. Future research that aims to better understand the relationship between cultural identity and gender identity would encourage a more holistic understanding of identity formation and how culture influences experiences. Expanding research to include participants from diverse cultural backgrounds could provide more nuanced insights into the intersection of culture and gender identity. Similarly, the geographical focus of this thesis was North America, specifically western Canada, and did not incorporate a robust cultural lens. This can be improved by instead focusing on integrating different cultural contexts, beliefs, and values that can provide more insight into the experience of identity formation in gender-diverse individuals. Colonial notions of gender adhere to a more strict binary lens, whereas other cultures embrace a more fluid acceptance of gender. An example of this is in Indonesia, where Bugis society views gender through a different lens as opposed to a binary. They recognize five genders, akkunrai, oroané, bissu, calabai, and calalai, each one playing a significant cultural role. Bissu, for example, is considered to be representative of the gender spectrum as a whole as opposed to being strictly male or female (Novianti, 2020). Contrasting this cultural background and exposure with a more colonial country, such as Canadian history, we can see how cultural differences can shape one’s experience and have a significantly influential role in the experience of gender identity formation and self-acceptance. By widening the scope of participant inclusion geographically, we may better understand the role that location plays in developing identity and shaping prespectives for gender-diverse individuals. This would account for how widely divisive societal acceptance can be towards gender diversity in a cross-cultural context. Another suggestion for future research is to focus on how we, as a society and as individuals, can support and nurture protective factors for gender-diverse individuals. For example, focusing on strengthening connections in meaningful ways, or encouraging validation 106 and freedom in authentic self-expression. Perhaps future research dedicated to understanding and enhancing factors that mitigate adverse mental health will unearth more protective factors, too. Future research can aim to address the limitations of this study while striving towards deepening the understanding of a variety of factors that bolster resiliency and influence identity formation. Limitations of the Study This research has several limitations. A primary one is that this study, having only six participants involved, is consequently unable to fully portray the broad scope of gender diversity. While I did my utmost in participant recruitment, there are still several gender identities that are considered gender-diverse that are not represented in this study, such as agender or genderfluid. As noted above, future research would benefit from a broader sample of participants to continue to enhance understanding of their lived experience. Similarly, this study was limited geographically to Western Canada and would be augmented by a wider scope of geographically diverse experiences. Although this research was focused on gendered experiences, taking a more robust cultural consideration into identity formation and its impact on gender would be a beneficial direction. For example, participants of Indigenous ancestry mentioned the role that culture plays in their identity formation, and having the opportunity to integrate these aspects of their identity and experience further would have fortified the research and lent insight into the role that culture plays in shaping the experience of gender identity formation. Another main limitation of this study is simply one that is difficult to avoid in qualitative research: my own interpretation as a researcher. Although I have discussed my own reflexivity and did my utmost to be mindful of these limitations throughout the research process, it is simply an ongoing point of consideration for qualitative research. Similarly, my role or skill may have influenced participants during their interviews and impacted the data gathered. It is important to note that I am a new researcher whose skills are continuously evolving and developing. 107 Ultimately, there is a degree of subjectivity that is unavoidable in qualitative research, and it is important to maintain awareness of that as a limitation. Strengths of the Study Although this research does possess some limitations that open the door for future research directions, it also contains several strengths. One of the objectives of this study was to fill in the gaps in the literature in regard to gender-diverse representation. The participants in this study covered several different gender identities (e.g. Two-Spirit, non-binary) and provided more insight into lived experiences of gender-diversity, and therefore met that objective. Similarly, the participants' ages are quite representative within the confines of the study focus, with the parameters being 18-30 and participants' ages consisting of 20, 23, 25, 27 (n=2), and 29. Overall, one of the strengths of this study was how representative the participants were of the target demographic, and the findings can be transferable to a broader demographic of diversity. Another strength that builds on this is the richness of the qualitative data in the study. Taking a moment to assess the method of data collection, we can ascertain how effective the semistructured interviews were in obtaining rich data. Of the possible qualitative research data collection methods, interviews outweighed the other options, such as focus groups or observations, as the best and most effective way to learn from participants' lived experiences. Although focus groups, for example, could have provided a platform for participants to share their experiences in a communal setting, I was concerned that the presence of others might inhibit open discussion, particularly on sensitive topics like gender identity and self-acceptance. Some participants may have felt unable to share as openly, and there was a stronger likelihood of other people, factors, or biases influencing what was shared. Utilizing interviews as a method of data collection best allowed for an open platform for participants to share their experiences while also allowing for more control over variables. 108 Qualitative interviews may follow a structured, unstructured, or semi-structured format. While each approach has a purpose in research overall, I felt like having a strict structure to adhere to in the interviews for this study would be detrimental to the participant’s ability to share freely and inhibit the exploratory framework. Although structured interviews offer a high degree of consistency and ensure that all participants answer the same set of questions, I felt that this approach would have limited the depth and richness of the storytelling. As gender identity is a deeply personal and complex subject, I wanted to allow participants the space to explore and share their experiences in a way that reflected the meanings they attribute to specific occurrences and milestones in their journey. Despite the consistency found in structured interviews, I was concerned this would be too restrictive for participants and not encourage authentic expression in the way I intended for this research. Initially, I intended on doing unstructured interviews for the data collection as I thought that would align well with simply listening to the narrative and allowing it to unfold naturally in a storytelling manner. However, I was concerned that participants may require additional prompting in the interviews and may not discuss some of the points I was most curious about for this research (i.e. self-acceptance). So, I devised a handful of questions that would allow for a more robust discussion and ensure that there would be sufficient information gathered. These questions were specifically designed to be open and still encourage participants to answer in their own unique way: "Has anything made it easier or harder for you to accept yourself?” or “What does self-acceptance mean to you?” or “Has accepting your gender identity impacted you in any way?” They serve as a soft guidance that was used when conversation lapsed or the anecdote concluded, as a way of keeping the conversation going. As the approach to data collection and analysis was inductive, there was no set agenda that I was trying to uphold or goal to reach. Instead, I approached the interviews with an air of curiosity, to simply learn from participants' 109 lived experiences. This curious approach fostered good relationships with the participants, and in turn, increased their openness in sharing their stories. Thus, this approach served to strengthen relationships and enrich the data. Building on this, using semi-structure interviews as a way of collecting data also contributed to upholding the methodological framework of the research. Another strength of the study that allowed for such rich data was through an exploratory qualitative approach, which was chosen for this research because it allows participants to share their lived experiences in a way that feels authentic to them, which is particularly important when exploring something as personal and evolving as gender identity formation. In the context of this research, where the journey toward self-acceptance is unique and not always linear, this approach created space for participants to reflect on their paths in a way that felt true to their experiences. While methodologies such as case studies or phenomenology could have provided valuable insights into individual experiences, they may not have captured the developmental aspects of identity formation as effectively. This dynamic approach made it possible to delve into the complexities of identity development, which might have been missed in an alternative method that focused solely on isolated experiences of acceptance as opposed to a more holistic understanding and interpretation of the influence acceptance has had in the lives of participants. The core objective of this research is to understand how gender-diverse individuals construct and make meaning of their identities. My approach aimed to emphasize the importance of participants’ own voices, encouraging authentic expression and amplifying the meaning of their experiences. Therefore, I truly believe that my method of data collection is a strength of the research and allows for the richest possible data and depth to the interviews. Due to the semistructured interview approach, the interviews flowed organically, but also softly guided participants to cover a broader spectrum of topics that still fell under the scope of the research. 110 This directly contributed to the variety of influences and factors that arose throughout their journey and allowed for such a robust thematic analysis. It also fits seamlessly in with the exploratory qualitative approach wherein the storytelling of the participants provides insights into the meanings they ascribe to their experiences and serves to directly respond to the research question and purpose. Reflexivity Throughout this thesis I have aimed to express the necessity of ongoing reflexivity and how I have approached this as a researcher. As it is difficult to avoid subjectivity in qualitative research, it is essential to mindfully apply the personal lens as a researcher through critical subjectivity and awareness of how my perspective can shape the research. Engaging in ongoing reflection to understand what biases are present and their influential role is integral, and aiming to be as transparent in the research process as possible enhances trustworthiness. To address potential biases stemming from my shared identity with participants, I actively engaged in supervision and sought feedback to ensure that my interpretations remained grounded in participants’ experiences. This awareness has been a recurring discussion throughout the thesis, where I am open about my own contextual lens as a person while also discussing my growth as a researcher. This openness about my critical subjectivity provides greater transparency and reliability in my analysis. Similarly, this shapes my interpretation of the data throughout the analysis process. As I have previously discussed, my own context as a person is influential in the development of this research. Having a counselling background, for instance, established valuable skills such as active listening and creating a safe, non-judgmental space which were beneficial in the interview process. For example, I was able to pick up on participants’ emotional undertones, which enriched my understanding of their meaning-making. However, I also had to 111 navigate the line between my experience as a counsellor and my role as a researcher and be mindful of where they divest; conducting the interview as a counsellor may compromise the neutrality of the research. In reflecting on these dynamics, I recognize that my identity and background were both assets and challenges in this research. While my shared identity with participants helped build trust, it also introduced moments where my assumptions could have influenced the analysis. Thus, my experiences as a member of the LGBTQ community and interacting with others in the community was a key factor in evolving this research topic and guided me in reflecting on how to approach this research. The topic stemmed from discussions with gender-diverse friends and hearing their experiences for years before beginning this thesis. I believe my own identity and positionality was an asset to the research in fostering a good rapport with participants throughout the interview and facilitating a willingness to share but I did have to check my own expectations and biases. I am to be mindful of the risks that shared identity may post to the objectivity of the research. One of the challenging parts was having an expectation about how participants' stories were going to flow, with the assumption that their journey was similar to my own or the stories I have listened to previously. However, during the course of the research process, the concept of each journey being unique to the person was deeply reinforced. Instead of coming into the interviews with set expectations, I strived to set them aside and instead simply approach the interviews with a sense of curiosity, listening to and learning from participants. Being mindful of my phrasing and neutrality, I found that using open-ended questions in the interview was one way I could avoid shaping the participants' narratives and instead encourage their unique perspective and experience without feeling guided by my own. Another area that I had to be very mindful of my own biases and utilize reflexivity was in the interpretation of the data. Due to the subjective nature of research, it is necessary to be 112 mindful of how my own perspective can shape the findings that derive from the data. My aim in interpretation has been to uphold the meaning of participants' stories, and by clearly mapping out the coding process and evolution of themes I have strived to meet that standard. Another purpose of the clarity in the analysis process is that it aims to provide transparency. Production transparency, which clarifies the research design and methodology, and analytic transparency, which reviews the coding and analysis of data, are two ways in which I provided a clear overview of my process and interpretation (Moravcsik, 2019). Transparency and reflexivity are two key ways of increasing the reliability of the research and my own interpretation of the data that led to the conclusions. Another benefit of critical subjectivity and reflexivity is how it enhances methodological rigour. For example, it can help to correct biases and present a more accurate interpretation of participants’ experiences. Specific practices to note any biases or emotional reactions that arose were applied as a way of incorporating rigour into reflection, examples including an ongoing notebook and supervision discussions. This helped me identify points where my personal experiences might have influenced my interpretation, and I revisited the raw data to correct for any potential biases. Another strategy included triangulation, wherein relevant literature was relied upon as a method of cross-referencing the findings and noting their alignment with previous research. For instance, I compared findings to theories on minority stress and intersectionality to validate the consistency of the data. I triangulated my data by crossreferencing participant responses with relevant literature and theoretical frameworks on gender identity. Utilizing theoretical frameworks throughout the research process allowed for increased credibility and reliability in the findings. This helped validate the consistency of my findings and ensured they aligned with existing knowledge in the field. Member checking was another method of increasing trustworthiness, where participants had the opportunity to read their contributions 113 to the data and how I interpreted their stories in the findings, which ensured an active role in shaping their experiences and that my interpretation upheld the meaning in their stories accurately and reliably. Engaging in member checking was another way in which ethical considerations were continued throughout the course of the research. Providing the space for feedback on the representation of their story aligned with my goal is for participants to feel empowered and positive about their role in this research. Ethical standards such as informed consent and confidentiality were upheld, and fortunately no ethical challenges arose during the research process. Confidentiality was adhered to through redacting any personal identifying information and enhancing anonymity, including the use of pseudonyms. I was also mindful of the emotional impact that discussing identity formation and gender may have on participants. An ethical consideration that required careful attention was ensuring participants’ emotional well-being during discussions about sensitive topics like gender identity and personal experiences of marginalization. A benefit to the openness of the interview questions is that participants had agency and were able to speak about what felt appropriate to them and I, as the researcher, did not push into topics that may have evoked emotional responses. Fortunately, the research progressed in an empowering and positive manner and there were no instances of psychological distress that occurred. Overall, I have aimed to be aware of my biases, being cognizant of how my perspective can influence both the data collection and interpretation, and instead continue to reflect on staying true to the participants' storytelling. Participant Messages In this final section, we end on a note of hope, positivity, and community. I have clearly outlined the themes throughout the last few chapters and reinforced how they show up in participants’ stories. This purpose of section is simply to provide a space for participants voices 114 to be amplified. In the interview, participants were asked if they had any messages they would like to share with readers. If you, reader, are questioning your gender in any way or resonated with anything in this thesis or what participants said, then these messages are meant for you. For anybody who does struggle with finding themself gender-wise, don’t focus on it like it’s just gender . . . Focus on the whole picture, focus on what’s happening around you, who you’re friends with, how your mental state is . . . Let it come to you but also don’t overlook it because every piece in your life, I would say, plays a part. (Aspen) For every person out there who’s gender-diverse, please don’t let anyone stop you from expressing yourself however feels comfortable. Don’t let gender norms and genderbinaries keep you locked up and keep you from living your truth. The people who love you will support you in your journey. (Arbutus) It’s not that you’ve changed. It’s that you’re just continuing to be the same you, as other things are changing around you . . . [N]o one has to be afraid of me finding my true self, because that’s my journey to have and my journey alone. And it shouldn’t impact them . . . I guess I wish people weren’t so afraid of letting people just try and be themselves. (Cedar) There’s no timeline or crunch. Everybody can take the amount of time that they need to go through this journey, because it is a journey and there are a lot of ups and downs, and there’s a lot of twists and turns . . . every person has to take their time and experience it, and the only way that you can really learn these things is by living your life. (Cypress) 115 Authenticity breeds authenticity. Even having things like blue hair . . . is, for me, living authentically. I’ve had other people tell me that me being confident about even just having blue hair has made them feel more confident to put a coloured streak in their hair which in turn makes me feel really good, because if I can make other people feel good about themselves without even knowing it - that’s awesome! (Maple) Don’t tell yourself tomorrow. Do it now. It’s easy to stay in that cycle. There’s a reason why being uncomfortable creates change. We’re meant to do that. We’re meant to put ourselves into things that make us uncomfortable. That’s the only way we’re going to grow. That’s the only way we’re going to change. It’s scary and there might be a portion where you feel like you are completely alone, even if you are surrounded by people. But if you keep walking through it, and just keep pushing forward, you do come out to the other side. (Willow) The participants’ messages reflect not only their individual journeys but also a collective narrative of hope, resilience, and self-acceptance. Each voice carries the weight of lived experience but also a deep belief in the transformative power of embracing one’s true self. Their words resonate with a broader message of the power of authenticity and relate to the themes that have evolved throughout the course of the research, including support and expression. As we conclude this research, it’s important to remember that these stories are not just accounts of struggle, but also of growth and resilience. For anyone reading who is on their own journey, I would like to add my own brief message: This journey is hard. It is not an easy thing to do that deep self-searching. But it is also hard to stay in a mindset and place of suppression, to feel like you can’t breathe or be you. At the end of the day, both paths are hard and it’s up to you to choose - but one of those options has an outcome that feels so much more authentic. I truly hope 116 that anyone who has read this and resonated with what participants said is able to follow their own path and their own journey to a place that is filled with acceptance, joy, and love. Summary of Chapter Five This chapter presented an overview of the conclusions derived from the research. The conclusions have been clearly demonstrated and explored, with a description of how they emerged from the themes. Some conclusions discussed included the positive impact of acceptance and how connection enhances well-being. The conclusions reinforce prior research while adding depth through participants' stories. Implications of the research were also assessed, with suggestions including increasing accessibility to safe community gathering spaces. These implications were beneficial in reflecting on how the conclusions might be applicable to increasing psychological well-being in this demographic. Limitations of the research were also discussed, with some areas of further research and exploration noted. Finally, this chapter included a section aimed at amplifying the participants' voices and messages towards individuals at the start of their own journey. Thesis Conclusion This thesis has aimed to improve the understanding of the journey of self-acceptance in gender-diverse individuals by drawing on their lived experiences. Six participants were interviewed, and their stories construed the data. In Chapter One, we reviewed the rationale for the research and emphasized some of the challenges gender-diverse individuals face and why gaining an improved understanding of their experience is integral. This set the context of importance and then introduced the research question. In this chapter, we also reviewed the core concept of identity formation and established the conceptual framework for the research. Chapter Two consisted of the literature review, wherein relevant research was explored and reinforced the contextual influences of the research question. Topics explored included 117 LGBTQ mental health, the role of systemic barriers, and protective factors such as support systems that work to mitigate adverse mental health. Self-acceptance as a protective factor was solidified through assessing previous literature. In Chapter Three we explored the research process. The recruitment process was explained, and the six participants were introduced. The method in which data collection occurred was examined, as it was a semi-structured interview that allowed for flexibility and for the participants to have a space to discuss what felt relevant to them in their own stories. The exploratory qualitative approach was explained with respect to its applicability to the research question. Ethical considerations were also mentioned in this chapter. Another significant section in this chapter was the introduction to thematic analysis, which was further built on in Chapter Four. Chapter Four was an essential chapter that reviewed and explored the findings that emerged from the research process. It expanded on the thematic analysis previously introduced and applied it to the research data. This chapter details the coding process, how the data was organized into codes, then how these codes evolved into subthemes and themes. This process relied on detailed descriptions with relevant quotes to support the analysis process. Chapter Four also detailed each of the five themes as well as the overlap between them in a push and pull conceptualization. Theme one involved a depiction of how participants' mental health intersected with a variety of factors in their lives and journeys. Theme two examined the importance of connection in participants’ journeys. Theme three assessed the role that expression played in participants' stories and how they engaged in the self-exploration process. Theme four furthered the exploration with a focus on identity formation. Theme five delved into the impact that acceptance had on participants' lives, finding an overwhelmingly positive effect. Each of these 118 themes provided clear points and topics that were evidenced through the use of participant quotes and allowed us to further our insight into their lived experiences. Chapter five of this thesis consisted of the conclusions that were derived from the assessment in Chapter four. It also examined the implications of this research as well as limitations. It concluded with a section where participants' messages were amplified. Overall, this research has the goal of deepening our understanding of how the world in which we live shapes the perspectives and experiences of gender-diverse individuals. Previous research has demonstrated the mental health struggles this demographic faces, and to address this my aim was to expand on a powerful protective factor: self-acceptance. By engaging in an exploratory qualitative approach, participants' stories actively shaped the findings and themes for this research. The themes that emerged were shared across participants' journeys and contribute to broadening our scope of understanding of what the journey to self-acceptance looks like for gender-diverse individuals. This research served to establish and reinforce the powerful positive impact of acceptance on mental health and well-being in gender-diverse individuals. 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Perspectives in Psychiatric Care, 57(1), 304-310. 127 APPENDIX A Recruitment Poster Fig. 1. Social Media Post for Participant Recruitment 128 APPENDIX B Participant Information and Consent Form You are invited to participate in a study entitled The Role of Self-Acceptance in Mental Health Outcomes Among Gender-Diverse Individuals. Josephine Deschamps is carrying out the research under the direction of Dr. John Sherry through the University of Northern British Columbia (UNBC). Why is this research being done? This research project is being conducted with the purpose of better understanding the experience of being gender-diverse with a particular focus on the resilience factor of self-acceptance. In other words, I am curious about the relationship between self-acceptance and mental health. I would like to hear your story of understanding and acknowledging this piece of your identity and your experience within the world. My goal is to give a voice to those who do not fit within the gender binary to share their experiences, provide others with insight into what it is like to identify as gender-diverse and how we can better support the community to create a place of acceptance. Why was I chosen? You are being asked to participate in this study because: ● You are currently between the ages of 18 and 30 ● You identify as gender-diverse in some way ● You are willing to participate in this study’s research process, a 60-minute interview What is involved? If you agree to take part in the study, you will be asked to participate in a private one-on-one interview that will last approximately 60 minutes and be audio recorded. You will be asked to share your journey to understanding your gender identity and whether you feel you have 129 accepted that part of you. You may disclose experiences in a social context or any impact your gender identity has had on your mental health, but you will not be directly asked this as it may be challenging to discuss. Although these are deeply personal and intimate topics, you can decide what you do and do not share. What are the benefits and risks involved in taking part in the study? One potential benefit of participating in this research is you may feel rewarded by discussing your experiences of identifying as gender-diverse and in knowing that you are contributing to research and providing valuable knowledge and insight about a socially marginalized community. A potential risk is that it may be uncomfortable to talk about your experiences as it is quite personal or might bring up some difficult emotions. You can refuse to answer any question and may stop the interview anytime. Your participation is completely voluntary. If you choose to withdraw from the study during the interview, the audio recording and any information you provide will be destroyed. How will my identity be protected? The audio recording of your interview will be transcribed (typed word for word), but any information that might identify you or someone else will be removed. Your name will not appear in any data, and your transcript will be identified by a code instead. Your participation in this is completely anonymous. It will also be kept confidential, with everything you discuss in the interview only being accessed by myself and shared with my supervisor. The only exceptions to this confidentiality are if there is suspected child endangerment or neglect, you tell me you will harm yourself or others, or if the information is court ordered. How will my information be destroyed? Data from this study will be destroyed five years after publication. Hardcopies will be shredded and electronic data will be erased from the hard drive. What will be done with the results? 130 The completed research will be presented for my thesis defence at UNBC. The results may be presented at conferences, to community organizations, and published in professional journals or reports. You can obtain a copy of the research results by contacting the researcher, Josephine Deschamps at deschamps@unbc.ca, or Dr. John Sherry at sherryj@unbc.ca. Who should I contact if I have more questions? Please contact the researcher, Josephine Deschamps at deschamps@unbc.ca if you have any questions. Any concerns about the project should be directed to the Office of Research at the University of Northern British Columbia (250) 960-5820 or by email: reb@unbc.ca. I have read the participant information letter and understand the risks and benefits of participating in this research study. Confidentiality and anonymity has been explained to me and I understand that I am free to refuse to participate or withdraw from the research study at any time. The research purpose and process has been explained to me, and I understand that I have the right to ask questions at any time. Printed name of Research Participant: _________________________________ I agree to participate in this research study: ____________________________________ Signature of Research Participant ____________________________ Date