Dissident Genders and Sexualities in The OT

Review Article
Dissident Genders and Sexualities in

the Occupational Therapy Peer-
Reviewed Literature: A Scoping Review
Jaime Daniel Leite, Jr., Roseli Esquerdo Lopes
Downloaded from http://research.aota.org/ajot/article-pdf/76/5/7605205160/76400/7605205160.pdf by Ryan Lavalley on 16 September 2022

Importance: The lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other dissident gender and
sexuality (LGBTQIA1) population is prone to experiencing violence and social deprivation. Although occupational
therapy research and practice has addressed populations experiencing various forms of discrimination, few
studies have focused on the LGBTQIA1 population as an area of concern.
Objective: To map, characterize, and analyze peer-reviewed journal articles related to the LGBTQIA1 population
in the occupational therapy literature.
Data Sources: We searched for journal articles published up to December 2021 indexed in the Virtual Health
Library, CINAHL, SciELO Citation Index, SCOPUS, and Web of Science.
Study Selection and Data Collection: We used Arksey and O’Malley’s methodology and the Preferred Reporting
Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) extension for
scoping reviews. Included articles articulated occupational therapy practice, education, research, and theoretical
analysis in relation to LGBTQIA1.
Findings: Forty-three articles published from 1987 to 2021 met the inclusion criteria. They included 28 research
articles, 9 reflection articles, 3 experience reports, and 3 literature reviews.
Conclusions and Relevance: Articles primarily offered general recommendations and possible professional
contributions. More studies that seek to ascertain the effectiveness and limitations of occupational therapy
practice with the LGBTQIA1 population are needed. With its diverse theoretical and methodological assumptions,
occupational therapy can offer support so that professionals can alleviate these people’s suffering in oppressive
conditions and contribute to a more just society.
What This Article Adds: This scoping review provides an overview of academic publications in occupational
therapy on the LGBTQIA1 population, identifies dominant topics and gaps in this context, and points to ways to
advance occupational therapy’s contributions and actions that consider the needs and demands of people of
dissident genders and sexualities.
Leite, J. D., Jr., & Lopes, R. E. (2022). Dissident genders and sexualities in the occupational therapy peer-reviewed literature: A scoping review.
American Journal of Occupational Therapy, 76, 7605205160. https://doi.org/10.5014/ajot.2022.049322
ccupational therapy is “a field of knowledge and social participation, considering social justice (Lopes,
O practices whose focus is humans in their everyday
manifestations—the care of oneself and others, work,
2021; Townsend, 1993).
Hegemonically (Gramsci, 1971), the history of the
play, culture, social participation. [Occupational ther- occupational therapy profession points out that, from
apy involves] studying, dealing with, and intervening the outset, professionals cared for people with physical
to reduce limits and barriers and to activate the poten- impairments and a need for rehabilitation, people with
tial of life, of everyday living” (Galheigo & Sim
o, 2012, intellectual disabilities, and people in mental distress.
p. 35). Historically, most occupational therapists have However, a feminist reading of this history recognizes
addressed individuals who have been excluded from that Hull House and its directors were extremely influ-
elements that comprise citizenship, whether civil, polit- ential in establishing the foundations of the profession
ical, and/or social, to promote personal autonomy and within the social realm, as, for example, within its social
THE AMERICAN JOURNAL OF OCCUPATIONAL THERAPY SEPTEMBER/OCTOBER 2022, VOLUME 76, NUMBER 5 1
work with immigrant women and families in situations occupational (Beagan, De Souza, et al., 2012; Jackson,
of vulnerability. Such work marked both immediate 1995) participation. Therefore, occupational therapists
support actions attending to vulnerability and the con- can contribute to developing technical, political, and
struction of theoretical knowledge of these themes as ethical actions that translate into complex social in-
within the scope of what would be called occupational terventions whereby people can be included and
therapy (Monzeli et al., 2019). participate, leading to care and social justice (Ghirardi
The profession is continually reshaped according to et al., 2021; Lopes, 2021).
new emerging problems faced by society, expanding
its possibilities and aiming to contribute to social de-
mands and population groups that could benefit from Method
its professional practices. On the basis of the propo- We conducted a scoping review to identify and map
sition of social occupational therapy, a perspective the peer-reviewed literature focused on people who ex-
that has been present since the 1970s, Barros et al. perience dissident genders and sexualities, apprehend
(2005) pointed out the need for the profession to the robustness of investigations on these subjects, and
focus on supporting individuals and groups who identify gaps that require further research (Arksey &

face disruptive processes of social support networks, O’Malley, 2005; Levac et al., 2010). Moreover, we
including social vulnerability. sought to deepen understanding of how this topic has
Within the contemporary context, occupational thus far been addressed in occupational therapy, given
therapy has established a shift in professionals’ inter- that Jackson (1995), Beagan et al. (2013), Beagan,
vention from the automated world to the human Carswell, et al. (2012), Leite and Lopes (2017), and
world of organizations and conflicts—that is, a shift Marchant Castillo (2019) highlighted the lack of refer-
from the functional biological human to the world of ences regarding this population in this area. We also
historical and social human praxis (Galheigo, 2009; Sa- wanted to understand how occupational therapy has
kellariou & Pollard, 2013). Therefore, macro- and been involved in providing professional support to the
microsocial profiles for practice are considered, recog- LGBTQIA1 population. We ensured optimal reporting
nizing that the profession focuses on ways of life and by using the five-stage process for analyzing journal
the everyday life of people who experience deprivation articles developed by Arksey and O’Malley (2005), dis-
of rights, deficits in participation, and social insertion cussed in the sections that follow, and the Preferred
as a result of intersecting socioeconomic and cultural Reporting Items for Systematic Reviews and Meta-
issues (Barros et al., 2005; Lopes & Malfitano, 2017). Analyses extension for scoping reviews (PRISMA-ScR;
On the basis of this shift, it is worth thinking about Tricco et al., 2018).
how gender and sexuality norms allow and legitimize
the categorization of the “other” (i.e., people who Identifying the Research Question
break with such norms) in pejorative ways, creating The research question guiding this review was “What
subalternities (Spivak, 2015) that are recurrent among has been produced academically about lesbian, gay,
people who experience dissident genders and sexual- bisexual, travesti, transsexual, transgender, queer,
ities. The concept of dissident genders and sexualities intersex, non-binary and other dissident genders and
expands the recognition of subordinated groups, going sexualities in occupational therapy?” Travesti is a
beyond the identity categories, such as homosexual, political and historical native Brazilian classification,
transgender, and nonbinary, among others (Colling, derived from popular culture and media, of people
2016). The word dissident refers to opposition to who use different technologies to build their bodies
something—in this case, to the regulatory norms im- and identities linked to the feminine; however, they do
posed by cisheteronormativity, heterosexism, and
not necessarily recognize themselves as women. This
patriarchy. The concept does not negate or invalidate
identity is distinct from the clinical terms transvestite
the identity categories; rather, it incorporates people
and transvestism (Leite, 2012).
who do not fit, nor want to fit, in such categories
(Colling, 2016). Occupational therapists need to con-
sider this concept to produce care strategies, support, Identifying Relevant Studies
and public policies for these groups. We conducted searches of the Virtual Health Library,
Lesbian, gay, bisexual, transgender, queer, intersex, CINAHL, SciELO Citation Index, SCOPUS, and Web
and asexual, among other dissident genders and sexual- of Science, all of which collect and index a substantial
ities (LGBTQIA1 population), rupture a framework of number of journals in the field of occupational ther-
intelligibility, according to Butler (1999, p. 23): “‘intelli- apy. The searches included articles published at any
gible’ genders are those which in some sense institute time through December 2021. The searches were
and maintain relations of coherence and continuity made by title, keywords, and abstract using the follow-
among sex, gender, sexual practice, and desire.” This ing English keywords, selected in consultation with a
rupture means that, in a heteronormative society, these university librarian: asexual*, bisex*, dissident gender,
populations are more prone to violence and depriva- dissident sexuality, gay, homosex*, intersex*, lesbian*,
tion in social (Braga et al., 2020; Miskolci, 2017) and nonbinar*, queer, sexual and gender minorities,
transex*, transgender, transvesti*, and travesti* related gations of occupational therapy, social occupational
to the key term occupational therap* (see Table A.1 in therapy, genders, sexualities, and populations in social
the Supplemental Appendix, available online with this vulnerability.
scoping review at https://research.aota.org/ajot, for
a sample search strategy). Records not in Spanish,
English, or Portuguese were excluded. Both authors Results
screened titles, abstracts, and keywords for possible We identified 320 documents, 258 from the search re-
inclusion; disagreements were resolved through sults and 62 from the hand search of reference lists.
discussion to achieve consensus. In addition, we After excluding duplicate files, we read the titles, key-
words, and abstracts of 171 texts and excluded 128
manually screened the reference lists of eligible articles
that were not articles published in an academic jour-
for articles to consider for inclusion (Arksey &
nal. We read the remaining 43 articles (37 from the
O’Malley, 2005).
database searches and 6 from the reference list
searches) in full and mapped the data; at this stage, no
Selecting Studies additional articles were excluded. Figure 1 presents the

We included academic journal articles describing stud- PRISMA flow diagram (Moher et al., 2009).
ies focused on any aspect of occupational therapy with The 43 articles in this review (see Table A.2 in the
the LGBTQIA1 population, including professional Supplemental Appendix) include 28 research articles,
practice, undergraduate and graduate education, and 9 reflection articles, 3 experience reports, and 3 literature
theoretical analyses of the profession or research. Ar- reviews. The oldest article was published in 1987 and
ticles focused on interprofessional education and the most recent in 2021, and there was a 6-yr gap be-
practice were included if occupational therapy was an tween publication of the first article and the second in
explicit focus of the investigation. 1993. The year in which the most articles (6) were pub-
lished was 2020 (Figure 2). Only from 2012 onward was
at least 1 article related to our topic of interest published
Mapping the Data every year. Moreover, in this period some of the authors
Consistent with recommendations by Levac et al. published more than 1 article related to the theme, but
(2010), we created an Excel spreadsheet to map the not more than 2, denoting the incipience of the theme
following data from included articles: names of au- in occupational therapy research and practice.
thors, year of publication, country of authors’ The authors’ institutions were located in Australia,
institutional affiliations, research design, objective, Brazil, Canada, Chile, India, Ireland, Israel, Portugal,
population, key findings, and limitations. South Africa, the United Kingdom, and the United
States of America. Fifteen articles (35%) were written
by only one author. Of the total of 110 authors, 99
Collating, Summarizing, and Reporting the
(90%) published only once, demonstrating the incipi-
Results
ence already mentioned, as specific experiences prevail
On the basis of a reading of the full text, we carried
without a tradition of researchers who have studied
out a comprehensive analysis and established interrater
the same subject for years. The author with the largest
reliability, reaching 95% consistency. We discussed number of articles was Jeanne Jackson (United States);
each article’s content to identify its contribution to authors who published 2 articles were Diego Almeida,
elucidating our research question. This process gave Ricardo Correia, Jaime Leite Jr., Roseli Lopes, Kesia de
rise to some axes of analysis, which also enabled a Melo, and Gustavo Monzeli (Brazil); Brenda Beagan
thematic clustering of the articles, summarizing their and Barry Trentham (Canada); Rebecca Twinley
objectives. Leite categorized the articles by theme, and (United Kingdom); and Elizabeth Crepeau (United
Leite and Lopes discussed the categorization to achieve States). Except for Crepeau, Jackson, and Trentham,
consensus. the other authors published from 2012 onward, which
Taking the assumptions of social and human scien- may indicate a more recent trend of researchers and
ces, as well as contributions from the philosophy of professionals devoting their efforts to the subject.
sciences, we depart from the notion of neutral research The 43 articles were published in 18 journals
(Bourdieu, 2003; Kuhn, 1995). This does not limit the (Table 1). Eight articles each were published in the
production of qualified analyses with academic and Brazilian Journal of Occupational Therapy between 2015
scientific rigor that help in understanding the investi- and 2020, and in the British Journal of Occupational
gated field. However, understanding how the Therapy, mostly between 1993 and 2015. Six were
construction of the individual directly impacts the published in the American Journal of Occupational
knowledge produced, it is important to present the Therapy between 1995 and 2000.
authors’ positionality. Leite is a gay, cisgender, Latino, The articles discuss different groups of the
middle-class man without disabilities, and Lopes is a LGBTQIA1 population, as noted in Table A.1 in the
heterosexual, cisgender, Latino, middle-class woman Supplemental Appendix. A dominant focus on the
without disabilities. Over the years, both have devel- transgender population from 2015 onward can be ob-
oped academic knowledge that focuses on investi- served, although the first 2 studies in our search results
Figure 1. PRISMA flow diagram of article selection for the scoping review.
Identification
Records identified through Additional records identified through

database searches hand searches of reference lists
(N = 258) (n = 62)
Records after duplicates removed

(n = 171)
Screening

Articles screened based on title, abstract,
Articles excluded
and keywords
(n = 128)
(n = 171)
Eligibility
Full-text articles
Full-text articles assessed for eligibility
excluded
(n = 43)
(n = 0)
Articles included in scoping review

Included
(N = 43)
Database searches, n = 37
Reference list searches, n = 6
Note. From “Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement,” by D. Moher, A. Liberati,
J. Tetzlaff, and D. G. Altman; PRISMA Group, 2009, PLoS Medicine, 6 (7), e1000097. https://doi.org/10.1371/journal.pmed.1000097
also addressed this population. Articles published from the objectives of these articles, we divided this axis into
1995 to 2015 were mostly about homosexuality and four subthemes: work, gender affirmation, critical reflec-
bisexuality. tion, and instrumentalization for professional practice.
We categorized the articles into three axes of
analysis: (1) demands for occupational therapy, (2) Work
professional education, and (3) interventions. Some The findings that dealt with the dimension of
articles are included in more than one axis. In the work had different approaches, such as the chal-
analysis that follows, we identify how each category lenges involved in assuming a dissident identity in
dialogued and can inform the profession. the work environment, such as stereotypes and
gender performances expected for certain posi-
Demands for Occupational Therapy tions and discrimination experienced (Daly &
The articles mostly point to life paths of the Hynes, 2020; Phoenix & Ghul, 2016; Soeker et al.,
LGBTQIA1 population that do not necessarily start 2015); woman-to-woman rape and sexual assault and
from experiences in occupational therapy but address the impacts on victims’ occupations, including when
the profession and professionals by aiming to facilitate they work in places that welcome other women who
and inform possibilities for actions with these people, have been raped (Twinley, 2017); the experiences of
considering their needs or challenges. To better describe lesbian, gay, bisexual, and queer occupational
Figure 2. Distribution of articles included in the scoping review, by year.
7
5
No. of Arcles
0
1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020 2022

Year
therapists (Beagan, Carswell, et al., 2012; Falzarano and the notion of emancipatory health in the trans
& Pizzi, 2015); and the ways an organization’s population in Chile (G omez-Antilef et al., 2020); the
work climate can interfere with the inclusion of gay affirmation process of transgender people and its im-
men, lesbians, and bisexuals (Jackson, 2000). pact on the world of work (Bar et al., 2016; Daly &
Hynes, 2020; Phoenix & Ghul, 2016); the reality of
Gender Affirmation young travesties dealing with challenges, violence, and
Another group of articles focused on gender affirma- pleasures in educational, family, and sex work spaces
tion process, in which people shape their identity and (Monzeli et al., 2015); and a case study about a cross-
body according to the gender with which they identify. dresser and the nuances of creating a new persona
We found articles about self-construction processes (Curtis & Morris, 2015).
Table 1. Distribution of Articles Included in the Scoping Review, by Journal (N = 43)

Journal No. of Articles (%)
Brazilian Journal of Occupational Therapya 8 (18.6)
British Journal of Occupational Therapy 8 (18.6)
American Journal of Occupational Therapy 6 (14.0)
Journal of Allied Health 3 (7.0)
Work 3 (7.0)
Australian Occupational Therapy Journal 2 (4.7)
Canadian Journal of Occupational Therapy 2 (4.7)
Annals of International Occupational Therapy 1 (2.3)
Behavior Therapy 1 (2.3)
Interinstitutional Brazilian Journal of Occupational Therapy 1 (2.3)
Journal of Homosexuality 1 (2.3)
MedEdPORTAL 1 (2.3)
Occupational Therapy in Health Care 1 (2.3)
Occupational Therapy International 1 (2.3)
Occupational Therapy Now 1 (2.3)
PLoS ONE 1 (2.3)
b
Chilean Journal of Occupational Therapy 1 (2.3)
Open Journal of Occupational Therapy 1 (2.3)
a
The Brazilian Journal of Occupational Therapy is a continuation of the Journal of Occupational Therapy From UFSCar; the title was changed
in 2017 to better designate the journal’s scope. We have used Brazilian Journal of Occupational Therapy to refer to all articles published in
this journal.
b
Revista Chilena de Terapia Ocupacional is its title in Spanish.
Critical Reflection occupational therapy, reiterating the need for the pro-
Articles in the critical reflection subtheme set out criti- fession to review its attitudes, considering color and
cal arguments related to the professional field, with the social class in its propositions. Nowaskie et al. (2020)
aim to rethink theoretical and practical assumptions surveyed dentistry, medicine, occupational therapy,
and take into account the relevance of professionals to pharmacy, physician assistant, physiotherapy, and so-
the demands of the LGBTQIA1 population. The re- cial work students in several U.S. universities and
flections elucidated how gender and sexuality are showed that occupational therapy students had the
elementary variables in understanding the possibilities lowest workload including content regarding LGBT
of experimentation in people’s everyday lives and people, interacting with fewer than five LGBT patients
occupations. These reflections dialogued with social per year. In a survey study comparing transphobia
occupational therapy based on queer theory (Braga among undergraduate social work, nursing, psychol-
et al., 2020; de Melo, 2016); practice with elderly peo- ogy, and occupational therapy students at a U.S.
ple and in the context of aging (Correia et al., 2020; public university, Acker (2017) found that occupa-
Harrison, 2001; Simon et al., 2021; Twinley, 2014); tional therapy students had high levels of transphobia.
and the experiences of gay, lesbian, bisexual, and queer Leite and Lopes (2017) investigated the curricula of

professionals (Beagan, Carswell, et al., 2012) in profes- public universities in the state of S~ao Paulo in Brazil
sional education (Crepeau, 1998) and professional and found a lack of education aimed at the travesti
practice (Jackson, 1995; Kingsley & Molineux, 2000). and transsexual population. Javaherian et al. (2008)
Other articles explore leisure (Almeida, 2020; Almeida and Kingsley and Molineux (2000) reported similar
& Lugli, 2018), homelessness (Gutman et al., 2021), gaps in education on the care of lesbian, gay, and
and territorialization and deterritorialization as forms bisexual individuals.
of gender expression (see Swenson et al., 2022). With an interprofessional perspective, McCave
et al. (2019) and Pechak et al. (2018) used the case of
a transgender person in their education activities,
Instrumentalization for Professional Practice considering that the dialogue between the different
This subtheme brought together articles that analyzed professional groups could expand care provision,
examples and possibilities of therapeutic occupational which was positively evaluated in the studies. In each
actions with the LGBTQIA1 population. These exam- study, the case was constructed in dialogue with social
ples include the analysis of undergraduate education activists focused on the rights of people who are gen-
programs to apprehend issues involving the needs der and sexuality dissidents, seeking to enhance
of travesties and transsexuals (Leite & Lopes, 2017); awareness and understanding of the challenges faced
possible occupational therapists’ intervention with by the transgender population in health services.
transgender clients (Beagan et al., 2013); students’
comfort in dealing with sexuality in clinical practice
(Jones et al., 2005); practitioners’ comfort in interven- Interventions
ing with gay, lesbian, or bisexual clients (Javaherian The scoping review showed evidence of the incipience
et al., 2008); and if interventions are responsive to the of articles that analyzed the practices of occupational
aging of this population (Simon et al., 2021; Twinley, therapists with LGBTQIA1 people, which corroborates
2014) and of people with HIV (Bedell, 2000; Yallop, Marchant Castillo’s (2019) study that focused on occu-
2000). Moreover, professional actions to resolve daily pational therapy research on the sexual education of
injustices experiences by dissident people of gender children, adolescents, and young LGBT people. The ar-
and sexualities were addressed (Bergan-Gander & von ticles addressing results of interventions are the two
Kürthy, 2006; Gutman et al., 2021; Jackson, 1998; oldest articles, and both reported experiences with
Kirsh et al., 2006; Murasaki & Galheigo, 2016; Walsh transgender people (Jessop, 1993; Khanna et al., 1987).
& Crepeau, 1998; Williamson, 2000). A third article by Jackson (1998) also reflected on treat-
ment of a patient.
Khanna et al. (1987) discussed the case of a trans-
Professional Education sexual woman and efforts of several professional
Professional education was a concern raised by authors practices, including therapeutic–occupational ones,
in a set of publications published between 2017 and to assess the possibility of conversion, pointing out
2020, demonstrating a thematic trend. Articles in the transsexuality as a rare condition and highlighting the
axis of professional education explore how occupa- success of conversion interventions. Jessop’s (1993) ar-
tional therapists were being prepared for education ticle was the first and only work, within the scope of
and professional practice with the transgender popula- this review, published by an occupational therapist in
tion (Acker, 2017; Leite & Lopes, 2017; McCave et al., an occupational therapy journal and reporting on ther-
2019; Nowaskie et al., 2020; Pechak et al., 2018) and apeutic–occupational practice with a transsexual
with gay men, lesbians, and bisexuals (Jackson, 1995; person. The author presented the case of a transsexual
Javaherian et al., 2008; Kingsley & Molineux, 2000; woman referred by psychiatry, who had doubts about
Nowaskie et al., 2020). Jackson (1995) noted that her ability to “perform successfully as a woman”
sexual orientation was an invisible dimension in (Jessop, 1993, p. 322). Jackson (1998) cited the
treatment of a lesbian who had a double stroke, ad- continue to be governed by a rule of power that re-
dressing advances in the therapeutic relationship and iterates its “docilization” (the production of docile
treatment after the patient was able to identify her sex- bodies) and “disciplinarization” (the disciplinary
ual orientation to her occupational therapist, who also process; Foucault, 2010). We highlight the study
came out to the patient. by Khanna et al. (1987), which, in addition to the
pathologizing transsexuality, states that it is an er-
rant condition and therefore amenable to
Discussion treatment and conversion.
Academic publications that articulate occupational At the same time, especially in articles by Latin
therapy in relation to the LGBTQIA1 population American authors, a perspective can be observed that
were mostly about general recommendations and pos- dialogues with sociological studies, especially those re-
sible contributions from professionals. Although some ferring to cultural studies and, among them, queer
articles addressed descriptive results of therapeutic– theorists (Almeida, 2020; Almeida & Lugli, 2018; Braga
occupational actions targeted to this population, the et al., 2020; Correia et al., 2020; G
omez-Antilef et al.,
number of articles was small and restricted to the ini- 2020; Leite & Lopes, 2017; de Melo, 2016; Monzeli

tial publication period of included articles and 1 article
et al., 2015). According to these scholars, gender is un-
published in 1998. Thus, there is an urgency to move
derstood as a social construction, fluid and unfinished,
forward in this area so that we can apprehend the per-
in which changes and crossings make up life and are
tinence, effectiveness, limitations, and problems
not linked to any deviation. This perspective brings
involved in occupational therapists’ practice with the
different meanings to possible body constructions and
LGBTQIA1 population. The demands saliently
can contribute to occupational therapists’ understand-
pointed out in the articles are essential for guiding
ing of these processes beyond biomedical logic.
practice but should be supplemented by the work of
Jessop (1993) provided a critical reading of her ac-
researchers and activists who study and make up this
tions, noting that they may have reinforced gender
population and have been making efforts to guide so-
stereotypes while also considering that this could be
ciety in terms of what these needs would be. It is up to
part of her clients’ expectations. Building practices
professionals and researchers in the field of occupa-
that move in the direction of expanding the ways of
tional therapy to contribute to this agenda with our
being and living, including breaking with gender and
knowledge and actions.
sexuality stereotypes, is essential (Crepeau, 1998;
Among the results of this scoping review, we found
Jackson, 2000; Leite & Lopes, 2017; Soeker et al., 2015).
some notions that cross the three axes presented ear-
lier (demands for occupational therapy, professional Moreover, this should align with clients’ wishes. As
education, interventions). Different notions about pointed out by Leite and Lopes (2017), in their prac-
transgender people have been raised; however, the re- tice occupational therapists seek clients’ social
search that addresses this collective is largely about participation and autonomy, offering support to over-
transgender women, pointing to a gap in attending to come impediments and limitations in the fullest
the needs and challenges of transmasculinities. The ar- realization of their everyday lives in ways that align
ticles contain a certain criticism of the binary logic of with clients’ aspirations. Occupational therapy’s actions
gender and the organization of professional practices, should favor freedom and support security in the pro-
but building professional reasoning that goes beyond cess of gender and sexuality affirmation; that is,
the biomedical–pathological nomenclature remains a It is not a matter of saying that travesties and trans-
challenge, given that some authors still use this lan- gender people cannot or should not be helped with
guage (Bar et al., 2016; Beagan et al., 2013; Curtis & dressing, makeup, walking in high heels, skin or hair
Morris, 2015; Jessop, 1993; Khanna et al., 1987; care, if these are their demands, but certainly, this
Phoenix & Ghul, 2016). process cannot be naturalized or considered to be the
This notion, currently understood as gender dys- most ambitious project of their lives. . . . When fo-
phoria, according to the Diagnostic and Statistical cusing on people’s work in the transition process,
Manual of Mental Disorders (5th ed.; American there is a need to reduce the social isolation that
these people suffer from, as well as intervention in
Psychiatric Association, 2013), and as gender incon-
schools, jobs, health services, among other places, en-
gruence, according to the International Classification
suring their rights. (Leite & Lopes, 2017, p. 487)
of Diseases, 11th Revision (World Health Organization,
2019), has been widely criticized over the years. Acti- Thus, a reinterpretation of the interconnected ways
vists, researchers, and other people around the world of thinking about and doing occupational therapy re-
have pointed out the dangers of maintaining a bio- quires recognizing how heterosexism, compulsory
medical perspective on the bodies of trans people. heterosexuality, and heteronormativity cross and un-
Although the central justification for maintaining these derpin the profession. According to Miskolci (2017),
categories is related to strategies for claiming and heterosexism refers to the assumption that every per-
guaranteeing public policies, there is a logic of valida- son is, or should be, heterosexual; compulsory
tion of the gender affirmation process (Bento, 2016; heterosexuality refers to imposition of the model of
Mas Grau, 2017) and the bodies of trans people loving or sexual relationships between people of the
opposite sex, and heteronormativity operates as one highlight the need to understand that coming out of
model for the regulation of life—of heterosexual and the closet, an expression commonly used when some-
nonheterosexual people—based on the heterosexual, one reveals their dissident identification, is an act that is
family, and reproductive model. Recognizing these repeated in the different spaces in which the person cir-
structural issues and their place in creating and main- culates and therefore must be understood not as a single
taining abject bodies (Butler, 1999) makes it possible episode but as one that happens repeatedly, in different
to construct escape routes from the heterosexist disci- institutions, places, and situations; with different people;
plinary function. LGBTQIA1 people will feel these and at different times (Sedgwick, 2007). These exit–re-
impacts in their everyday lives and occupations, en- entry movements out of and into the closet are marked
abling experiences of mutual respect (Sennett, 2004). by modulations, depending on the power relationships,
Occupational therapy education, practice, and re- the possibilities of living without prejudice and with dif-
search on LGBTQIA1 people needs to be made more ferences, security, and job guarantees, among others.
complex, questioning the perspective by which such Finally, seeking to contribute to overcoming a
content is produced and whether the work, in fact, derogatory and stereotyped vision of LGBTQIA1 peo-
aligns with social justice. Moreover, if occupational ple, focused only on the suffering that they experience,

therapy interventions themselves are to be important, means that occupational therapists need to intensify
services must be provided in ways that align with the investigations that broaden the focus on this popula-
demands of LGBTQIA1 people. In this scoping re- tion. Such expansion would go beyond the scope of
view, the understanding that the LGBTQIA1 violence, restrictions, and impossibilities to unravelling
population is experiencing great difficulty in accessing the sociability networks, new everyday activities and
institutions is practically unanimous, whether it be at other ways of life, and pleasures and knowledge that
school or in sociolegal service or general health care are established in the process of constructing identifi-
services. Violence perpetrated by professionals and cation as a dissident person (Leite & Lopes, 2017;
other users (patients, clients, students) and the cishe- Monzeli et al., 2015).
teronormative structure of the institutions (e.g.,
disrespecting their names, making jokes about their Study Limitations
genders and sexualities, denying treatments) cause Part of the study’s limitations are a result of having da-
LGBTQIA1 people to be excluded from care, generat- tabases that are relevant to the academic environment
ing neglect in comprehensive care and contributing, but potentially restricted with regard to professional
for example, to school dropout rates (Andrade, 2015; interests. However, seeking to minimize this limitation,
Bento, 2008). we selected databases that bring together the largest
On the basis of this review, the importance of con- number of occupational therapy journals worldwide.
sidering sexuality and gender in professional practice Although gray literature can be included in a scoping
is clear. Moreover, according to Jackson (1995), other review, we considered only articles from academic jour-
intersections of this subject in addition to sexuality nals, aiming at a worldwide panorama with a specific
need to be taken into account, such as color and social focus. Gaps on the subject and recurring themes were
class. Recognizing these social markers of difference in identified, but priority topics were not listed. Moreover,
interventions means carrying out actions that deal consistent with scoping review guidelines, we did not
with the intersectionality that shapes individuals and evaluate the level of evidence of reviewed articles, denot-
their demands and makes it possible to break with a ing an initial and exploratory perspective. The inclusion
mistaken notion of equality of relations and to recog- of publications from different countries meant that cov-
nize the different nuances and intersecting inequalities ering the specificities of the geopolitical context of each
that challenge these people (de Melo et al., 2020). of them or developing a comparative analysis was not
Ensuring respectful spaces is also essential for possible. Nevertheless, we expect that future and ongo-
LGBTQIA1 professionals. The articles addressing ing studies will overcome these limitations.
work demands showcased the significant ways an op-
pressive work environment contributes to professional
dissatisfaction, resulting in career losses and ruptures. Implications for Occupational
As raised by Beagan, Carswell, et al. (2012), Falzarano Therapy Practice and Education
and Pizzi (2015), and Javaherian et al. (2008), it is im- The findings of this scoping review have the following
portant that occupational therapists and the people implications for occupational therapy practice and
with whom they intervene form sincere, trusting rela- education:
tionships in an environment that supports their 䊏Dissident genders and sexualities are important
intersecting identities and roles. expressions of people and must be considered
Coming out and “coming out of the closet” is a for occupational therapy practice.
theme that many LGBTQIA1 people go through, and 䊏
LGBTQIA1 people face constant subordination
many of the articles addressed this an issue for partici- processes and are exposed to different types of
pants. However, in the investigation by Murasaki and violence and harassment; therefore, education
Galheigo (2016), it was central. Their findings that allows occupational therapists to stop
reproducing violence both in their direct profes- Terapia Ocupacional, 26, 747–758. https://doi.org/10.4322/2526-8910.
sional practice and with LGBTQIA1 colleagues ctoAO1628
American Psychiatric Association. (2013). Diagnostic and statistical
is essential, to broaden their understanding
manual of mental disorders (5th ed.). American Psychiatric
of possible ways of life in addition to
Publishing.
heteronormativity.
Andrade, L. N. (2015). Travestis na escola: Assujeitamento e resistência a
䊏 Education and occupational therapy interven- ordem normative [Travestis in school: Subjection and resistance to
tions aimed at the LGBTQIA1 population, free the normative order]. Metanoia.
from a biomedical or pathological and cishetero- Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a
normative perspective, need to be encouraged. methodological framework. International Journal of Social Research
Methodology, 8, 19–32. https://doi.org/10.1080/1364557032000119616
*Bar, M. A., Jarus, T., Wada, M., Rechtman, L., & Noy, E. (2016). Male-
Conclusion to-female transitions: Implications for occupational performance,
Historically, the everyday lives, occupations, and ways health, and life satisfaction. Canadian Journal of Occupational
of life of LGBTQIA1 people have been bounded by Therapy, 83, 72–82. https://doi.org/10.1177/0008417416635346
cisheteronormative society. Occupational therapists Barros, D. D., Ghirardi, M. I. G., & Lopes, R. E. (2005). Social

should contribute to resolving the inequalities that re- occupational therapy: A social–historical perspective. In F.
Kronenberg, S. S. Algado, & N. Pollard (Eds.), Occupational therapy
sult from this, such as in the scope of work and leisure
without borders: Learning from the spirit of survivors (pp. 140–151).
and access to and strengthening of public policies
Elsevier Science/Churchill Livingstone.
linked to gender affirmation, among other sectors of *Beagan, B. L., Carswell, A., Merritt, B. K., & Trentham, B. (2012).
life. Breaking with an analytical perspective that fo- Diversity among occupational therapists. Occupational Therapy Now,
cuses only on suffering within oppressive conditions, 14(1), 11–12.
we should learn more about how experiences of identi- *Beagan, B. L., Chiasson, A., Fiske, C. A., Forseth, S. D., Hosein, A. C.,
fication can also create new networks of sociability Myers, M. R., & Stang, J. E. (2013). Working with transgender
and strategies to face prejudice, overcoming, to some clients: Learning from physicians and nurses to improve occupational
degree, oppression and producing recognition. Never- therapy practice. Canadian Journal of Occupational Therapy, 80,
theless, a need exists for more academic publications 82–91. https://doi.org/10.1177/0008417413484450
on professional practice aimed at people dissident from Beagan, B. L., De Souza, L., Godbout, C., Hamilton, L., Macleod, J.,
Paynter, E., & Tobin, A. (2012). “This is the biggest thing you’ll ever
the sex–gender system, presenting their strengths and
do in your life”: Exploring the occupations of transgendered people.
limits within contemporary sociopolitical conditions.
Journal of Occupational Science, 19, 226–240. https://doi.org/10.1080/
Finally, occupational therapy, based on its various 14427591.2012.659169
theoretical and methodological assumptions, can offer *Bedell, G. (2000). Daily life for eight urban gay men with HIV/AIDS.
resources so that professionals committed to the par- American Journal of Occupational Therapy, 54, 197–206. https://doi.
ticipation of everyone in social life can dedicate org/10.5014/ajot.54.2.197
themselves to actions that attempt to resolve people’s Bento, B. (2008). O que é transexualidade [What transsexuality is].
suffering and advocate for a more just society, where Brasiliense.
differences can exist and citizenship can be enjoyed. Bento, B. (2016). Disforia de gênero: Geopolítica de uma categoria
psiquiátrica [Gender dysphoria: The geopolitics of a psychiatric
category]. Revista Direito e Práxis, 7, 496–536. https://doi.org/
Acknowledgments 10.12957/dep.2016.25170
We are grateful to Dr. Ana Paula Serrata Malfitano, *Bergan-Gander, R., & von Kürthy, H. (2006). Sexual orientation and
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academic dialogues that contributed to this study. This
https://doi.org/10.1177/030802260606900903
study was funded by the S~ao Paulo Research Founda-
Bourdieu, P. (2003). L’objectivation participante [Participant
tion (FAPESP Grant 2019/13921-3) and the Coor- objectification]. Actes de la Recherche en Sciences Sociales, 150, 43–58.
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Dissident Genders and Sexualities in

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Articles included in scoping review

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Table 1. Distribution of Articles Included in the Scoping Review, by Journal (N = 43)

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Downloaded from http://research.aota.org/ajot/article-pdf/76/5/7605205160/76400/7605205160.pdf by Ryan Lavalley on 16 September 2022

Downloaded from http://research.aota.org/ajot/article-pdf/76/5/7605205160/76400/7605205160.pdf by Ryan Lavalley on 16 September 2022

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