Challenging confidence: How essentialist, microaggressive, and medicalizing attitudes shape Italian psychologists’ work with trans* individuals

Introduction Trans* individuals continue to face profound health inequities compared to cisgender populations, including barriers to appropriate and affirming mental health care. Research highlights gaps in individualized services, insufficient training, and persistent microaggressions and heterocisnormative attitudes among healthcare professionals. These barriers are shaped not only by deficits in knowledge but also by deeper normative and epistemological frameworks. This study addresses an underexplored area within the Italian context by examining how psychologists’ attitudes and beliefs affect their confidence in working with trans* clients. Methods A sample of 315 Italian psychologists Results Essentialist beliefs were not directly associated with lower confidence. Instead, their negative impact was mediated by microaggressive and medicalizing attitudes, which significantly reduced psychologists’ confidence in providing affirmative care. These findings suggest that confidence is shaped not merely by technical skills but also by pervasive heterocisnormative assumptions embedded in psychological practice. Conclusions By uncovering how essentialist beliefs indirectly undermine confidence through discriminatory attitudes, this study highlights the need for interventions that go beyond technical training to foster critical reflexivity and challenge the normative assumptions of the discipline. Addressing these deeper epistemological issues is crucial for promoting more affirmative, competent, and inclusive mental health care for trans* individuals.