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Michelle Balch, PsyD, is a 2025 graduate of the PsyD program in Clinical Psychology at Antioch University, Seattle.

Dissertation Committee:

William Heusler, PsyD, Committee Chair

Michael Toohey, PhD, Committee Member

A. Ianto West, PsyD, Committee Member

Keywords

transgender, real-life experience (RLE), transition protocol, passing, Interpretative Phenomenological Analysis (IPA)

Document Type

Dissertation

Publication Date

2025

Abstract

The Real-Life Experience (RLE) has been described as a coercive and arbitrary requirement without evidence of validity or reliability. This can cause more harm than it prevents for a significant subset of transition-seeking transgender clients. For these reasons the RLE was dropped from the WPATH Standards of Care after version six. However, the RLE has been adopted by a number of health insurance companies as a measure of readiness to receive transition services. An Interpretative Phenomenological Analysis (IPA) and semi-structured interviews of five individuals were conducted to evaluate their perceptions of RLE and the meaning they attach to their broader experiences. The themes identified: safety, identity, process of transition, and trans-sensitive health care underscore the variability of the experiences of Trans individuals, and highlight the complexity and difficulty of implementing the RLE in contexts where Trans individuals must balance their needs for integrity with community values. However, difficulties encountered in the attempt to sample Trans individuals may have limited direct experiences of RLE from discussion. Further research can address these limitations. This research supports recommendations to providers and insurance companies for the relaxation of arbitrary requirements for RLE. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

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Michelle Balch, PsyD, 2025

ORCID Scholar No. 0009-0007-8090-9626

Michelle Balch was born near Tacoma, WA to a home of psych nurses who both worked in our state’s psychiatric institution, and graduated from Bellarmine Preparatory H.S. in 1984. After training and working in Defense Satellite Communications Systems repair, she left the USAF in 1988 and retrained as an LPN, working as a psych nurse at Western State Hospital for 23 years until 2012, with a short break to work at St Joeseph’s MHU for 1.5 years, and then drive semi-trucks with her brother for 2 years.

After transitioning in 2004, and founding the Gender Alliance of the South Sound, a non-profit and 501-3c registered charity gender-identity support and education organization in Tacoma, she left the state hospital in 2012 to reapply herself to her life-long dream of earning her doctoral degree in clinical psychology, graduating from UW-Tacoma in 2016 and Antioch University, Seattle’s PsyD program in 2025.

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