Advertisement

An Intersectional Approach to Therapy with Transgender Adolescents and Their Families

  • Rachel Lynn GoldenEmail author
  • Matthew Oransky
Special Section: Transgender Identities Emerging During Adolescence

Abstract

In recent years, transgender individuals have experienced both greater visibility and increased discrimination, such as direct discriminatory practices and removal of Obama-era protections for transgender students. Minority stress theory suggests that discrimination toward gender identity is related to poor mental health outcomes. This hypothesis is supported by the literature regarding transgender adults and adolescents; notably, familial rejection is highlighted as having a strong association with negative outcomes. The field of psychology has continued to explore best practices in approaches to family therapy with transgender individuals. Gender-affirming techniques have gained momentum, largely due to a recognized need for therapy techniques that aim to cultivate familial support for this vulnerable population. As transgender individuals and their families hold many social identities, including race, ethnicity, socioeconomic status, and gender, affirming family therapy involving transgender individuals must explore ways in which gender identity intersects with and is understood in context of family members’ other identities. In particular, we must explore how identities may serve to bolster or impede therapeutic processes targeting acceptance. The current article aims to raise awareness of a need for an intersectional approach with gender-affirming family therapy techniques. We detail ways intersectionality can inform therapy practice and provide case examples from our work with a diverse group of transgender adolescents and their families.

Keywords

Transgender Adolescents Family therapy Intersectionality Gender dysphoria 

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human Participants or Animals

This article does not contain any studies with human participants or animals performed by the authors.

References

  1. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864.  https://doi.org/10.1037/a0039906.CrossRefGoogle Scholar
  2. Barnett, J. E. (2012). Clinical writing about clients: Is informed consent sufficient? Psychotherapy, 49, 12–15.  https://doi.org/10.1037/a0025249.CrossRefPubMedGoogle Scholar
  3. Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada. BMC Public Health, 15(1), 525.  https://doi.org/10.1186/s12889-015-1867-2.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943–951.  https://doi.org/10.2105/ajph.2013.301241.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Breslow, A. S., Brewster, M. E., Velez, B. L., Wong, S., Geiger, E., & Soderstrom, B. (2015). Resilience and collective action: Exploring buffers against minority stress for transgender individuals. Psychology of Sexual Orientation and Gender Diversity, 2(3), 253–265.  https://doi.org/10.1037/sgd0000117.CrossRefGoogle Scholar
  6. Brewster, M. E., Moradi, B., Deblaere, C., & Velez, B. L. (2013). Navigating the borderlands: The roles of minority stressors, bicultural self-efficacy, and cognitive flexibility in the mental health of bisexual individuals. Journal of Counseling Psychology, 60(4), 543–556.  https://doi.org/10.1037/a0033224.CrossRefPubMedGoogle Scholar
  7. Brewster, M. E., Velez, B. L., Mennicke, A., & Tebbe, E. (2014). Voices from beyond: A thematic content analysis of transgender employees’ workplace experiences. Psychology of Sexual Orientation and Gender Diversity, 1(2), 159–169.  https://doi.org/10.1037/sgd0000030.CrossRefGoogle Scholar
  8. Brill, S., & Pepper, R. (2008). The transgender child: A handbook for families and professionals. San Francisco, CA: Cleis Press.Google Scholar
  9. Carter, B., & Peters, J. (1996). Love, honor and negotiate, making your marriage work. New York: Pocket Books.Google Scholar
  10. Clifft, M. A. (1986). Writing about psychiatric patients: Guidelines for disguising case material. Bulletin of the Menninger Clinic, 50(6), 511–524.PubMedGoogle Scholar
  11. Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Gooren, L. J. (2008). The treatment of adolescent transsexuals: Changing insights. Journal of Sexual Medicine, 5(8), 1892–1897.  https://doi.org/10.1111/j.1743-6109.2008.00870.x.CrossRefPubMedGoogle Scholar
  12. Cohen-Kettenis, P. T., & Pfäfflin, F. (2003). Transgenderism and intersexuality in childhood and adolescence: Making choices. Thousand Oaks, CA: Sage.  https://doi.org/10.4135/9781452233628.CrossRefGoogle Scholar
  13. Combahee River Collective Statement. (1979). A Black feminist statement. In Z. R. Eisenstein (Ed.), Capitalist patriarchy and the case for socialist feminism (pp. 362–372). New York: Monthly Review Press.Google Scholar
  14. Connolly, M. D., Zervos, M. J., Barone, C. J., Johnson, C. C., & Joseph, C. L. (2016). The mental health of transgender youth: Advances in understanding. Journal of Adolescent Health, 59(5), 489–495.  https://doi.org/10.1016/j.jadohealth.2016.06.012.CrossRefPubMedGoogle Scholar
  15. Corbett, K. (2009). Boyhoods: Rethinking masculinities. New Haven, CT: Yale University Press.Google Scholar
  16. Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241–1299.  https://doi.org/10.2307/1229039.CrossRefGoogle Scholar
  17. Crenshaw, K. W. (1994). Mapping the margins: Intersectionality, identity politics, and violence against women of color. In M. A. Fineman & R. Mykitiuk (Eds.), The public nature of private violence (pp. 93–118). New York: Routledge.Google Scholar
  18. de Vries, K. M. (2012). Intersectional identities and conceptions of the self: The experience of transgender people. Symbolic Interaction, 35(1), 49–67.  https://doi.org/10.1002/symb.2.CrossRefGoogle Scholar
  19. de Vries, K. M. (2015). Transgender people of color at the center: Conceptualizing a new intersectional model. Ethnicities, 15(1), 3–27.  https://doi.org/10.1177/1468796814547058.CrossRefGoogle Scholar
  20. Dee-Watts Jones, T. D. (2010). Location of self: Opening the door to dialogue on intersectionality in the therapy process. Family Process, 49(3), 405–420.  https://doi.org/10.1111/j.1545-5300.2010.01330.x.CrossRefGoogle Scholar
  21. DeGruy Leary, J. (2005). The post-traumatic slave syndrome. Milwaukee, WI: Uptone Press.Google Scholar
  22. dickey, L. M., Burnes, T. R., & Singh, A. A. (2012). Sexual identity development of female-to-male transgender individuals: A grounded theory inquiry. Journal of LGBT Issues in Counseling, 6(2), 118–138.  https://doi.org/10.1080/15538605.2012.678184.CrossRefGoogle Scholar
  23. Dolan-Del Vecchio, K. (2008). Making love playing power: Men, women and the rewards of intimate justice. Berkeley, CA: Soft Skull Press.Google Scholar
  24. Duffy, M. (2010). Writing about clients: Developing composite case material and its rationale. Counseling and Values, 54, 135–153.  https://doi.org/10.1002/j.2161-007x.2010.tb00011.x.CrossRefGoogle Scholar
  25. Edwards-Leeper, L., Leibowitz, S., & Sangganjanavanich, V. F. (2016). Affirmative practice with transgender and gender nonconforming youth: Expanding the model. Psychology of Sexual Orientation and Gender Diversity, 3(2), 165–172.  https://doi.org/10.1037/sgd0000167.CrossRefGoogle Scholar
  26. Gay and Lesbian Alliance Against Defamation. (2018). Accelerating acceptance: A survey of American acceptance and attitudes toward LGBTQ Americans. New York: GLAAD.Google Scholar
  27. Goldberg, S. (2017). The gender revolution [Special issue]. National Geographic, 231, 1–154.Google Scholar
  28. Green, E. L., Benner, K., & Pear, R. (2018, October 21). ‘Transgender’ could be defined out of existence under Trump administration. New York Times. Retrieved October 21, 2018 from https://www.nytimes.com/2018/10/21/us/politics/transgender-trump-administration-sex-definition.html?module=inline.
  29. Greytak, E. A., Kosciw, J. G., & Diaz, E. M. (2009). Harsh realities: The experiences of transgender youth in our nation’s schools. New York: Gay, Lesbian and Straight Education Network (GLSEN).Google Scholar
  30. Grossman, A. H., & D’augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior, 37(5), 527–537.  https://doi.org/10.1521/suli.2007.37.5.527.CrossRefPubMedGoogle Scholar
  31. Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43(5), 460–467.  https://doi.org/10.1037/a0029597.CrossRefGoogle Scholar
  32. Hidalgo, M. A., Ehrensaft, D., Tishelman, A. C., Clark, L. F., Garofalo, R., Rosenthal, S. M., … Olson, J. (2013). The gender affirmative model: What we know and what we aim to learn. Human Development, 56(5), 285–290.  https://doi.org/10.1159/000355235.CrossRefGoogle Scholar
  33. James, S. E., Brown, C., & Wilson, I. (2017a). 2015 U.S. Transgender survey: Report on the experiences of black respondents. Washington, DC: National Center for Transgender Equality, Black Trans Advocacy & National Black Justice Coalition.Google Scholar
  34. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.Google Scholar
  35. James, S. E., Jackson, T., & Jim, M. (2017b). 2015 U.S. Transgender survey: Report on the experiences of American Indian and Alaska Native respondents. Washington, DC: National Center for Transgender Equality.Google Scholar
  36. James, S. E., & Magpantay, G. (2017). 2015 U.S. Transgender survey: Report on the experiences of Asian, Native Hawaiian, and Pacific Islander respondents. Washington, DC: National Center for Transgender Equality & National Queer Asian Pacific Islander Alliance.Google Scholar
  37. James, S. E., & Salcedo, B. (2017). 2015 U.S. Transgender survey: Report on the experiences of Latino/a respondents. Washington, DC: National Center for Transgender Equality and TransLatin@ Coalition.Google Scholar
  38. Jereb, A. M. (2017). The bathroom right for transgender students and how the entire LGBT community can align to guarantee this. Wake Forest Journal of Law & Policy, 7, 585–606.Google Scholar
  39. Korell, S. C., & Lorah, P. (2007). An overview of affirmative psychotherapy and counseling with transgender clients. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (pp. 271–288). Washington, DC: American Psychological Association.  https://doi.org/10.1037/e693122007-001.CrossRefGoogle Scholar
  40. Lev, A. I., & Malpas, J. (2011). Introduction. In J. Malpas & A. O. Lev (Eds.), At the edge: Exploring the changing facets of gender and sexuality in couples and families (pp. 2–8). Washington, DC: American Family Therapy Academy.Google Scholar
  41. Lombardi, E. L., Wilchins, R. A., Preising, D., & Malouf, D. (2002). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42, 89–101.  https://doi.org/10.1300/J082v42n01_05.CrossRefGoogle Scholar
  42. MacNish, M., & Gold-Peifer, M. (2011). Families in transition: Supporting families of transgender youth. In J. Malpas & A. I. Lev (Eds.), At the edge: Exploring gender and sexuality in couples and families (pp. 34–42). Washington, DC: American Family Therapy Academy.  https://doi.org/10.1007/978-3-319-03248-1_13.CrossRefGoogle Scholar
  43. Mallon, G. P. (2009). Social work practice with transgender and gender variant youth (2nd ed.). New York: Routledge.CrossRefGoogle Scholar
  44. Malpas, J. (2011). Between pink and blue: A multi-dimensional family approach to gender nonconforming children and their families. Family Process, 50(4), 453–470.  https://doi.org/10.1111/j.1545-5300.2011.01371.x.CrossRefPubMedGoogle Scholar
  45. McGuire, J. K., Catalpa, J. M., Lacey, V., & Kuvalanka, K. A. (2016). Ambiguous loss as a framework for interpreting gender transitions in families. Journal of Family Theory & Review, 8(3), 373–385.  https://doi.org/10.1111/jftr.12159.CrossRefGoogle Scholar
  46. Menvielle, E. (2012). A comprehensive program for children with gender variant behaviors and gender identity disorders. Journal of Homosexuality, 59(3), 357–368.  https://doi.org/10.1080/00918369.2012.653305.CrossRefPubMedGoogle Scholar
  47. Menvielle, E. J., & Tuerk, C. (2002). A support group for parents of gender-nonconforming boys. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1010–1013.  https://doi.org/10.1097/00004583-200208000-00021.CrossRefPubMedGoogle Scholar
  48. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior.  https://doi.org/10.2307/2137286.CrossRefPubMedGoogle Scholar
  49. Meyer, I. H. (2003). Prejudice as stress: Conceptual and measurement problems. American Journal of Public Health, 93(2), 262–265.  https://doi.org/10.2105/ajph.93.2.262.CrossRefPubMedPubMedCentralGoogle Scholar
  50. Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation and Gender Diversity, 2(3), 209–213.  https://doi.org/10.1037/sgd0000132.CrossRefGoogle Scholar
  51. Meyer, I. H., & Frost, D. M. (2013). Minority stress and the health of sexual minorities. In C. J. Patterson & A. R. D’Augelli (Eds.), Handbook of psychology and sexual orientation (pp. 252–266). New York, NY: Oxford University Press.Google Scholar
  52. Olson, K. R., Durwood, L., DeMeules, M., & McLaughlin, K. A. (2016). Mental health of transgender children who are supported in their identities. Pediatrics, 137, 1–8.  https://doi.org/10.1542/peds.2015-3223.CrossRefGoogle Scholar
  53. Olson, J., Schrager, S. M., Belzer, M., Simons, L. K., & Clark, L. F. (2015). Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. Journal of Adolescent Health, 57(4), 374–380.  https://doi.org/10.1016/j.jadohealth.2015.04.027.CrossRefPubMedGoogle Scholar
  54. Oransky, M., Burke, E. Z., & Steever, J. (2018). An interdisciplinary model for meeting the mental health needs of transgender adolescents and young adults: The Mount Sinai Adolescent Health Center approach. Cognitive and Behavioral Practice, 4, 5.  https://doi.org/10.1016/j.cbpra.2018.03.002.CrossRefGoogle Scholar
  55. Perez-Brumer, A., Hatzenbuehler, M. L., Oldenburg, C. E., & Bockting, W. (2015). Individual- and structural-level risk factors for suicide attempts among transgender adults. Behavioral Medicine, 41(3), 164–171.  https://doi.org/10.1080/08964289.2015.1028322.CrossRefPubMedGoogle Scholar
  56. Pleak, R. R. (2009). Formation of transgender identities in adolescence. Journal of Gay & Lesbian Mental Health, 13(4), 282–291.  https://doi.org/10.1080/19359700903165290.CrossRefGoogle Scholar
  57. Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, E., … Baral, S. D. (2016). Global health burden and needs of transgender populations: A review. The Lancet, 388(10042), 412–436.  https://doi.org/10.1016/s0140-6736(16)00684-x.CrossRefGoogle Scholar
  58. Rosenberg, M. (2002). Children with gender identity issues and their parents in individual and group treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 619–621.  https://doi.org/10.1097/00004583-200205000-00020.CrossRefPubMedGoogle Scholar
  59. Saeger, K. (2006). Finding our way: Guiding a young transgender child. Journal of GLBT Family Studies, 2(3/4), 207–245.  https://doi.org/10.1300/j461v02n03_11.CrossRefGoogle Scholar
  60. Sieck, B. C. (2012). Obtaining clinical writing informed consent versus using client disguise and recommendations for practice. Psychotherapy, 49, 3–11.  https://doi.org/10.1037/a0025059.CrossRefPubMedGoogle Scholar
  61. Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793.  https://doi.org/10.1016/j.jadohealth.2013.07.019.CrossRefPubMedGoogle Scholar
  62. Singh, A. A. (2013). Transgender youth of color and resilience: Negotiating oppression and finding support. Sex Roles, 68(11–12), 690–702.  https://doi.org/10.1007/s11199-012-0149-z.CrossRefGoogle Scholar
  63. Spack, N. P., Edwards-Leeper, L., Feldman, H. A., Leibowitz, S., Mandel, F., Diamond, D. A., & Vance, S. R. (2012). Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics, 129(3), 418–425.  https://doi.org/10.1542/peds.2011-0907.CrossRefPubMedGoogle Scholar
  64. Steensma, T. D., van der Ende, J., Verhulst, F. C., & Cohen-Kettenis, P. T. (2013). Gender variance in childhood and sexual orientation in adulthood: A prospective study. Journal of Sexual Medicine, 10, 2723–2733.  https://doi.org/10.1111/j.1743-6109.2012.02701.x.CrossRefPubMedGoogle Scholar
  65. Steensma, T. D., Zucker, K. J., Kreukels, B. P., VanderLaan, D. P., Wood, H., Fuentes, A., & Cohen-Kettenis, P. T. (2014). Behavioral and emotional problems on the Teacher’s Report Form: A cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents. Journal of Abnormal Child Psychology, 42(4), 635–647.  https://doi.org/10.1007/s10802-013-9804-2.CrossRefPubMedGoogle Scholar
  66. Steinmetz, K. (2014). The transgender tipping point. Time Magazine, 183(22), 38–46.Google Scholar
  67. Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the gender minority stress and resilience measure. Psychology of Sexual Orientation and Gender Diversity, 2, 65–77.  https://doi.org/10.1037/sgd0000081.CrossRefGoogle Scholar
  68. Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L., & Papadimitriou, M. (2012). Impacts of strong parental support for trans youth: A report prepared for Children’s Aid Society of Toronto and Delisle Youth Services. Toronto, ON: Trans Pulse Project.Google Scholar
  69. Vanderburgh, R. (2009). Appropriate therapeutic care for families with pre-pubescent transgender/gender-dissonant children. Child and Adolescent Social Work Journal, 26(2), 135–154.  https://doi.org/10.1007/s10560-008-0158-5.CrossRefGoogle Scholar
  70. Wahlig, J. L. (2015). Losing the child they thought they had: Therapeutic suggestions for an ambiguous loss perspective with parents of a transgender child. Journal of GLBT Family Studies, 11(4), 305–326.  https://doi.org/10.1080/1550428x.2014.945676.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric PsychiatryCentral New York Psychiatric CenterNew YorkUSA
  2. 2.Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkUSA

Personalised recommendations