Stephanie Budge

• Doctor of Philosophy
• University of Wisconsin–Madison

This article reports program evaluation findings of the effectiveness of a pilot training program integrating key principles from the psychological framework for radical healing (French et al., 2020) and models aimed at decreasing internalized stigma (Israel et al., 2021). Our main goal of the training program was to increase psychotherapists’ know...

Although studies on the dual-continua model have demonstrated that distress and well-being are two separate but interrelated factors of mental health, only limited research exists regarding these concepts for lesbian, gay, bisexual, transgender, queer, intersex, asexual+ (LGBTQIA+) individuals. The present study aimed to investigate the factor stru...

Internalization of stigmatizing messages from society is a primary risk factor for transgender and nonbinary (TNB) people. To locate points of intervention for TNB people with a high level of internalized transnegativity, the present study examined predictors of internalized transnegativity in Korean TNB adults ( N = 268) using a multiple mediator...

This article introduces The Companionship Model as a template for conducting ethical and affirming assessment sessions for transgender and nonbinary youths (TNBY) and their guardians. The Companionship Model emphasizes proactive clinical companionship as TNBY and their guardians navigate access to gender-affirming care. The model offers specific ac...

BACKGROUND Background: There is a notable lack of psychotherapeutic services tailored to the needs of Black, Brown, People of Color (BBPOC) who are Two Spirit, transgender, and nonbinary (2STNB); research indicates that 2STNB BBPOC clients report a lack of competence and cultural humility on the part of their therapists. OBJECTIVE Objective: The p...

The gender minority stress and resilience measure (GMSRM) is the premiere measure for understanding the impacts of gender-related stress on the mental health of trans and nonbinary (TNB) individuals. However, the distal and proximal stress scales of the GMSRM have yet to be subjected to rigorous psychometric testing despite prior research identifyi...

The American Psychological Association Division 44 Science Committee created this guidance to provide support and assistance to those who conduct sexual orientation and gender diversity (SOGD) research. We aim to: (a) provide guidance to new researchers on publishing SOGD research; (b) advance the field by creating standards for publications; (c) s...

In psychotherapy, emotional tears occur frequently but have received limited attention. We set out to replicate and extend findings of previous studies conducted in Italy (Genova et al., 2021) and Israel (Katz et al., 2022) with U.S. clients. We hypothesized that positive crying experiences would be associated with improvement and stronger alliance...

This study explored the experiences of trans and nonbinary (TNB) individuals in relation to gender dysphoria, specifically focusing on information they have received from sociocultural agents (i.e., messages) about gender dysphoria and how their actual experiences align or differ from these messages. A sample of 104 participants responded to four p...

This study examined concordance of family members’ perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13–17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14–24 years) from 30 families from the U.S. New Englan...

In October 2022, the World Professional Association for Transgender Health published updated international guidelines (Version 8) regarding Standards of Care for medical interventions for transgender and nonbinary (TNB) people. We encourage providers to use The Companionship Model when they are required to write referral letters for patients and cl...

Background: Transnormativity refers to the accountability structure that regulates the acceptable gender presentations, narratives, and ways of being of trans and nonbinary (TNB) individuals. Aims: The present research extends prior qualitative research on transnormativity to develop and validate the Transnormativity Measure (TM). Methods: The init...

Objective: Goal setting is an important factor that contributes to positive outcomes in psychotherapy, yet research has not focused on this particular aspect of process and outcome of psychotherapy for transgender and nonbinary (TNB) patients. Methods: The present study used secondary data analysis from a pilot randomized controlled trial focuse...

The present study sought to develop and validate the Masculine Sexual Entitlement Norms (MSEN) Scale. Following scale development best practices, a thorough review of the literature and existing measures was conducted. Next, the construct was operationalized with six hypothesized subscales. Items were developed with input from content experts (N =...

Extant research on sexual identity development among sexual minority individuals has been predominantly conducted in Western contexts and focused on factors that hinder identity development processes. Using thematic analysis, this qualitative study sought to explore the experiences of sexual identity development among Chinese sexual minority men as...

Trans and nonbinary (TNB) individuals cope with gender-related stress in unique ways that are not captured in existing coping measures. The present research extends prior qualitative research on these unique coping strategies to develop and validate the Trans and Nonbinary Coping Measure (TNCM). The initial developed pool of potential items was pre...

Expanding upon the larger body of literature that focuses on adverse mental health concerns among trans and nonbinary (TNB) populations, emerging research has recently begun to investigate positive outcomes and psychological well-being among TNB people. This study contributes to this growing area of research by investigating one subjectively experi...

Despite recent trans-affirming research centering experiences of gender dysphoria and its relation to psychological outcomes, there is a dearth of research studying the components of experiences of gender dysphoria. This has limited the ability of clinicians to intervene and reduce the distress caused by gender dysphoria. The current study utilized...

The aim of this study was to examine concordance and discordance in how different family members in families with transgender or nonbinary (TNB) youth described topics related to the TNB youth’s gender identity and its effects on the family. TNB youth, ages 7–18 years, and their caregivers (54 family members: 20 TNB youth, 34 caregivers) participat...

Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgende...

De mentale gezondheid en identiteitsontwikkeling van transgender en genderdiverse jongeren (TGD) worden beschermd door steun en acceptatie vanuit het gezin. Hoewel in sommige studies wel is gekeken naar de rol van steunende gezinsrelaties voor TGD-jongeren, is nog niet eerder diepgaand onderzocht hoe TGD-jongeren en hun verzorgers aankijken tegen d...

We hypothesized that transgender and nonbinary (TNB) individuals who reported a longer period of time from realizing they were TNB to beginning their transition will have a longer history of nonsuicidal self-injury (NSSI) and that participants who report higher levels of body investment, fewer years from realization of TNB identity to transition, a...

It is undeniable that the field of transgender and nonbinary (TNB) research has grown exponentially since the turn of the century. In contrast, literature on Asian, Asian American, and Pacific Islander (AAPI) individuals has been a well-established field of research for many decades. However, limited research has focused on TNB AAPI individuals’ ex...

Transgender people have higher rates of posttraumatic stress disorder (PTSD) than the general population. This risk can be partially understood by conceptualizing day-to-day bias-related stressors and non-affirmation as potentially traumatic, but there is currently limited empirical evidence to support such a framework. This study aimed to explore...

Background: A trans person is murdered every 3 days in the world, with the majority of these murders occurring in Latin America. This violence is a motivating factor for Latinx trans immigrants to immigrate to the United States. Regardless of whether individuals may be able to remain in the U.S., trans immigrants and asylum seekers are often held...

Research on the interaction between gender and emotions has largely been constrained by the gender binary. This article seeks to advance theory of constructed emotions as relates to marginalized identities by describing the emotional experiences of individuals with a nonbinary gender identity. We conducted a two-phase analysis (grounded theory, con...

Trans and nonbinary individuals experience high rates of identity-based stigma and stress (minority stress) in U.S. society. Despite research empirically linking minority stress with adverse mental health outcomes, the extent to which minority stress experiences are discussed in psychotherapy and how therapists respond is unknown. The primary aim o...

Psychotherapie mit transmaskulinen Personen kann ein wichtiges Hilfsmittel sein, um sie bei einer Vielzahl von Anliegen zu unterstützen. Dabei liegen Themen wie Identitätsentwicklung, geschlechtsspezifische traumatisierende Erlebnisse und verinnerlichte Transnegativität (Stigma) im Fokus sowie die Bewältigung belastender Emotionen und Hilfestellung...

Family support and acceptance are protective for transgender and gender diverse (TGD) youths’ mental health and identity development. Although some studies have examined the role of supportive family relationships for TGD youth, prior research has not fully explored how TGD youth and their caregivers understand or characterize these relationships w...

Increased scientific understanding explains why transgender and gender nonconforming (TGNC) youth report more mental health concerns than their cisgender peers. However, the emotional processes of TGNC youth have not been assessed beyond mental health diagnoses. Our aim in this study was to investigate how TGNC youth understand, experience, and lab...

Minority stress has been determined to contribute to some mental health concerns for transgender, nonbinary, and gender nonconforming individuals, yet little is known regarding interventions to decrease the effects of minority stress. The purpose of this pilot study was to assess the feasibility and relative effectiveness of two interventions devel...

Rationale Men who have sex with men (MSM) in China are disproportionately affected by HIV and mental health issues. Although predominately western-based research suggests a minority stress perspective to explain health disparities, how Chinese MSM experience stress related to being a sexual minority and how such experiences affect their health have...

Given the rise in the visibility of the trans community, increasing attention has been paid to mental health disparities in trans populations. Specifically, research findings conclude that suicide is considered 1 of the major health disparities in trans populations. Across several studies it has been found that 40% or more of trans people have atte...

This introductory article to the special issue on psychotherapy and HIV provides an overview of the state of HIV intervention research, recommendations for future psychotherapy practice, and an emphasis on how psychotherapy researchers focusing on HIV should move away from the typical public health model. We provide information about how historical...

Background: Transgender, nonbinary, and gender nonconforming (TNG) young people are a diverse group, including young people with gender identities beyond the gender binary. Whereas nonbinary youth experience disparities in victimization and mental health, school belonging, support, and resources have not been well described. Methods: We conducte...

Much has been written in recent years regarding the integration of social justice values with psychology and psychotherapy; however, the discourse surrounding social justice perspectives related to conducting psychotherapy research is scant. Psychotherapy researchers are beholden to various professional ethical standards, laws, and policies; howeve...

Increasing numbers of studies have begun to focus on minority stress within transgender, nonbinary, and gender nonconforming (TNG) populations. These studies indicate a strong positive relationship between minority stress and increased mental health concerns. However, little research has been conducted on nonbinary students enrolled in institutions...

The clinical need for lesbian, gay, bisexual, and queer (LGBQ+) affirmative psychotherapies has been widely recognized; however, empirical research on the outcomes of such psychotherapies is limited. This chapter begins by offering definitions and delineating four key themes of LGBQ+ affirmative psychotherapies. The authors conceptualize LGBQ+ affi...

This chapter reviews the research evidence on the effectiveness of attending to clients’ gender identity in psychotherapy. It begins with definitions and measures of gender identity and provides clinical examples. A literature search did not yield studies that fit the authors’ search criteria; thus meta-analyses were not conducted. Instead, the aut...

Psychotherapy Relationships That Work is the definitive, evidence-based book on the psychotherapy relationship: what works in general (Volume 1) and what works for particular patients (Volume 2). Each chapter presents definitions, clinical examples, landmark studies, comprehensive meta-analyses, diversity considerations, and training implications a...

An increasing number of young adults identify with nonbinary gender identities. Yet health providers and therapists often lack understanding of such identities. In this mixed-methods study of 506 transgender undergraduate and graduate students, most of whom (75%) had nonbinary gender identities, we aimed to understand participants’ mental health an...

Purpose: An emerging body of research analyzes the scope, ethics, and inequalities of web-based crowdfunding to raise money for medical expenses related to illness or injury. To date, little research has investigated how transgender communities utilize crowdfunding expenses related to gender affirming medical care. Methods: Using GoFundMe.com, we c...

Objective: Sexual satisfaction has implications for well-being and may be related to gender norms. This study was conducted to understand the relationship between U.S. sexual minority (SM) individuals’ gender norm conformity and levels of sexual satisfaction, as well as examining the following potential mediators: sexual communication, internalized...

The clinical need for lesbian, gay, bisexual, and queer (LGBQ+) affirmative psychotherapies has been widely recognized; however, empirical research on the outcomes of such psychotherapies is limited. Moreover, key questions about whom such psychotherapies are for and what they comprise require critical consideration. We begin by offering definition...

This study reviews the research evidence on the effectiveness of attending to clients’ gender identity and gender as a system of power in psychotherapy. We begin with definitions and measures of gender identity and provide clinical examples. Next, we summarize our search for studies to conduct two meta‐analyses on: (a) randomized controlled trials...

Despite an upward trend in research focused on trans youth, how trans youth cope with their gender identity remains relatively unknown. We aimed to gather in-depth information about how trans youth described the developmental process of coping with factors that arise when youth are exploring their gender identity, coming out to others, and navigati...

Transgender (trans) individuals and their partners demonstrate significant diversity in terms of sexuality and approaches to romantic relationships. Over 3/4 (77%) of trans individuals identify as sexual minorities, but little is known about how they negotiate sexual and gender identities within a relationship. Additionally, findings have indicated...

In this article, we introduce a special section focused on the application of advanced methodologies to specific research questions in counseling psychology. The articles include applications of natural language processing, dynamic systems, mediation analyses in single studies and meta-analysis, and synthesis of qualitative research. We provide a b...

Research has just begun to study associations between sexual fluidity and health among cisgender individuals; only 1 cross-sectional study examined these links among transgender individuals. The goals of the current study were to prospectively examine fluidity in sexual attractions and fluidity in sexual orientation identity, and associations with...

Background: Transgender people in the United States often lack access to high-quality health care. Methods: A group of researchers and transgender people came together in a community-based participatory research process to survey transgender Wisconsinites about their health care experiences. A multiple regression analysis of survey data was used to...

Purpose of Review The goal of this paper is to give current understanding of non-binary/genderqueer identities, non-binary mental health trends and identity development, unique experiences of non-binary individuals, and recommendations for clinicians and researchers. Recent Findings About one third of individuals who identify as transgender primar...

This study examined associations between changes in self-reported attractions and mental health in a community-based sample of self-identified transgender adults. Participants were purposively recruited in 2013 using bimodal sampling methods and completed a one-time survey. Multivariable logistic regression models estimated adjusted risk ratios and...

Current psychotherapy research with sexual and gender minorities (SGMs) is inadequate to address the health disparities in this population. Psychotherapy can benefit from research demonstrating the unique experiences of SGMs with respect to behavioral health, internalized stigma, coping, and resilience. This article describes research approaches, q...

Background: A growing body of research has examined transgender identity development, but no studies have investigated developmental pathways as a transactional process between youth and caregivers, incorporating perspectives from multiple family members. The aim of this study was to conceptualize pathways of transgender identity development using...

Existing research on trans individuals has primarily focused on their negative experiences and has disproportionately examined coming-out processes and identity development stages. Using a grounded theory approach, this qualitative study sought to examine facilitative coping processes among trans-identified individuals. Facilitative coping was oper...

Future perspectives of transgender youth and their caregivers may be shaped by knowledge of discrimination and adverse mental health among transgender adults. Qualitative data from the Trans Youth Family Study were analyzed to examine how transgender and gender nonconforming (TGN) youth and their caregivers imagine the youth’s future. A community-b...

This article addresses the challenges that clinicians face in writing letters of support for transgender and gender-diverse clients. It addresses common but challenging clinical representations to help the reader understand the nuances associated with writing letters. Three cases are presented. The first addresses systemic challenges, the second ad...

In this article, we aim to provide readers with tools to critically consider decisions related to conducting research with trans populations. We first present the historical and contemporary contexts that shaped our approach to writing this article, and drawing from various social justice frameworks, we set forward our own critical framework to gui...

Purpose: Research has demonstrated associations between discrimination and mental health in lesbian, gay, bisexual, and transgender populations. However, little is known about the influence of geographic location on psychological distress in these populations, particularly among transgender people. Methods: This secondary analysis conducted on a na...

The present study examined patterns in trans individuals’ multiple identities and mental health outcomes. Cluster 1 (socioeconomic and racial privilege; n = 239) was characterized by individuals who identified as trans women or cross-dressers, lesbian, bisexual, or questioning; had associates degrees; reported household incomes of $60,000 or more a...

Purpose: Research has demonstrated associations between discrimination and mental health in lesbian, gay, bisexual, and transgender populations. However, little is known about the influence of geographic location on psychological distress in these populations, particularly among transgender people. Methods: This secondary analysis conducted on a na...

This study provides a content analysis of more than a decade (2002?2012) of academic scholarship about trans people and issues. A total of 960 trans-focused publications were coded; there was a close balance of nonempirical (54%) and empirical (46%) publications. The analyses revealed that the literature on trans people and issues is growing, altho...

This special issue was created to address a very clear gap in the literature on clinical errors in psychotherapy. This special issue is comprised of 20 articles which follow the same format as the "Clinical Processes" special issue and "Supervision Processes" special section, previously published in. Specifically, authors were provided with instruc...

The current study examined how dimensions of masculinity and femininity were expressed for sexual minorities. Cluster analysis was used to determine the number of latent classes for conformity to masculine and feminine norms for sexual minorities. A four-class solution was the best fit to the data. Cluster 1 (labeled Relating to others through equa...

Objective: Alliance, empathy, and genuineness are each integral parts of the therapeutic relationship. No previous meta-analysis has explored the extent to which therapist empathy and genuineness contribute to the therapeutic alliance. Method: In this meta-analysis, a multifaceted search strategy yielded 53 studies. Forty studies reported allian...

Health insurance is considered by many to be a basic human right. This study explored the differences in health insurance coverage and access to health care by comparing the results of data from 2 large datasets that were collected in 2008. Data from the National Health Interview Survey were compared with data from the National Transgender Discrimi...

This entry has three main purposes: to present theories related to sex differences research; to critique research focusing on sex differences; and to offer recommendations. Sex differences research often conceptualizes sex and gender interchangeably, confounding two distinct constructs. This entry addresses how theories of essentialism and social c...

Scholarship about lesbian, gay, bisexual, and transgender (LGBT) people and issues has been growing. However, trans issues are often overlooked or addressed only nominally in this literature, leading to calls for further focused attention to trans people and issues. In a series of articles, this Major Contribution addresses such calls by (a) provid...

With the new revision of the DSM-5, research and theory related to the diagnosis of gender dysphoria (GD) have increased. Through debates and discussions of controversy with the GD diagnosis, knowledge of gender identity and psychopathology related to minority stress have also become more prevalent. One of the primary limitations noted in the major...

This study examined transgender community belongingness as a mediator between strength of transgender identity and well-being. A total of 571 transgender adults (n = 209 transgender women, n = 217 transgender men, and n = 145 nonbinary-identified individuals) completed an online survey assessing transgender community belongingness, strength of tran...

The Behavioral Health Measure–20 (BHM-20; Kopta & Lowry, 2002) through the computer-based CelestHealth System–MH (CHS-MH) has proven to be an effective and efficient instrument for assessing psychotherapy outcomes and providing feedback to psychotherapists. This article describes its features, the psychometric and research support of the measure, a...

As tension continues to exist between those who endorse contextual versus medical explanations for the efficacy of psychotherapy, it remains undetermined how psychotherapy works. One of the primary purposes of this chapter is to provide a rationale on evolved social and relational characteristics for the efficacy of psychotherapy. In conjunction wi...

In order to receive medically necessary gender-affirming treatments, transgender individuals are required to provide evidence of their readiness for gender transitioning. Most often, this evidence includes 1 letter for hormone therapy and 2 letters for surgery. According to the World Professional Association for Transgender Health (WPATH) Standards...

The current study used multilevel growth mixture modeling to ascertain groups of patients who had similar trajectories in their psychological functioning over the course of short-term treatment. A total of 10,854 clients completed a measure of psychological functioning before each session. Psychological functioning was measured by the Behavioral He...

In this article, a common and specific factors model of how the psychotherapy supervision relationship contributes to supervisee learning is proposed. Reasoning by analogy (Milne, 2006), the Wampold/Budge (2012; Budge & Wampold, 2015) psychotherapy relationship model is extrapolated to psychotherapy supervision. We propose a convergence of supervis...

The current study used grounded theory methods to analyze trans men’s positive emotions. The sample included 11 participants who were assigned a female sex at birth and currently identify with a binary male identity. Results yielded eight positive emotion themes emerging for trans men, which included the following: confidence, comfort, connection,...

Les essais cliniques aléatoires (ECA) sont le principal moyen de déterminer les traitements visant à réduire les symptômes des troubles de la personnalité (TP). Les preuves au sujet des traitements pour les TP indiquent que l’ampleur de l’effet de la psychothérapie est significative, ce qui a permis aux chercheurs de conclure que celle-ci réduit le...

This research explored identity processes related to mid-life gender transitioning in 13 trans women (assigned male at birth), ages 44–67 years, who lived in the Midwestern United States. Participants completed a semi-structured qualitative interview with questions about transgender identity development and experiences of gender transitioning. Inte...

Addressing clients’ minority stress experiences and using positive psychology interventions can be difficult to balance. The current article provides two primary interventions that can assist therapists with navigating minority stress and positivity. The first intervention includes instilling hope for the future and creating positive expectations f...

Objective: The current study examined the good-enough level (GEL) and dose-effect model on three outcome variables: well-being, symptom distress, and life functioning, while accounting for therapist effects. The dose-effect model assumes the rate of change is consistent across clients, and the GEL model assumes that the rate of change will vary ac...

Research on mentoring in higher education is increasingly widespread. This article aims to provide insight into different kinds of mentoring programs and the research conducted to determine the effectiveness of these programs. A review of the literature revealed multiple definitions of what mentoring means, how programs operate, and types of resear...

Sexual pressure can have detrimental effects to individuals both physically and emotionally; however, research in this area is lacking regarding the experiences by lesbian, gay, bisexual, queer, and questioning (LGBQ) women. This online study qualitatively examined sexual pressure experienced and explained by LGBQ women (n = 50) using grounded theo...

This study examined the relationships between social support, coping, depression, and anxiety in a sample of genderqueer individuals (n = 64). Genderqueer is a label used within the broader transgender community and is defined as a gender identity that is outside the binary construct of male and female. Findings indicate that 53% (n = 34) of partic...

Interpersonal therapy (IPT) is a particularly useful approach to use when working with clients who identify as transgender or gender nonconforming. All transgender individuals will experience changes and adjustment throughout their identity process, often referred to as transitioning. IPT offers specific interventions for psychotherapists to use wi...

Do adolescents model their mothers’ self-objectification? We measured self-objectification (body surveillance and body shame), body mass index, body esteem, and quality of the mother–adolescent relationship in 179 female and 162 male adolescents at age 15, as well as self-objectification in their mothers. Initial analyses indicated no improvement i...

The purpose of Study 1 was to examine the relative efficacy of evidence-based treatments (EBTs) when compared to treatment-as-usual (TAU) for adults diagnosed with a personality disorder (PD). The purpose of Study 2 was to investigate the strength of the differences between bona fide psychotherapeutic treatments for PDs. Two separate computerized s...

Eighteen transgender-identified individuals participated in semi-structured interviews regarding emotional and coping processes throughout their gender transition. The authors used grounded theory to conceptualize and analyze the data. There were three distinct phases through which the participants described emotional and coping experiences: (a) pr...

Objective: The purpose of the current study was to examine facilitative and avoidant coping as mediators between distress and transition status, social support, and loss. Method: A total of 351 transgender individuals (n = 226 transgender women and n = 125 transgender men) participated in this study. Participants completed measures on transgende...

This study evaluated an adolescent depression in-service training for school staff in the United States.A total of 252 school staff (e.g., teachers, principals, counselors) completed assessments prior to and following the in-service and a subsample of these staff participated in focus groups following the in-service and three months later.Questionn...

This study investigated psychotherapy trainees' ability to facilitate change in outcomes (e.g., well-being, symptom reduction, and life functioning) specifically related to the phase model. Four different psychotherapist experience levels (beginning practicum, advanced practicum, intern/postdoc, and psychologist) were compared to determine whether...

A debate exists about whether the common factors or specific ingredients are critical to producing the benefits of psychotherapy. A model of the relationship, based on evolved human characteristics related to healing, is presented that integrates common factors and specific ingredients. After the initial bond is formed, the relationship involves th...

The aim of this study was to examine the relative efficacy of evidence-based treatments (EBTs) versus treatment-as-usual (TAU) in routine care for anxiety and depression in adults. A computerized search of studies that directly compared an EBT with a TAU was conducted. Meta-analytic methods were used to estimate effectiveness of EBTs relative to TA...

Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers regarding their Latino patients, particularly, issues impacting their patients' access to and utilization of services. Interviews were conducted with ei...