Article

Between Pink and Blue: A Multi-Dimensional Family Approach to Gender Nonconforming Children and their Families

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

Families of gender nonconforming children need to negotiate the interactions between two gender systems: a rigid gender binary imported from familial, social, and cultural experiences and a fluid gender spectrum articulated by their child. This article reviews parental reactions to nonconforming gender developments and poses that the parental mandates of protection and acceptance are problematized by the difference of gender norms between the child and the family, as well as the child and the environment. Through multiple therapeutic modalities—parental coaching and education, parent support group, and child and family therapy—the author illustrates interventions supporting both parents and prepubescent children in their negotiation of safety, connection, and fluidity. Case vignettes illustrate the method in action. 家有异性特质孩子的家庭需要协调两种性别体系之间的互动。这两种性别体系一个是源于家庭、社会和文化经历的严格的性别二分法,另一个是由其孩子明确表达的流动的性别光谱。本文评论了家长对异性特质发展的反应,并提出家长的保护与接受因孩子与家庭以及孩子与环境之间在性别规范上的差异而出现问题。本文作者通过多种治疗方式——家长辅导教育、家长支持小组、儿童与家庭治疗——阐明了支持家长以及青春期前孩子协调安全、关系以及流动性的干预治疗。本文以案例场景来阐明实践方法。 Las familias de niños de sexo indefinido necesitan negociar las interacciones entre dos sistemas de género, un binario de género rígido importado de experiencias familiares, sociales y culturales y un espectro de género fluido expresado por su hijo. En este artículo se analizan las reacciones de los padres a los desarrollos de género indefinido y se plantea que los mandatos paternales de protección y aceptación se problematizan por la diferencia de normas de género entre el niño y la familia así como entre el niño y el entorno. Mediante múltiples modalidades terapéuticas (preparación y enseñanza para padres, grupo de apoyo para padres, terapia infantil y familiar) el autor pone de manifiesto las intervenciones que apoyan tanto a los padres como a los niños prepúberes en su negociación de seguridad, conexión y fluidez. Se presentan casos para ejemplificar la implementación del método.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... Considering that gender roles for men have been more rigid traditionally, risking a variety of abuse should they drop the "mask of masculinity," it follows that they would cling to their paternal role of protecting the family while also "protecting" the gender roles of their children. Parents play an active role in the gender identity development of their children (Malpas, 2011), as children are actively gender labeling by age 3½, comprehending its stability by 4½, and its constancy by six (Kohlberg & DeVries, 1987;MacNish, 2015). Ultimately, parents who prove to be the most supportive of their child's journey with gender are those who are able to separate their own transitional needs from their child's (Coolhart & Shipman, 2017). ...
... It is no wonder, then, that psychologists originally accused parents for promoting gender non-conforming behavior. Yet, by shifting the lens and recognizing parents not as the perpetrator of gender non-conformity but as a potential support system for a child who demonstrates gender diversity, families are better able to cope with the stress of defying social conventions (Malpas, 2011). Parents embark on a journey, a transformative one for many, that challenges their notions of what is "normal." ...
... Once a parent's feelings and worries are affirmed and normalized, they then can explore their own understandings of gender and how these understandings were "informed by culture, race/ethnicity, religion, and class" (Coolhart & Shipman, 2017, p. 118). Likewise, Jean Malpas's (2011) Multi-Dimensional Family Approach also considers the gender identity education of the parents themselves. He writes, "Mapping the gender traditions and flexibility of both parents, their families and cultures of origin through a genogram clarifies the potential points of conflict and alliances between parents and with significant family members around the child" (p. ...
Thesis
Full-text available
Although studies have been conducted on the experiences of transgender and non-binary children, limited research has looked at the parents of these children. This qualitative study explored the transformative learning (Mezirow, 1978) of the parents of transgender and non- binary children by employing the concepts of biographical learning (Alheit, 1994) and holistic learning (Illeris, 2003) as its conceptual framework. The research questions asked: to what extent the parents experienced transformative learning, how they made the cognitive-affective shift in learning, how their own gender identity development informed their interpretations of their child’s gender transition, and how they navigated any tensions created within a family. Applying life history methods and methodology, I conducted 2 to 3 interviews with 16 parents of children aged 6 to 29, most of whom recorded their thoughts in journals, and I wrote an autoethnography as a parent of a non-binary child myself. The findings showed that for many parents, holistic learning took place in two phases. First, parents experienced a private phase of transformative learning through a cognitive reframing of the meaning of gender and a relinquishing of the emotions that were attached to gender (such as losing your daughter). Then began a public phase where parents learned to advocate for their children in schools, medical offices, or courtrooms. Parents of non-binary children may take longer working through these stages and many participants benefitted from lingering at a particular place of learning as they processed their thoughts or emotions. Furthermore, a parent’s personal sense of gender identity did not play a salient role for most parents; rather, their value in authenticity or the ability to be yourself influenced their commitment to their child. A parent’s gender identity did play a notable role for two mothers who identified as feminist who found it necessary to revisit their definition of woman at the time of their children’s transition. These findings provide a better understanding of the transformative learning of parents of transgender and non-binary children who often need support on this personal and public journey towards championing their children, challenging societal norms, and promoting inclusivity.
... Thus, it is clear that supports for the family as a group are imperative (Ashley, 2019). As there are a number of discussions on family based care for TGE youth (e.g., Lev, 2004;Malpas, 2011;Nealy, 2017), we will focus on the evidence-based relationship variables that should be a focus of treatment, as they can be used to measure outcomes in the therapeutic space in the absence of evidence-based protocols. ...
... The multidimensional family approach (Malpas, 2011;Malpas, Glaeser, & Giammattei, 2018) is an example of a flexible model of family support that takes the child, family, and community context into account in moving the family toward a more inclusive and resilient space. The main idea of this approach is to move toward a dialectic of "both/and," where families can affirm and nurture their children while also being aware of societal expectations and helping their child to navigate the world in which they live (Malpas, 2011). ...
... The multidimensional family approach (Malpas, 2011;Malpas, Glaeser, & Giammattei, 2018) is an example of a flexible model of family support that takes the child, family, and community context into account in moving the family toward a more inclusive and resilient space. The main idea of this approach is to move toward a dialectic of "both/and," where families can affirm and nurture their children while also being aware of societal expectations and helping their child to navigate the world in which they live (Malpas, 2011). The flexibility of the parental role is modeled by the clinician, who acts as consultant/coach to the parents, therapist to the youth, and group facilitator to the family. ...
Article
Transgender and gender expansive (TGE) youth represent a very vulnerable population. Research suggests high levels of anxiety, depression, disordered eating, substance abuse, self-injurious behaviors, and suicidal ideation and attempts in TGE youth. One of the most important protective factors for TGE youth is family support. In the current article, we discuss the evidence-based relationship variables such as alliance, cohesion, and empathy that can impact treatment. We then underscore how each of these evidence-based relationship variables play a role in family based treatment for TGE youth. We conclude with a discussion of how evidence-based relationship variables are extremely important to be aware of when working with transgender and gender expansive youth and families, and how researchers and clinicians can focus on the inclusion of these variables to optimize clinical care and assess clinical change, given the lack of evidence-based treatments for this population.
... Parenting a gender diverse child or adolescent can be a challenging experience (Gregor et al., 2015;Riggs & Due, 2015). Malpas (2011) highlighted that parents may be concerned for their gender diverse children's well-being and may feel doubtful about how to best support them. They often worry about the future and health of their child, including possible medical interventions. ...
... Based on the approach outlined by Di Ceglie and Thümmel (2006), as further integrated with contributions from other studies (Malpas, 2011;Menvielle & Rodnan, 2011) and our own clinical experience, the aims of the group were: ...
... Despite the promising results of the Di Ceglie and Thümmel (2006) study, only three studies have focused on support groups for parents of gender diverse children, Malpas (2011), Menvielle and Rodnan (2011) and Menvielle and Hill (2010). Only the third one reported an evaluation of the group processes, based on a telephone semi-structured interview to parents. ...
Parenting gender diverse children and adolescents can be a challenging experience, entailing doubts about how to protect and support them during their development. Parental reactions impact on the child’s sense of security and well-being. Therefore, when caring for families with gender diverse children, it is important to offer support to parents. In this article we present an experience with a 12-month support group for parents of young people who attended the service for gender identity development at a paediatric hospital. We describe the group structure and methodology, together with the process for evaluating the intervention. At 6-month intervals, parents were asked to indicate the most important topics that had emerged during the monthly sessions. At 12months, they completed a semi-structured feedback questionnaire about their experience in the group, including possible difficulties encountered. Thematic analysis showed an evolution in time, with participants taking a more complex perspective on gender diversity and the needs of their children, while feeling more able to deal with the uncertainties related to gender identity development. After attending the group, parents reported feeling less lonely, more confident, and better able to communicate with their children. They related these positive changes to the opportunity of sharing experiences and mutual learning. This feed-back provides preliminary evidence that the psychological support group was perceived to be a useful resource by parents of gender diverse young people.
... The third stage of the Lev model, negotiation, refers to the period of time during which families confer boundaries surrounding the child's TNB identity, which may vary according to private or public setting. Parents of TNB youth may feel conflicted about how to accommodate their child's gender identity and expression in the context of a gendered and transphobic social environment (Malpas, 2011). The fourth stage of the Lev model, finding balance, describes when the family resolves their initial emotionality and move toward family concordance. ...
... The fourth stage of the Lev model, finding balance, describes when the family resolves their initial emotionality and move toward family concordance. Malpas (2011) found that mothers and fathers positioned themselves along gender role stereotypes when expressing concerns about their TNB children in a therapeutic support group, with fathers more likely to express protective concerns around the child's safety, and mothers more likely to express nurturing concerns around the child's acceptance. Extending Lev's model of transgender emergence in families, Zamboni (2006) proposed a fifth stage, latency, to capture the experience of families who are aware of their child's gender nonconformity but remain unwilling to openly discuss it. ...
Article
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) participated in one-on-one qualitative interviews. Interview transcripts were analyzed to determine concordance/discordance in family members’ responses (between TNB youth and each caregiver, between caregivers in two-caregiver families, and among all three family members) to 13 different interview questions. Results indicated the highest concordance was found between family members regarding how the youth’s gender identity affected family relationships. The highest discordance was found in family member’s descriptions of the TNB youth’s gender expression and future expectations for the TNB youth. Findings from this study have implications for supporting families with TNB youth.
... Counselors should be cognizant of how emotions such as grief, loss, surprise, confusion, fear, and anger can motivate parental rejecting behaviors, and assess these emotions during counseling sessions with parents. Counselors should normalize these emotions and remind parents that these are by-products of societal expectations; however, because these emotions are often related to behaviors that can be damaging to trans adolescents, as detailed in this article, counselors should use strategies to help to reduce these emotional reactions in parents (Katz-Wise et al., 2017;Malpas, 2011;Rosenfeld & Emerson, 1998). For example, counselors can engage parents in grief work to help process feelings of loss related to their child's gender identity (Malpas, 2011;Wahlig, 2015). ...
... Counselors should normalize these emotions and remind parents that these are by-products of societal expectations; however, because these emotions are often related to behaviors that can be damaging to trans adolescents, as detailed in this article, counselors should use strategies to help to reduce these emotional reactions in parents (Katz-Wise et al., 2017;Malpas, 2011;Rosenfeld & Emerson, 1998). For example, counselors can engage parents in grief work to help process feelings of loss related to their child's gender identity (Malpas, 2011;Wahlig, 2015). Counselors can also employ anxiety-reducing strategies to address feelings of fear and anger, including mindfulness practices, cognitive-behavioral therapy, and somatic work (Austin & Craig, 2015;Gehart, 2012). ...
Article
Transgender (trans) adolescents consistently report higher rates of adverse mental health outcomes compared to their cisgender peers. Parental support is a recognized adolescent protective factor; however, little is known about the specific parental behaviors that trans adolescents perceive as most or least supportive. To address this gap, we analyzed data from qualitative interviews conducted with an ethnically diverse, urban-based sample of trans adolescents (N = 24; 16-20 years old) to describe (a) the spectrum of specific parental behaviors across 3 categories-rejecting, supportive, and mixed (i.e., simultaneous supportive and rejecting behaviors)-and (b) the perceived psychosocial consequences across these 3 categories of parental behaviors. Qualitative data were gathered through lifeline interviews (i.e., visual representations from birth to present) and photo elicitation (i.e., photographs representing parental support and/or rejection). Supportive behaviors included instances where parents made independent efforts to learn about trans issues or help their child obtain gender-affirming health care. Rejecting behaviors included instances when parents refused to use their child's name or pronouns or failed to show empathy when their child struggled with gender-identity-related challenges. Mixed behaviors included examples when parents expressed support of their child's gender identity, but not of their sexual orientation (or vice versa). Overall, participants reported that rejecting and mixed parental behaviors contributed to a range of psychosocial problems (e.g., depression and suicidal ideation), while supportive behaviors increased positive wellbeing. These findings expand upon descriptions of parental support and rejection within the trans adolescent literature and can help practitioners target specific behaviors for interventions. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
... One parenting intervention that has been put forward for TGD youth is the Multidimensional Family Approach [49]. According to this approach, parents are guided to move from holding "all or none" viewpoints toward practicing more dialectical "both/and" thinking. ...
... It is also important for the family to be aware of how the child is still present in the family, and explore how the family system can include their identity. In addition, the importance of parent support groups has been noted for parents to discuss the pressures of parenting in general, and to share strategies on how to deal with people who are not supportive of TGD youth [46,49]. These groups can also help members feel valued and respected by their peers, which might not otherwise occur [46]. ...
Chapter
Transgender and gender diverse individuals experience a high rate of adverse health outcomes. In order to understand the basis for this phenomenon, it is important to understand the relationship between minority stress and health outcomes, as well as the impact of acceptance. This chapter describes the minority stress model, the expansion of this model with transgender and gender diverse individuals, and the impact of acceptance (or non-acceptance) among various supports and systems, including family, peers, schools, and health providers. Specific examples of how to bolster support are then discussed within each system.
... Family support of LGB [12][13][14] and transgender youth 6,15 has been shown to be protective against psychological distress and increased risk behaviors such as drug use and increased rates of sexually transmitted infections (STIs) among the youth; however, parents often do not know how to approach their teens' gender identity concerns or provide the support their children may need. 8,12,16,17 One study found that parental support of transgender youth was associated with "higher life satisfaction. . . and fewer depressive symptoms" 15 among trans youth; however, parents often require their own support systems to help them understand, validate and advocate for their children. ...
... Yet parents from this group reported decreased feelings of isolation after meeting other parents in similar situations. 19 Thus, while there is some literature that describes the structure, process, and experiences with a transgender parent group and relates common topics discussed in the group, 16,17,20 fewer authors have shared data reporting regarding member preferences associated with the development of those groups. ...
Article
Full-text available
The purpose of this cross-sectional survey study is to explore transgender teens' and their parents' interest in and preferences regarding support groups in an effort to optimally serve the entire family's needs. The aims of the study were to: (1) describe transgender teens interest level and preferences regarding support groups; (2) describe parents of transgender teens interest level and preferences regarding support groups; and (3) compare responses based on demographics including teens versus parent, natal sex, and gender identity. De-identified surveys were collected from a convenience sample of transgender patients (N = 26), ages 13-18 years, and their parents (N = 20). Overall level of interest in support groups was 7.20/10 for youth and 7.95/10 for parents where 0 is not interested and 10 is very interested. Both groups endorsed benefits of a support group, including help with managing school issues, learning about local resources for transgender teens, and providing peer support. Both groups indicated "no time" as the most common potential barrier to attendance. Both groups expressed moderate interest in support groups, with minor differences between youths and parents noted in preferred support group structure. Further examination is warranted to determine optimal support group characteristics aimed specifically at parents and, separately, for youth. Additional support services might complement groups for a more comprehensive approach to support resources for this community.
... An increasing number of children have socially transitioned to live in transgender identities, yet very little is known about what factors may contribute to their wellbeing (Malpas 2011;Ehrensaft et al. 2018). Though gender-related social support has been frequently suggested as a potential predictor of psychopathology in such youth (Turban & Ehrensaft 2018;Holpuch 2016), and though some studies have demonstrated the relation between psychopathology and social support for one's ...
... An increasing number of children have socially transitioned to live in transgender identities, yet very little is known about what factors are protective against psychopathology in transgender youth who have made such a transition (Malpas 2011;Ehrensaft et al. 2018). Though it has frequently been suggested that social support for a youth's gender identity may be associated with lower levels of psychopathology in this group (Turban & Ehrensaft 2018; Holpuch 2016), very little empirical work has examined this potential association. ...
Article
Full-text available
Although increasing numbers of children have socially transitioned to live in line with their gender identities, little is known about factors associated with their wellbeing. This study examines the associations between parent-reported family, peer, and school support for a youth’s gender identity, as well as an objective measure of state-level support, with parent-reported internalizing symptoms in 265 transgender youth (67.2% transgender girls, 32.8% transgender boys), ages 3–15 years (M = 9.41, SD = 2.62). Parents who reported higher levels of family, peer, and school support for their child’s gender identity also reported fewer internalizing symptoms; the objective measure of state-level support was not related to internalizing symptoms. Additionally, peer and school support buffered against the association between gender-related victimization and internalizing symptoms, as reported by parents. This work demonstrates that even among transgender youth with families who supported their transitions, parents see better well-being in their children when they also see more support for the child’s gender identity from family, peers, and schools.
... In recent years, increasing scholarly and clinical attention has been paid to the experiences and challenges of parents of transgender (trans) children (e.g., Abreu et al., 2019;Field & Mattson, 2016;Malpas, 2011;Medico et al., 2020;Pullen Sansfaçon et al., 2020a). This article attempts to add to this growing body of knowledge by exploring the experiences and ascribed meanings of parents of trans emerging adults (between the ages of 18 and 26) in the specific context of Israel. ...
... The experiences of parents of trans children and their pathways to parenting have received growing scholarly attention in recent years (e.g., Abreu et al., 2019;Field & Mattson, 2016;Malpas, 2011;Medico et al., 2020;Pullen Sansfaçon et al., 2020a). Studies on trans children have demonstrated the fundamental importance of affirming family environments for improving the mental health of gender diverse youth and fostering resilience (Olson et al., 2016;Sansfaçon et al., 2018;Simons et al., 2013). ...
Article
Full-text available
Background Emerging adulthood is a developmental period that encompasses individuals from their late teens through at least their mid-twenties, causing parents to be engaged in “parenting” activities longer than in the past. The present study aims to explore the parenting experience and its ascribed meaning among parents of trans emerging adults in Israel. Method Perceptions and perspectives of 18 Israeli parents of trans emerging adults regarding their parenting experiences were explored using in-depth, semi-structured interviews. All interviews were audiotaped, fully transcribed verbatim, and thematically analyzed. Results Analysis of the interviews yielded three main themes. The first pertains to parental worries; the second pertains to parental support practices, including accompanying and supporting their child in different arenas and serving as their companions and advocates; and the third pertains to parental coping skills. Conclusion Participants portrayed the parenting of trans emerging adults as a demanding, challenging, and complex experience which they described as a “full time job.” Their parenting experiences revolved around the tension between responding to the special needs of their trans children by helping them navigate this period of experimentation and exploration, and the need to give them autonomy and help them develop the independence they want and need. This tension should be understood in light of the specific situation and the stage of the child’s transition, the parent-child relationship, and the family situation, in addition to the wider societal context, which is often hostile and transphobic.
... Kane (2006) associates the discrepancy between the support from mothers and fathers to the paternal anxiety that their child's nonconformity to their assigned gender could reflect on their masculinity. Moreover, many authors have observed that acceptance of a minor's gender identity can become a reason for conflict if parents take different positions on how to consider gender expression (Ferrari & Mancini, 2020;Hill & Menvielle, 2009;Malpas, 2011). Moreover, responses to gender nonconformity also vary depending on the child's gender at birth, as it seems that biologically female children expressing 'masculine' preferences are more socially tolerated that their male counterparts (Kane, 2006). ...
... First, attention must be paid to the child and the needs that he\she expresses in protecting his\her health. As constantly emerging during the interviews, the parents find themselves contributing to the development of the child's singularity while simultaneously acting as mediators between the child's needs and the social context, which is not always inclusive of diversity (Malpas, 2011;Robertson, 2014). ...
Article
Full-text available
Identities that differ from what is expected of each gender challenge the crystallised binary form of social organisation. Furthermore, having a gender-variant child is an experience that confronts parents with something unknown to them that questions most of their assumptions. In the Italian context, there is a lack of awareness about the population of transgender and gender-variant minors, and what their or their families’ needs are. In the present study, we interviewed the parents of gender-variant minors from Italy and asked them to describe the ways they got to know their child’s gender identity and how they managed such a completely new situation. The interviews were transcribed literally and analysed through discourse analysis. We carried out descriptions of how parents configure this topic and the different positionings adopted thorough their experience of understanding and managing gender variance. Overall, we discussed and promoted parent-children interacting modalities aimed at co-constructing and sharing the process of gender identity development, instead of adopting self-referential or ideological positionings. The present article offers a qualitative exploratory study of gender-variant minors and their families in the Italian context. The limitations of the study and suggestions for future research are also presented.
... A similar approach has also been adopted in studies on trans people and their families that examine resilience at the family level, delineating the crucial role played by parental and familial support in the well-being and protection of trans children (von Doussa et al., 2017;Malpas et al., 2018). Moreover, studies have revealed that parental support may enhance resilience in trans young adults, demonstrating its protective role vis-a-vis transphobia (Kuvalanka et al., 2014;Malpas, 2011). Other studies expand our understanding of the familial aspects of gender diversity by exploring the experiences of family members of trans persons, particularly their parents (Singh & McKleroy, 2011). ...
... Although growing scholarly and clinical attention in recent years has been paid to the experiences and challenges of parents of trans children with a focus on parents of young children and adolescents (Abreu et al., 2019;Field & Mattson, 2016;Gray et al., 2016;Malpas, 2011), the literature dealing with the experiences of parents of trans young adults remains scarce. The present study aims to start filling this gap and explore the experiences and accounts of parents of trans young adults. ...
Article
This study explores the lived experiences of Israeli parents of transgender young adults, depicting gender diversity as a family-relational phenomenon. The analysis of 18 in-depth, semi-structured interviews with Israeli parents of trans young adults suggests that the parents' experiences were characterized by a dialectic between feelings of vulnerability and resilience. The parents' vulnerability was shaped by their social positioning as a minority group as well as their socio-political environment, and their ability to cope with these hardships enhanced their resilience. As the parents developed their resilience through meaning-making, social support, and activism, they gained a new sense of agency alongside a deep sense of vulnerability, suggesting that vulnerability and resilience are not objective, opposite binaries but rather fluid categories that are continually constructed through the intersection of micro- and macro-level factors.
... For younger patients, family or caregiver involvement should be encouraged in treatment decisions with the understanding that, in most circumstances, parents have primary medical decision-making rights for minors. In such cases, MI can be implemented with parents or caregivers to establish rapport, which may facilitate psychoeducation and perspective-taking to assist families whose treatment goals may not align (Malpas, 2011). By implementing a more collaborative approach, health professionals can facilitate the decision-making process while recognizing that the decision may ultimately belong to the patient and/or their family. ...
... For example, both Al and his mother want to improve Al's depressive symptoms and overall health. The psychologist also should inquire about the mother's understanding of what it means to be transgender and offer to provide education and address any misperceptions (Malpas, 2011). For instance, if the mother shares that she believes being transgender is a choice, that she is fearful of Al's future as a Black transgender man, or that her cultural or religious beliefs are standing in the way of her support for Al's transition, the psychologist can offer a space for mom to share her concerns and fears in a nonjudgmental manner. ...
Article
Implicit bias and health-related stigma can impact patient-provider communication, particularly related to pediatric chronic conditions that are currently increasing in incidence. This paper highlights the intersection of stigma and bias in health care using a complex clinical vignette to illustrate ethical problem-solving and patient-centered communication through motivational interviewing. Motivational interviewing may improve patient-centered communication and assist in navigating ethical considerations for youth facing stigmatizing conditions such as obesity, chronic pain, and major depression. Clinical considerations for health service psychologists are provided and tailored for gender identity, race/ethnicity, and other relevant sociocultural considerations. Psychologists play an important role in providing education and training to other health professionals on motivational interviewing strategies to facilitate ethical problem-solving and foster more effective patient-provider communication for youth facing stigma in health care settings.
... Parents may experience grief, shame, guilt, or anger when they first become aware of their child's gender identity. They also may be faced with new stressful experiences such as coming out to family members and friends, navigating conflict within the family, fearing that their child will be bullied, and making important medical decisions for their child, (Dierckx et al., 2016;Hill & Menvielle, 2009;Kuvalanka et al., 2014;Malpas, 2011;Zamboni, 2006). Parents often feel overwhelmed, confused, and isolated upon the discovery of their child's transgender status (Kuvalanka et al., 2014;Pullen Sansfaçon et al., 2020). ...
... Furthermore, parents may blame their child for the distress they experience (Zamboni, 2006) which could increase conflict in their relationship. Parents may also experience conflict between each other if they disagree about the acceptance or rejection of their child's transgender identity (Hill & Menvielle, 2009;Kuvalanka et al., 2014;Malpas, 2011). Parental conflict can have negative impacts on children, especially if the child feels responsible for the conflict (Yap et al., 2014). ...
Article
Parental support plays a vital role in protecting trans youth from mental health risks including depression, anxiety, substance use, and suicide. This study examined the acceptability of the Parent Support Program, an online intervention aimed at increasing transgender affirming behaviors. The Parent Support Program includes three modules with psychoeducational text, affirming images, educational videos, videos of parents and trans youth, writing activities, and interactive quizzes. The program content and structure were developed based on psychological theories of behavior change and relevant research. Feedback was collected from two focus groups with parents of transgender youth and experts in transgender mental health. This pilot study found that the intervention was highly acceptable and provided useful information on how to improve the intervention in preparation for a larger efficacy study. Improvements include making the intervention more tailored to the participant and modifying writing exercises. Implications for future research and practice with this population are discussed.
... Some parents immediately affirm their child's gender and are able to express their support and love (Aramburu Alegría, 2018;Travers et al., 2012;Wallace & Drake, 2018), while other young people report experiencing outright rejection, lack of explicit support or ambivalence regarding their experienced gender identity from their parents (Sansfaçon et al., 2018;Travers et al., 2012). Initial reaction to becoming aware of their child's gender identity have been reported to include confusion, dismissal, sadness, disbelief, fear for the future, uncertainty, and ambivalence (Gregor et al., 2015;Malpas, 2011). Initial reactions may also be positive and supportive (Pullen Sansfaçon et al., 2015;Pyne, 2016;Wren, 2002). ...
... Initial reactions may also be positive and supportive (Pullen Sansfaçon et al., 2015;Pyne, 2016;Wren, 2002). Over the course of their child's gender identity journey, parents report experiences of worry, anxiety, stress, loss and grief, helplessness and loneliness but also positive experiences of personal growth and stronger parent-child relationships (Aramburu Alegría, 2018; Bennett & Glasgow, 2009;Bull & D' Arrigo-Patrick, 2018;Gregor et al., 2015;Malpas, 2011). ...
Article
Trans youth are at high risk of mental health difficulties and negative life events. Strong parental support is highly protective however there is little understanding of what factors facilitate the process of parental understanding and acceptance of a child’s gender identity. We aimed to better understand a) preexisting factors influencing levels of parental acceptance of their child’s gender identity; b) the factors parents find helpful in facilitating acceptance of their child’s gender identity once they become aware; and c) how parents experience extended family, cultural and religious reactions. Using cross-sectional survey data, we explored the experiences of parents and guardians (N = 194). Quantitative data were primarily analyzed using Bayesian regression models and qualitative data were thematically analyzed. Several factors were salient in influencing parental acceptance, including the nature of their child’s gender identity, and levels of awareness and acceptance of the child’s gender identity at time of initial parental awareness. Multiple factors aided acceptance, including information, peer support, and the quality of the dyadic relationship. Findings provide a better understanding of how parental acceptance of a child’s gender identity develops. We provide recommendations on what may help parents to optimally support their child, such as accessible, good-quality information.
... The prevailing contemporary theory affirms that all human beings carry with them the socially constructed attributes of masculine and feminine, with characteristics that challenge any binary categorization (Goldner, 1991). Malpas (2011) and other clinicians 226 report the existence of a large proportion of parents who accept gender variance and want to know how to handle this challenge (Brill & Pepper, 2008) ...
... However, such interventions should not be undertaken in isolation for reasons of access and scale. Study has shown that there are important environmental factors such as parental attitudes, which can vary from shock, sadness, and anger in response to their child's minority identity (Malpas, 2011), and bullying and harassment (Kosciw et al., 2016) that can contribute to mental illness meaning larger scale initiatives are thus also needed. Initiatives such as promoting school nurses as advocates for improving parental education (Gower et al., 2018), gender-affirming interventions to enhance family support (Simons et al., 2013), and school policies, which address bullying based on youth's perceived or actual sexual orientation and gender (Hatzenbuehler, Schwab-Reese, et al., 2015), may be community-and policy-level solutions for health care practitioners to pursue in furtherance of combating community-and society-level stressors affecting vulnerable youth. ...
Article
Full-text available
Background/Aims. Adolescents who identify as nonbinary gender or as not heterosexual report higher levels of mental illness than their counterparts. Cannabis use is a commonly employed strategy to cope with mental illness symptoms among adolescents; however, cannabis use can have many deleterious health consequences for youth. Within the frame of minority stress theory, this study investigates the relationships between gender identity and sexual orientation, internalizing disorder symptoms, and cannabis use among adolescents. Method. A national cross-sectional survey of a generalizable sample of high school students in Canada from the 2017 wave (N = 15,191) of the Cancer Risk Assessment in Youth Survey was analyzed in spring 2019. Mediation analyses were completed to examine risk of internalizing disorder symptoms as a potential mediator of the association between (1) gender identity and (2) sexual orientation, and cannabis use. Results. Indirect effects in all models show significantly higher levels of reported internalizing disorder symptoms for female (OR = 3.44, 95% CI [2.84, 4.18]) and nonbinary gender (OR = 3.75, 95% CI [2.16, 6.51]) compared with male students. Sexual minority adolescents had higher odds of internalizing disorder risk relative to non–sexual minority adolescents (OR = 3.13, 95% CI [2.63, 3.74]). Students who reported higher rates of internalizing disorder symptoms were more likely to have ever used cannabis. Patterns of partial mediation are also present among all groups. Discussion/Conclusions. Findings can be used to better inform mental health interventions for adolescents. Future study should explore specific mental health stressors of vulnerable adolescent groups with respect to cannabis use as a coping mechanism.
... lower) levels of father acceptance (van Beusekom, Bos, Overbeek, & Sandfort, 2015). Other researchers have highlighted parental acceptance of GNC as central for the mental health of gender-nonconforming children (e.g., Hill & Menvielle, 2009;Malpas, 2011;Menvielle & Tuerk, 2002;Olson, Durwood, DeMeules, & McLaughlin, 2016;Wren, 2002). ...
Article
Full-text available
No study to date has simultaneously tested how poor peer relations, generic risk factors, and parental attitudes impact the behavioral and emotional challenges of children who vary in their gender expression. In a community sample, the present study investigated various hypothesized psychosocial and generic risk factors regarding the association between childhood gender nonconformity (GNC) and psychological well-being. Canadian parents/guardians reported on their children aged 6–12 years (N = 1719, 48.8% assigned male at birth) regarding their child’s GNC, measured by the Gender Identity Questionnaire for Children; behavioral and emotional challenges, measured by the Child Behavior Checklist (CBCL); and peer relations, measured by the CBCL and Strength and Difficulties Questionnaire. Parent/guardian gender-stereotypical attitudes toward child-rearing were assessed using an adapted version of the Child-Rearing Sex Role Attitude Scale, and attachment between the parent/guardian and child was measured with an adapted version of the Child-Rearing Practices Report. Based on regression analyses, GNC was related to elevated behavioral and emotional challenges, and this association was stronger for those who experienced poor peer relations as well as for those whose parents/guardians endorsed gender-stereotyped attitudes and were less willing to serve as a secure base for the child. Recommendations are provided for ways in which social environments can be altered to improve psychological well-being among gender-nonconforming children.
... Previous research has found that parental support, a strong protective factor, increases with education and support (Pullen Sansfaçon et al., 2019). Parent coaching and parent support groups focused on psychoeducation, support for their process of acceptance, and raising awareness of their cisgender privilege can aid parents in understanding and supporting their TNB youth (Harper & Singh, 2014;Malpas, 2011). Family therapy focused on family connectedness has the potential to be an additional protective factor for TNB youth (Catalpa & McGuire, 2018). ...
Article
The current study used family and ecological systems approaches to understand transgender and/or nonbinary (TNB) youths' experiences of their gender identity within family and community contexts. A sample of 33 TNB youth, ages 13-17 years (M = 15.18, SD = 1.24), were recruited from community-based venues in the New England region of the United States to participate in the Trans Teen and Family Narratives Project, a longitudinal community-based mixed methods study. TNB youth in the sample identified as trans girls (n = 12), trans boys (n = 17), and nonbinary (n = 3 assigned female at birth; n = 1 assigned male at birth). Race/ethnicity of the sample was 73% White and 15% mixed race/ethnicity. All participants completed a one-time, in-person semi-structured qualitative interview at baseline about their family and community-based experiences related to their TNB identity. Interviews were audio-recorded and professionally transcribed. Interview transcripts were coded and analyzed using immersion/crystallization and thematic analysis approaches. Eight themes were developed, which correspond to different levels of the ecological systems model: individual-level (identity processes, emotions/coping), family-level (general family experiences, family support), community-level (general community experiences; community support; lesbian, gay, bisexual, transgender, queer (LGBTQ) community), and societal/institutional-level (external forces). Findings emphasize the importance of using family and ecological systems approaches to understanding the family- and community-based experiences of TNB youth and have implications for improving clinical practice with TNB youth and families.
... Unfortunately, evidence suggests that in the field of SFT, students are not being adequately trained because (a) there is a lack of LGBTQI affirmative program policies and procedures in place in graduate MFT programs and (b) there is a lack of LGBTQI affirming course content and a lack of access to affirmative supervision when working with LGBTQI and gender non-binary clients (McGeorge & Stone Carlson, 2011). Non-binary people in couples and families continue to be routinely marginalized and omitted from theories, training, and clinical work (Giammattei, 2015;Malpas, 2011). ...
Article
Sexual identity development has traditionally been theorized about from within heteronormative societies founded on patriarchal notions with links to misogyny, racism, and classism, among others. These forms of domination have constrained the way sexual identity has been conceived of, researched and written about within the mental health fields and limited the efficacy of clinical work with all people but especially sexual minorities and those who are gender non‐binary. In this chapter the authors will deconstruct heteronormativity, examine the deleterious effect of it on mental health, and locate the influence of intersections of oppression on the field of SFT theory and in clinical work. An LGBTQI (lesbian, gay, bisexual, transgender, questioning, intersex) affirmative clinical framework developed from systems theory and queer theory will be outlined, and then a case study using the framework will be described.
... Ebeveynler kendilerini temel işlevleri açısından çatışmalı bir noktada bulabilirler. Çocuğun kendine güvenli, bütünlüklü ve zorluklara dirençli bir kimlik geliştirmesini desteklemekle, cinsiyet kimliklerinin katı bir şekilde yaşandığı, trans bireylere yönelik şiddete varan ayrımcı tutumların hakim olduğu bir toplum içinde güvenliğini ve kabullenilmesini sağlamak arasında gelgitler yaşanabilir 47 ...
Article
Full-text available
Psikiyatride Güncel, Cinsel İşlev Bozuklukları | CİLT 4 • SAYI 4 | KIŞ 2014 | I
... However, such interventions should not be undertaken in isolation for reasons of access and scale. Study has shown that there are important environmental factors such as parental attitudes, which can vary from shock, sadness, and anger in response to their child's minority identity (Malpas, 2011), and bullying and harassment (Kosciw et al., 2016) that can contribute to mental illness meaning larger scale initiatives are thus also needed. Initiatives such as promoting school nurses as advocates for improving parental education (Gower et al., 2018), gender-affirming interventions to enhance family support (Simons et al., 2013), and school policies, which address bullying based on youth's perceived or actual sexual orientation and gender (Hatzenbuehler, Schwab-Reese, et al., 2015), may be community-and policy-level solutions for health care practitioners to pursue in furtherance of combating community-and society-level stressors affecting vulnerable youth. ...
Article
Background Adolescent cannabis use is perceived as a risky behavior, has been linked with many negative health outcomes, and is increasingly being connected with stigma. Methods The purpose of this study is to investigate how cannabis use is associated with potentially stigmatizing markers of identity among adolescents two waves of a repeat cross-sectional survey (2015 N=12,110; 2017 N = 15,191) of high schools students in seven Canadian provinces. Students were asked about ever use of cannabis, as well as “stigma markers”, including their current living arrangement, mother’s education, and ethnicity. Multivariable logistic regression models were used to examine associations between cannabis use and stigma markers. Results After adjusting models for grade, gender and province of residence, students who did not live with their mothers had higher odds of cannabis use relative to students living with their mothers [OR = 1.94, 95% CI 1.62–2.31]. Low maternal education was also significantly associated with cannabis use, as was ethnicity (students who identified as Indigenous had 3.38 (95% CI 2.29–4.99) times higher odds of using cannabis compared to students who identified as “white” in 2017). Findings related to attending school in a rural (vs. urban) area (2015 OR = 1.33 95% CI 0.99–1.78; 2017 OR = 1.44 95% CI 0.9–-2.15) and low SES (2015 OR = 0.99, 95% 0.98–1.00; 2017 OR = 1.00, 95% CI 0.98–1.01) were more marginal. Conclusions Future research should explore cannabis initiation experiences among vulnerable groups to better understand potential stigma triggers.
... The first category was gender expression. Expansive expression seemed to pose risks to personal or family safety, which was consistent with other studies (Airton, 2018;Giammattei, 2015;Malpas, 2011;Nolle, 2006). Gender expansive participants were possibly dealing with multiple levels of oppression and felt that social support for their families was especially limited (Airton, 2018;Giammattei, 2015). ...
Article
Full-text available
Although there is a growing body of knowledge focusing on lesbian families and their parenting experiences, African American lesbian mothers are often underrepresented in research. This qualitative exploratory study aims to understand the constructions and perspectives of African American lesbian mothers, from an urban East Coast area, on risk and well-being. Fifteen in-depth semi-structured interviews were conducted and analyzed at the end of 2016, coinciding with the presidential election yielding main themes that were significant for the participants pertaining to the mothers' experiences and construction of the challenges and risks to well-being. Main themes first focused on discrimination and insensitivity in everyday spaces; then moved into the effects of political climate on perceived safety and security, conditions and unintended consequences of the coming out process; and ended with strategies for reducing risk. Adoption of an intersectional framework to discuss our findings allowed us to explore the ways in which multiple identities engage to shape experiences and constructions of risk and well-being among African American lesbian parents. The results suggest the importance of context (e.g., political, historical, gender-related, racial) when working with LGBTQ+ families of color.
... Findings highlight the importance of an enhanced emphasis on caregiver involvement in therapy for GM youths. Results suggest that therapists should acknowledge and validate caregivers' experiences, rather than being assertive or giving explicit advice, which may risk alienating caregivers and result in early termination [32]. Likewise, it may be clinically advantageous for therapists to address caregivers' knowledge and acceptance of their child's gender identity before, or in conjunction with, other forms of caregiver involvement (e.g., family therapy). ...
Preprint
Full-text available
Purpose: Gender minority (GM) adolescents’ risk for mental health problems is partially attributable to barriers they face accessing and engaging in mental health services. GM adolescents and their caregivers have highlighted the dearth of providers trained in gender affirming care as a critical treatment barrier, yet little is known about their specific experiences in mental health therapy. The present study sought to elucidate these experiences and highlight practices that may be acceptable to GM adolescents and their caregivers. Methods: Qualitative description was employed to code data from 100 clinical interviews completed with GM adolescents (n = 59; ages 11–20) and/or their caregivers (n = 72). Participants were seeking medical gender transition services at a pediatric gender program and consented to have their clinical interview data used for research purposes.Results: Most adolescents (81%) had a history of mental health treatment. Participants reported both positive and negative therapy experiences pertaining to therapists’ qualities (e.g., behaviors, attributes), therapists’ gender affirmation (e.g., engagement in discussions of GM identity and health), therapy practices (e.g., teaching skills), and caregiver involvement in therapy (e.g., attending sessions, terminating the adolescent’s therapy). Conclusions: Results suggest that GM adolescents and their caregivers find commonly used therapy practices helpful and sometimes differ in their reactions to gender affirming therapists. Findings highlight the importance of caregiver engagement in therapy and underscore the need for increased efforts to train therapists in gender affirming practices.
... Not only have such centers quadrupled in numbers, they have also reported an influx of gender diverse youth seeking medical treatments (Shumer, Nokoff, & Spack, 2016). Unfortunately, research on gender diversity in children prior to puberty is limited and only now slowly emerging (Malpas, 2011;Olson, 2016). The paucity of research may be due to the fact that gender diverse youth generally have not been seen by professionals in gender clinics, which more typically cater to older children and adolescents (e.g., De Vries & Cohen-Kettenis, 2012;Zucker, Wood, Singh, & Bradley, 2012). ...
Article
Abstract The goals of the present article are to summarize the current state of assessment measures pertaining to the evaluation of gender in young children, identify gaps in knowledge, and propose priorities for research regarding gender identity development as concepts of gender evolve over time. We provide an overview of assessment tools that have been used to measure gender-related constructs in young children and highlight areas in which more nuanced concepts of gender have driven the creation of new approaches to assessment. We identify a number of overarching assessment limitations as well, with recommendations for research priorities: (a) developing and validating measures of gender identity in young children, (b) examining gender development in typical and gender diverse young children, (c) incorporating a nonbinary model of gender into assessment, (d) examining family and broader ecological variables as they impact gender development, and (e) studying factors that influence parental beliefs about their young child’s gender. (PsycInfo Database Record (c) 2020 APA, all rights reserved)
... Parents (mostly mothers) of transgender and gendernonconforming youth consistently report to therapists their fears and concerns for the physical safety and emotional well-being of their children given their children's increased risk for exposure to violence, IPV, and minority stressors (Hidalgo et al., 2017;Katz-Wise et al., 2017;Kuvalanka, Weiner, & Mahan, 2014). Therapeutic approaches such as the multidimensional family approach seek to both validate parental concerns and underscore to parents (through the use of psychoeducation) that their support of their transgender child is perhaps the most significant psychosocial protective factor (Malpas, 2011). The findings of the current study provide parents and clinicians alike with an even stronger evidence base for foundational psychoeducational approaches that ultimately benefit their children. ...
Article
Research is critically needed to understand protective processes that may lessen the impact of intimate partner violence (IPV) on negative outcomes for transgender individuals. The current study utilized a latent class analysis to identify combinations of protective processes (i.e., collective self-esteem and social support) in relation to internalizing mental health symptoms among young transgender women (YTW) survivors of IPV. Data from Project LifeSkills (2012-2015), a multisite trial for HIV sexual risk reduction intervention, were used for the present study. A subsample of 78 YTW (ages 16 to 29) who were IPV survivors (i.e., indicated lifetime IPV) were included in the analyses. Participants completed measures of general social support, perceived social support from their mother and friends, and collective self-esteem, as well as mental health symptoms. Three latent classes emerged: 1) YTW who perceived high levels of social support and collective self-esteem (48%), 2) YTW who perceived low levels of collective self-esteem, but average to high levels of social support from mother and friends (23%), and 3) YTW who perceived low levels of collective self-esteem and low to average levels of social support from mother and friends (29%). YTW in the overall low class had significantly higher levels of depressive, anxiety, and somatization symptoms, compared to the other two classes. These findings highlight how low levels of social support and collective self-esteem can place YTW survivors of IPV at significant risk for experiencing negative internalizing mental health symptoms.
... One of the difficulties that families face concerns the genderist perspective and the rigid gender binary system that has been culturally transmitted by their own families of origin and society. Such a conceptual framework is questioned and challenged by the gender identity of their TGE children (Malpas, 2011). Parents may also struggle with the fear of prejudice and violence in a social context in which gender variance is still stigmatized, and they may also experience a sense of guilt and responsibility for their children's condition (Johnson & Benson, 2014;Kuvalanka et al., 2014). ...
Article
The aim of the study was to explore the experiences and representations of Italian parents of TGE (Transgender and Gender-Expansive) adolescents diagnosed with gender dysphoria who, for the first time, attended a gender clinic for psychological consultation. This study presents findings from fifteen parents of TGE adolescents, mostly (93%) trans boys, aged 14–19. The analysis identified four main themes: Gender Dysphoria: Something Impossible to Understand, Resigned Acceptance, Strategies of social acceptance in a complex context and The Limits of Healthcare Services. Results are discussed in the light of a highly transphobic social and cultural context.
... Menvielle and Tuerk (2002) highlighted that one obstacle to engaging parents is the stigma attached to gender non-conformity. Parents who participate in group interventions are likely to be more accepting of their teen's gender exploration (Malpas, 2011) due to a selection bias. In future studies, it would be helpful to explore this further and measure caregivers' level of acceptance of their teen's gender identity and gender journey pre-and post-participation in the group. ...
Article
Full-text available
Gender non-conforming and trans youth experience high rates of bullying and victimization, placing them at risk for serious mental health challenges. Parent support is one of the most significant protective factors in this population, and yet few programs are specifically developed to promote parenting sensitivity, understanding, and acceptance. Connect , a trauma-informed and attachment-based group program for caregivers of at-risk adolescents, has been shown to reduce parent stress and depressed mood, increase parents' sense of efficacy and satisfaction, and reduce parent-teen conflict. Teens benefit from increased attachment security and improved mental health and well-being. Treatment effects have been documented to continue for up to 2 years post-treatment. This paper describes the adaptation of the Connect program to create a new program, Transforming Connections , for caregivers of transgender and gender non-conforming youth. Participants in the first three groups were 20 parents of 16 gender non-conforming youth (ages 12–18). Common themes in group discussions related to gender included: coming out, connecting with peers, affirming pronouns/names, medical transition, parental reactions (e.g., confusion, isolation, grief, acceptance), and concerns about safety and mental health. All parents completed the full program, attending on average 9 of 10 sessions. Caregivers reported feeling respected, safe, and welcomed in the program and indicated that learning about attachment enhanced their understanding of their teen and their gender journey as well as themselves as a parent. Additionally, all parents reported applying the ideas discussed in the group frequently (60%) or somewhat frequently (40%). The majority indicated that their relationship with their teen had improved somewhat (65%) or a great deal (20%). Findings provide positive preliminary evidence of the fit and value of Transforming Connections for these families.
... They have also focused on the coming-out processes related to the development of gay and lesbian identities, while bisexual and other more fluid forms of sexual nonconformity -whose narratives do not hinge on the 'fateful' moment of coming out -have been largely overlooked (Watson, 2014). Similarly, studies on the family experiences of trans people are emerging; these too acknowledge the importance of supportive families, and the parents' need for support in their adjustment to their children's social difference (Malpas, 2011;Norwood, 2013). Comparing parents of transgender children with other parents from PFLAG, the US organization of parents of LGBTQ children, Field and Mattson (2016) trace some specificities in these families: the greater social invisibility and stigmatization of transsexuality and transgenderism (see also Dierckx and Platero, 2017), the actual physical changes with gender transitions and the challenges to parents' own understandings about gender identity. ...
Article
In the past 10-15 years, paediatric transgender care has emerged at the forefront of several general practice and subspecialty guidelines and is the topic of continuing medical education for various medical disciplines. Providers in specialties ranging from family medicine, paediatrics and adolescent medicine to endocrinology, gynaecology and urology are caring for transgender patients in increasing numbers. Current and evolving national and international best practice guidelines recommend offering a halt of endogenous puberty for patients with early gender dysphoria, in whom impending puberty is unacceptable for their psychosocial health and wellness. Pubertal blockade has implications for fertility preservation, transgender surgical care and psychosocial health, all of which must be considered and discussed with the patient and their family and/or legal guardian before initiation.
Article
Working with lesbian, gay, bisexual transgender, and queer-identified (LGBTQ) youth can present a uniquely challenging opportunity for clinicians given the rapidly changing landscapes of gender and sexuality and deficits in training and education. The goal of this article is to provide the most up-to-date trends and advances in the mental health care of LGBTQ youth to empower clinicians in delivering evidence-based care. We adapt the "Spheres of Influence" model to challenge the clinician to think more globally about our interventions. When LGBTQ youth are supported at every sphere, we give them the best chance to survive and thrive into adulthood.
Article
Research has shown that parents of trans children face numerous challenges as they navigate their parenting role, however, little is known about the impact of these challenges on parents’ psychological wellbeing. Utilizing an interpretative phenomenological approach and interpretive phenomenological analysis (IPA), the current study aimed to address this gap in the literature by exploring how parents perceive their experience of having a trans child has impacted their psychological wellbeing. Semi-structured in-depth interviews were conducted with Australian parents of trans children aged 17 and under (N = 12). Five major themes were identified in the data: 1) Dyadic factors; 2) Threats to mental health; 3) Personal growth; 4) Support and acceptance; and 5) Coping. Overall, results indicated that experiences of psychological wellbeing were multidimensional, characterized by numerous mental health threats and concurrent positive experiences of personal growth. Findings also highlighted the importance of support and acceptance from others, and various coping strategies employed by parents to protect against mental health threats and enhance their wellbeing. These findings provide an in-depth understanding of factors that both threaten and enhance wellbeing amongst parents of trans children, offering nuanced insight for clinicians and a foundation for future research.
Article
Résumé Cet entretien est la suite et le complément de l’article « Transidentités et changement de sexe : le point de vue du sociologue, le rôle du psychiatre ». Les psychologues Sandrine Coussinoux, Eirini Rari et le psychiatre Thierry Gallarda y évoquent la problématique de la réassignation de sexe pour des personnes transidentitaires ainsi que le rôle des psychologues qui travaillent sur ce sujet au sein de l’équipe parisienne pluridisciplinaire spécialisée « Dysphorie de genre et santé mentale ».
Article
Modern transgender and non-binary (TGNB) pediatric health care originated in the 1990s. This patient population is adversely affected by minority stress, victimization, mental health disparities, and barriers to health care With improving social and cultural support for TGNB identities and favorable evidence for affirming social and medical interventions, the need for pediatric gender services clinics has grown. Gender-affirming care requires collaboration between social and medical entities, including school personnel, community services, medical providers, and mental health professionals, which is best served within a multidisciplinary treatment model of care. This article provides an overview of the components within multidisciplinary pediatric gender clinics.
Article
"If One Feels Better Like That …". Adolescent Sibling Relationship in the Context of Transgender Development A transgender development in youth can influence the relationship of concerned youth and their siblings. While in most surveys, the focus lies on transgender adolescents, both sides shall be interviewed here to capture the situation of siblings and to relate the results. For this purpose, guide interviews with ten transgender adolescents and twelve of their siblings were analysed in accordance to Grounded Theory. In most cases, participants were satisfied with the sibling relationship. After the coming-out of the transgender adolescent they showed both positive and negative reactions that, however, changed to respect and acceptance by time without exception. Doubt, compassion and grief were short lived and often replaced by joy for the transgender adolescent. Transgender youth were mostly satisfied with the reaction of their sibling though the amount of support varied. The time of coming-out and transition often led to an improvement in sibling relationship, more closeness and family cohesion. In general, siblings seem to be immediately concerned by transgenderism in adolescence. In clinical practice, they should thus be included from the beginning. By taking into account their situation, negative developments can be prevented, and the sibling relationship become usable as a resource.
Article
This critical review article examines research to date on the experiences of parents of gender-diverse children. This research is expanding quickly, but its history spans decades and disciplines. Based on a review of 64 research publications from 1996 to 2021, the article traces a development from pathologizing to affirming approaches to research with parents. The earlier pathologizing approach is evident in what researchers report in terms of parent reactions, involving exclusively negative emotions and a discourse of parental “grief,” but also in how researchers approach the topic themselves, failing to conceive of alternative ways of reacting that do not involve negative emotions and trauma. This article discusses ways this earlier research could be interpreted differently, including how negative emotions can reflect secondary stigma and gender minority stress, and how grief can point to internalized cisgenderism. The review identifies changes toward an affirming approach in more recent research, which relocates the problem from gender-diverse children themselves to the society surrounding them. It also highlights directions for future research, centering around resilience rather than trauma – how parents find strength and hope in a challenging environment, and how parenting a gender-diverse child can be a positive experience for parents and children alike.
Chapter
Cultural narratives of our society surrounding gender identity and sexuality can provide a rigid narrative of these constructs leading to homophobia and transphobia toward individuals who identify outside of these constructs. This book chapter will explore how cultural narratives create homophobia and transphobia as well as how these phobias affect individuals within the LGBTQ+ community. Mental health practitioners need to be aware of the pervasive discrimination, prejudice, and violence toward LGBTQ+ persons as these acts can create clinical issues that present common problems for child, adolescent, and adult clients, their families, and their partners. Mental health practitioners may hold internalized biases and benefit from recognizing these biases and bracketing values so that they can more effectively work with, and be an ally for, LGBTQ+ clients. Furthermore, educators in the field of mental health can work to create affirming classroom settings and effectively prepare students to work with the LGBTQ+ community. This chapter will address these issues within the mental health community as well as strategies for clinicians to help clients heal from homophobia and transphobia.
Article
Social work in the US has failed to respond to the largest legislative attack on the rights of transgender and non-binary people in the history of the country. Hundreds of laws have been proposed over the past several years, aiming to ban transgender and non-binary people from public life, as well as criminalising gender-affirming healthcare and attempting to remove transgender youth from supportive families for forced detransition. Beginning with the Trump administration, these bills have exponentially increased in number, now being proposed in more than 60 per cent of the US. This article critically reviews the ways in which national social work organisations have failed to address both the systemic erasure of transgender people in their pedagogy and the behaviours of specific actors within the social work profession who are actively helping to draft anti-trans legislation and advocate for conversion therapy, contravening both the evidence base and code of ethics.
Article
Working with transgender, gender diverse, and non‐binary (TGDNB) young people and their families requires a family therapist to hold multiple positions of expert, supporter, cheerleader, coach, and creator of a safe space. Anxiety is often high in family systems following a young person's disclosure of their gender diverse identity. Parents experience a range of emotions while trying to support their child to navigate challenging decisions, heavily influenced by society and untold family rules. The existing literature relating to families of TGDNB young people focuses on parental responses and the impact of an affirming or rejecting position. However, little research has focused on working with families to increase their position of support, which ultimately improves outcomes for TGDNB young people. This case study demonstrates the effectiveness of an integrative family therapy approach to working with TGDNB young people and their families, as a way of navigating this challenging and rewarding area of work.
Article
Full-text available
As a nonbinary public health advocate , therapist, and researcher and as a parent of a trans girl, I am both moved and troubled by Rider et al.'s article in this issue of AJPH (p. 499). I want to thank and congratulate the authors for studying an extremely important yet underexa-mined topic in this put-at-risk population , and I thank AJPH for shedding light on this public health issue. As a sex work rights activist, it is important for me to clarify that sex trading among youths is psychologically, legally, and morally distinct from sex trading among adults. As such, trading sex as youths is, by nature, exploitative. Trading sex is an extreme risk factor for mental health challenges, including suicide and self-harm among youths, and especially among transgender and gender diverse (TGD) youths. Approximately 6% of TGD 9th and 11th graders report having traded sex in their relatively short lifetimes. More than three quarters of TGD youths who traded sex attempted to end their lives by suicide. This is a public health catastrophe. Think about Layla, a 16-year-old Black trans girl, who trades sex to buy food and sleep in someone's place to spend the freezing winter nights indoors. Consider the multiple systems that actively pushed Layla to trade sex: the rejecting family; the overburdened school staff who do not understand why Layla is struggling academically; the lack of community support for TGD youths due to lack of funding by the city and state; and the transphobic laws and policies, along with pervasive negative attitudes toward TGD individuals in the United States. Sex trading among youths is a result of the unjust lack of support, resources , and programs designed to empower youths, especially TGD youths. Put differently, sex trading among TGD youths is an indicator of failure at multiple levels, including the family, school, community, city, state, and federal systems. Clearly, there is a dire need for multilevel public health interventions and programs addressing sex trading among youths, especially among TGD youths. In fact, we need interventions far earlier in the trajectory into sex trading. Tangible intervention recommendations to address sex trading among TGD youths, along with its antecedents and consequences across multiple levels are included (Box 1). To continuously inform and refine multilevel intervention programs, further research on TGD youths who trade sex is warranted. First, investigating the individual, interpersonal, and institutional risk factors for sex trading is critical to further elucidate trajecto-ries into sex trading and to identify more intervention targets to eliminate sex trading among TGD youths. Second , given the alarming rates of suicide attempts and self-harm among TGD youths who trade sex, examining famil-ial, school, community, and other structural resilience factors is particularly needed. Third, applying syndemics theory to research about sex trading among TGD youths may prove beneficial because sex trading often coexists with other syndemic conditions, such as housing instability, polysubstance use, childhood trauma, and intimate partner violence. 11 Fourth, to protect TGD youths, future studies would benefit from inquiring with whom they traded sex and for what purposes. Last, given that most TGD youths who traded sex identified as LGBQ1 and of color, employing an intersectional framework in future research is essential to identifying the unique needs of TGD youths who trade sex.
Article
Parents of non-binary children undergo profound changes as they learn to first understand and then support their child. The question guiding this study was: what are the stories parents of non-binary children tell about how they came to understand and affirm their child? This narrative study provides a definition of non-binary gender, a review of peer-reviewed literature on therapy with children and adolescents who identify as transgender or non-binary, as well as narrative findings from three mothers of non-binary children ages 8 −11. Stories of parents confronting core beliefs, stepping into leadership, and feeling like they do not fit in or belong in ostensibly supportive spaces are presented. Relevance to narrative therapy is highlighted as well as the need for more research on family processes that enact support for transgender and non-binary children.
Article
Transgender and gender diverse (TGD) children face increased behavioral health risks including suicidal behaviors and substance abuse. Parental affirmation is associated with behavioral health outcomes similar to non-TGD peers. This integrative review synthesizes and appraises evidence regarding experiences of parenting a TGD child in the United States or Canada from 2008 to 2018. Most parents across these 15 studies described affirming their child’s gender at time of interview. Parents reported initial interpersonal processes (emotions, concerns, beliefs), sought education (frequently online), and described interactions with family members and professionals that were not always affirming. Parents accessed support groups but described their own well-being as a low priority relative to the child’s needs. Parents’ own needs for well-being may affect the process of parenting a TGD child and should be explored. Future research should address the experiences of non-parent family members and participants from more diverse backgrounds. Nursing education must consistently address gender affirming care.
Article
Research on transgender and gender expansive (TGE) youth has highlighted the disproportionate and challenging mental health and developmental outcomes faced by these young people. Research also largely suggests that family acceptance of TGE youth's gender identity and expression is crucial to preventing poor psychosocial outcomes in this community. Recently, family-based treatment has become common practice with TGE youth whose families are available for care, but it is unclear whether research provides outcome data for family interventions with TGE youth. This study follows Preferred Systematic Reviews and Meta-Analyses (PRISMA) guidelines to systematically review articles that provide outcome data or clinical recommendations for family-based interventions with TGE youth and their families. No quantitative outcome data for family therapy with TGE youth were found, but numerous articles spanning decades (n=32) provided clinical practice recommendations for family-based interventions with this population. Very few articles provided outcome data for family therapy with sexual minority youth (n=2). Over time, clinical strategies have moved from pathologizing to affirming of TGE youths' gender journey. Common clinical strategies of affirming interventions include (1) providing psychoeducation, (2) allowing space for families to express reactions to their child's gender, (3) emphasizing the protective power of family acceptance, (4) utilizing multiple modalities of support, (5) giving families opportunities for allyship and advocacy, (6) connecting families to TGE community resources, and (7) centering intersectional approaches and concerns. Future research should examine the efficacy of family-based interventions that incorporate these clinical strategies and collect quantitative data to systematically determine their effect on psychosocial outcomes.
Chapter
This chapter examines the emergence of the “transgender child” in the early decades of the twenty-first century, exploring in particular the public conversation around these children’s behavior and identities within the US media, analyzing several television documentaries and news articles from 2007 to 2015. Ultimately Vooris argues that while children are gaining access to new identity categories on a larger scale than before, we see the continuation of many historical narratives of queer and gender-nonconforming children within these media representations. Even as transgender children are increasingly visible in mainstream media, their identities are still pathologized and defined within a framework of childhood innocence and fear of harm.
Article
Socialization surrounding gender and sexuality is prominent within the familial context. Gender and sexuality are frequently linked with the assumption that gender-expansive behavior leads to nonheterosexuality. Research has largely focused on parental perspectives, leaving queer youth experiences largely invisible. Utilizing semistructured interviews with 10 queer young adults, this project contributes to the existing discussions regarding gender and sexuality socialization while growing up. First, participants described parents’ seemingly natural ability to correctly categorize youth’s sexual orientation, which is often linked to gender nonconforming behavior. Participants reinforced essentialized ideas of gender and sexuality through their discussion of engagement in expansive gender behavior. Furthermore, women discussed more freedom to engage in diverse gender behavior, while being expected to conform to traditional gender roles. Through elevating youth’s viewpoints on gender and sexuality family dynamics, these findings can assist service providers and parents in supporting queer youth across their gender and sexual development.
Article
Full-text available
In this article I describe the accounts of a group of parents with transgendered adolescents. I look specifically at how the parents try to build an intelligible story of the young people’s gender identity and how their story shapes their coping strategies. For the qualitative study on which this article is based, I interviewed adolescents with a well-established cross-gender identification and their parents from families referred to a specialist NHS service. The first-person reports were analysed using grounded theory methodology. There were a number of suggestive findings. First, communication about gender identity issues within the family and outside was handled with enormous care; second, it was clear that these parents are aware that their response to the gender problems is a deeply moral issue; third, there was an iterative relationship between the activities of making-meaning and accepting (or not) the child’s claims, and a similar interaction between the activity of meaning-making and the tasks of practical coping; fourth, a belief in biological causation of transgenderism was associated with a more benign view of the adolescent; and fifth, there were interesting differences between the accounts of mothers and fathers. The findings of the study hopefully illuminate clinical encounters, stimulate further research into how families cope with this unusual predicament and encourage reflexive thinking in practitioners in related fields.
Article
Full-text available
While debates continue as to whether or not a diagnosis of gender identity disorder (GID) is wanted or needed by today's adult transsexual, there is increasing concern both in academic and lay literature regarding the diagnosis of children and adolescents with GID. This paper critically evaluates the diagnosis, assessment, and treatment of GID in children and adolescents in light of published controversies, evidence, and arguments in psychological, psychiatric, and lay discourse since the release of the DSM-IV. In the years since GID's first inclusion in the DSM-III, growing criticisms weigh heavily against the diagnosis of GID in children and adolescents. This analysis urges a re-evaluation of the GID diagnosis for children and, to a lesser extent, adolescents. Overall, there is deepening discomfort with pathologizing children and youth for extreme gender variance. In the very least, since this is a highly contentious diagnosis, with little established reliability and validity, and problematic assessment and treatment approaches, researchers and clinicians need to establish that GID is validly diagnosed with non-biased assessments and treated effectively in accordance with current standards.
Article
Full-text available
In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families, schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize, viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization is the path they would prefer.
Article
Full-text available
This paper focuses on the impact of heteronormativity on research and clinical theory, utilizing the case of a lesbian couple with a young gender dysphoric child as a backdrop to discuss the contextual unfolding of gender development within a lesbian parented family. The extant research on LGBTQ-headed families has minimized the complexity of children's developing gender identity and sexual orientation living in queer families, and has been guided by heteronormative assumptions that presume a less optimal outcome if the children of LGBTQ parents are gay or transgender themselves. This article challenges family therapists to recognize the enormous societal pressure on LGBTQ parents to produce heterosexual, gender-normative children, and the expectations on their children, especially those questioning their own sex or gender identities.
Article
Full-text available
This is a report on parents who have children who exhibit gender variant behaviors and who contacted an affirmative program in the United States for assistance. All parents completed the Child Behavior Checklist, the Gender Identity Questionnaire, and the Genderism and Transphobia Scale, as well as telephone interviews. The parents reported comparatively low levels of genderism and transphobia. When compared to children at other gender identity clinics in Canada and The Netherlands, parents rated their children's gender variance as no less extreme, but their children were overall less pathological. Indeed, none of the measures in this study could predict parents' ratings of their child's pathology. These findings support the contention that this affirmative program served children who were no less gender variant than in other programs, but they were overall less distressed.
Article
Full-text available
The aim was to formulate practice guidelines for endocrine treatment of transsexual persons. This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence, which was low or very low. Committees and members of The Endocrine Society, European Society of Endocrinology, European Society for Paediatric Endocrinology, Lawson Wilkins Pediatric Endocrine Society, and World Professional Association for Transgender Health commented on preliminary drafts of these guidelines. Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe, effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person's genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person's desired gender. A mental health professional (MHP) must recommend endocrine treatment and participate in ongoing care throughout the endocrine transition and decision for surgical sex reassignment. The endocrinologist must confirm the diagnostic criteria the MHP used to make these recommendations. Because a diagnosis of transsexualism in a prepubertal child cannot be made with certainty, we do not recommend endocrine treatment of prepubertal children. We recommend treating transsexual adolescents (Tanner stage 2) by suppressing puberty with GnRH analogues until age 16 years old, after which cross-sex hormones may be given. We suggest suppressing endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and monitoring for known risks in adult transsexual persons.
Article
Full-text available
To establish the psychosexual outcome of gender-dysphoric children at 16 years or older and to examine childhood characteristics related to psychosexual outcome. We studied 77 children who had been referred in childhood to our clinic because of gender dysphoria (59 boys, 18 girls; mean age 8.4 years, age range 5-12 years). In childhood, we measured the children's cross-gender identification and discomfort with their own sex and gender roles. At follow-up 10.4 +/- 3.4 years later, 54 children (mean age 18.9 years, age range 16-28 years) agreed to participate. In this group, we assessed gender dysphoria and sexual orientation. At follow-up, 30% of the 77 participants (19 boys and 4 girls) did not respond to our recruiting letter or were not traceable; 27% (12 boys and 9 girls) were still gender dysphoric (persistence group), and 43% (desistance group: 28 boys and 5 girls) were no longer gender dysphoric. Both boys and girls in the persistence group were more extremely cross-gendered in behavior and feelings and were more likely to fulfill gender identity disorder (GID) criteria in childhood than the children in the other two groups. At follow-up, nearly all male and female participants in the persistence group reported having a homosexual or bisexual sexual orientation. In the desistance group, all of the girls and half of the boys reported having a heterosexual orientation. The other half of the boys in the desistance group had a homosexual or bisexual sexual orientation. Most children with gender dysphoria will not remain gender dysphoric after puberty. Children with persistent GID are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality.
Article
Full-text available
This article provides a selected overview of the literature on gender identity disorder and psychosexual problems in children and adolescents, with a focus on diagnosis, clinical course, etiology, and treatment.
Article
Full-text available
A 12-item gender identity interview schedule was administered to 85 children referred for concerns regarding their gender identity development and 98 clinical and normal control children. Factor analysis identified two factors, which were labeled Affective Gender Confusion and Cognitive Gender Confusion. The gender-referred group gave significantly more deviant responses than did the controls on both factors. Results were discussed with regard to several diagnostic and assessment issues pertaining to children with gender identity disorder.
Article
Full-text available
This paper reports on the psychometric properties of a 16-item parent-report Gender Identity Questionnaire, originally developed by P. H. Elizabeth and R. Green (1984), to aid in the assessment of children with potential problems in their gender identity development. The questionnaire, which covered aspects of the core phenomenology of gender identity disorder (GID), was completed by parents of gender-referred children (N = 325) and controls (siblings, clinic-referred, and nonreferred; N = 504), who ranged in age from 2.5-12 years (mean age, 7.6 years). Factor-analysis indicated that a one-factor solution, containing 14 of the 16 items with factor loadings > or =.30, best fit the data, accounting for 43.7% of the variance. The gender-referred children had a significantly more deviant total score than did the controls, with a large effect size of 3.70. The GIQ total score had negligible age effects, indicating that the questionnaire has utility for assessing change over time. The gender-referred children who met the complete DSM criteria for GID had a significantly more deviant total score than did the children who were subthreshold for GID, although the latter group had a mean score that was closer to the threshold cases than to the controls. With a specificity rate set at 95% for the controls, the sensitivity rate for the probands was 86.8%. It is concluded that this parent-report gender identity questionnaire has excellent psychometric properties and can serve as a useful screening device for front-line clinicians, for whom more extensive, expensive, and time-consuming assessment procedures may be precluded.
Article
Full-text available
This article describes a therapeutic process that combines individual and family sessions to maximize therapeutic opportunities to bring forward, understand, validate, and empower children's experience as equal participants in family therapy. The aim is to strengthen relational bonds within the family. Drawing from earlier work with families where incest had occurred, the authors present a recursive process that utilizes a "decision dialogue" to link individual and family sessions. Clinical examples are provided.
Book
Transgenderism and Intersexuality in Childhood and Adolescence: Making Choices presents an overview of the research, clinical insights, and ethical dilemmas relevant to clinicians who treat intersex youth and their families. Exploring gender development from a cross-cultural perspective, esteemed scholar Peggy T. Cohen-Kettenis and experienced practitioner Friedemann Pfäfflin focus on assessment, diagnosis, and treatment issues. To bridge research and practical application, they include numerous case studies, definitions of relevant terminology, and salient chapter summaries.
Article
Familiar and expected gender patterns help us to understand boys but often constrict our understanding of any given boy. Writing in a wonderfully robust and engaging voice, Ken Corbett argues for a new psychology of masculinity, one that is not strictly dependent on normative expectation. As he writes in his introduction, "no two boys, no two boyhoods are the same." In Boy Hoods Corbett seeks to release boys from the grip of expectation as Mary Pipher did for girls in Reviving Ophelia. Corbett grounds his understanding of masculinity in his clinical practice and in a dynamic reading of feminist and queer theories. New social ideals are being articulated. New possibilities for recognition are in play. How is a boy made between the body, the family, and the culture? Does a boy grow by identifying with his father, or by separating from his mother? Can we continue to presume that masculinity is made at home? Corbett uses case studies to defy stereotypes, depicting masculinity as various and complex. He examines the roles that parental and cultural anxiety play in development, and he argues for a more nuanced approach to cross-gendered fantasy and experience, one that does not mistake social consensus for well-being. Corbett challenges us at last to a fresh consideration of gender, with profound implications for understanding all boys.
Chapter
While debates continue as to whether or not a diagnosis of gender identity disorder (GID) is wanted or needed by today's adult transsexual, there is increasing concern both in academic and lay literature regarding the diagnosis of children and adolescents with GID. This paper critically evaluates the diagnosis, assessment, and treatment of GID in children and adolescents in light of published controversies, evidence, and arguments in psychological, psychiatric, and lay discourse since the release of the DSM-IV. In the years since GID's first inclusion in the DSM-III, growing criticisms weigh heavily against the diagnosis of GID in children and adolescents. This analysis urges a re-evaluation of the GID diagnosis for children and, to a lesser extent, adolescents. Overall, there is deepening discomfort with pathologizing children and youth for extreme gender variance. Since this is a highly contentious diagnosis–with little established reliability and validity, and problematic assessment and treatment approaches–researchers and clinicians need to establish that GID is validly diagnosed with nonbiased assessments and treated effectively in accordance with current standards.
Article
The inclusion of Gender Identity Disorder and Transvestic Fetishism in a psychiatric diagnostic nosology is a complex topic that is best understood within the larger context of the history and politics of diagnostic classification systems. The diagnostic labeling of gender-variant individuals with a mental illness is a topic of growing controversy within the medical and psychotherapeutic professions and among many civil rights advocates. An overview of both sides of this controversy is outlined, highlighting questions about the potential damage caused by using psychiatric diagnoses to label sexual behaviors and gender expressions that differ from the norm, and the ethical dilemmas of needing a psychiatric diagnosis to provide legitimacy for transsexuals' right to attain necessary medical treatments. The author reviews the use of diagnostic systems as a tool of social control; the conflation of complex issues of gender identity, emotional distress, sexual desire, and social nonconformity; the reification of sexist ideologies in the DSM; the clinical and treatment implications of diagnosing gender for “gatekeepers”; and some recommendations for GID reform.
Article
The world of mainstream psychotherapy encounters unfamiliar territory when a four-year-old girl, desperate to have a different-gendered body, is treated over a three-year period by a psychologist who is not a gender specialist. Evolution of the work with the child, family, extended family, and school is described. Implications for theories of the etiology of transgender identity are considered in light of the family structure. Treatment issues are highlighted, including the interface of transgender issues with family dynamics.
In this article I describe the accounts of a group of parents with transgendered adolescents. I look specifically at how the parents try to build an intelligible story of the young people's gender identity and how their story shapes their coping strategies. For the qualitative study on which this article is based, I interviewed adolescents with a well-established cross-gender identification and their parents from families referred to a specialist NHS service. The first-person reports were analysed using grounded theory methodology. There were a number of suggestive findings. First, communication about gender identity issues within the family and outside was handled with enormous care; second, it was clear that these parents are aware that their response to the gender problems is a deeply moral issue; third, there was an iterative relationship between the activities of making-meaning and accepting (or not) the child's claims, and a similar interaction between the activity of meaning-making and the tasks of practical coping; fourth, a belief in biological causation of transgenderism was associated with a more benign view of the adolescent; and fifth, there were interesting differences between the accounts of mothers and fathers. The findings of the study hopefully illuminate clinical encounters, stimulate further research into how families cope with this unusual predicament and encourage reflexive thinking in practitioners in related fields.
Gender identity disorder (GID) as a psychiatric category is currently under debate. Because of the psychosocial consequences of childhood GID and the fact that childhood GID, in most cases, appears to have faded by the time of puberty, we think that a cost-effective treatment approach that speeds up the fading process would be beneficial. Our treatment approach is informed by the known psychosocial factors and mechanisms that contribute to gender identity development in general, and focuses on the interaction of the child with the parents and with the same-gender peer group. To minimize the child’s stigmatization, only the parents come to treatment sessions. A review of a consecutive series of 11 families of young boys with GID so treated shows a high rate of success with a relatively low number of sessions. We conclude that this treatment approach holds considerable promise as a cost-effective procedure for families in which both parents are present.
Article
The first part of this article presents the epistemological evolution of the therapeutic frameworks regarding the treatment of transgender individuals and their partners. It outlines a medical approach and two others-the developmental approach and the deconstructive approach, ones not based on the conception of transgender identity as pathological. Two case studies of couples presenting with gender identity-related issues illustrate their application with particular emphasis on the relational process of gender identity formation and on partners of transgender-identified persons.
Article
Lesbian, gay, bisexual, and transgender (LGBT) youth may face particularly hostile school climates, as they often report experiencing harassment, discrimination, and other negative experiences in school. LGBT youth, regardless of their gender identity, often face victimization and stigmatization based on both sexual orientation and gender expression. The authors examine transgender students' experiences with regard to indicators of negative school climate, such as biased language, experiences of harassment and assault, and the impact of victimization on educational outcomes. The authors also investigate transgender students' engagement in their school community and access to institutional resources. Data used in this report come from the Gay, Lesbian and Straight Education Network's (GLSEN) fifth National School Climate Survey, which was conducted during the 2006-2007 school year. Two methods were used in order to locate participants in an effort to obtain a representative sample of LGBT youth: outreach through community-based groups serving LGBT youth and outreach via the Internet, including targeted advertising on the social networking site MySpace. This report examines the specific experiences of the 295 students in the survey who identified as transgender. These transgender students were between 13 and 20 years of age, and the majority of the sample was White, and identified as gay or lesbian. Findings demonstrate that transgender students frequently face extremely hostile school environments. Similar to non-transgender lesbian, gay, and bisexual students, most transgender students hear biased language, feel unsafe in school, are regularly harassed, and lack LGBT-related resources and supports. Compared to their non-transgender peers, transgender students consistently reported higher levels of harassment and assault, were less likely to feel like a part of their school community, and had poorer educational outcomes. Transgender students were also more likely to be involved with LGBT-related issues in their schools, perhaps because they are faced with unique challenges in school, such as accessing gender-segregated facilities and being addressed by their preferred names and pronouns. Educators, policymakers, and safe school advocates must continue to seek to understand the specific experiences of transgender students, and implement measures to ensure that schools are safe and inclusive environments for all LGBT youth. (Contains 50 notes, 32 figures, and 4 tables.)
Article
The author, a co-founder and the Director of the Gender & Sexuality Psychosocial Program at Children's National Medical Center in Washington, D.C., discusses clinical issues and interventions for prepubertal children with atypical gender development. He describes developmental issues related to concepts of gender for preadolescent children. The importance of working within the family system and helping the family to accept their child in order to become advocates for the child are discussed. Finally, some of the complicated issues surrounding the question of whether a child should begin to transition genders prior to reaching puberty are explored.
Article
There is little information about the formation of transgender identities in adolescence. Diagnosis and treatment of transgender adolescents is often surrounded by confusion and controversy on the part of clinicians and family. This paper identifies some of the issues that arise in these treatments and offers some guidelines. The importance of understanding and embracing the diversities of outcomes of gender variant children is stressed, as is the concept of affirmative and adaptive treatment approaches for these children and their families, in order to foster more positive self-esteem and identity formation as these children become adolescents.
Article
This landmark work reports the extensive research findings that address the questions: What is the role of the parents in the development of a son's sexuality? Why do some boys become "feminine"? Which "feminine" boys become homosexual? Why is there a link between being a "sissy boy" and a "gay man"? Parents, teachers, mental health professionals, social scientists, and anyone curious about the development of his or her sexual identity will find this book unusually informative and provocative. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Treatment of individuals with gender identity disorder (GID) has in medicine nearly always met with a great deal of skepticism. Professionals largely follow the Standards of Care of the World Professional Association for Transgender Health. For adolescents, specific guidelines have also been issued by the British Royal College of Psychiatrists. To describe the stepwise changes in treatment policy which, in recent years, have been made by the team of the Gender Identity Clinic at the VU University Medical Center in Amsterdam, The Netherlands. The first step taken to treat adolescents was that, after careful evaluation, (cross-sex hormone) treatment could start between the ages of 16 and 18 years. A further step was the suppression of puberty by means of gonadotropin-releasing hormone analogs in 12-16 year olds; the latter serves also as a diagnostic tool. Very recently, other clinics in Europe and North America have followed this policy. Results. The first results from the Amsterdam clinic show that this policy is promising. Professionals who take responsibility for these youth and are willing to help should yet be fully aware of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with GID are presented, hopefully inciting a sound scientific discussion of the issue.
Introduction At the edge: Explor-ing the changing facets of gender and sexuality in couples and families (pp. 2–8). Washing-ton
  • A I Lev
  • J Malpas
Lev, A.I., & Malpas, J. (2011). Introduction. In J. Malpas, & A.I. Lev (Eds.), At the edge: Explor-ing the changing facets of gender and sexuality in couples and families (pp. 2–8). Washing-ton, DC: American Family Therapy Academy.
Gender dissonance: Diagnostic reform of gender identity disorder for adults
  • Winters
Winters, K. (2005). Gender dissonance: Diagnostic reform of gender identity disorder for adults. Journal of Psychology & Human Sexuality, 17(3), 71-89.
The transgender child: A handbook for families and professionals
  • S Brill
  • R Pepper
Brill, S., & Pepper, R. (2008). The transgender child: A handbook for families and professionals. San Francisco, CA: Cleis Press.
Gender born, gender made
  • D Ehrensaft
Ehrensaft, D. (2011). Gender born, gender made. New York: The Experiment.
Adjustment and resiliency following disclosure of transgender identity in families of adolescents and young adults: Themes and clinical implications
  • M Macnish
  • M Gold
MacNish, M., & Gold, M. (2011). Adjustment and resiliency following disclosure of transgender identity in families of adolescents and young adults: Themes and clinical implications. In Malpas J., & Lev A.I. (Eds.), At the edge: Exploring gender and sexuality in couples and families (pp. 34-42). Washington, DC: American Family Therapy Academy.
The Ackerman relational approach in action
  • J Malpas
  • M Sallick
Malpas, J., & Sallick, M. (2009). The Ackerman relational approach in action. Unpublished manuscript.
Introduction Sissies and tomboys. Gender nonconfor-mity and homosexual childhood (pp. 1–5) Finding our way: Guiding a young transgender child
  • M Rottnek
Rottnek, M. (1999). Introduction. In M. Rottnek (Ed.) Sissies and tomboys. Gender nonconfor-mity and homosexual childhood (pp. 1–5). New York: New York University Press. Saeger, K. (2006). Finding our way: Guiding a young transgender child. The Journal of GLBT Family Studies, 2(3/4), 207–245.
Transforming families: Real stories about transgendered loved ones
  • M Boenke
Boenke, M. (Ed.). (1999). Transforming families: Real stories about transgendered loved ones. Imperial Beach, CA: Walter Trook Publishing.
From otherness to alliance: Transgender couples in therapy
  • Malpas
Malpas, J. (2006). From otherness to alliance: Transgender couples in therapy. The Journal of GLBT Family Studies, 2(3/4), 183–206.
The Ackerman Institute's relational approach
  • M K Brewster
Brewster, M.K. (2011). The Ackerman Institute's relational approach. A training manual. Unpublished manuscript.
Between pink and blue: Exploring gender fluidity
  • J Malpas
Malpas, J. (2010). Between pink and blue: Exploring gender fluidity. Paper presented at the Psychotherapy Networker Symposium, Washington, DC.
Handbook of child and adolescent sexual problems
  • G A Reckers
Reckers, G.A. (1995). Handbook of child and adolescent sexual problems. New York: Lexington Books.
Finding our way: Guiding a young transgender child
  • Saeger
Saeger, K. (2006). Finding our way: Guiding a young transgender child. The Journal of GLBT Family Studies, 2(3/4), 207-245.
Sissies and tomboys. Gender nonconformity and homosexual childhood
  • K Corbett
Corbett, K. (1999). Homosexual boyhood. Notes on girlyboys. In M. Rottnek (Ed.), Sissies and tomboys. Gender nonconformity and homosexual childhood (pp. 107-139). New York: New York University Press.
At the edge: Exploring the changing facets of gender and sexuality in couples and families
  • A I Lev
  • J Malpas
Lev, A.I., & Malpas, J. (2011). Introduction. In J. Malpas, & A.I. 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.