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Between Pink and Blue: A Multi-Dimensional Family Approach to Gender Nonconforming Children and their Families
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.
... 2 Screening and identification of early signs of GD is crucial to a child's or adolescent's wellbeing, but a lack of training makes management of GD in primary care complex and challenging, especially in more traditional, rural areas. 3 We describe the diagnosis of GD and the implementation of a patient-centered multidisciplinary and family approach in a transgender adolescent, to enlighten early manifestations of GD and difficulties faced by trans people, but also by other elements of the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and plus (LGBTQIA+) community, their families and primary care professionals from a rural environment. ...
... We have learned that, in these situations, a multidisciplinary and multi-dimensional family approach is recommended. 3,10 The treatment of GD in adults involves psychotherapy, hormonal treatment, and surgical treatment. Parental engagement, education, and coaching is key when approaching children with GD by increasing acceptance of gender fluidity and facilitating harmony between the child and their environment. ...
... Working with the school community is also important. 3 The case described revealed that the lack of information, community discrimination, social isolation, and segregation during childhood may have a serious impact on mental health. This article also points to the fact already described in the literature that transgender adolescents in rural communities are at risk of drug use and self-harm, of being rejected by family and exploited or abused by adults during sexual initiation. ...
Gender dysphoria is socially more visible and discussed today, but still underdiagnosed. It refers to distress and/or impaired function caused by inconsistency between the sex assigned at birth and gender identification. Clinical manifestations are variable. Lack of training and investment in gender issues make the diagnosis and management in primary care complex, particularly in conservative and isolated communities, with poor access to information and specialized health services. We describe the diagnosis of gender dysphoria and use of a patient centered multidisciplinary and family approach in a 12-year-old rural born adolescent, assigned female at birth. Our aim is to raise awareness of early symptoms and signs of gender dysphoria and problems faced by transgender people and their families during childhood, leading to gender dysphoria, and we hope our successful approach might improve healthcare provision for these patients, particularly in rural areas.
... Research is clear about the importance of strong family support for the health and wellbeing of TGD people, particularly at the formative times of gender questioning and/or affirming, but also across the life span (Giammattei, 2015;Lev & Gottlieb, 2019;Malpas, 2011;Nichols, 2018;Riggs, 2019a;Ryan, 2009;Smith et al., 2014). Involvement of family has been shown to drastically reduce the risk of self-harm and suicide in younger TGD people (Ryan, Huebner, Diaz, & Sanchez, 2009;Smith et al., 2014). ...
... As there is increasing evidence about the risk and protective factors for the health of TGD people, it is also important that counsellors are familiar with current literature and best practice guidelines. As Malpas (2011) has said in relation to the importance of psychoeducation for family members, "While parents have often researched the issue of transgender children thoroughly and are quite expert on the topic, it is useful to assess their level of information and potential misinformation and review the existing research" (p. 458). ...
... Other families of young people we saw were struggling with the very common challenges of parenting in an increasing techno-mediated world. When identifying the needs of the TGD person by talking with family members, it may be useful to remember the words of Malpas (2011): "in some cases parent's [or other family member's] anxiety and coping mechanisms participate in underestimating or overestimating the level of distress or the clarity of the child's [or adult's] wish to identify with one particular gender" (p. 460). ...
Counsellors and family therapists unfamiliar with working with transgender and gender diverse (TGD) people may be hesitant to undertake this work. A lack of familiarity is not a reason to avoid the work. There is a clear need for professionals to be open to supporting people with TGD lived experience and their families, who are increasingly turning to healthcare services for help. This paper outlines an approach adopted by an organisation not well practised in working with TGD people, in response to increased calls for support. The Bouverie Centre, in Victoria, Australia, paired a researcher (who works in other contexts with TGD people and their families) and a clinical family therapist (not well practised in working with TGD people) to synthesise their skills and knowledge to fill the service gap. This paper offers reflections and (un)learnings from these 45+ year old, cisgender workers who were new to clinical work with people with TGD lived experience and their families.
... Esta información "debe darse con el objetivo de que la pequeña o joven persona, sus 35 El modelo afirmativo parte de la base de que la creatividad de género es una expresión más de la diversidad humana y que, por tanto, su problematicidad reside en el contexto sociocultural en el que vive la pequeña persona y no en dicha persona. (Ehrensaft 2014;Hidalgo et al. 2013;Hill et al. 2010;Hill y Menvielle 2009;Malpas 2011;Menvielle y Gomez-Lobo 2011;Olson et al. 2016). El modelo afirmativo considera que la criatura debe poder expresar su género e identidad libremente, en el modo en que lo considere oportuno, a cualquier edad, sin tener que esperar necesariamente a la pubertad. ...
... Malpas, uno de los principales defensores del modelo afirmativo y de un enfoque familiar multidimensional, subraya la importancia de pasar de una modalidad de acompañamiento de la infancia trans fundada en el "o/o" a una basada en el "tanto/como". Es decir, una modalidad que incluya la posibilidad de cultivar la particularidad de le propie hije y, al mismo tiempo, desarrollar la mediación entre el deseo de la criatura y la realidad social en la que vive (Malpas 2011). El conflicto que surge entre los intereses de las personas más pequeñas y el respeto de la norma social es una presencia constante en el trabajo de estas madres y estos padres, especialmente de las madres (Johnson y Benson 2014;Ryan 2017), que tienen que lidiar con la repercusión social de ver cómo su mandato de crianza se valora como un fracaso, en una sociedad donde la cultura del fracaso va acompañada de un sinfín de consecuencias negativas, como la decepción, la desilusión y la desesperación 61 . ...
... La producción científica más reciente, sobre todo la norteamericana y la española, ha cuestionado fuertemente esta forma de considerar la experiencia trans, considerando que un acompañamiento que aspire a reconocer y afirmar la identidad de género de les niñes les permite crecer con más serenidad y desarrollar menos patologías en la edad adulta (Durwood, Mclaughlin, y Olson 2017;Ehrensaft et al. 2018;Garaizabal et al. 2016;Hill y Menvielle 2009;Malpas 2011). Aunque la mayoría de les especialistas más reconocides están de acuerdo en que un modelo terapéutico que aspira a la corrección de los comportamientos no conformes con el género en les niñes no solo es inútil sino también perjudicial, el ámbito del debate científico sobre la infancia trans dista mucho de ser unánime sobre cuál es la mejor modalidad de acompañamiento. ...
Until recently, talking about transgender children was only accepted and described in medical terms as a pathology to be prevented and treated. Although this interpretative framework still prevails today, we are witnessing an important epistemological change that fosters the recognition of this experience as an expression of human diversity to be claimed first and foremost by families. From the sociological point of view, we are dealing with a new phenomenon. This is the first generation of parents who choose to support and accompany their transgender not just at home but in public, thus facing unexplored paths and heading to unknown destinations. This thesis aims to describe how parenting a transgender child takes shape from the voices of those directly involved: the families. My research takes place in the Catalan and the Italian contexts, which are very close in cultural, historical, and economic terms, but show remarkable differences when it comes to the object of this study. The world of associations, the current medical model, and the legislative instruments designed to protect young gender variant people are organized differently in Catalonia and in Italy and can deeply affect the way families attribute meaning to their children's experience and the way they accompany them. Ethnography is the method chosen to develop this work because it gives researchers closer access to the reality they want to describe and the opportunity to show the reality based on the meanings, language, and relationships of the social actors that constitute the subject of study. The analysis of the interviews, which is the central part of the thesis, highlights such elements as the emotions felt by the parents, their ethical reflections when confronted with the breaking of the gender norm by their children, the social meanings attributed to them by the available discourses and the practical strategies activated to create legitimate and socially recognized possibilities of existence.
Hasta hace unos años, hablar de infancia trans* era concebible únicamente dentro de un marco médico, que consideraba este tipo de experiencias una patología que había que prevenir y tratar. Aunque este sigue siendo hoy el principal campo de conocimiento desde el que se desarrolla el discurso sobre lo trans* en la infancia, estamos asistiendo a un importante cambio epistemológico que lleva a reconocer estas experiencias como una mera expresión de la diversidad humana que debe ser afirmada, ante todo, por las familias. Desde el punto de vista sociológico, estamos ante un fenómeno nuevo. Se trata de la primera generación de progenitores que opta por apoyar y acompañar a sus hijes trans* y que lo hace de forma pública, navegando por caminos hasta ahora inexplorados y de destinos inciertos. Esta tesis pretende describir cómo toma forma la crianza de criaturas trans* a partir de las voces de las personas directamente implicadas, las familias. He situado la investigación en dos contextos, el catalán y el italiano, muy próximos entre sí en cuanto a cultura, historia y economía, pero que presentan importantes diferencias por lo que se refiere al objeto de estudio de esta tesis. El mundo asociativo, el modelo médico actual y los instrumentos legislativos destinados a proteger a las pequeñas personas trans* se organizan de forma diferente en Catalunya y en Italia, y contribuyen a determinar el modo en que las familias atribuyen un significado a la experiencia de su prole, así como el modo en que la acompañan. La etnografía es el método elegido para desarrollar este trabajo por su capacidad de acercar a la persona investigadora a la realidad que desea describir, permitiéndole emerger a través de los significados, el lenguaje y las relaciones de los actores sociales que conforman el objeto de estudio. El análisis de las entrevistas, que constituye la parte principal de esta tesis, pone de relieve las emociones que sienten madres y padres, las reflexiones éticas que surgen cuando se enfrentan a la ruptura de la norma de género por parte de sus criaturas, los significados sociales que los discursos disponibles les atribuyen y las estrategias prácticas.
... 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. ...
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.
... Existe claridad entonces, en que la aceptación parental es un componente central de la afirmación de género (Malpas, 2011;Malpas et al., 2022), no sólo por su influencia directa en la salud mental de NNA TGNC, sino también porque la posibilidad de que niños, niñas, y adolescentes accedan al sistema de salud, legal y educativo recibiendo intervenciones y acompañamientos afirmativos depende, en muchos contextos, de los padres/madres o cuidadores (Olsavsky et al, 2023). ...
... Históricamente los procesos de transición y afirmación de la identidad eran vividos de manera individual y en solitario, muchas veces con distancia de la familia o derechamente rompiendo los lazos con ellas (Malpas, 2006). Hoy sabemos que, por lo general, y sobre todo si se les acompaña en su empeño, las familias, específicamente padres y madres, son capaces de participar de la transición e integrarla a su trayectoria biográfica, manteniendo la conexión y el sentido de pertenencia entre sus miembros (Maedow, 2018;Malpas, 2011;. Para que esto ocurra, sin embargo, es necesario un proceso que contemple las distintas necesidades de las personas que conforman el sistema familiar, sobre todo si la reacción inicial es de rechazo, en particular los/as adultos/as responsables del cuidado, cuya tranquilidad será la base sobre la cual los hijos e hijas puedan explorar. ...
... Existe claridad entonces, en que la aceptación parental es un componente central de la afirmación de género (Malpas, 2011;Malpas et al., 2022), no sólo por su influencia directa en la salud mental de NNA TGNC, sino también porque la posibilidad de que niños, niñas, y adolescentes accedan al sistema de salud, legal y educativo recibiendo intervenciones y acompañamientos afirmativos depende, en muchos contextos, de los padres/madres o cuidadores (Olsavsky et al, 2023). ...
... Históricamente los procesos de transición y afirmación de la identidad eran vividos de manera individual y en solitario, muchas veces con distancia de la familia o derechamente rompiendo los lazos con ellas (Malpas, 2006). Hoy sabemos que, por lo general, y sobre todo si se les acompaña en su empeño, las familias, específicamente padres y madres, son capaces de participar de la transición e integrarla a su trayectoria biográfica, manteniendo la conexión y el sentido de pertenencia entre sus miembros (Maedow, 2018;Malpas, 2011;. Para que esto ocurra, sin embargo, es necesario un proceso que contemple las distintas necesidades de las personas que conforman el sistema familiar, sobre todo si la reacción inicial es de rechazo, en particular los/as adultos/as responsables del cuidado, cuya tranquilidad será la base sobre la cual los hijos e hijas puedan explorar. ...
El capítulo describe, desde la perspectiva transdisciplinaria de los estudios de género, la situación actual de niños, niñas y adolescentes mexicanos que se identifican como trans*. considerando los efectos que han tenido tanto los procesos activistas como las políticas públicas implementadas cinco años después del surgimiento del movimiento de familias organizadas.
... Existe claridad entonces, en que la aceptación parental es un componente central de la afirmación de género (Malpas, 2011;Malpas et al., 2022), no sólo por su influencia directa en la salud mental de NNA TGNC, sino también porque la posibilidad de que niños, niñas, y adolescentes accedan al sistema de salud, legal y educativo recibiendo intervenciones y acompañamientos afirmativos depende, en muchos contextos, de los padres/madres o cuidadores (Olsavsky et al, 2023). ...
... Históricamente los procesos de transición y afirmación de la identidad eran vividos de manera individual y en solitario, muchas veces con distancia de la familia o derechamente rompiendo los lazos con ellas (Malpas, 2006). Hoy sabemos que, por lo general, y sobre todo si se les acompaña en su empeño, las familias, específicamente padres y madres, son capaces de participar de la transición e integrarla a su trayectoria biográfica, manteniendo la conexión y el sentido de pertenencia entre sus miembros (Maedow, 2018;Malpas, 2011;. Para que esto ocurra, sin embargo, es necesario un proceso que contemple las distintas necesidades de las personas que conforman el sistema familiar, sobre todo si la reacción inicial es de rechazo, en particular los/as adultos/as responsables del cuidado, cuya tranquilidad será la base sobre la cual los hijos e hijas puedan explorar. ...
Niñeces trans*: Voces, experiencias y reflexiones en torno a la vida y acompañamiento de les niñes trans* es una obra colaborativa y multidisciplinaria que se erige como un recurso imprescindible para comprender, desde perspectivas diversas, las realidades, desafíos y derechos de las niñeces trans*. Compilado por Ximena Faúndez Abarca, Débora Fernández Cárcamo, Lucha Leftraru Venegas Navarrete y Ketty Cazorla Becerra, el libro reúne una variedad de ensayos académicos, testimonios familiares y representaciones artísticas realizadas por les niñes, conformando un retrato amplio y profundo de esta temática.
La obra se organiza en capítulos que abordan desde testimonios personales hasta análisis legales, educativos y psicológicos. Entre sus aportes más destacados están:
Testimonios personales y familiares: Historias de vida que reflejan las vivencias de niñeces trans* y sus familias, narradas con una sinceridad que invita a reflexionar sobre el amor incondicional y los retos sociales.
Marco teórico y crítico: Textos académicos que exploran la relación entre derechos humanos, educación y afirmación de género, destacando las brechas legales y la importancia de políticas inclusivas.
Abordaje psicológico y legal: Análisis sobre cómo los sistemas educativos y de salud deben adaptarse para garantizar la protección y bienestar de las infancias trans*, enfatizando enfoques afirmativos y despatologizantes.
Arte y expresión gráfica: Ilustraciones creadas por niñes trans* que plasman su identidad y emociones, ofreciendo una ventana única hacia sus mundos internos.
El libro no solo se enfoca en las experiencias locales de Chile, sino que incluye perspectivas internacionales que enriquecen el debate sobre los derechos y la visibilización de las niñeces trans*. Destaca por su compromiso con el uso del lenguaje inclusivo, que subraya la diversidad y dignidad de todas las identidades de género.
En síntesis, Niñeces trans es una obra necesaria para educadores, activistas, familias, profesionales de la salud y cualquier persona interesada en construir una sociedad más inclusiva y respetuosa de los derechos humanos. A través de sus páginas, se propone trascender los prejuicios y las resistencias, invitando a un entendimiento más profundo y empático de las niñeces trans*.
... Evidence-based treatments have not been established specifcally for gender dysphoria, but theoretical models indicate that reducing gender dysphoria would focus on targeting the affective distress of gender dysphoria (Leibowitz et al., 2016). For youth with gender nonconformity, intervention can span individual and family work, as well as parent guidance techniques (Malpas, 2011). Interventions can look to process the emotional aspects of the child and family navigating the child's gender expression, with some interventions focusing on social considerations about passing or not (Malpas, 2011). ...
... For youth with gender nonconformity, intervention can span individual and family work, as well as parent guidance techniques (Malpas, 2011). Interventions can look to process the emotional aspects of the child and family navigating the child's gender expression, with some interventions focusing on social considerations about passing or not (Malpas, 2011). Behavioral techniques like setting limits on cross-gender behaviors, encouraging gender-normative play and preferences, and promoting same-sex peer relationships can provide important clinical information (Ehrensaft, 2012;Leibowitz et al., 2016). ...
... 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. ...
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.
... 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). ...
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.
... 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. ...
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.
... 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. ...
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.
... Although only a larger randomized-controlled trial can further demonstrate the efficacy of such an adapted ABFT for SGM youth and their parents, these findings suggest promise in family-based interventions that work with parents to reduce negative responses to their SGM child. Another family-based treatment that can help to support parents and SGM children is the multidimensional family approach (MDFA) for transgender and gender-nonconforming (TGNC) children and their families (Malpas, 2011). The MDFA employs the therapeutic goals of supporting parents in accepting their child's gender identity and expression, mitigating their anxiety, and ultimately advocating for their child beyond the family system in social environments (e.g., school, faith communities). ...
... The MDFA employs the therapeutic goals of supporting parents in accepting their child's gender identity and expression, mitigating their anxiety, and ultimately advocating for their child beyond the family system in social environments (e.g., school, faith communities). The MDFA model involves several components to support parents and children including parent engagement and psychoeducation, child assessment and therapy, parental coaching, family therapy, and parent support group (Malpas, 2011). Although ABFT and MDFA both represent promising interventions for increasing acceptance among parents of SGM children, the most rejecting parents might also be the least likely to seek treatment; thus, any efforts to develop and test family based interventions for SGM youth and their nonaccepting parents should concurrently seek to develop effective avenues to identify and engage the most high-risk families. ...
In this study of parents of sexual and/or gender minority (SGM) children, we derived a typology of parental responses to their children’s SGM identities and documented associations between these response classes and child’s recent mental health (e.g., depression) and related social difficulties (e.g., bullying). Parents with an SGM child younger than 30 years old (N = 205) completed an online survey assessing their relationship with their child and their child’s mental health. Latent profile analysis classified parents based on 5 positive and 5 negative indicators of parental responses to their SGM child. We examined associations between parental response classes, parent and child sociodemographic characteristics, and child’s recent (last 6 months) mental health problems. Uncovered parental classes were negative response (Class 1; 15.1%), mixed response (Class 2; 10.7%), and positive response (Class 3; 74.1%). Parent and child sociodemographic profiles differed across response classes. Adjusted logistic regression models showed that parents classified as negative response versus positive response reported that their SGM children experienced substantially greater odds of recent anxiety/worry (adjusted odds ratio [AOR] = 3.91, p < .01), depression (AOR = 2.73, p < .10), substance use (AOR = 12.79, p < .01), and bullying (AOR = 6.74, p < .01). Parents classified as mixed response versus positive response reported that their SGM children experienced substantially more recent bullying (AOR = 6.74, p < .01). These findings can identify parents requiring additional support navigating the significant process of accepting their child’s SGM identity to improve SGM youth’s mental health.
... 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). ...
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.
... 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). ...
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.
... 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. ...
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.
... 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). ...
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.
... It appeared that these experiences were enough to shake the fantasy parents held regarding their children's role and their hope for their success. It can be likened to a process of mourning, where the parent is required to internalize the loss of a dream (Malpas, 2011). This is not surprising, since a parent's success and value in the eyes of themselves and wider society is, to a certain extent, determined according to their children's successes and achievements (Holmstrom . ...
This phenomenological research examined family relationships among ideological nonhuman-animal rights activists, while distinguishing between law-breaking and law-abiding activists. Analysis of semi-structured interviews with 30 activists highlighted two phases within the familial dynamics. During the joining phase, conflicts arose between the participants’ identities as activists and their identities as family members, creating a crisis in their relations with their parents and spouses. During the establishing phase, however, different familial dynamics developed among each group. The law-breaking activists were able to balance family life with their activism, ensuring the preservation of the relationship. By contrast, to try and maintain peaceful relations, the law-abiding activists kept their activism from their family, leading to a deterioration in the relationship. The findings are interpreted through literature dealing with the family dynamics of social activists in general, and animal rights activists in particular.
... The literature is consistent with FRF in identifying psychoeducation and emotional processing with caregivers as common and effective practices for addressing belief systems on gender (Bernal & Coolhart, 2012;Malpas, 2011). Several free and publicly available resources exist for psychoeducation for families. ...
Transgender and nonbinary (TGNB) youth are at increased risk for poor mental health. Families significantly impact the mental health of TGNB youth because of the need for acceptance and support for their gender exploration, identity, and access to gender-affirming services. We conducted a theoretically grounded literature review using the Family Resilience Framework (FRF; Walsh, 2015). The aim was to center family resilience as a guiding theory in understanding TGNB youth mental health for family intervention. The review highlighted the following: (1) belief systems for making meaning of gender, sexuality, and the TGNB youth coming out and their embodied futures; (2) flexible organizational processes for a youth-lead gender transition, sustained family connectedness, and accessing gender-affirming community and healthcare resources; and (3) communication processes that empower TGNB youth to emotionally share and collaboratively make decisions with caregivers. Implications offered for family intervention.
... If we might think that the presence of SB justi es the higher rates of internalizing symptoms, emotional dysregulation and emotional disinvestment in the body in GD-SB adolescents [44,45], on the other hand GD adolescents could develop SB, being subjected to negative social experiences like discrimination and victimization including cyber victimization, homophobic and peer bullying; so, self-harm could be the result of internalizing mental di culties because the person begins to expect such experiences [42,[46][47][48][49][50][51]. Beyond such psychological challenges, developing secondary sexual characteristics may take the form of "shame, selfhatred, and physical discomfort" (McDermott, Roen, & Piela, 2015), which can trigger self-harm [52][53][54]. ...
Over the past twenty years the age at first visit in Gender Identity Clinics decreased and the number of adolescents referred to such Services appears to be increasing. Moreover, a growing body of research reveals that youths with Gender Dysphoria (GD) experience a range of psychiatric disorders at higher rates than the general population, including depression, anxiety, eating disorders and self-harm. The objective of this study was to clinically describe a sample of adolescents with GD seeking Gender Affirmation (GA) who referred to the Child and Adolescent Neuropsychiatry and Psychiatry Units, Translational Biomedicine and Neurosciences (DiBraiN), University of Bari, Italy, in the attempt to better characterize internalizing symptoms, emotion regulation ability, and emotional investment in the body, depending on whether the GD onset was early or late in life and whether GD is associated with self-harm or not. A total of 66 adolescents with a GA request with an average age of 14.6 (SD±1.68) were included in this study. the comparison according to the GD onset shows significant differences in the emotion dysregulation profile in the total score (p=0.018) and in non-acceptance and strategies scales (p=0.030; p=0.41) with higher scores in the adolescent onset group. The comparison according to the presence of SA behaviors shows statistically significant differences in YSR internalizing symptoms with higher scores in SA behaviors group in almost all dimensions investigated. Lastly, in this group, statistically significant higher scores were found in BIS dimensions Care and Protection (p=0.013; p=0.006).
... This is consistent with a prior study that found a deficiency. This research backs up earlier results that a lack of parental support might cause family friction and exacerbate a young person's melancholy (Malpas, 2011). The experiences of the participants with stigma, discrimination, bullying, and harassment as a result of their gender identities are similar to prior study findings from larger trans communities (Clark et al., 2014). ...
Despite the traditional trends in gender classification, people are suffering from a condition known as Gender Dysphoria (GD) in Asian countries generally and in Pakistan particularly. The study was intended to explore how young individuals with gender dysphoria define and interpret their gender identity. Through the purposive sampling technique, eleven young individuals (19–30 years) with GD were recruited from three cities in Pakistan; Gujrat, Jhelum, and Lahore. Semi-structured interviews were undertaken, and theme analysis was used to examine the data. The study findings revealed that participants utilized the internet as an information source to explore and learn about their gender. They had the chance to investigate, discover, validate, and embrace their genders through talking with others both inside and outside the transgender community. The influence of gender confusion and bodily pain on their emotional well-being may be worsened or lessened depending on how others respond and support them. Participants believed that the stigma and prejudice towards persons with GD were fueled by a lack of knowledge, awareness, and education. As a result, there was a desire to protest and initiate social action to decrease the stigma and improve the quality of life of individuals with gender dysphoria.
... Broadly speaking, ecological systems models have the potential to reveal how risk and resilience unique to transgender youth are impacted by the interplay of many social positions. Overall, the GAM mirrors the multi-dimensional approach MDFA (Multi-Dimensional Family Approach; Malpas et al., 2011) created to be used with transgender youth, which encourages that family support, access to the community, and child well-being must be each be considered with respect to other contexts. Within transgender students' immediate community, research clearly demonstrates the need for resilience to be fostered in school spaces, above all other community settings (Greytak et al., 2009;Keo-Meier & Ehrensaft, 2018). ...
The theoretical basis of the proposed study is drawn from an ecological-transactional (Lynch & Cicchetti, 1998) systems approach to development, which focuses on contexts, and correspondingly, overlays the gender affirmative model’s (GAM) transactional model of support (Keomeier & Ehrensaft, 2018) to reveal protection in the school ecology. Combining these two approaches provides unique insights into protective factors in the school ecology, distinct from developmental systems approaches driven by the minority stress model (Meyer, 2003), which are designed to highlight the multidimensional quality of risk (Eisenberg et al., 2019).
The dissertation had two central aims: 1) to report on the development of the Gender Affirmative School Climate (GASC) scale, a self-report survey designed to capture high school climate specific to the domain of gender, and 2) to explore how gender affirmative school climate (GASC) relates to student self-esteem and school belongingness. Unique from risk factors approaches the central aims sought out to identify protective factors within a developmental system ecology of the high school context.
In two pilot studies (N=12; N=758; trans = 413, non-trans = 344) and primary study (N=813; trans = 482, non-trans = 328) results for scale development provide evidence to validate assumptions that the proposed (GASC) construct captures what was intended, that is, school climate specific to the domain of gender. However, measurement invariance procedure showed that not all items operated equivalently across trans and non-trans groups, and confirmed that the proposed scale meets criteria for “weak measurement invariance”.
High school students that reported more positive school climate reported lower self-esteem scores. Only one protective moderator was consistent with hypotheses: More feelings of similarity to peer group gender (boys) emerged as a protective factor for transgender identified high schoolers attenuating the negative relationship between perceptions of school climate and self-esteem. Latent measurement models for each gender group demonstrated that the school belongingness construct is highly related to the proposed (GASC) construct. This demonstrated domain overlap with “feelings of school belongingness” signals that the proposed scale showed good convergent validity. The results provide insight about ways high schools can be pro-active to promote a healthier school climate for transgender students.
... By failing to address the changing nature of gender throughout the life cycle, providers reinforce the idea that there is a normative experience of transition -norms that have historically been established by everyone but transgender people themselves (Kennedy, 2022). This failure also provides room for social workers and mental health providers who have little experience with gender-diverse people to mistake the natural progression of an individual's gender identity through the exploration of new modes of self-expression and self-identification as being somehow evidentiary that a given service user's identity is less legitimate or merely transitory (Malpas, 2011). It also imputes pathology and regret to all instances where a gender-diverse person's identity evolves to a cisgender identity, sometimes referred to as 'detransition' (Hildebrand-Chupp, 2020). ...
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.
... 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. ...
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.
... 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). ...
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.
Despite an established body of knowledge supporting the efficacy of systemic and relational approaches in children’s mental health care, there are mounting barriers to family involvement. The current reflexive thematic analysis included data from parents, social work students, university faculty and field professionals, and school board professionals ( n = 65) to understand the mental health needs of parents and families. The findings exemplify the importance of systemic and relational family work for parents supporting their child and family’s mental health. We found a pre-existing and deepening gap in the accessibility of such supports since COVID-19. Implications include a call to renew systems thinking in children’s mental health, a systemic re-shift toward family service organizations including options for multiple members of a family, and education in social work that fosters systemic and relational family approaches to children’s mental health.
Aim: The aim of present study was the application of the Attachment-Based Family Therapy (ABFT) for a transgender adolescent with suicidal thoughts. Methods: Multiple baseline experimental single case study was used as the method of the present study. The population sample is a transgender adolescent (female to male) and his/her parent chosen according to the purposive sampling method. The adolescent completed The Suicidal Ideation Scale (SIS) over the course of the sessions. ABFT was implemented in twenty-seven 90 minute-sessions. Furthermore, visual inspection is applied to analyze and interpret data. Results: The results of this qualitative and step-by-step investigation of the attachment-based family therapy showed that this therapy was effective in significantly reducing the suicidal thoughts in the transgender adolescent. Conclusion: Effective intervention with transgender adolescents and their families can foster a secure attachment relationship. Family therapists may employ attachment-based family therapy to address suicidal tendencies among transgender individuals. This approach also supports families in navigating the transformative journey of their transgender child.
Objective
This article calls on family scholars to take seriously how families are invested and divested in maintaining and reproducing cisnormativity.
Background
Families can be a prime institution for the reproduction of cisnormativity. For transgender and nonbinary family members, families' investment in cisnormativity can generate ambiguous and toxic familial relations. Yet, family studies have not developed an adequate framework to examine how and why cisnormativity operates within families.
Method
The authors engage with empirical and theoretical work on gender, intersectionality, and families to examine how cisnormativity operates within family dynamics and processes. This article also focuses on work about trans people and families to capture how cisnormative processes within families affect trans people's familial relations.
Results
The authors advance a trans family systems framework to show how families' cisgender investments and divestments shape familial processes. The concept of cisnormative compliance is introduced to capture the beliefs and practices of obedience established by family members for the purpose of reproducing cisnormativity. Family studies can move forward in studying these cisnormative processes through documenting how gender accountability shapes family dynamics, implementing new methods, furthering an intersectional analysis, and exploring complexities of space and place.
Conclusion
To reimagine gender and families, family scholars need to study and foreground how cisnormativity shapes family dynamics and processes.
For many parents of transgender or non-binary children the experience is transformative learning (Mezirow, 1978). This life history study of 17 parents of children aged 6 to 29 comprised of 33 interviews, 10 participant journals, and an autoethnography. Findings from the data indicated parental learning was a holistic experience (Illeris, 2003), a balance of emotion, cognition, and sociality. When one domain of learning was overstimulated, learning could be disrupted. Parents restructured their conceptions of gender, working through understandings of gender from their past and new ideas of the present. Learning also occurred in two phases, a private phase of cognitive reframing and then a more public phase as parents learned to advocate for their child. Most parents were anchored by value of authenticity, and some mothers revisited the notion of “What makes a woman?” For some, working through discomfort was one part of the learning process.
This article outlines a qualitative metasummary of studies with qualitative findings collected from parents of transgender and gender-nonconforming (TGNC) children. This literature review study describes parents’ experiences of responding to TGNC children. The step of data analysis for this study resulted in a data set of 34 research articles with two primary themes, four subthemes, and 17 findings. The two primary themes represent challenges parents faced and changes they made relating to their TGNC children. We created this report to share with mental health professionals, such as clinical social workers, serving TGNC children and their parents. This metasummary report concludes with recommendations mental health professionals can implement to improve services offered to TGNC child mental health care recipients and their accompanying parents.
Using a phenomenological framework, we interviewed gender nonconforming, nonbinary, and binary transgender (GNBT) youth and young adults on the topic of disclosing non-cisgender identities within families of origin. We found that before a formal conversation and declaration takes place, there are subtle and unconscious in/formal hints of identifying as something beyond the bounds of cisgenderism. We call these precursors “breadcrumbs.” These crumbs of gendered truths function to consciously test the relational waters while simultaneously subconsciously understanding familial gendered expectations. While there are some positive reactions from family to these breadcrumbs, GNBT youth often experience conflict, disappointment, and moments of rejection as they test the boundaries of what is possible within their families’ understanding of gender norms.
Purpose:
In youth, gender nonconformity (GNC; gender expression that differs from stereotypes based on assigned sex at birth) is associated with a higher likelihood of peer and caregiver victimization and rejection. However, few studies have examined the relationship between GNC, overall family conflict, perceptions of school environment, and emotional and behavioral health problems among children ages 10-11.
Methods:
The Adolescent Brain Cognitive Development Study data release 3.0 was used (n = 11,068; 47.9% female). A path analysis was used to examine whether school environment and family conflict, mediated the relationship between GNC and behavioral and emotional health outcomes.
Results:
We found significant mediation of the relationship between GNC and behavioral and emotional health by school environment a2b2 = .20, 95% CI [0.13, 0.27] and family conflict a1b1 = 0.34, 95% CI [0.25, 0.42].
Discussion:
Our results suggest that youth who present as gender nonconforming experience elevated family conflict, poorer perceptions of their school environment and elevated behavioral and emotional health problems. Further, the relationship between GNC and elevated emotional and behavioral health problems was mediated by perceptions of school environment and family conflict. Clinical and policy suggestions to improve environments and outcomes for youth who present as gender nonconforming are discussed.
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.
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.
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.
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.
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.
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.
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.
This introductory article presents some subtle and, perhaps, controversial aspects of providing care to adolescents who identify as transgender. I will describe (1) how praise from careproviders can benefit parents who have difficulty accepting the gender identity of their child that was not assigned at birth; (2) how adolescents who identify as transgender may follow the internet advice of peers on how to "con" careproviders; (3) how it may be difficult for careproviders to decide whether to further patients' felt needs and to protect them, paternalistically, from making an irreversible decision they may later regret; and (4) how careproviders can benefit adolescents by taking the initiative to discuss sex and how to say "no." I emphasize how careproviders who see these patients, even when they have no special expertise in this area, may be able to enhance patients' equality in every respect, even when they otherwise might not choose to do so.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.)
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.
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.
Since its appearance in 1980, the diagnostic category “gender identity disorder” (GID) in the Diagnostic and Statistical Manual of Mental Disorders (DSM) has sparked concern among gender variant people and their advocates that it contributes to hurtful stigma and social barriers faced by gender variant individuals, while at the same time it contradicts the medical legitimacy of sex reassignment for the treatment of gender dysphoria. This paper examines the GID diagnosis of adults and adolescents and the social and medical consequences posed by its implication of “disordered” gender identity. Parallels are drawn to the removal of homosexuality and ego dystonic homosexuality from the DSM in the 1970s and '80s. At issue is the label of mental illness for behaviors that are otherwise ordinary or even exemplary based only on natal anatomical sex. Finally, a path forward is proposed to replace GID with a new diagnosis unambiguously defined by chronic distress rather than social nonconformity.
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)
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.
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