Mental health professionals are sooooooo important in changing individuals, families, and communities’ experiences with coming out and transitioning. As budding social workers and former transgender and gender non-conforming (GNC) youth (we grew up, unfortunately), we all know the difference a good mental health professional can make. We’ve experienced the worst of the worst, and don’t want any person (queer kids especially) to EVER have to go through the same nonsense. Different therapeutic techniques, resources, and interventions can create a respectful and fruitful environment for trans and GNC kids to grow into their identities, even if their provider is cisgender (their gender identity aligns with the “sex” they were assigned at birth).
First and foremost, we want to address the ethical question of supporting trans and GNC youth in the transition process: leading mental and medical health professionals who work specifically with trans and GNC youth have stated on COUNTLESS occasions that supporting queer youth through the transition process is the most ethical course of action for practitioners. If you feel like your inherent biases or personal beliefs will get in the way of fully supporting trans or GNC youth as clients, refer them to another practitioner. DO NOT damage our kids.
Many trans and GNC folx who came out at earlier ages have heart-wrenching stories about horrific things shrinks and doctors said or did to them. These practitioners, many of whom were conversion-therapists masquerading as “gender-specialists,” did more harm than good, further exacerbating their clients’ depression, anxiety, self-loathing, self-harm, and suicidal ideation.
With that in mind (sorry if that was a bit abrasive, we just want to keep our kids safe), there are a lot of ways to be culturally competent when working with transgender and gender non-conforming youth. While the research regarding individual therapeutic interventions specifically targeting LGBTQIA+ youth isn’t great, we’ve combined techniques we use in our own practice with what’s worked best in our personal therapy sessions to come up with a comprehensive list:
Compared to Ego Psychology and Behavior Therapy, Narrative Therapy is definitely the new kid on the therapeutic intervention block. It rejects pathologizing clients and externalizes their problems to create a safe distance from which they can process their feelings. Narrative Therapy has three core tenets for building relationships: respect, non-blaming, and client-as-expert. Unlike other forms of therapy, Narrative Therapy requires the practitioner to do more than listen—they must engage with clients in dissecting narratives they’ve created about their lived experiences.
Narrative Therapy is especially helpful for therapists who work with clients from certain marginalized communities. Some research has been conducted on the effectiveness of using Narrative Therapy with LGBTQIA+ individuals, all of which have produced positive initial findings. While intersecting identities may cause clients to be hesitant about the “client-as-expert” component, many trans and GNC folx find it refreshing as an acknowledgement that they are the ultimate authorities on their gender identity. Check out this website for additional information about practicing Narrative Therapy.
Feminist Therapy was a by-product of second-wave feminism and posits that gender roles—especially those prescribed to womxn in a patriarchal society—are central to analyzing individuals’ reactions and emotional health. Essentially, society says you have to do _________ because of the gender you were assigned at birth. Feminist Therapy demands a culturally competent understanding of gender politics and a nonjudgmental environment.
While little to no research has been done on Feminist Therapy’s effectiveness with trans and GNC youth, gender is central to our mental health struggles and growing into our gender identities. Unlearning societal expectations and understanding how they affect and oppress us is crucial to improving mental health. For more information on practicing Feminist Therapy, check out this website.
Trans & GNC CBT
This trans and GNC-specific form of Cognitive Behavioral Therapy (CBT) should only be practiced by people who feel very comfortable and knowledgeable about issues within the trans and GNC community. It can be conducted in group or individual sessions, and while research about it is limited and not very good, many of our clients have had wonderful, productive experiences with trans-specific CBT. For more information about trans and GNC-specific CBT, click here.
Coping Strategies & The “Miracle” Question
One of the main focal points of Ego Psychology is coping mechanisms. While we don’t necessarily recommend exclusively using Ego Psychology with trans and GNC youth, we think it could be valuable to assess which, if any, coping mechanisms a client is currently using. Media representations of queer coping strategies predominantly focus on addiction, so having a conversation about positive coping strategies could be useful and preventative in the long run. Here is a list of coping strategies to review with clients.
The “miracle” question is, in our humble opinion, the only helpful part of Solution-Focused Brief Therapy (SFBT). Other techniques associated with SFBT, such as looking for previous solutions or exceptions, feel dismissive and create unequal power dynamics. The “miracle” question, if used in a culturally competent manner, can give trans and GNC youth insight into what their ideal outcomes of transitioning and coming out could be, and help them get on a path to making those “miracles” reality. For individuals from certain religious or cultural backgrounds, “miracles” don’t exist as a word or concept, have negative connotations associated with them, or complicate the purpose of the exercise. In these cases, it’s best to substitute a synonym or explain the idea in a different way.
Here’s how it works:
You (the therapist) say to your client:
“Let’s say you leave your session with me, go home, and go about the rest of your day. You go to bed, and in the morning all of your problems are solved. You’ve changed.”
- How will you know that the change has happened?
- What would you see/hear?
- How will you feel different?
- How will your loved-ones know you or something in your life has changed?
- Will strangers or acquaintances be able to tell that something is different? If so, how?
We HIGHLY recommend using mind-body practices with trans and GNC youth. Many individuals from marginalized communities don’t find value in traditional talk-therapy, so mind-body interventions, such as trauma-informed yoga, mindfulness, and meditation can be used as more comfortable alternatives. We recommend that if you decide to use trauma-informed yoga or any other mind-body practices with trans or GNC youth, it is best to avoid gendered statements (ex. “Ladies, if you’re menstruating, don’t do this pose.”). Also, unless you are a licensed instructor, DO NOT practice yoga, mindfulness, or meditation with a client—you may do more harm than good. Refer your clients to individuals who are licensed and trained to teach these practices. Check out some examples on insightLA and the Point Foundation‘s websites.
For more information about the mind-body connection or interventions for gender dysphoria, feel free to explore our website. While the research about yoga and mindfulness-based interventions isn’t always specific to trans and GNC youth, we have seen promising results, and all three of us at Out of Yer Shell have some form of mindfulness practice.
Transgender and gender non-conforming youth deserve the same adequate access to mental health services as their cisgender peers. While some research is emerging, the mental health profession as a whole has not done enough to serve these kids. More research and training need to be done.
If you don’t feel comfortable or knowledgeable enough to work with trans and GNC youth, don’t. Refer them to other mental health providers or resources, such as the Trevor Project. They offer a wide range of digital and human services, 24 hours a day, 7 days a week. Every trans and GNC youth should be referred to their website if they don’t already know about it. It may also help to familiarize yourself with the list of LGBTQIA+ groups we advertise under out Advocacy Groups tab.
Overall, working with trans and GNC youth takes a kind, affirming, and respectful mental health provider. You don’t have to be queer to work with trans and GNC kids, but you certainly need to be intentional and frequently check your biases. We believe in the inherent goodness of people, and that most folx in mental health fields go into the profession because they want to help others. If you have any questions about providing mental health services to trans and GNC youth, please feel free to contact us.
“All children should be taught to unconditionally accept, approve, admire, appreciate, forgive, trust, and ultimately, love their own person.”Asa Don Brown