‘If they didn’t support me,I most likely wouldn’t be here’: Transgender young people and their parents negotiating medical treatment in Australia

Abstract

Background: It is increasingly recognized that transgender young people require affirming medical care, however the provision of such care may be mitigated by the availability of services and the views of parents.

Aims: This study aimed to explore the views of Australian transgender young people (aged 11–17) and their parents with regards to medical treatment.

Methods: Ten qualitative interviews were conducted with parent-child dyads in two Australian states. Thematic analysis was undertaken on responses to interview questions related to family relationships, views about medical treatment (specifically hormone blockers and hormones), and the relationship between medical treatment and sense of self.

Results: Themes developed focused on the importance of strong supportive parent-child relationships, the meaning of and access to hormone blockers, and the meaning of and access to hormones.

Discussion: The paper concludes by discussing the implications of the findings for clinical services, particularly in relation to supporting parents to be affirming of a transgender child, the need to prepare transgender young people and their parents for the passage of time in regards to medical treatment, and the need to focus on expectations in regards to sense of self in relation to medical treatment.     

An initial study of transgender people's experiences of seeking and receiving counselling or psychotherapy in the UK

Background: There are no published empirical research studies exploring transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. As a result, counsellors know little about why transgender people seek counselling, who they seek counselling from, and what their experiences are of receiving counselling. Aim: To address this gap in the literature, this study investigated transgender people's experiences of seeking and receiving counselling or psychotherapy outside of gender identity clinics within the UK. Funding for this study was provided by a BACP Seedcorn grant. Method: A mixed method small‐scale qualitative research design was employed, comprising an online survey and five semi‐structured interviews. Findings: Participants tended to seek counselling on two or more occasions and received between 2 and 12 sessions. Participants sought counselling for common psychological concerns as well as gender identity and coming out issues. A fear of being discriminated against and exploring gender for the first time were significant barriers in seeking help. Participants reported mixed experiences of counselling but valued a therapeutic relationship in which they felt affirmed, listened to and understood. Discussion: The findings from this study mirror aspects of previous research conducted in the USA concerning transgender clients' experiences of counselling. However, these findings point to the importance of recognising the potential vulnerability transgender clients experience when seeking counselling and the need for therapists to develop greater awareness, knowledge and competence regarding working with transgender clients.     

“I love you as both and I love you as neither”: Romantic partners’ affirmations of nonbinary trans individuals

Abstract

Background: Transgender microaffirmations are subtle endorsements of a person’s gender identity through both verbal acknowledgements and behavioral gestures. Microaffirmations positively impact individuals who identify as transgender by acknowledging their gender identity and by communicating a sense of support and validation.

Aims: This study focuses on microaffirmations specifically directed toward nonbinary transgender individuals within romantic relationships.

Methods: Participants included 161 adults who identified as nonbinary: 85 who identified as gender nonconforming and 76 who identified as agender. These participants were either currently in a romantic relationship or had been in a romantic relationship within the past 5 years. Participants completed an online survey and provided examples of the microaffirmations they experienced from their romantic partners.

Results: Responses were analyzed via thematic analysis, resulting in four overarching themes: (1) Identity Validations, acknowledgement and acceptance of nonbinary identity; (2) Identity Endorsements, active endorsements of nonbinary through language or behavior; (3) Active Learning, self-education about nonbinary identities; and (4) Active Defense, interruptions of others’ negative actions directed at nonbinary partners.

Discussion: Discussion of the results focuses on understanding how microaffirmations operate to complicate binary notions of gender/sex and positively influence nonbinary transgender individuals in interpersonal relationships.     

You,me, and meaning: an integrative review of connections between relationships and meaning in life

Social relationships are seen to be vital to human functioning, both in terms of psychological functioning and physical health. Relationships are a cornerstone of well-being. For instance, having positive relationships has been linked to greater happiness, life satisfaction and physical health outcomes. Meaning in life, or the perception that one's life is significant and has a purpose, is another prominent cornerstone of well-being. As such, social relationships and meaning in life should have reciprocal associations. In this paper, cross-cultural theory and empirical research will be reviewed to explore the role of family, romantic and friendship relationships in supporting meaning in life. Further, we will discuss the implications of the current research and propose new directions for future research.     

Fibromyalgia: Predicting openness to counselling referrals

Fibromyalgia (FM) is a chronic pain condition that can negatively impact on all aspects of patients’ lives. The purpose of this study was: first, to explore the biopsychosocial factors that may contribute to adjustment to FM symptoms; second, to investigate how referrals to counselling related to patients’ ratings of their relationship with their physicians; and, last, to examine if self-reports of illness distress, emotional problems, and practical problems can predict who will be open to counselling referrals. For this cross-sectional study, data from 190 people were collected through an online survey. Statistical analysis revealed that emotional problems reported were the best predictor of variance in illness distress and contentment scores. Further, results indicated that referrals made in accord with patients’ perceptions that they would benefit from counselling may have a positive influence on how patients rate their relationships with their physicians. Finally, self-reported scores of illness distress, number of emotional problems, and number of practical problems accurately predicted who would be open to counselling referrals in 67% of cases. Research results provide support for addressing emotional issues to facilitate adjustment to FM symptoms, and for use of psychosocial measures to determine when patients with FM will be open to counselling referrals.     

What are the relationship experiences of in which one member identifies as transgender? A systematic review and meta-ethnography

Transgender individuals and their partners may face unique challenges that other couples do not. These unique challenges merit investigation, understanding and consideration by systemic practitioners in order to provide a culturally attuned service for transgender clients. A systematic review of the literature into the experiences of couples in which one member is transgender identified 22 qualitative papers. A translation and synthesis of constructs from these papers utilising a meta-ethnographic approach generated a number of third order constructs organised into nine overarching themes. These themes included experiences of stigma and discrimination, issues of power, privilege, visibility and identity, and experiences of dissonance and dysphoria that required adjustments and negotiations on the personal and relationship levels. Implications for practice and avenues for future research are discussed.     

Do close supportive relationships moderate the effect of depressive symptoms on suicidal ideation?

Depressive symptoms, a lack of close supportive relationships and suicidal ideation are important risk factors for suicidal acts. Previous studies have primarily focused on the additive effects of close relationships and depressive symptoms on suicide risk. Here we explored whether, in addition, close relationships moderated the impact of depressive symptoms on suicidal ideation. An analysis of pre-existing data from 319 attendees at a student counselling service using moderated regression models indicated that when the student has close supportive relationships, the association between depressive symptoms and suicidal ideation is weaker than when he/she feels an absence of close relationships. This confirms the need to include enquiries about the presence of close relationships and depression as part of any suicide risk assessment.     

How prisoners and their partners experience the maintenance of their relationship during a prison sentence

Research shows that intimate relationships, and their maintenance via prison visits, have a positive impact on factors associated with prisoner well‐being and reduced likelihood of recidivism. It is therefore in the interest of corrections, government, and wider society to enable prisoners to maintain healthy relationships with their family and intimate partners throughout their prison sentence. Despite this evidence, little is known about how prisoners experience the maintenance of a significant intimate relationship in prison. This study aims to explore heterosexual couples' experiences in maintaining their well‐established intimate relationships, while the male partner is incarcerated. Four main themes were identified: how they experienced “having a special connection” that they were motivated to maintain; “coping with challenges and threats” to that connection; “developing reciprocal behaviours” to meet those challenges; and “maintaining a belief in the future.” Implications for how the relational context of rehabilitation can best be supported is considered.     

Transactional pathways of transgender identity development in transgender and gender-nonconforming youth and caregiver perspectives from the Trans Youth Family Study

Background: A growing body of research has examined transgender identity development, but no studies have investigated developmental pathways as a transactional process between youth and caregivers, incorporating perspectives from multiple family members. The aim of this study was to conceptualize pathways of transgender identity development using narratives from both transgender and gender-nonconforming (TGN) youth and their cisgender (nontransgender) caregivers.

Methods: The sample included 16 families, with 16 TGN youth, ages 7 to 18 years, and 29 cisgender caregivers (N = 45 family members). TGN youth represented multiple gender identities, including trans boy (n = 9), trans girl (n = 5), gender-fluid boy (n = 1), and girlish boy (n = 1). Caregivers included mothers (n = 17), fathers (n = 11), and one grandmother. Participants were recruited from LGBTQ community organizations and support networks for families with transgender youth in the Midwest, Northeast, and South regions of the United States. Each family member completed a one-time, in-person semistructured qualitative interview that included questions about transgender identity development.

Results: Analyses revealed seven overarching themes of transgender identity development, which were organized into a conceptual model: Trans identity development, sociocultural influences/societal discourse, biological influences, family adjustment/impact, stigma/cisnormativity, support/resources, and gender affirmation/actualization.

Conclusions: Findings underscore the importance of assessing developmental processes among TGN youth as transactional, impacting both youth and their caregivers.     

Differences in the importance of romantic structures among transgender and cisgender adults during the COVID-19 pandemic

The stressors of the global COVID-19 pandemic have led to an increased need for support. For adults, romantic relationships often represent an environment of emotional support and stability; as such, attitudes toward—and particularly the importance of—romantic relationships may have shifted as a result of the pandemic. The present cross-sectional study explores how U.S. transgender (n = 99) and cisgender people (n = 1886) report whether they have perceived a change in their feelings about the importance of long-term romantic structures (i.e., committed relationships, monogamy, cohabiting with a romantic partner, and marriage) as a result of the COVID-19 pandemic. Results found that transgender people reported a more positive perceived change in importance placed on all four romantic items relative to cisgender people. Different forms of stress (e.g., social, financial, health) associated with the COVID-19 pandemic may have contributed to an increased need, and subsequent desire, for social connection and support in the form of romantic relationships among transgender individuals to a greater extent than cisgender individuals, perhaps in part due to the additional layers of stress transgender people must navigate. Results are discussed through the lens of the minority stress framework.     

Conflictual relationships between kindergarten children and their teachers: Associations with child and classroom context variables

The focus of this study was on kindergarten children's reports of teacher-child relational conflict and the associations of the reported conflict with (a) child characteristics (gender, behavior problems, and academic achievement); (b) the quality of classroom practices (teacher instructional practices, transition-to-school activities, and perceptions of support provided by the school); (c) teachers' perceptions of the classroom and school relational climates; and (d) teachers' perceptions of workload stress. These variables were examined with a group of 103 economically disadvantaged children and their kindergarten teachers in 24 public schools. There was evidence that teacher-child conflict was related to problem behaviors, teachers' perceptions of workload stress, as well as classroom instructional practices and the classroom/school relational climate.     

“She was on my side,and grounded me when I needed it:” Research supervision in the field of therapy,based on counsellors’ and psychotherapists’ views on their engagement with research

Research‐supported practice is increasingly emphasised within counselling and psychotherapy at all stages of training. Guided by an interest in how to support therapists in their efforts to develop research knowledge during doctoral training, this paper focuses on research supervision. Research supervision is a surprisingly under‐researched area. Little is known to date about how supervisors “go about their supervision” (Bruce & Stoodley, 2013, p. 5), despite the fact that “high failure rates for research dissertations in the social sciences have been partly attributed to student dissatisfaction with supervision and poor student–supervisor relationships” (Armstrong, 2004, p. 134). Between 2016 and 2019, we explored accredited counsellors' and 'psychotherapists engagement with research during or after their doctoral training. This paper explores research supervision with these two previous studies serving as the backdrop (Bager‐Charleson et al., 2018; Bager‐Charleson et al., 2018b), together with a literature review into research supervision within social sciences and psychotherapy. Supervision is discussed as a crucial coping/support strategy to (a) link research with practice in therapy work, practically and epistemologically; (b) contain and make sense of the use of transformative learning; (c) balance “enculturation” with critical thinking and emancipation; and (d) support reflective and reflexive development. This paper discusses an adaptive research supervision model, akin to a “holding bond” (Stevens, 2016) which supports the student to reflexively position her/himself personally, intersubjectively, theoretically and socio‐culturally, whilst “negotiating the tension” (Lee, 2008) during a process of enculturation into the discipline, and also fostering critical thinking and emancipation to contribute to new knowledge.     

Secondary school pupils’ views of their school peer counselling for bullying service

Pupils (n=99) from two secondary schools in the UK were interviewed to investigate their views and experiences of the peer counselling for bullying service set up in their school. They were asked about various things concerning (1) the characteristics of the service and service providers that they valued and (2) their reasons for not using the service. Overall, a majority of participants reported a willingness to use this type of service and they identified numerous characteristics that they valued, including peer counsellors with good listening skills who were trustworthy and maintained confidentiality. A noteworthy proportion of participants also wanted the service to provide advice on solving bullying‐related problems. Some barriers to using the service were also identified, including fear of being stigmatised. Responses offered by girls and boys, and by users and non‐users of the service, were compared and several significant differences emerged. The results are discussed in terms of the implications for adults who run this type of service and the peer counsellors who deliver it.     

A Seat at the Table: Using Social Media as a Platform to Resolve Microaggressions Against Transgender Persons

Transgender, gender variant, and/or gender nonconforming persons are marginalized and pathologized in society and communities. The advent and widespread use of social media introduce an entirely new avenue of expression where cyber bullying and verbal assaults are common. Yet, social media also has the capacity to reach more people in more places, thus presenting a potentially powerful platform for advocacy. Grounded in digital critical participatory action research, the authors present a multimedia advocacy project that highlights advocacy strategies in which counselors can utilize social media to raise awareness, promote inclusion, and resolve microaggressions toward transgender persons.     

Supporting families of transgender children/youth: Parents speak on their experiences,identity, and views

ABSTRACT

Background: Transgender children/youth demonstrate the best possibility for resilience and positive mental health when they are part of an affirming and supportive family. To optimize families in supporting transgender children/youth, parents/caregivers need to be supported. Transgender children/youth and their families regularly navigate a myriad of challenges through society.

Aims: Within the extant literature on transgender children and youth, relatively little attention is focused on the experiences of parents/caregivers and how their close family relationships are affected. The present qualitative study addresses this gap in knowledge through its exploration of the experiences, identities, and views of parents/caregivers of transgender children/youth.

Method: The study is longitudinal and this article represents the first wave. Fourteen parents of 12 transgender children/youth, aged 6–17, participated in in-depth semistructured interviews. Participants were recruited via social media and at an on-site conference for transgender youth and their families. All children/youth had socially transitioned. Those who were eligible for puberty suppression and/or hormone therapy were receiving those. The interviews were inductively coded for themes by two coders using the constant comparative method.

Results: Participants' reports on their experiences yielded three themes: (1) transgender issues as the family's focus; (2) proactivity, child-focused: preemptive actions to prevent adverse consequences; and (3) self-care. These themes included subthemes on effective coping strategies to mitigate struggles. Three themes related to participants' identity and views emerged: (1) identity reformation, (2) self-evaluation, and (3) views of future. These themes included subthemes that reflected how participants viewed themselves, their child, and the future.

Discussion: A transgender identity in one family member affects all household members. Parents/guardians may experience guilt and self-doubt over decisions. Factors that may improve outcomes with extended family and schools include families' preemptive dissemination of information on transgender identities and explicating expectations of respect and nonintrusion. Ingrained traditions may force life-altering decisions.     

“The Parallel Dialogue”: Parental experience of their role in the relationship with their child's counsellor/psychotherapist

The parent–therapist relationship is a central consideration in child counselling and psychotherapy, particularly in private practice where parents are typically financially, emotionally and practically invested in the process. The relationship, which can be ambiguous and anxiety-laden on both sides, has historically received scant attention in therapeutic discourse, leading to gaps in practitioner confidence and training. In this context, and seeking to centre parent voices, this study provides an interpretative phenomenological analysis of four mothers' experiences of their role in the relationship with their child's therapist. Key identified themes encompass parental expectation of involvement; the destabilising, disorienting nature of the relationship; the centrality of trust; and critical evaluations of value. Findings are discussed in relation to attachment theory and cultural expectations of parental responsibility. The study concludes that the relationship is a live and potent property with potential to impact the course of the intervention, and recommends that practitioners thoughtfully consider the potential benefits and drawbacks of meeting or frustrating parental involvement expectations.