Demarginalizing Stigmatized Identities of Transgender and Gender Nonconforming Individuals Through Affirmative Group Therapy

Factors that drive mental health disparities and promote well-being in transgender and nonbinary people

Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgender and non-binary (TNB) individuals, an emergent literature has begun to explore protective and health-promoting factors and dimensions of psychological well-being. In this Review, we discuss the sociocultural context for TNB people, beginning with a brief history of TNB identity before highlighting frameworks for understanding the higher prevalence of certain mental health concerns among TNB individuals. Next, we summarize the predictive factors associated with higher rates of depression, anxiety, suicidality, trauma-related concerns, disordered eating behaviours and substance use. We also review TNB coping, resilience and resistance to anti-trans stigma, as well as psychological well-being, flourishing and gender euphoria. Tying these topics together, we discuss affirming interventions for reducing mental health disparities and promoting psychological health in TNB individuals and communities. We conclude by discussing future research directions.

Individuals who are transgender or nonbinary experience a higher prevalence of certain mental health concerns, including depression, anxiety and disordered eating behaviours. In this Review, Tebbe and Budge discuss these disparities along with factors that protect these individuals from negative outcomes and promote well-being.

Group Psychotherapy as a Specialty: An Inconvenient Truth

Group psychology and group psychotherapy (GPGP) are distinctive, effective practices that meet an important need. In 2018, the American Psychological Association recognized GPGP as a specialty, thus setting standards for education and training in the field. Although there is a need for high-quality group psychotherapy, practitioners often lack standardized training, thus posing a risk to patients. Adoption of these standards by practice settings and training programs is essential for expanding the availability of quality group therapy. An understanding of how the specialty became recognized and of the specific criteria for its practice (i.e., public need, diversity, distinctiveness, advanced scientific and theoretical preparation, structures and models of education and training, effectiveness, quality improvement, guidelines for delivery, and provider identification and evaluation) are essential for expanding the availability of high-quality group psychotherapy. Such understanding also informs how training programs can align with standards. This article provides a foundation of understanding and details implications of group psychotherapy's establishment as a specialty. The benefits of high-quality group psychotherapy are far-reaching, whereas the risks of inadequate practice loom large.

Introduction to the Special Section on Group Psychotherapy and Gender Identity

This introduction to the special section of this issue of the International Journal of Group Psychotherapy provides context for the articles that follow. I discuss how recent events (both within and outside of the American Group Psychotherapy Association) highlight the need for an ongoing discussion about how group psychotherapists have a duty to provide ethical and affirming care of transgender and gender nonconforming (TGNC) individuals. I then provide a brief overview of some foundational terms and constructs related to gender identity and briefly review the existing literature before previewing the two articles in the special section that focus on ethical issues in group psychotherapy with TGNC individuals (Darby, this issue, 2020) and in providing affirming group psychotherapy (Chen et al., this issue, 2020). I conclude with recommendations for readers to gain additional knowledge, awareness, and skills related to gender identity and to working with TGNC clients in group psychotherapy.