The effects of gender identity change efforts on Black, Latinx, and White transgender and gender nonbinary adults: Implications for ethical clinical practice

Mental Health Practitioners' Knowledge of LGBTQA+ Conversion Practices and Their Perceptions of Impacts on Survivors

The aims of this study were to identify Australian mental health practitioners' knowledge of what LGBTQA+ conversion practices are and their perceptions of impacts on survivors. We interviewed 18 mental health workers from a range of clinical modalities who were practicing in Australia. We used reflexive thematic analytic techniques to identify themes that characterized Australian mental health practitioners' knowledge of LGBTQA+ conversion practices and perceptions of the impacts of such practices on survivors. Practitioners' understandings of what constitutes LGBTQA+ conversion practices were varied and derived from a range of sources, and practitioners' perceptions of the impacts that conversion practices had on survivors ranged from undeveloped to nuanced. Generalist and specialist practitioners provided vastly different responses. We identified the following four themes: (1) inexperienced practitioners' understandings were limited and reliant on stereotypes about conversion practices; (2) specialist practitioners' understandings were refined and match experiences reported by survivors; (3) generalist practitioners emphasized specific and undeveloped negative impacts; (4) specialist practitioners were aware of deeper harms and the need for sustained support. These themes may be translated into strategies to facilitate improved services offered by practitioners, which may assist survivors in managing and coping with the trauma associated with exposure to these practices.

Adaptive transition decisions and identity exploration among transgender and nonbinary persons exposed to gender identity conversion efforts

Introduction

Transgender and nonbinary (TNB) persons' healthcare experiences and related transition decisions have received increasing attention in recent years. Growing literature indicates gender non-affirming practices, such as gender identity conversion efforts (GICE), are harmful for the wellbeing of TNB persons. Yet, how exposure to GICE is linked to transition related decisions among TNB persons remains unexplored. This study examines links between GICE and TNB persons' transition decisions and identity exploration, using a conceptual framework that distinguishes adaptive transition decisions (e.g. transition interruptions due to interpersonal coercion) from identity-related transition decisions.

Methods

This study is a secondary data analysis of the 2015 U.S. Transgender Survey (N = 27,630). Multinomial logistic regression was conducted to examine the relationship between GICE and transition decisions among TNB persons while controlling for demographic covariates.

Results

Overall, 13.5% of TNB participants experienced GICE. Participants interrupted their transition due to interpersonal coercion (4.9%), structural factors (2.0%), and identity-related factors (0.4%). Participants with GICE exposure were more likely to report interrupting their transition due to interpersonal coercion than not interrupting their transition. However, GICE-exposed participants did not have a higher chance of identity-related transition interruptions than no interruptions.

Conclusions

These findings point to a potentially harmful role GICE may play in the transition decisions of TNB persons. Our analysis adds to evidence indicating the need for banning GICE and calls for a more nuanced understanding, recognition, and respect for TNB persons' non-linear transitioning trajectories. Otherwise, we risk vilifying gender-affirming practices and pathologizing adaptive transitioning decisions of TNB persons.

A Latent Profile Analysis of Religious Parents' Responses to Their Sexual and Gender Diverse Child

Prior research indicates that religious parents can have negative, positive, or ambivalent responses to their child's sexual orientation and gender identity (SOGI). Yet, to our knowledge no research has quantitatively examined patterns of sexual and gender diverse (SGD) youth's perceptions of their religious parents' responses to their SOGI. Without examining variations in these patterns, we are unable to better understand the experiences of SGD youth with religious parents. In the current paper, we examined patterns of SGD youth's perceptions of their religious parents' SOGI-specific rejection, acceptance, and SOGI change efforts. We also examined if these patterns differed by SGD youth's individual and contextual factors. The analytic sample consisted of online responses from 5,686 SGD youth (Mage = 15.95). We found four distinct profiles: Positive Parental Response, Moderate Negative Parental Response, Low Parental Response, and High Negative Parental Response. The largest profile was the Positive Parental Response, suggesting that many SGD youth perceived positive responses from their religious parents. SGD youth with diverse gender identities and intersecting identities, such as race/ethnicity, were more vulnerable to religious parents' negative responses. Findings have implications for existing resources and programs aimed at strengthening SGD youth's relationship with their religious parents.

Gender identity differences in the experiences of family stressors and violence among transgender and non-binary individuals in China

Emerging research has demonstrated that transgender and non-binary (TNB) individuals face an elevated risk of experiencing family rejection and violence. However, there remains a significant knowledge gap regarding how TNB individuals manage stressors and their gender identity within the family context, particularly in regions where TNB individuals are highly stigmatized and where legal protections against family violence are lacking. The present study represents one of the first pioneering efforts to provide large-scale quantitative data examining the experiences of family stressors, the management of gender identity and expression, and family violence among TNB individuals in China. A national sample of 1063 TNB individuals in China was involved in the study. They completed questionnaires about their experiences of family stressors and violence. The results indicated that 76.0% of TNB individuals reported having encountered at least one form of violence perpetrated by their family members. Transfeminine individuals were more likely to report experiencing emotional and physical abuse, whereas transmasculine individuals were more likely to be subjected to gender identity and/or expression change efforts. Family stressors, including family non-acceptance and the pressure to marry and reproduce, were positively associated with non-disclosure of gender identity, the suppression of gender expression, and family violence. The findings underscore the substantial burden of family violence borne by TNB individuals in China, which warrants immediate legal, institutional, and social responses. Trans-inclusive family violence prevention and intervention are urgently needed, with a focus on Chinese cultural factors and gender identity differences in violence screening and risk assessment.

Understanding harms associated with gender identity conversion efforts among transgender and nonbinary individuals: The role of preexisting mental well-being

Background: Affirmation of gender identity is critical for the mental health and overall well-being of transgender and nonbinary (TNB) persons. Gender identity conversion efforts (GICE), an outlawed practice for licensed professionals in numerous U.S. jurisdictions, have been associated with negative mental health and substance use outcomes. Limited previous literature examining GICE exposure has been criticized for failing to distinguish mental well-being for TNB persons before or after GICE. Our study builds on current literature by examining differences in TNB persons' psychosocial risk indicators based on their GICE exposure, accounting for pre-GICE mental well-being. Methods: We conducted a secondary data analysis using the 2015 U.S. Transgender Survey (N = 25,810), the largest available national survey aimed at understanding TNB persons' experiences. Using logistic regression models, we examined how GICE exposure (disaggregated by temporal precedence of initial suicide attempts) is related to health (psychological distress, extra-medical prescription use, healthcare avoidance), socio-structural (public restroom avoidance, housing instability), and interpersonal outcomes (sexual assault, emotional and physical intimate partner violence (IPV)). Results and conclusions: Initiating a suicide attempt post-GICE or in the absence of GICE were the only consistently significant predictors of poor outcomes across all domains compared to participants who never experienced GICE or attempted suicide. Findings suggest, however, that a combination of GICE with a history of suicide attempts (pre- or post-GICE) was indicative of the highest risk across outcomes, highlighting the particularly hazardous nature of combining poor mental well-being and GICE exposures. Our study adds much-needed complexity to our understanding of how GICE exposure's role in the well-being of TNB persons may differ related to their pre-GICE mental health. Our findings add further credence to previous studies identifying harms associated with GICE exposure, regardless of pre-GICE mental well-being.

"Extremely toxic and evil" reflections on gender identity change efforts by Christian religious leaders: Implications for therapy with transgender and nonbinary clients

Given the religious groundings that support the practice of gender identity change efforts (GICE), we sought to explore the beliefs of Christian religious leaders about this practice and their understanding of marginalized gender identities. Nineteen religious leaders mainly from diverse Mainline Christian Protestant traditions were interviewed. Queer theory-informed thematic analysis revealed two themes related to participants' beliefs about transgender and nonbinary identities: (1) Transgender and nonbinary identities are normative and authentic and (2) God created gender diversity. The analyses also highlighted two themes reflecting the pastors' beliefs about GICE: (1) GICE is harmful and (2) Therapy should affirm transgender and nonbinary identities. Finally, the thematic analysis exploring participants' messages for couple and family therapists could be organized into two themes: (1) Christian religious beliefs do not justify the use of GICE and (2) Therapists should be helpful and not harmful. Implications for couple and family therapists are also discussed.

The Feasibility of Providing Remote Functional Family Therapy with Adolescents During the COVID-19 Pandemic: A Mixed-Method Study

Background

Due to the recent COVID-19 pandemic, mental health care has largely transferred its services to online platforms, using videoconferencing (VC) or teletherapy. Within the field of family therapy, however, there is little evidence on the feasibility of using VC, especially when working with whole families at the edge of care.

Objective

This study investigated the feasibility of remote Functional Family Therapy (FFT), using a mixed-method approach.

Method

Study 1 consisted of semi-structured interviews with 23 FFT professionals (18 female) about their experience of providing remote FFT during the COVID-19 pandemic. Study 2 included monitoring data of 209 FFT clients (46% female, M age  = 14.00) who participated in FFT during the pandemic. We compared families who received mainly in-person, mainly remote or a mix of remote and in-person on client-reported alliance, drop-out, therapist-rated outcomes, and treatment intensity using MANCOVA's and chi-square tests.

Results

In Study 1 two themes emerged around experienced challenges, namely 'Feeling in control' and 'Engagement and alliance'. Two other themes emerged around adaptations, namely 'Being more on top' and 'Connecting in different ways'. In Study 2, we found that the therapeutic alliance was not related to using VC. Also, families had less between-session contact during the Engagement and Motivation Phase when receiving mainly VC, but had more sessions and longer therapy when receiving a mix of in-person and remote therapy.

Conclusions

The current study suggests that providing systemic family teletherapy to families on the edge of care is feasible. Further development of systemic family teletherapy is warranted.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10566-022-09692-y.