Approximately 1.9 million youth across the United States between the ages of 13 and 17 identify as lesbian, gay, bisexual, or transgender (Williams Institute, 2020). Nearly 70 percent of homeless transgender teens are homeless due to family exclusion (Williams Institute, 2020). Even when LGBTQIA+ youth have stable housing and family life, there are unique stressors related to identity exploration, coming out, and acceptance (Meyer, 2003).  Transgender teenagers are currently a lightning rod in our national conversations (New York Times, 2022). There are deep cultural divides about what it means to protect, nurture, and support the development of teenagers coming into gender expansive identities. The conflicts adults play out in families, politics, and the media have an impact on what young people internalize (Waddell, 2002).  

Transgender teens’ support needs

It doesn’t take a lot of imagination to understand the stressors transgender teens experience as they come into their own understandings of who they are and how they express themselves in their families, friendships, and community. Affirmative therapists play an important role in helping transgender teenage clients to:

• Normalize the ordinary experiences of identity development in the teenage years
• Put words to the  distress of gender dysphoria and the joy of gender euphoria
• Prioritize transition needs 
• Manage big emotions in the face of other people’s opinions and perspectives about transgender politics. 

Helping transgender teenagers with identity development

Gender is only one piece of managing all the uncertainties that emerge in the years between childhood and adulthood. The anxiety of discovering one’s self and knowing who one is becoming feels incredibly urgent (Waddell, 2002). The distress of gender dysphoria can contribute to a need to figure everything out (Brewster, et al 2019). Teenagers can elicit big feelings from grown ups, and injustices that LGBTQIA+ young people experience can move therapists into action.

Helping teenagers and their families slow things down and explore the anxieties rooted in uncertainty about gender can uncover other similar anxieties about school, friendship, independence, and all the uncertainties about the future. Separating the ordinary stressors from the extraordinary stressors in a young person’s life can be an important first step in relieving anxiety of gender dysphoria. It can also be important to understand where the anxiety is rooted. Kids can take on the worries and anxieties of their parents and getting clear about what is most important to them can help separate their parent’s anxieties from their own (Waddell, 2002).

Further, this exploration can help a client understand how they may be coping with other developmental anxieties. Those strengths can be considered in coping with gender dysphoria. Poet Pádraig Ó Tuama (2020) says, “life is filled with finding oneself in unexpected rooms where you think, ‘everybody here knows something that I don’t know yet.”  Helping trans teens get in touch with how they manage their ordinary stressors and insecurities can help them manage the deeper anxieties stored in their bodies. 

Finding words for gender dysphoria

Affirmative therapists should expect defensiveness and resistance in exploring gender dysphoria with their teenage clients.  Talking about all the strange things the body is doing in the teenage years is a topic of tremendous anxiety (Gilmore K. J. Meersand, 2014).  When a transgender teenager is developing secondary sex characteristics they don’t identify with this becomes even more complicated (Brewster, et al 2019). When teens come out to their parents they are met with a whole host of questions they probably don’t know the answers to yet. 

Creating a safer space to make meaning of all the growth spurts, impulses, strange feelings, incongruences, mixed feelings, and insecurities takes slow and gentle work. Noticing and talking about all the ways trans teenagers protect themselves with both their parents and their therapist can help them build more awareness around their behaviors and communication. Affirmative therapists can normalize awkward conversations, help teens decide what are reasonable questions, and help them find answers for both themselves and the grown ups in their lives. These are important skills as a transgender teenager begins thinking about social and medical transitions.

Celebrating gender euphoria

Throughout this exploration, affirmative therapists can help their clients to notice gender euphoria; the deep feeling of connecting to their gender and being able to express it with others. These moments can help a teenager build confidence in themself and their bodies that will support them into adulthood. It is also essential for young people to feel a sense of pride and celebration in who they are. This sense of self-esteem and well being helps build resilience and distress tolerance in difficult moments. 

Prioritizing transition needs for transgender teens

Teenagers and parents can have different priorities and different timelines when thinking about transition (Brewster, et al 2019). Teenagers can and do begin many elements of social transition on their own. Many teenagers make independent choices about their grooming and fashion as well as setting expectations about the names and pronouns they use. When gender dysphoria requires more intervention parents and teenagers can find conflict in how to move forward. 

Affirmative therapists should be educated in age appropriate medical transition options and have the ability to make referrals to gender affirming medical care. Providing psychoeducation as well as resources for families to gather more information is essential. Supporting teens and their families to communicate openly and make plans for big decisions can help medical transition move more smoothly. 

Managing Social and Political Stressors

Parents experience an enormous amount of stress when they make the decision to support their teenager with medical transition. Political conflicts throughout the country criticize parent’s choices and in some extremes accuse parents of child abuse. Making sure parents have strong social supports in place and potentially their own therapy can make sure they aren’t putting undo stress on their transgender teenager. 

Further, many transgender teenagers are deeply connected to conversations about transgender experiences both online and in school and friendships. Supporting clients to find boundaries in how they consume information, and how they respond to it can be essential in managing external stressors families experience while their teenager is coming out. Knowing a teen’s relationships with digital communities, their political and advocacy practices, as well as their community resources are important parts of helping a client manage the public parts of incredibly private and personal choices. 

Working with transgender teens: the affirmative therapist’s experience

It can be tempting to move into action to support all the stressors and anxieties transgender teenagers and their families face. Structural transphobia, political conflicts, and the therapists’ own experiences can also pull attention away from the personal experience of the client (Meyer, 2003). It is also important for affirmative therapists to develop their own political advocacy practices to direct big feelings into action without impacting the boundaries of the treatment setting.  

It takes education, skill, and ongoing supervision and consultation to tend to the thoughts and feelings that emerge for the clinician during work with transgender teenager in treatment. Additionally, affirmative therapists should seen out trans joy; stories of euphoria, connection, and resilience that exist in the transgender community. It is important for affirmative therapists to hold hope in the ease and euphoria that is possible when a young person finds their self. 

Affirmative clinicians should not struggle with all these complicated emotional experiences alone. Affirmative continuing education offers a community with clinicians doing similar work, and meets licensure requirements! Creating affirmative professional networks and close consultation relationships can provide additional support. Personal therapy is a confidential space where clinicians can  tend to their own reactions. All the ways therapists have to take care of themselves helps keep therapy centered on their clients.

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References

Brewster, M. E., Motulsky, W., & Glaeser, E. (2019). Working with gender‐expansive clients in psychotherapy. Journal of Clinical Psychology, 75(11), 1993–2005. https://doi.org/10.1002/jclp.22859

Gilmore K. J. Meersand P. & American Psychiatric Publishing. (2014). Normal child and adolescent development : a psychodynamic primer (1st ed.). American Psychiatric Publishing. Retrieved September 30 2022 from http://www.r2library.com/Resource/Title/1585624365. 

Meyer, I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674-697. doi:10.1037/0033-2909.129.5.674

Núñez, L., Midgley, N., Capella, C., Alamo, N., Mortimer, R., & Krause, M. (2021). The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists. Psychotherapy Research, 31(8), 988–1000. https://doi.org/10.1080/10503307.2021.1876946. 

New York Times, (October 8, 2022). Surgery for Transgender Youths Becomes a Political Issue.  Retrieved from: https://www.nytimes.com/2022/10/08/opinion/letters/transgender-surgery.html

Ó Tuama, P. (2020). On listening to your teacher take attendance. Poetry Unbound. Retrieved from: https://onbeing.org/programs/aimee-nezhukumatathil-on-listening-to-your-teacher-take-attendance/

Waddell M. (2002). Inside lives : psychoanalysis and the growth of the personality (Rev.). Karnac Books. Retrieved October 12 2022 from http://site.ebrary.com/id/10464033.

Wilson, B., Cooper, K. , Kastanis, A, Nezhad, S. (2014). Sexual and Gender Minority Youth in Foster Care. Williams Institute, California. Retrieved from: https://williamsinstitute.law.ucla.edu/publications/sgm-youth-la-foster-care/