Adult Attachment and Transgender Identity in the Italian Context: Clinical Implications and Suggestions for Further Research

The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study

Introduction

This study aimed to measure dyadic adjustment, social support, and psychological well-being.

Methods

A research protocol composed of the Dyadic Adjustment Scale, the Outcome Questionnaire 45.2, and the Multidimensional Scale of Perceived Social Support was administered to a sample of 109 Italian transgender individuals.

Results

Higher levels of global psychological distress, symptom severity, and interpersonal relationship distress were associated with lower levels of family support and dyadic adjustment. In addition, transgender women and younger transgender individuals reported higher levels of interpersonal relationship distress.

Conclusions

The results indicate that the support and acceptance of one's partner and family of origin play a crucial role in promoting well-being. It represents an important protective factor with respect to negative psychological health outcomes.

Policy Implications

The findings emphasize the need to develop specific clinical and social practices for transgender individuals and their families. Building family and partner-centered policies and programs is particularly important to enable transgender individuals to avoid paying the emotional and psychological costs associated with rejection and non-acceptance.

The Role of Internalized Transphobia, Loneliness, and Social Support in the Psychological Well-Being of a Group of Italian Transgender and Gender Non-Conforming Youths

Although transgender and gender non-conforming (TGNC) youth represent a highly resilient community capable of successfully overcoming adverse life circumstances, they still face social stigma that negatively impacts their health, being at risk of developing negative feelings toward their own TGNC identity (i.e., internalized transphobia). A poorly investigated dimension in TGNC health research is perceived loneliness. Thus, within the minority stress theory, the present study aimed to investigate the mediating role of loneliness and the moderating role of social support in the relationship between internalized transphobia and psychological well-being among 79 Italian TGNC youths aged 18 to 30-years-old who participated in an online survey. The main results show that loneliness partially mediated the relationship between internalized transphobia and psychological well-being. In addition, social support emerged as a significant moderator, as the impact of internalized transphobia on psychological well-being decreased at moderate and high levels of social support, but not at low levels. The findings have significant implications for clinical practice and psychosocial interventions to reduce the impact of internalized stigma and stress on psychological health.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

"We're just two people in a relationship": A qualitative exploration of emotional bond and fairness experiences between transgender women and their cisgender partners

Trans-including couples experience systemic marginalization impacting their relationships, yet studies on these relationships or narratives of strength are few. The purpose of this qualitative study was to explore emotional bonding and perceptions of fairness between transgender women and their cisgender partners. Interpretative Phenomenological Analysis was utilized to answer the research question: What are the experiences of emotional bond and fairness between transgender women and their cisgender partners? This research was situated within frameworks of minority stress, romantic attachment, and contextual therapy. Seven couples of transgender women and cisgender partners were interviewed. Three themes emerged: Minority Stress Contexts and Relational Strengths; The Experience of Emotional Bond; and Negotiating Balance. Processes of boundary creation, attunement, affirmations, and balance of care were noted. Findings reframe partner relationships as opportunities to construct transphobia-resistant and resilient narratives. Recommendations for clinicians include prioritizing the couple subsystem as an avenue for building resilience against minority stress.

The buffer of resilience in the relations of gender-related discrimination, rejection, and victimization with depression among Chinese transgender and gender non-conforming individuals

BACKGROUND

According to the minority stress theory, the minority stressors of gender-related discrimination, rejection, and victimization will increase depression in the transgender and gender non-conforming (TGNC) population. However, few studies focused on these relations in the context of mainland China, and the positive perspective of their resilience still remained unstudied.

METHODS

This cross-sectional study recruited 361 TGNC individuals through the online community of TGNC people. The participants were involved in this study by measuring their experiences of gender-related discrimination, rejection, victimization, resilience, and depression. The SPSS and PROCESS were used to assess the relations of the studied variables.

RESULTS

High rates of gender-related discrimination, rejection, and victimization were reported by TGNC participants in this study (80.1%, 98.9%, and 77.0% accordingly). The participants who had experienced gender-related discrimination and victimization showed a significantly higher level of depression than those who never experience such unfair treatments. Besides, gender-related discrimination and resilience significantly contributed to the variance of the depression (R² adjusted=0.344, F=21.674, p<0.01), and their resilience was found to play a moderating role between discrimination and depression.

LIMITATIONS

A longitudinal study may need to examine the causal effects, and the limitations of the online data should be noted.

CONCLUSIONS

The Chinese TGNC people are living in a relatively unfavorable environment with experiencing high rates of gender-related unfair treatments, which can be detrimental to their mental health status. However, their resilience can be a buffer for them in facing adversity. Intervention and educational programs might be developed accordingly.

Sexual Satisfaction in Trans Masculine and Nonbinary Individuals: A Qualitative Investigation

The present study investigated the ways trans masculine and nonbinary individuals describe aspects of their sexual satisfaction. Sexual satisfaction refers to an individual's subjective evaluation of their sexual experiences, and is influenced by relational, contextual, and personal experiences. Prior research with sexual satisfaction among trans individuals utilized quantitative measures, restricting the ability for respondents to describe trans-related aspects. Further, the pervasive focus on the effects of medical transition on binary trans individuals' experiences in prior research limits our understanding of those who do not desire a medical transition or live outside of the gender binary. Participants represented a community sample of 358 trans masculine and nonbinary individuals who responded to the question: "In what ways are you satisfied with your sex life?" Thematic analysis revealed eight overarching themes that represented two categories: universal and trans-related. Discussion focuses on the ways in which clinicians and researchers can utilize the current findings to improve the sexual satisfaction of trans masculine and nonbinary individuals.

Minority Stress and Mental Health in Italian Bisexual People

Bisexual people are a strongly stigmatized population experiencing health disparities caused by social stigmatization. The predominant framework helping to understand these health disparities and the impact of stigma on mental health of social groups belonging to a sexual minority identity constitutes the minority stress theory. In Italy, studies assessing this model in bisexual populations are very limited. Within this framework, the current study aimed at assessing in 381 Italian bisexual individuals (62 men and 319 women) the effects of anti-bisexual discrimination, proximal stressors (i.e., anticipated binegativity, internalized binegativity, and outness), and resilience on psychological distress. The results suggested that only anti-bisexual discrimination and internalized binegativity were positively associated with psychological distress, and that resilience was negatively associated with mental health issues. Furthermore, the results suggested that internalized binegativity mediated the relationship between anti-bisexual discrimination and mental health problems. No moderating effect of resilience was found. This is the first study to have thoroughly applied minority stress in Italian bisexual people, providing Italian clinicians and researchers with an outline of the associations between minority stress, stigma, resilience, and psychological distress within this population.

Attachment as a Predictor of Psychological and Sexual Wellbeing Among Transgender Women in New York City

Transgender women are disproportionately affected by HIV and experience high rates of depression and anxiety. The importance of secure attachment in buffering against negative sexual and mental health outcomes is well established. However, few studies have examined attachment among transgender women. We recruited a community-based convenience sample of 213 transgender women in New York City (M_age =34.3; SD = 11.7). The majority were women of color (75.6%), almost half identified as heterosexual (47.4%), and 34.7% were HIV-positive. Preliminary analyses examined the sample distribution across attachment categories using the Revised Experiences in Close Relationships scale. Specifically, Brennan, Clark and Shaver's guidelines were used for categorization (43.19% fearful, 22.5% preoccupied, 21.6% dismissive, and 12.7% secure). Regression analyses examined the association of dimensional attachment anxiety, attachment avoidance, and their interaction with depression, anxiety, self-efficacy for condom use, temptations for condomless sex, and condomless sex acts. Results indicated a positive association between attachment anxiety and depression, anxiety, temptations and probability for condomless sex; and also between attachment avoidance and condomless sex probability. A significant interaction indicated that individuals with low attachment anxiety and attachment avoidance (i.e., secure) had the greatest condom use self-efficacy and the lowest probability of engaging in condomless sex.

Health of Non-binary and Genderqueer People: A Systematic Review

Background: Non-binary and genderqueer (NBGQ) people are those who do not identify within the gender binary system (male vs. female), not falling exclusively in man/male or woman/female normative categories. A higher proportion of NBGQ people is usually found within young persons. This population is marginalized and, as such, is at risk of stigmatization and of developing negative health outcomes. As literature on the health of NBGQ people is sparse, this study aims at systematically review the limited studies on this field. Methods: The research questions which guided the systematic review were: (1) What are the differences in the health levels between NBGQ and binary transgender (BT) individuals? (2) What are the differences in the health levels between NBGQ and cisgender individuals? (3) Which medical and psychological interventions are most suitable for improving NBGQ health? According to PRISMA guidelines, a systematic search was conducted in PubMed, PsycInfo, Web of Science, and Google Scholar. Results: Eleven studies met the inclusion criteria for the current systematic review. Among them, 9 were focused on the health differences between NBGQ and BT individuals, 4 of the latter and 1 individually were focused on the health differences between NBGQ and cisgender individuals, and 1 was focused on the evaluation of health outcomes related to medical procedures. No studies assessed psychological interventions aimed at improving health in NBGQ individuals. All studies were cross-sectional, did not generally recruit a large sample of NBGQ individuals, and used non-probability sample design. Results related to the difference in health between NBGQ and BT were mixed; indeed, some found a better health status while others a worse one. Results related to the differences in health between NBGQ and cisgender highlighted higher health needs in NBGQ than in BT individuals. The only study analyzing the effects of medical interventions on health found that NBGQ female-assigned at birth individuals improved their quality of life after chest surgery. Conclusions: Although scholars are starting to pay attention to the NBGQ health, research needs to be expanded both in terms of methodology and research contents. Clinical, health-related social policies, and research recommendations in this field are reported.

Parenting Desire and Minority Stress in Lesbians and Gay Men: A Mediation Framework

Despite the rapid increase in lesbian and gay (LG) people who desire and decide to become parents, LG childless individuals may encounter serious obstacles in the parenthood process, such as minority stress. Notwithstanding, the psychological processes by which prejudice events might affect the desire to become parents are still understudied. As an extension of the minority stress theory, the psychological mediation framework sheds light on these psychological processes, as it encompasses a more clinical view of stress. Within this framework, the current study aimed at assessing the role of prejudice events in affecting parenting desire in 290 childless Italian LG individuals (120 lesbians and 170 gay men), as well as the role of internalized heterosexism and sexual orientation concealment in mediating the relationship between prejudice events and parenting desire. The results suggest that only in lesbians prejudice events were negatively associated with parenting desire, and that sexual orientation concealment and internalized heterosexism were also negatively associated with parenting desire. Furthermore, sexual orientation concealment, and not internalized heterosexism, mediated the relationship between prejudice events and parenting desire in lesbians, but not gay men. The findings have important implications for clinical practice.

Group Psychodynamic Counselling as a Clinical Training Device to Enhance Metacognitive Skills and Agency in Future Clinical Psychologists

Metacognitive skills and agency are among the main psychological abilities a clinical psychologist should have. This study aimed to assess the efficacy of group psychodynamic counselling as a clinical training device able to enhance metacognitive skills and agency in final-year undergraduates in clinical psychology within an educational context. Thirty-three final-year students of clinical psychology participated in an experiential laboratory lasting two months. Participants completed measures regarding metacognitive skills and agency at pre-, post-treatment, and 3-month follow-up assessment. The results suggested that group psychodynamic counselling made students feel more capable of recognizing emotional states, understanding causal relationships, inferring mental states of others in terms of beliefs, desires, intentions, and expectations, and thinking critically. Furthermore, the group psychodynamic counselling helped students to feel more able to derive pathways to desired goals and to motivate themselves via agency thinking to use those pathways. Thus, the study confirmed the efficacy of group psychodynamic counselling as a clinical training device able to enhance metacognitive skills and agency in future clinical psychologists.

Internalized Transphobia, Resilience, and Mental Health: Applying the Psychological Mediation Framework to Italian Transgender Individuals

Transgender and gender nonconforming (TGNC) people are a highly-stigmatized population. For this reason, they might internalize society’s normative gender attitudes and develop negative mental health outcomes. As an extension of the minority stress model, the psychological mediation framework sheds light on psychological processes through which anti-transgender discrimination might affect mental health. Within this framework, the current study aimed at assessing in 149 TGNC Italian individuals the role of internalized transphobia as a mediator between anti-transgender discrimination and mental health, considering resilience as the individual-level coping mechanism buffering this relationship. The results suggest that both indicators of internalized transphobia (i.e., shame and alienation) mediate the relationship between anti-transgender discrimination and depression, while only alienation mediates the relationship between anti-transgender discrimination and anxiety. Furthermore, the results suggest that the indirect relation between anti-transgender discrimination and anxiety through alienation is conditional on low and moderate levels of resilience. Findings have important implications for clinical practice and psycho-social interventions to reduce stigma and stress caused by interpersonal and individual stigma.

Narratives of Transgender People Detained in Prison: The Role Played by the Utterances "Not" (as a Feeling of Hetero- and Auto-rejection) and "Exist" (as a Feeling of Hetero- and Auto-acceptance) for the Construction of a Discursive Self. A Suggestion of Goals and Strategies for Psychological Counseling

Purpose: Understanding how transgender people, who committed criminal offenses and are detained in prison, produce a narrative representation of self within different prison contexts. More specifically, this study has been based on two sub-aims: On a paradigmatic level, it has been aimed at critically investigating how the discursive positioning among the Self and the Other might promote the internalization of positive and/or negative attitudes toward the self. On a pragmatic level, it intends to offer some suggestions for goals and strategies of psychological counseling with these inmates inside such highly institutionalized contexts. Method and Materials: In total, 23 in-depth interviews were conducted with transgender women detained in either female or male prison contexts in Italy and Brazil. The lexical, semantic, and semiotic structure of the transcribed interviews has been investigated by adopting the quali-quantitative software Iramuteq for performing statistical text-mining analysis. Frequency, correspondences, and distribution of the most representative utterances across the corpus of data have been accessed and critically analyzed. Results: The findings showed that transgender inmates in Brazil made repeated use of the adverb "not," while the verb "exist" became the most representative word for the Italian sample. In Brazil, indeed, transgender women assumed masculine-driven behavior due to a common imprisonment with cis-gender men. On the contrary, transgender women in Italy are detained in protected sections, where they are allowed to wear female clothing and continue hormonal treatments. Surprisingly, transgender inmates in Italy suffered more violence in a female sector when compared to exclusively male jails. Conclusions: Transgender people represent a challenge for prison administration because it is not clear in which penitentiary context they should be detained. They should receive special attentions in order to face their special needs, which are radically different when compared to other typologies of inmates. Within penitentiary contexts, psychological counseling with transgender women should pay a special attention to the several psycho-social dimensions of this existential condition. In particular, psychological counselors should consider its inner complex articulation within different social, cultural and normative contexts.

Transphobia Among Students Majoring in the Helping Professions

The study was designed to further the understanding of transphobia among students majoring in the helping professions including social work, occupational therapy, and nursing. The study's hypotheses examined the effects of transgender content in education (e.g., textbooks and lectures), religiosity, contact with transgender people, and several sociodemographic variables with transphobia. Differences in transphobia levels between social work students and those in aligned professions were also explored. The sample consisted of 600 students of a public, urban university in New York City who participated in an online survey. Measures included transphobia and transgender content scales. Students reported (75%) a deficient amount of transgender content in education, and almost one half of the sample reported moderate to high levels of transphobia. Other findings showed that transgender content in education was positively correlated with transphobia, and 1-way ANOVA showed that transphobia differed significantly across the majors. The author suggestions included increasing transgender content in textbooks, lectures, and class discussions as well as developing field sites that provide students with opportunities to serve this population.

The Impact of Social Connectedness and Internalized Transphobic Stigma on Self-Esteem Among Transgender and Gender Non-Conforming Adults

The transgender and gender non-conforming (TGNC) community continues to represent a notably marginalized population exposed to pervasive discrimination, microaggressions, and victimization. Congruent with the minority stress model, TGNC individuals persistently experience barriers to wellbeing in contemporary society; however, research uncovering resilience-based pathways to health among this population is sparse. This study aimed to explore the impact and interaction between internalized transphobic stigma and a potential buffer against minority stress-social connectedness-on the self-esteem of TGNC identified adults. Data were collected from 65 TGNC identified adults during a national transgender conference. Multiple regression analysis reveals that self-esteem is negatively impacted by internalized transphobia and positively impacted by social connectedness. Social connectedness did not significantly moderate the relationship between internalized transphobia and self-esteem. Micro and macro interventions aimed at increasing social connectedness and decreasing internalized transphobic stigma may be paramount for enhancing resiliency and wellbeing in the TGNC community.