Shedding light on thirteen years of darkness: content analysis of articles pertaining to transgender issues in marriage/couple and family therapy journals

"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.

Depression, Anxiety, and Stress among the Malay Muslim Transgender Women in Northern Malaysia: A Mixed-Methods Study

The study aimed to determine the prevalence and associated factors of depression, anxiety, and stress among the Malay Muslim transgender women in the northwestern states of Peninsular Malaysia. This mixed-method, quantitative and qualitative, study was conducted in collaboration with a nongovernmental organization that works incognito to advocate and help transgender women. Participants were recruited using a snowball method. A self-administered questionnaire was used that included information related to the demographic background of participants, and the Depression, Anxiety and Stress Scale and Oslo-3 Social Support Scale. For the qualitative part of the study, 13 in-depth interviews were conducted using a semi-structured interview guide in the Malay language. The study showed the prevalence of depression, anxiety, and stress was 33.3% (n = 47), 48.2% (n = 68), and 26.2% (n = 37), respectively. Difficulty in finding employment was significantly associated with depression, anxiety, and stress, whereas a history of physical abuse was also significantly associated with anxiety, and being ostracized by friends was significantly associated with depression. During in-depth interviews, suicidal thoughts were mentioned by several respondents and many lamented poor support from family and cisgender friends, and they complained of societal pressure. In addition to being physically and verbally abused, some also complained about cyberbullying. There is an urgent need to identify those with mental distress among transgender women in Malaysia to enable early interventions. More research is needed to identify mental health issues among transgender women and highlight these issues to sensitize the general public to their problems.

Family-Based Interventions with Transgender and Gender Expansive Youth: Systematic Review and Best Practice Recommendations

Research on transgender and gender expansive (TGE) youth has highlighted the disproportionate and challenging mental health and developmental outcomes faced by these young people. Research also largely suggests that family acceptance of TGE youth's gender identity and expression is crucial to preventing poor psychosocial outcomes in this community. Recently, family-based treatment has become common practice with TGE youth whose families are available for care, but it is unclear whether research provides outcome data for family interventions with TGE youth. This study follows Preferred Systematic Reviews and Meta-Analyses (PRISMA) guidelines to systematically review articles that provide outcome data or clinical recommendations for family-based interventions with TGE youth and their families. No quantitative outcome data for family therapy with TGE youth were found, but numerous articles spanning decades (n=32) provided clinical practice recommendations for family-based interventions with this population. Very few articles provided outcome data for family therapy with sexual minority youth (n=2). Over time, clinical strategies have moved from pathologizing to affirming of TGE youths' gender journey. Common clinical strategies of affirming interventions include (1) providing psychoeducation, (2) allowing space for families to express reactions to their child's gender, (3) emphasizing the protective power of family acceptance, (4) utilizing multiple modalities of support, (5) giving families opportunities for allyship and advocacy, (6) connecting families to TGE community resources, and (7) centering intersectional approaches and concerns. Future research should examine the efficacy of family-based interventions that incorporate these clinical strategies and collect quantitative data to systematically determine their effect on psychosocial outcomes.

Deconstructing cissexism: The journey of becoming an affirmative family therapist for transgender and nonbinary clients

This article proposes a model for family therapists to become more competent, inclusive, and affirmative in their clinical work with transgender and nonbinary clients. In particular, this article details: (1) barriers to transgender and nonbinary affirmative therapy, (2) impacts of these barriers on transgender and nonbinary people's mental health, (3) a three-step model for becoming an affirmative therapist for transgender and nonbinary clients, and (4) strategies for deconstructing cissexism in therapy. This goal of this article is to invite family therapists to join in on a lifelong journey of "becoming" an affirmative therapist for transgender and nonbinary clients, a journey on which none of us will ever "arrive". We can, however, take continual action to minimize the negative impacts of cissexism on therapists and clients; this article offers ideas for a place to start.

"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.

A Systematic Review of Recommendations for Behavioral Health Services for Transgender and Gender Diverse Adults: The Three-Legged Stool of Evidence-Based Practice is Unbalanced

There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD communities. More research, including clinical trials adapting established interventions, is needed to inform state-of-the-art TGD-affirmative behavioral health care.

Tracking trends of transgender health research online: are researchers and the public on the same page?

Altmetric Explorer was searched for the most popular online articles published in Pubmed-indexed journals. The 75 articles with the highest Altmetric Attention Score (AAS) were screened for article information (date, journal, access), authorship (number of authors, affiliation and origin of the corresponding author), and research (type, subject, funding). The reviewed articles displayed a mean AAS of 241.52, were broadcast 17.03 times by news agencies, posted on Twitter 101.47 times, downloaded by 67.21 Mendeley readers, and received 62.67 citations. There was intense online interest in the transgender health literature, mainly related to mental health and social well-being. Online visibility of transgender health articles was not significantly correlated with citation counts, implying that the public, likely including transgender persons and allies, may place emphasis on different health issues than scholars. Monitoring altmetrics and interactions on electronic media may help researchers conduct research that is more meaningful to transgender individuals, and to society in general.

Content analysis of psychological research with lesbian, gay, bisexual, and transgender people of color in the United States: 1969-2018

This article updates previous content analyses that identified a relative paucity of U.S.-based psychological research on lesbian, gay, bisexual, and transgender (LGBT) people of color by extending the period covered to 2018. In addition to documenting how many such studies occurred and when, it considers the research questions asked, funding sources, impact, and journal outlets. This richer description of this research area allowed us to describe historically not only when LGBT people of color in the United States were studied but why they were studied, which journals published this work, and which published studies were most influential. We found that the literature starts in 1988 for LGB people of color and in 2009 for transgender people of color and that a significant shift occurred in 2009, with the majority of the articles being published in the last 10 years. Findings suggest that U.S. federal funding and support for LGBT research as well as divisions of the American Psychological Association focused on minoritized identities and their journals played a role in the recent increase. Half of the studies investigated psychological symptoms, and more than a third of studied experiences and psychological processes related to holding multiple minority statuses, many of which focused on potentially deleterious aspects of these identities. These findings indicate that this literature has a significant focus on pathology. Underrepresented groups included cisgender and transgender women; transgender men; older individuals; Asian Americans, Native Hawaiians, and Pacific Islanders; American Indians and Alaska Natives; and multiracial individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reflecting on the Past: A Content Analysis of Family Therapy Research from 2000-2015

In this content analysis, researchers examine articles published from 2000 to 2015 in three family therapy journals, yielding a total of 948 empirical articles. The purpose is to provide an overview of the research being published, assess who is publishing, and investigate the current state of clinical effectiveness research in marriage and family therapy (MFT). Most first authors were affiliated with MFT programs and primarily included diversity and couples in their research. There was a significant increase of research on clinical process-though the number of clinical outcome studies held steady. There were no significant changes with regard to research funding. Implications support the use of innovative research methods to provide evidence of clinical effectiveness.

The Impact of the Parental Support on Risk Factors in the Process of Gender Affirmation of Transgender and Gender Diverse People

Research involving transgender and gender diverse people (TGD) increased in the last years, mostly concerning healthcare associated to this population. Few studies dedicated their analysis to the impact of parental support on transgender people, even though this is an important aspect in creating a safe environment on which these individuals can build their identity. In addition, the link between family support, TGD identity and homelessness is not completely established. Thus, due to the specificities of the family context of TGD individuals, the aim of this study is to investigate the association between family support and TGD in different moments of the process of gender affirmation. In addition, this study also aims to explore the relationship between a lack of social support and low self-esteem, home abandonment, and dwelling in the street. The survey was designed based on the TransPULSE project and was made available in electronic format. The sample was constituted of 423 TGD residents in two Brazilian states. A Structural Equation Model analysis suggested that the impact of gender affirmation status on homelessness was mediated by parental support, through self-esteem, and the need to move from home. The association between the status of the gender affirmation procedures, family support and self-esteem was significant and indicated that the further TGD individuals advanced in gender affirmation, the more self-esteem and family support they would have. The association between family support and self-esteem indicated that family support was associated with higher self-esteem. Low family support was associated with the willingness to move from home due to one’s TGD status and there was also a significant correlation between low self-esteem and the willingness to move from home due to one’s TGD status. Finally, homelessness was associated with the willingness to move with a large effect size. Limitations include the sample that was constituted by individuals with Internet access and who had more contact with TGD communities. The findings indicate directions for interventions involving TGD people and their families, considering the parental relationship as a critical variable to improve TGD quality of life in the process of gender affirmation.

A Critical Analysis and Applied Intersectionality Framework with Intercultural Queer Couples

Intercultural queer couples are growing at an extensive rate in the United States, exemplifying diversity across multiple dimensions (e.g., race, ethnicity, sexuality, affectional identity, gender identity) while experiencing multiple converging forms of oppression (e.g., racism, heterosexism, genderism). Given the dearth of conceptual and empirical literature that unifies both dimensions related to intercultural and queer, applied practices and research contend with a unilateral approach focusing exclusively on either intercultural or queer couples. Intersectionality theory has revolutionized critical scholarship to determine overlapping forms of oppression, decenter hegemonic structures of power relations and social contexts, and enact a social justice agenda. This article addresses the following aims: (1) an overview of the gaps eliciting unilateral approaches to intercultural queer couples; (2) an illustration of intersectionality's theoretical underpinnings as a critical approach; and (3) applications for insights in practices and research with intercultural queer couples.

A Systematic Review of Gay, Lesbian, and Bisexual Research Samples in Couple and Family Therapy Journals

The purpose of this study is to review samples from research on gay, lesbian, and bisexual (GLB) issues and to evaluate the suitability of this body of research to support affirmative and evidence-based practice with GLB clients. The authors systematically reviewed the sampling methodology and sample composition of GLB-related research. All original, quantitative articles focusing on GLB issues published in couple and family therapy (CFT)-related journals since 1975 were coded (n = 153). Results suggest that within the GLB literature base there is some evidence of heterocentrism as well as neglect of issues of class, race, and gender. Suggestions to improve the diversity and representativeness of samples-and, thus, clinical implications-of GLB-related research in CFT literature are provided.

A Content Analysis of Literature on Trans People and Issues

This study provides a content analysis of more than a decade (2002–2012) of academic scholarship about trans people and issues. A total of 960 trans-focused publications were coded; there was a close balance of nonempirical (54%) and empirical (46%) publications. The analyses revealed that the literature on trans people and issues is growing, although many publications include trans people and issues nominally without substantive attention. The analyses also pointed to underutilized research designs and methodologies, the need for more clear assessment and more consistent reporting of demographic characteristics, and topics that warrant further attention. Specifically, literature on trans people and issues continues to be needed on the topics of focus thus far, such as psychological and identity-related distress. Scholarship is also needed to address important topics that have been understudied, including self-harm and suicide, positive functioning and mental health promoting factors, developmental issues across the life span, school and workplace experiences, and the training and competencies of health care providers to ensure affirmative and effective services for trans people.

Enhancing Scholarship Focused on Trans People and Issues

Scholarship about lesbian, gay, bisexual, and transgender (LGBT) people and issues has been growing. However, trans issues are often overlooked or addressed only nominally in this literature, leading to calls for further focused attention to trans people and issues. In a series of articles, this Major Contribution addresses such calls by (a) providing a content analysis of scholarship about trans people and issues, (b) discussing methodological considerations and strategies for conducting research with trans populations, and (c) presenting an empirical study that addresses how intersecting identities (e.g., ethnicity/race, sexual orientation, socioeconomic status) combine in relation to trans people’s mental health. This article provides a context for the Major Contribution and offers an overview of each of the component articles.

Marriage and Family Therapy Trainees' Reports of Explicit Weight Bias

Discrimination based on an individual's weight has been observed in health care, education, retail, and other public sectors (Puhl & Huer, Obesity, 17, 941, 2007). Such inequity, known as "weight bias," generates negative short-term and long-term consequences for the individuals that experience it (Puhl & Brownell, Weight bias in health care settings, 2007). Past research has shown that healthcare trainees exhibit weight bias (Phelan et al., Obesity, 22, 1201, 2014; Wigton & McGaghie, Journal of General Internal Medicine, 16, 262, 2001), yet little focus is given to weight bias in marriage and family therapy (MFT) education. The purpose of this study was to survey MFT students (N = 162) to explore weight bias and how contextual factors associate with weight bias. Participants in MFT programs reported explicit weight bias, with specific contextual factors associating with more bias. Female participants reported more fear of gaining weight, and individuals who identified as overweight had higher rates of explicit weight bias. Contextual differences and implications for training programs are discussed.

Adult development and quality of life of transgender and gender nonconforming people

PURPOSE OF REVIEW

Research on the health of transgender and gender nonconforming people has been limited with most of the work focusing on transition-related care and HIV. The present review summarizes research to date on the overall development and quality of life of transgender and gender nonconforming adults, and makes recommendations for future research.

RECENT FINDINGS

Pervasive stigma and discrimination attached to gender nonconformity affect the health of transgender people across the lifespan, particularly when it comes to mental health and well-being. Despite the related challenges, transgender and gender nonconforming people may develop resilience over time. Social support and affirmation of gender identity play herein a critical role. Although there is a growing awareness of diversity in gender identity and expression among this population, a comprehensive understanding of biopsychosocial development beyond the gender binary and beyond transition is lacking.

SUMMARY

Greater visibility of transgender people in society has revealed the need to understand and promote their health and quality of life broadly, including but not limited to gender dysphoria and HIV. This means addressing their needs in context of their families and communities, sexual and reproductive health, and successful aging. Research is needed to better understand what factors are associated with resilience and how it can be effectively promoted.

Expanding the Therapy Paradigm with Queer Couples: A Relational Intersectional Lens

North American and global cultures in general-and the field of Couple and Family Therapy in particular-have made significant strides toward recognizing and validating LGBTQ identities and relationships. However, clinical assessment and conceptualization of queer couples still lack the complexity needed to encompass the issues involved in treatment. Existing literature provides clinicians a basic understanding of queer couples and the dynamics that make them unique from nonqueer couples. However, much of this knowledge has been normed on White middle-class couples and has rarely included couples with transgender or bisexual members. This article invites clinicians and researchers to apply a feminist model of intersectionality to understand queer couples. Our proposed intersectional lens considers multiple axes of identity and power and their interrelationships (Crenshaw, 1989, 1991). We argue that intersectionality is important for understanding all identities, whether privileged or marginalized (Falicov, 2003). This application of the concept of intersectionality is unique in its relational focus, emphasizing how partners' complex individual identities overlap with and intersect with one another. Additionally, this lens considers how the therapists' and clients' multidimensional identities intersect. Three case studies are presented to illustrate application of the intersectional lens. In each case, exploring the partners' multiple social locations, their influences on one another, and the therapist's intersections of identity all proved critical to the direction of therapy.

"I Am Chelsea Manning": Comparison of Gendered Representation of Private Manning in U.S. and International News Media

On August 22, 2013, Bradley Manning released a statement requesting to be referred to as female. In the following days, the news media discussed whether language should shift toward a female representation. Using quantitative content analysis and qualitative contextual analysis, this study analyzed whether U.S. and international newspapers (N = 197) acknowledged Manning's request to be referred to as "Chelsea" in the two weeks after the statement. Results suggest that the mainstream press was hesitant in shifting toward a female representation. A comparison of international and U.S. newspapers suggests that the U.S. press lagged behind international coverage using a female depiction.

Assessing lesbian, gay, and bisexual affirmative training in couple and family therapy: establishing the validity of the Faculty Version of the Affirmative Training Inventory

This study established the validity and factor structure of the Faculty Version of the Affirmative Training Inventory (ATI-F), which assesses faculty members' perceptions of the level of lesbian, gay, and bisexual (LGB) affirmative training that occurs in clinical programs. Additionally, this study examined the latent associations among the subscales of the ATI-F and three convergent validity items utilizing a sample of 117 faculty members from accredited family therapy programs. The findings provide empirical support for the relationship between including classroom content on LGB affirmative therapy and faculty members' beliefs about LGB individuals and relationships. Specifically, faculty members who report more positive beliefs about LGB clients appear to be more likely to include LGB affirmative therapy content in the courses they teach.

Somewhere under the rainbow: Exploring the identities and experiences of trans persons

The literature on transgender/transsexual-spectrum persons is limited. Most studies are based on the assumption that trans persons are best understood within rigid and binary definitions of gender and sexuality and tend to focus on diagnostics, medical management and risk factors. Researchers and clinicians may also assume that people who challenge cultural norms of gender and sexuality can be grouped together. Such assumptions about the specific experiences of trans persons can be harmfully incorrect. The goals of the present study were to explore the gender and sexual identities of trans persons, to investigate group differences, and to examine factors that predict better psychological and physical well-being. Participants took part in an online study and provided information about their gender and sexual identity, social support, relationship quality, and mental/physical health. Results depicted diverse gender identities and sexual orientations among trans persons and emphasized that while many challenges faced by sexual and gender minorities are similar, trans persons report unique mental and physical health outcomes. Also, greater social support and relationship quality predicted mental, but not physical, health among trans persons. These results highlight the importance of acknowledging the complexity of trans identities and the key role of social and personal support.

How many bytes does it take? A content analysis of cyber issues in couple and family therapy journals

In the fifteen years since the explosion of the Internet, using cyber technology for work and social functions has exponentially increased. Yet, questions around how to manage such changes remain elusive in family therapy literature. In this investigation, we conducted a content analysis to determine to what extent marriage/couple and family therapy (M/CFT) journals have responded to the integration of the Internet in couple and family life. We found 79 of 13,274 articles across seventeen journals focused on the Internet in some capacity. Implications for clinical practice, training, and future research are discussed.

Perceived discrimination and depression among low-income Latina male-to-female transgender women

Background

This study examines exposure to perceived discrimination and its association with depression among low-income, Latina male-to-female transgender women as well as evaluates the impact of sexual partner violence and mistreatment on depression.

Methods

A total of 220 Latina male-to-female transgender women who resided in Los Angeles, California, were recruited through community based organizations and referrals. Participants completed individual interviews using a structured questionnaire. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Perceived discrimination was assessed using a fifteen-item measure that was designed to assess the experiences of maltreatment of transgender individuals. Multinomial logistic regression was used to examine the association between perceived discrimination and depression after controlling for the presence of other variables.

Results

Of the sample, 35% reported significant depressive symptoms (PHQ-9 ≥ 15). Additionally, one-third of the participants indicated that in the two weeks prior to the interviews they had thought either of hurting themselves or that they would be better off dead. The extent of perceived discrimination in this population was extensive. Many of the participants experienced discrimination on a daily basis (14%) or at least once or twice a week (25%) as demonstrated by a positive response to at least 7 of 15 items in the measure of perceived discrimination. Almost six out of ten participants admitted that they had been victims of sexual partner violence. Those who reported more frequent discrimination were more likely to be identified with severe depression. There was also a notable association between self-reported history of sexual partner violence and depression severity.

Conclusions

A significant association between depression severity and perceived discrimination was identified. How exposure to discrimination leads to increased risk of mental health problems needs additional investigation. Models investigating the association between perceived discrimination and depression among transgender women should include sexual partner violence as a potential confounding variable.