Individual & family (micro) level

 

Assessment

• Mental health history for all family members, including current diagnoses. Note that when assessed through a traditional lens, family members can present with anxiety, depression, or somatic symptoms that may actually be explained by ambiguous loss (Boss, 1999) — worth screening for this specifically, along with each family member's general tolerance for uncertainty and the unknown.

• Trauma history, for both the transgender family member and others in the family

• School or employment history, and how transition may affect it, for the transgender person and other family members as relevant

• Age and gender of the transgender parent's children, or the transgender child's siblings

• Family members' religious affiliations and any related spiritual concerns

 

Providing information
Offer clear definitions, current research, the science of gender development, and treatment facts. If your own knowledge needs strengthening, continuing education is available through the North American Association of Christians in Social Work, National Association of Social Workers, Christian Association for Psychological Studies, or the CMDA Psychiatry Section. A few certificate programs (not exclusively family-focused, but often relevant) include:

• Affirmative Therapy for Transgender Communities (Widener University)

• Trans Affirmative Therapy Certificate (Antioch University)

• WPATH Certification

• Sexual and Gender Minority Mental Health Certificate (Fairfield University)

• Affirmative Therapy with LGBTQ+ Clients (Southern Methodist University)

 

Validating and processing grief

• Watch for disenfranchised grief — family members may feel judged for grieving a loss others don't recognize as legitimate (Doka, 2016).

• Watch for ambiguous loss (Boss, 1999): help family members recognize what they're experiencing as exactly that, build awareness of how differently each family member may be experiencing it, and support them in gathering information about transition and loss, including the clinical literature. Because of this ambiguity, family members may be slow to consider redefining family roles or structure — some will prefer the status quo until they've had time to move through their grief, and that's a reasonable pace to allow.

• Prepare families for the possibility that the pre-transition relationship may not return to exactly what it was, including any anticipatory grief (the normal grief that comes from an expected loss; Walsh, 2012). Monitor grieving family members with appropriate social support, and provide grief-specific counseling where appropriate — see Grief and Loss: Theories and Skills for the Helping Professions for models.

• Facilitate communication among family members, help them find meaning in their experience (Norwood, 2013), and support forgiveness work where needed.

 

Facilitating the acceptance process — a caution

Given the documented risks transgender youth already face around substance use and suicide, and the further risks of estrangement (homelessness, child-welfare involvement — see Reflections on Forgiveness), clinicians can feel pulled to actively push ambivalent parents toward acceptance. This is worth resisting as a default approach. It can carry real unintended costs: parents often feel — sometimes rightly — that they know their child better than the clinician does, and may feel disrespected by being pushed toward something they aren't ready for, even when acceptance is a legitimate long-term goal. The same dynamic applies to other family members. Treating the transgender family member as the sole "real" client can also leave everyone else feeling sidelined, at precisely the moment their support matters most.

 

A family-systems lens offers a better starting point: treat all family members as clients, and recognize the disclosure itself as a stressor on the whole family unit — one that affects each person differently depending on their relationship to the transgender family member. Helping non-transgender family members work through their own ambiguous loss and disenfranchised grief, rather than pressing them toward acceptance before they're ready, tends to be the more effective path — and often arrives at the support you're hoping to build anyway. From there, forgiveness and reconciliation become possible where estrangement has occurred (again, see Reflections on Forgiveness).

 

Protective factors and resilience

Clinicians can help strengthen family protective factors (Dierckx, 2017):

• Continuity — maintaining shared family activities after transition

• Communication — open, honest answers to questions (see the Communication section of What Helps Family Members Cope? for discussion-topic ideas)

• Acceptance — supporting family members through the stages of grief toward it

• Attribution of meaning — reflecting together on how transition affects the transgender person's biological and social role

 

And build resilience directly (Garmezy, 1991; Luthar & Cicchetti, 2000):

• Strengthen social skills

• Build impulse control (anger, aggression)

• Strengthen close family ties and reduce conflict

• Support connections to school, work, and church

 

Developing therapeutic resources

Most existing therapy resources focus on the transitioning individual, not the family. Where family-oriented resources do exist, they often emphasize acceptance without addressing the grieving process (Canfield-Lenfest, 2008; Norwood, 2012, 2013b) or ambiguous loss (McGuire et al., 2016; Norwood, 2012, 2013a; Zamboni, 2006) directly — a gap worth being aware of.

 

Support and psycho-educational groups are a reasonable place to start:

• The most common existing groups are for Christian parents of transgender children — FreedHearts offers one example; more are listed in I'm a Family Member under "Consider joining a support group."

• Groups for Christian children (of any age) with transgender parents or siblings are far rarer — one example exists at a church in Texas. Worth creating one if there's local demand.

• A grief-focused psychoeducational group — set sessions, a set agenda covering normal grief responses, stages, coping skills, and meaning-making (Walsh, 2012) — can work well as a lower-intensity entry point, distinct from ongoing emotional-support groups.

• Consider developing social work interventions specifically addressing ambiguous loss and disenfranchised grief (Knight & Gitterman, 2018).

 

Program & system (macro) level

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Train therapists broadly on the range of issues a family member's transition raises:

• Family function and relationships, including difficulties with transgender or non-transgender parents, and peer-relationship concerns (Freedman et al., 2002)

• Living arrangements

• Family members' overall wellbeing — emotional health and coping

• Social support

• Disenfranchised grief and ambiguous loss

 

Have a resource we're missing, or want training or consultation? Reach out here.