If you haven't already, I'm a Family Member covers several of the clinical concepts below in more depth from the family's own perspective, and is worth reading alongside this page.

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Core concepts for working with these families

• Family Stress Theory — how a family experiences a member's transition depends heavily on historical time, place, and environment.[¹] Transgender-related behavior and surgical alteration of sex characteristics has a documented history from biblical times to the present; if that history is unfamiliar, the brief overview in I'm New is a useful starting point, and the Clinical History page covers its treatment history from the 19th century onward. This context matters because it shapes how well a given family is positioned to cope.

• Relational identity conflict — unclear or shifting self-definition in relation to the transgender family member's new identity.[¹]

• Stigma, shame, and embarrassment[²]

• Ambiguous loss — loss without closure.[³] See the "Ambiguous Loss" section of Resources for Families for more detail on how family members experience this.

• Grief[⁴]

• Disenfranchised grief — grief that can't be openly expressed and isn't socially recognized.[⁵] This connects closely to relational identity conflict above, since disenfranchised grief often stems from exactly this kind of identity-related loss. More detail is available in the "Disenfranchised Grief" section of I'm a Family Member.

• Depression, anger, and betrayal — common among family members of transgender adults specifically.[⁶]

 

What shapes the intensity of these reactions

Stigma and shame tend to vary with the family member's relationship to the transitioning person, as well as gender and age on both sides. This reference table illustrates the pattern. A few examples:

• A wife whose husband transitions may feel her original marital agreement was violated.

• A male child whose father transitions may feel more shame if the transition happens in adolescence than in early childhood — and a female child in the same situation may react differently still.

• A father who took pride in having a son may feel a distinct sense of loss if that child transitions to female.

 

This first-person account from the mother of a transgender daughter illustrates this adjustment process well.

 

Stages of grief

Kübler-Ross's stages of grief offer a useful framework for understanding how different family members react over time.[⁷] This behavior reference table maps example behaviors to each stage — though in practice, family members move through these stages at different rates, and some don't complete every stage.

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Forgiveness work

This process often surfaces real anger at the transitioning family member, which can make forgiveness a relevant clinical focus. See Reflections on Forgiveness for more on this.

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Continue exploring:

• Clinical History

• Etiology, Treatment, & Outcomes

• Implications for Clinicians

• Services & Other Resources

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The citations on this page come from the research literature and other publications and are available upon request.

1. Whitley, 2013

2. Veldorale-Griffin & Darling, 2016; White & Ettner, 2007; Whitley, 2013

3. Boss, 2007; Coolhart et al., 2017; McGuire et al., 2016; Norwood, 2012, 2013a; Zamboni, 2006; McGuire, Catalpa, Lacey, & Kuvalanka, 2016; Wahlig, 2015

4. Brill & Pepper, 2008; Canfield-Lenfest, 2008; Ehrensaft, 2011; McCullough, 2020; Norwood, 2012, 2013b

5. Doka, 2002; McCullough, 2020; Testoni & Pinducciu, 2019

6. Freedman, Tasker, & di Ceglie, 2002; Leland, 2017; Zamboni, 2006

7. Kübler-Ross, 1969; Emerson & Rosenfeld, 1996