Contemporary Family Therapy

, Volume 41, Issue 3, pp 258–274 | Cite as

An Ecological Framework for Transgender Inclusive Family Therapy

  • Lindsay EdwardsEmail author
  • Annabelle Goodwin
  • Michelle Neumann
Original Paper


Despite current demands for transgender inclusive family therapy, family therapy training programs provide limited coursework on gender identity and inclusive practice. As a result, written resources are critical for family therapists wanting to provide inclusive services to transgender clients. In the interest of expanding available resources, this article uses an ecological framework to summarize research findings on the unique resiliency and difficulties experienced by transgender people. This was done in the interest of identifying implications for family therapy and distilling these implications into a collection of concrete suggestions for transgender inclusive family therapy practice. A conceptual model and a table of concrete suggestions are included at the end of the article.


Transgender Family therapy Gender identity Therapeutic techniques Inclusive marriage and family therapy 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest and there are no funding sources to note for this project. We did not seek approval from the Institutional Review Board of our university because we did not collect human subject data for this project.


  1. Addison, S. M., & Coolhart, D. (2015). Expanding the therapy paradigm with queer couples: A relational intersectional lens. Family Process, 54(3), 435–453. Scholar
  2. ALGBTIC Transgender Committee. (2010). American counseling association competencies for counseling with transgender clients. Journal of LGBT Issues in Counseling, 4, 3–4. 135–159.CrossRefGoogle Scholar
  3. American Psychological Association. (2009). Report of the task force on gender identity and gender variance. Washington, DC: Author.Google Scholar
  4. American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70, 832–864. Scholar
  5. Auldridge, A., Tamar-Mattis, A., Kennedy, S., Ames, E., & Tobin, H. J. (2012). Improving the lives of transgender older adults: Recommendations for policy and practice. Washington. DC: National Center for Transgender Equality: Services & Advocacy for LGBT Elders.Google Scholar
  6. Benson, K. E. (2013). Seeking support: Transgender client experiences with mental health services. Journal of Feminist Family Therapy, 25, 17–40. Scholar
  7. Bigner, J. J., & Wetchler, J. L. (Eds.)., (2012). Handbook of LGBT-affirmative couple and family therapy. New York: RoutledgeGoogle Scholar
  8. Blumer, M., & Murphy, M. (2011). Alaskan gay males’ couple experiences of societal non- support: Coping through families of choice and therapeutic means. Contemporary Family Therapy, 33(3), 273–290. Scholar
  9. Blumer, M. L. C., Ansara, Y. G., & Watson, C. M. (2013). Cisgenderism in family Therapy: How everyday clinical practices can delegitimize people’s gender self-designations. Journal of Family Psychotherapy, 24(4), 267–285. Scholar
  10. Blumer, M. L. C., Green, M. S., Knowles, S. J., & Williams, A. (2012). Shedding light on thirteen years of darkness: Content analysis of articles pertaining to transgender issues in marriage/couple and family therapy journals. Journal of Marital & Family Therapy, 38(S1), 244–256. Scholar
  11. Bronfenbrenner, U. (2005). The bioecological theory of human development (2001). In U. Bronfenbrenner & U. Bronfenbrenner (Eds.), Making human beings human: Bioecological perspectives on human development (pp. 3–15). Thousand Oaks: Sage.Google Scholar
  12. Budge, S. L., Tebbe, E. N., & Howard, K. S. (2010). The work experiences of transgender individuals: Negotiating the transition and career decision-making processes. Journal of Counseling Psychology, 57(4), 377–393. Scholar
  13. Chang, S. C., & Singh, A. A. (2016). Affirming psychological practice with transgender and gender nonconforming people of color. Psychology of Sexual Orientation and Gender Diversity, 3(2), 140–147. Scholar
  14. Coolhart, D., Baker, A., Farmer, S., Malaney, M., & Shipman, D. (2013). Therapy with transsexual youth and their families: A clinical tool for assessing youth’s readiness for gender transition. Journal of Marital & Family Therapy, 39, 223–243.CrossRefGoogle Scholar
  15. Coolhart, D., & MacKnight, V. (2015). Working with transgender youths and their families: Counselors and therapists as advocates for trans-affirmative school environments. Journal of Counselor Leadership and Advocacy, 2(1), 51–64. Scholar
  16. Coolhart, D., Provancher, N., Hager, A., & Wang, M. (2008). Recommending transsexual clients for gender transition: A therapeutic tool for assessing readiness. Journal of GLBT Family Studies, 4(3), 301–324. Scholar
  17. Coolhart, D., & Shipman, D. L. (2017). Working toward family attunement: Family therapy with transgender and gender-nonconforming children and adolescents. Psychiatric Clinics of North America, 40(1), 113–125. Scholar
  18. Craig, S. L., & McInroy, L. (2014). You can form a part of yourself online: The influence of new media on identity development and coming out for LGBTQ youth. Journal of Gay & Lesbian Mental Health, 18(1), 95–109. Scholar
  19. Crenshaw, K. (1989). Demarginalizing the intersection of race and sex: A black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 140, 139–167.Google Scholar
  20. DeBord, K. A., Fischer, A. R., Bieschke, K. J., & Perez, R. M. (2017). Handbook of sexual orientation and gender diversity in counseling and psychotherapy. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  21. deHaan, G., Santos, G., Arayasirikul, S., & Raymond, H. F. (2015). Non-prescribed hormone use and barriers to care for transgender women in San Francisco. LGBT Health, 2(4), 313–323. Scholar
  22. Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry, 28(1), 44–57. Scholar
  23. Dickey, L. M., Ducheny, K. M., & Ehrbar, R. D. (2016). Family creation options for transgender and gender nonconforming people. Psychology of Sexual Orientation & Gender Diversity, 3(2), 173–179. Scholar
  24. Dispenza, F., & O’Hara, C. (2016). Correlates of transgender and gender nonconforming counseling competencies among psychologists and mental health practitioners. Psychology of Sexual Orientation & Gender Diversity, 3(2), 156–164. Scholar
  25. Erich, S., Tittsworth, J., Dykes, J., & Cabuses, C. (2008). Family relationship and their correlations with transsexual well-being. Journal of GLBT Family Studies, 4, 419–432. Scholar
  26. Frost, D. M., Meyer, I. H., & Schwartz, S. (2016). Social support networks among diverse sexual minority populations. American Journal of Orthopsychiatry, 86(1), 91–102. Scholar
  27. Galupo, M. P., Bauerband, L. A., Gonzalez, K. A., Hagen, D. B., Hether, S. D., & Krum, T. E. (2014). Transgender friendship experiences: Benefits and barriers of friendships across gender identity and sexual orientation. Feminist & Psychology, 24, 193–215. Scholar
  28. Galupo, M. P., Henise, S. B., & Davis, K. S. (2014). Transgender microaggressions in the context of friendship: Patterns of experience across friends’ sexual orientation and gender identity. Psychology of Sexual Orientation & Gender Diversity, 1(4), 461–470. Scholar
  29. Gamarel, K. K., Laurenceau, J., Reisner, S. L., Nemoto, T., & Operario, D. (2014). Gender minority stress, mental health, and relationship quality: A dyadic investigation of transgender women and their cisgender male partners. Journal of Family Psychology, 28(4), 437–447. Scholar
  30. Graham, L. F. (2014). Navigating community institutions: Black transgender women’s experiences in schools, the criminal justice system, and churches. Sexuality Research & Social Policy, 11, 274–287. Scholar
  31. Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force.Google Scholar
  32. Green-Hamann, S., Eichhorn, K. C., & Sherblom, J. C. (2011). An exploration of why people participate in second life social support groups. Journal of Computer-Mediated Communication, 16, 465–491. Scholar
  33. Green-Hamann, S., & Sherblom, J. C. (2014). The influences of optimal matching and social capital on communicating support. Journal of Health Communication, 19(10), 1130–1144. Scholar
  34. Green-Hamann, S., & Sherblom, J. C. (2016). Transgender transitioning: The influence of virtual on physical identities. Electronic Journal of Communication. 26(3/4).Google Scholar
  35. Grossman, A., D’Augelli, A., Howell, T., & Hubbard, S. (2005). Parents’ reactions to transgender youths’ gender noncomforming expression and identity. Journal of Gay & Lesbian Social Service, 18, 3–16.CrossRefGoogle Scholar
  36. Hill, D. B., & Menvielle, E. (2009). “You have to give them a place where they feel protected and safe and loved”: The views of parents who have gender-variant children and adolescents. Journal of LGBT Youth, 6(2/3), 243–271. Scholar
  37. Human Rights Campaign (2018). Finding insurance for transgender-related healthcare. Retrieved March 13, 2018 from
  38. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. transgender survey. Washington: National Center for Transgender Equality.Google Scholar
  39. Kattari, S. K., Walls, N. E., Whitfield, D. L., & Langenderfer-Magruder, L. (2015). Racial and ethnic differences in experiences of discrimination in accessing health services among transgender people in the United States. International Journal of Transgenderism, 16(2), 68–79. Scholar
  40. Khobzi Rotondi, N., Bauer, G. R., Scanlon, K., Kaay, M., Travers, R., & Travers, A. (2013). Nonprescribed hormone use and self-performed surgeries: ‘Do-it-yourself’ transitions in transgender communities in Ontario, Canada. American Journal of Public Health, 103(10), 1830–1836. Scholar
  41. Kidd, S. A., Veltman, A., Gately, C., Chan, K. J., & Cohen, J. N. (2011). Lesbian, gay, and transgender persons with severe mental illness: Negotiating wellness in the context of multiple sources of stigma. American Journal of Psychiatric Rehabilitation, 14(1), 13–39. Scholar
  42. Koh, J. (2012). The history of the concept of gender identity disorder. Seishin Shinkeigaku Zasshi, 114(6), 673–680.PubMedGoogle Scholar
  43. Koken, J. A., Bimbi, D. S., & Parson, J. T. (2009). Experiences of familial acceptance-rejection among transwomen of color. Journal of Family Psychology, 23(6), 853–860. Scholar
  44. Kosciw, J. G., Greytak, E. A., Giga, N. M., Villenas, C., & Danischewski, D. J. (2016). The 2015 national school climate survey: The experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. New York: GLSEN.Google Scholar
  45. Kosenko, K. A., Bond, B. J., & Hurley, R. J. (2016). An exploration into the uses and gratifications of media for transgender individuals. Psychology of Popular Media Culture. Advance online publication.CrossRefGoogle Scholar
  46. Kuvalanka, K., Weiner, J., & Mahan, D. (2014). Child, family, and community transformations: Findings from interviews with mothers of transgender girls. Journal of GLBT Family Studies, 10, 354–379.CrossRefGoogle Scholar
  47. Latorre, R. A., Endman, M., & Gossmann, I. (1976). Androgyny and need achievement in male and female psychiatric inpatients. Journal of Clinical Psychology, 32(2), 233–235.CrossRefGoogle Scholar
  48. Lev, A. I. (2004). Transgender emergence. Therapeutic guidelines for working with gender-variant people and their families. Binghamton: Haworth Clinical Practice Press.Google Scholar
  49. Liu, H., & Wilkinson, L. (2017). Marital status and perceived discrimination among transgender people. Journal of Marriage & Family, 79(5), 1295–1313.CrossRefGoogle Scholar
  50. Lombardi, E. L., Wilchins, R. A., Priesing, D., & Malouf, D. (2001). Gender violence: Transgender experiences with violence and discrimination. Journal of Homosexuality, 42(1), 89–101. Scholar
  51. McGeorge, C. R., Carlson, S., T., & Farrell, M. (2016). To refer or not to refer: Exploring family therapists’ beliefs and practices related to the referral of lesbian, gay, and bisexual clients. Journal of Marital & Family Therapy, 42(3), 466–480. Scholar
  52. Meier, S. C., Sharp, C., Michonski, J., Babcock, J. C., & Fitzgerald, K. (2013). Romantic relationships of female-to-male trans men: A descriptive study. International Journal of Transgenderism, 14(2), 75–85. Scholar
  53. Mizock, L., & Lundquist, C. (2016). Missteps in psychotherapy with transgender clients: Promoting gender sensitivity in counseling and psychological practice. Psychology of Sexual Orientation & Gender Diversity, 3(2), 148–155. Scholar
  54. Mizock, L., & Mueser, K. T. (2014). Employment, mental health, internalized stigma, and coping with transphobia among transgender individuals. Psychology of Sexual Orientation & Gender Diversity, 1(2), 146–158. Scholar
  55. Moradi, B. (2017). (Re)focusing intersectionality: From social identities back to systems of oppression and privilege. In K. A. DeBord, A. R. Fischer, K. J. Bieschke, R. M. Perez, K. A. DeBord, A. R. Fischer, K. J. Bieschke & R. M. Perez (Eds.), Handbook of sexual orientation & gender diversity in counseling and psychotherapy (pp. 105–127). Washington: APA.CrossRefGoogle Scholar
  56. National Center for Transgender Equality (2018a) Know your rights: Healthcare. Retrieved March 3, 2018 from
  57. National Center for Transgender Equality (2018b) Trump’s record of action against transgender people. Retrieved June 8, 2018 from
  58. Nemoto, T., Operario, D., & Keatley, J. (2005). Health and social services for male-to-female transgender persons of color in San Francisco. International Journal of Transgenderism, 8(2–3), 5–19. Scholar
  59. O’Hara, C., Dispenza, F., Brack, G., & Blood, R. C. (2013). The preparedness of counselors in training to work with transgender clients: A mixed methods investigation. Journal of LGBT Issues in Counseling, 7(3), 236–256. Scholar
  60. Persson, D. I. (2009). Unique challenges of transgender aging: Implications from the literature. Journal of Gerontological Social Work, 52, 633–646. Scholar
  61. Pflum, S. R., Testa, R. J., Balsam, K. F., Goldblum, P. B., & Bongar, B. (2015). Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults. Psychology of Sexual Orientation and Gender Diversity, 2(3), 281. Scholar
  62. Radix, A. E., Lelutiu-Weinberger, C., & Gamarel, K. E. (2014). Satisfaction and healthcare utilization of transgender and gender non-conforming individuals in NYC: A community-based participatory study. LGBT Health, 1(4), 302–308. Scholar
  63. Roller, C. G., Sedlak, C., & Draucker, C. B. (2015). Navigating the system: How transgender individuals engage in health care services. Journal of Nursing Scholarship, 47(5), 417–424. Scholar
  64. Russell, S. T., Ryan, C., Toomey, R. B., Diaz, R. M., & Sanchez, J. (2011). Lesbian, gay, bisexual & transgender adolescent school victimization: Implications for young adult health & adjustment. Journal of School Health, 81(5), 223–230. Scholar
  65. Safer, J. D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., & Sevelius, J. (2016). Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes, 23, 168–171. Scholar
  66. Sánchez, F. J., & Vilain, E. (2009). Collective self-esteem as a coping resource for male-to-female transsexuals. Journal of Counseling Psychology, 56(1), 202. Scholar
  67. Seelman, K. L. (2014). Transgender individuals’ access to college housing and bathrooms: Findings from the national transgender discrimination survey. Journal of Gay & Lesbian Social Services, 26(2), 186–206. Scholar
  68. Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. Scholar
  69. Singh, A. A., & Dickey, L. M. (2016). Implementing the APA guidelines on psychological practice with transgender and gender nonconforming people: A call to action to the field of psychology. Psychology of Sexual Orientation & Gender Diversity, 3(2), 195–200. Scholar
  70. Sperber, J., Landers, S., & Lawrence, S. (2005). Access to health care for transgendered persons: Results of a needs assessment in Boston. International Journal of Transgenderism, 8(2–3), 75–91. Scholar
  71. Stanton, M. C., Ali, S., & Chaudhuri, S. (2017). Individual, social and community-level predictors of wellbeing in a US sample of transgender and gender non-conforming individuals. Culture, Health & Sexuality, 19(1), 32–49. Scholar
  72. Stroumsa, D. (2014). The state of transgender health care: Policy, law, and medical frameworks. American Journal of Public Health, 104(3), e31–e38 1p. Scholar
  73. Toomey, R. B., & Richardson, R. A. (2009). Perceived sibling relationships of sexual minority youth. Journal of Homosexuality, 56(7), 849–860. Scholar
  74. Toomey, R. B., Ryan, C., Diaz, R. M., Card, N. A., & Russell, S. T. (2013). Gender-nonconforming lesbian, gay, bisexual, and transgender youth: School victimization and young adult psychosocial adjustment. Psychology of Sexual Orientation & Gender Diversity, 1(S), 71–80. Scholar
  75. Travers, R., Bauer, G., Pyne, J., Bradley, K., Gale, L., & Papadimitriou, M. (2012). Impacts of strong parental support for trans youth: A report prepared for Children’s Aid Society of Toronto and Delisle Youth Services. Trans Pulse.Google Scholar
  76. Trujillo, M. A., Perrin, P. B., Sutter, M., Tabaac, A., & Benotsch, E. G. (2017). The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample. International Journal of Transgenderism, 18(1), 39–52. Scholar
  77. U.S. Census Bureau. (2015). Current population survey. Annual Social & Economic Supplement.Google Scholar
  78. Utsey, S. O., Hook, J. N., & Stanard, P. (2007). A re-examination of cultural factors that mitigate risk and promote resilience in relation to African American suicide: A review of the literature and recommendations for future research. Death Studies, 31(5), 399–416. Scholar
  79. von Doussa, H., Power, J., & Riggs, D. (2015). Imagining parenthood: The possibilities and experiences of parenthood among transgender people. Culture, Health & Sexuality, 17(9), 1119–1131. Scholar
  80. Witten, T. M. (2009). Graceful exits: Intersection of aging, transgender identities, and the family/community. Journal of GLBT Family Studies, 5(1–2), 35–61. Scholar
  81. World Professional Association for Transgender Health. (2012). Standards of care for the health of transsexual, transgender, and gender nonconforming people (7th version). Retrieved from
  82. Xavier, J. M., Bobbin, M., Singer, B., & Budd, E. (2005). Needs assessment of transgendered people of color living in Washington, DC. International Journal of Transgenderism, 8(2–3), 31–47. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Counseling & Family TherapyRegis UniversityThorntonUSA
  2. 2.Northcentral UniversityScottsdaleUSA
  3. 3.DurhamUSA

Personalised recommendations