Abstract
An increasing number of transgender and gender nonconforming (TGNC) youth are seeking gender-affirming medical treatments and affirmative mental health supports. The field currently lacks guidelines or recommendations for the integration of spirituality and religion into such care. Providers must consider spirituality and religion when working with this population because it may reduce the burden of adversity and may also improve the likelihood of positive outcomes among this population. Informed by an adapted version of the Minority Stress Model and the cultural humility framework, our manuscript details recommendations for interdisciplinary care with TGNC youth and families in the following areas: functional assessment of spirituality and religion as they relate to gender identity, parental support, medical decision making, coping; religious/spiritual referral; psychotherapy referral; and community advocacy. Recommendations offer providers in interdisciplinary settings applicable frameworks and guidelines for integrating spirituality and religion into care with TGNC youth and families.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
Not applicable.
Code Availability
Not applicable.
Notes
For the purposes of the current article, we will utilize the term transgender and gender nonconforming (TGNC) to be consistent with current American Psychological Association guidelines. We recognize that some individuals do not ascribe to this phrase and we hope to be as inclusive as possible. Readers may also refer to our references for further reading on inclusive terms for TGNC individuals.
According to the American Psychological Association guidelines for supporting gender identity and sexual orientation diversity in schools, cisnormative is defined as “the assumption that all individuals are cisgender (i.e., the gender assigned at birth aligns with their gender identity” because this is the expected norm’” (Lytle & Sprott, 2020 p. 9).
It is important to note that not all TGNC individuals seek gender-affirming medical treatments. Some individuals may seek support or resources from interdisciplinary clinics. Other TGNC individuals may not seek services at interdisciplinary clinics at all. Interdisciplinary clinics providing services to TGNC individuals should strive to be gender-affirming regardless of individuals’ interest in medical treatments.
1 Throughout these recommendations we use the word parents for ease of reading, however, this word and may also apply to legal guardians, caregivers, or individuals involved with the youth’s development and well-being.
References
Abreu, R. L., Rosenkrantz, D. E., Ryser-Oatman, J. T., Rostosky, S. S., & Riggle, E. D. B. (2019). Parental reactions to transgender and gender diverse children: A literature review. Journal of GLBT Family Studies, 15(5), 461–485. https://doi.org/10.1080/1550428X.2019.1656132
Alegría, C. A. (2018). Supporting families of transgender children/youth: Parents speak on their experiences, identity, and views. International Journal of Transgenderism, 19(2), 132–143. https://doi.org/10.1080/15532739.2018.1450798
American College of Obstetricians and Gynecologists. (2017). ACOG committee opinion. American College of Obstetricians and Gynecologists.
American Psychological Association. (2009). Report of the American Psychological Association 342 Task Force on Appropriate Affirmative Responses to Sexual Orientation. Retrieved June 1, 2021, from https://www.apa.org/pi/lgbt/resources/therapeutic-response.pdf
American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864. https://doi.org/10.1037/a0039906
Arutyunyan, T., Odetola, F., Swieringa, R., & Niedner, M. (2018). Religion and spiritual care in pediatric intensive care unit: Parental attitudes regarding physician spiritual and religious inquiry. American Journal of Hospice and Palliative Medicine, 35(1), 28–33. https://doi.org/10.1177/1049909116682016
Ashley, F. (2019). Gatekeeping hormone replacement therapy for transgender patients is dehumanizing. Journal of Medical Ethics, 5(7), 480–482. https://doi.org/10.1136/medethics-2018-105293
Bautista, D., Mountain, Q., & Reynolds, H. M. (2014). Religion and spirituality. In L. Erickson-Schroth (Ed.), Trans bodies, trans selves: A resource for the transgender community (pp. 62–79). Oxford University Press.
Beagan, B. L., & Hattie, B. (2015). Religion, spirituality, and LGBTQ identity integration. Journal of LGBT Issues in Counseling, 9(2), 92–117. https://doi.org/10.1080/15538605.2015.1029204
Bernacki, J. M., & Weimer, A. K. (2019). Role of development on youth decision-making and recovery from gender-affirming surgery. Clinical Practice in Pediatric Psychology, 7(3), 312–321. https://doi.org/10.1037/cpp0000294
Betz, J., Szczesniak, R., Lewis, K., Pestian, T., Bennethum, A. S., McBride, J., & Grossoehme, D. H. (2019). Feasibility and acceptability of a telephone-based chaplaincy intervention to decrease parental spiritual struggle. Journal of Religion and Health, 58(6), 2065–2085. https://doi.org/10.1007/s10943-019-00921-8
Brandt, P. Y. (2019). Religious and spiritual aspects in the construction of identity modelized as a constellation. Integrative Psychological and Behavioral Science, 53(1), 138–157. https://doi.org/10.1007/s12124-018-9436-8
Campbell, M., Hinton, J. D., & Anderson, J. R. (2019). A systematic review of the relationship between religion and attitudes toward transgender and gender-variant people. International Journal of Transgenderism, 20(1), 21–38. https://doi.org/10.1080/15532739.2018.1545149
Clark, B. A. (2017). Ethics in child and youth care practice with transgender youth. International Journal of Child, Youth and Family Studies, 8(1), 74–96. https://doi.org/10.18357/ijcyfs82201716754
Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., & Monstrey, S. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people: 7th version. International Journal of Transgenderism, 13(4), 165–232. https://doi.org/10.1080/15532379.2011.700873
Collier, K. M., & James, C. A. (2021). Religion and spirituality in primary care. Primary Care Reports, 27(4).
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 and Family Therapy, 39(2), 223–243. https://doi.org/10.1111/j.1752-0606.2011.00283.x
Dahl, A. L., & Galliher, R. V. (2012). LGBTQ adolescents and young adults raised within a Christian religious context: Positive and negative outcomes. Journal of Adolescence, 35(6), 1611–1618. https://doi.org/10.1016/j.adolescence.2012.07.003
Day, J. K., Perez-Brumer, A., & Russell, S. T. (2018). Safe schools? Transgender youth’s school experiences and perceptions of school climate. Journal of Youth and Adolescence, 47(8), 1731–1742. https://doi.org/10.1007/s10964-018-0866-x
de Vries, A. L. C., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: The Dutch approach. Journal of Homosexuality, 59(1), 301–320. https://doi.org/10.1080/00918369.2012.653300
Edwards-Leeper, L., Leibowitz, S., & Sangganjanavanich, V. F. (2016). Affirmative practice with transgender and gender nonconforming youth: Expanding the model. Psychology of Sexual Orientation and Gender Diversity, 3(2), 165–172. https://doi.org/10.1037/sgd0000167
Eisenberg, M. E., McMorris, B. J., Rider, G. N., Gower, A. L., & Coleman, E. (2020). “It’s kind of hard to go to the doctor’s office if you’re hated there.” A call for gender-affirming care from transgender and gender diverse adolescents in the United States. Health & Social Care in the Community, 28(3), 1082–1089. https://doi.org/10.1111/hsc.12941
Exline, J. J., Pargament, K. I., Grubbs, J. B., & Yali, A. M. (2014). The Religious and spiritual struggles scale: development and initial validation. Psychology of Religion and Spirituality, 6(3), 208–222. https://doi.org/10.1037/a0036465
Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34(2), 165–181. https://doi.org/10.1080/02615479.2014.977244
Fitchett, G., & Risk, J. L. (2009). Screening for spiritual struggle. Journal of Pastoral Care & Counseling, 63(1–2), 1–12. https://doi.org/10.1177/154230500906300104
Grossman, A. H., & D’augelli, A. R. (2006). Transgender youth: Invisible and vulnerable. Journal of Homosexuality, 51(1), 111–128. https://doi.org/10.1300/J082v51n01_06
Grossman, A. H., Park, J. Y., & Russell, S. T. (2016). Transgender youth and suicidal behaviors: Applying the interpersonal psychological theory of suicide. Journal of Gay & Lesbian Mental Health, 20(4), 329–349. https://doi.org/10.1080/19359705.2016.1207581
Grossoehme, D. H., Teeters, A., Jelinek, S., Dimitriou, S. M., & Conard, L. A. E. (2016). Screening for spiritual struggle in an adolescent transgender clinic: Feasibility and acceptability. Journal of Health Care Chaplaincy, 22(2), 54–66. https://doi.org/10.1080/08854726.2015.1123004
Hidalgo, M. A., Ehrensaft, D., Tishelman, A. C., Clark, L. F., Garofalo, R., Rosenthal, S. M., Spack, N. P., & Olson, J. (2013). The gender affirmative model: What we know and what we aim to learn. Human Development, 56, 285–290. https://doi.org/10.1159/000355235
Hsieh, S., & Leininger, J. (2014). Resource list: Clinical care programs for gender-nonconforming children and adolescents. Pediatric Annals, 43(6), 238–244. https://doi.org/10.3928/00904481-20140522-11
Ibrahim, M., Russon, J., Levy, S., & Diamond, G. (2018). Promoting parental acceptance of bisexuality: A case study of attachment-based therapy. Journal of Family Psychotherapy, 29(3), 223–251. https://doi.org/10.1080/08975353.2018.1427401
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report of the 2015 U.S. Transgender Survey. National Center for Transgender Equality.
Koenig, H. G., Perno, K., & Hamilton, T. (2017). Effects of a 12-month educational intervention on outpatient clinicians’ attitudes and behaviors concerning spiritual practices with patients. Advances in Medical Education and Practice, 8(1), 129–139. https://doi.org/10.2147/AMEP.S125352
Kolbuck, V. D., Muldoon, A. L., Rychlik, K., Hidalgo, M. A., & Chen, D. (2019). Psychological functioning, parenting stress, and parental support among clinic-referred prepubertal gender-expansive children. Clinical Practice in Pediatric Psychology, 7(3), 254. https://doi.org/10.1037/cpp0000293
Lassi, S., & Mugnaini, D. (2015). Role of religion and spirituality on mental health and resilience: There is enough evidence. International Journal of Emergency Mental Health and Human Resilience, 17(3), 661–663.
Lytle, M. C., & Sprott, R. A. (2020). Introduction. In M. C. Lytle & R. A. Sprott (Eds.), Supporting gender identity and sexual orientation diversity in K-12 schools: Perspectives on sexual orientation and gender diversity Series (pp. 3–11). APA Books.
Malcolm, H. V., Desjardins, C. M., Ferrara, B., Kitamura, E. A., Mueller, M., Betz, J., Ragsdale, J. R., & Grossoehme, D. H. (2019). Parental use of religion and spirituality in medical decision-making. Journal of Health Care Chaplaincy. https://doi.org/10.1080/08854726.2019.1670566
McLaughlin, R. J., & Sharp, R. N. (2018). Working with parents and caregivers when conflicts arise. In C. Keo-Meier & D. Ehrensaft (Eds.), The gender affirmative model: An interdisciplinary approach to supporting transgender and gender expansive children (pp. 157–172). American Psychological Association.
Meerwijk, E. L., & Sevelius, J. M. (2017). Transgender population size in the United States: A meta-regression of population-based probability samples. American Journal of Public Health, 107(2), e1–e8. https://doi.org/10.2105/AJPH.2016.303578
Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56. https://doi.org/10.2307/2137286
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697. https://doi.org/10.1037/0033-2909.129.5.674
Mountz, S., Capous-Desyllas, M., & Pourciau, E. (2018). “Because We’re Fighting to Be Ourselves:” Voices from Former Foster Youth who are Transgender and Gender Expansive. Child Welfare, 96(1), 103–125.
Pargament, K. I. (2007). Spiritually integrated psychotherapy. Guilford Press.
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), 281–286. https://doi.org/10.1037/sgd0000122
Puchalski, C. M. (2014). The FICA spiritual history tool #274. Journal of Palliative Medicine, 17(1), 105–106. https://doi.org/10.1089/jpm.2013.9458
Rosmarin, D. H. (2018). Spirituality, religion, and cognitive-behavioral therapy: A guide for clinicians. Guilford Press.
Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescence, 64(4), 503–505. https://doi.org/10.1016/j.jadohealth.2018.02.003
Testa, R. J., Habarth, J., Peta, J., Balsam, K., & Bockting, W. (2015). Development of the gender minority stress and resilience measure. Psychology of Sexual Orientation and Gender Diversity, 2(1), 65–77. https://doi.org/10.1037/sgd0000081
Turban, J. L., Beckwith, N., & Reisner, S. L. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry, 77(1), 68–76. https://doi.org/10.1001/jamapsychiatry.2019.2285
Vieten, C., Scammell, S., Pilato, R., Ammondson, I., Pargament, K. I., & Lukoff, D. (2013). Spiritual and religious competencies for psychologists. Psychology of Religion and Spirituality, 5(3), 129–144. https://doi.org/10.1037/a0032699
Walsh, F. (2010). Spiritual diversity: Multifaith perspectives in family therapy. Family Process, 49(3), 330–348.
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
CK: Conceived of the presented idea and overall structure of the manuscript. OM: Encouraged CK to include certain recommendations regarding religion and spirituality. CO: Supervised the writing of this work and provided expertise regarding gender identity and the gender minority stress model. All authors discussed the manuscript and contributed to the final manuscript.
Corresponding author
Ethics declarations
Conflict of interest
Caroline C. Kaufman, October Mohr, Christy L. Olezeski declare that they have no conflict of interest to disclose.
Ethical Approval
Not applicable.
Consent to Participate
Not applicable.
Consent for Publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kaufman, C.C., Mohr, O. & Olezeski, C.L. Spirituality, Religion and Transgender and Gender Nonconforming Affirmative Care with Youth and Families: Guidelines and Recommendations. J Clin Psychol Med Settings 30, 318–329 (2023). https://doi.org/10.1007/s10880-022-09892-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10880-022-09892-7