Attachment and Shame in Gender-Nonconforming Children and Their Families: Toward a Theoretical Framework for Evaluating Clinical Interventions

Wallace, Robert L.; Russell, Hershel

doi:10.1080/15532739.2013.824845

Cited by 43 publications

(26 citation statements)

References 54 publications

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“…Critics of this approach highlight that gender variance is not inherently pathological and that cisgender identification is not an ethically permissible treatment goal. Furthermore, critics have expressed concern that this type of treatment might cause a child to feel shame or other negative and maladaptive feelings due to physicians and parents defining cross‐gender identification as ‘undesirable’ and a study conducted in Canada indeed found a higher incidence of shame‐related experiences in youth treated with this modality (Wallace & Russell, ). Such approaches have been labeled unethical and harmful by the American Academy of Pediatrics (Levine, ), The American Psychological Association (Association, ), among other professional organizations (Byne, ).…”

Section: Prepubertal Youth: Psychotherapeutic Approaches and Controvementioning

confidence: 99%

Research Review: Gender identity in youth: treatment paradigms and controversies

Turban

Ehrensaft

2017

Child Psychology Psychiatry

146

117

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Section: Prepubertal Youth: Psychotherapeutic Approaches and Controvementioning

confidence: 99%

Research Review: Gender identity in youth: treatment paradigms and controversies

Turban

Ehrensaft

2017

Child Psychology Psychiatry

146

117

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“…In contrast, the positioning of this goal as benign ignores the potential harms to young people who have undergone such treatments (Bryant, 2006). A 2013 attachment-based theoretical comparison of gender therapies for children concluded that there is a risk that children who are discouraged from expressing their gender identity may integrate shame into their fundamental sense of self (Wallace & Russell, 2013). Drescher and Pula (2014) offer: "It could be construed … that clinical attempts to prevent transsexualism, no matter how well meaning, are unethical because they demean the dignity of gender-variant children" (p.S19).…”

Section: Interpretive Concernsmentioning

confidence: 99%

A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

Newhook

Pyne

Winters

et al. 2018

International Journal of Transgenderism

116

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Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e. desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary "phase." This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender non-conforming children. Methods: A critical review methodology is employed to systematically interpret four frequentlycited studies that sought to document identity outcomes for gender non-conforming children (often referred to as "desistance" research). Results: Methodological, theoretical, ethical, and interpretive concerns regarding four "desistance" studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, "How should children's gender identities develop over time?" toward a more useful question: "How should children best be supported as their gender identity develops?" Conclusion: The tethering of childhood gender diversity to the framework of "desistance" or "persistence" has stifled advancements in our understanding of children's gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8 th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children's voices seriously. Listening to children's experiences will enable a more comprehensive understanding of the needs of gender non-conforming children and provide guidance to scientific and lay communities.

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“…These negative experiences may lead to mental health problems for TGNC youth, including depressive symptoms (Dank, Lachman, Zweig, & Yahner, 2014), self-injury (Almeida, Johnson, Corliss, Molnar, & Azrael, 2009;Spack et al, 2012), and suicide attempts (Clements-Nolle, Marx, & Katz, 2006). In addition, although we assume mental health practitioners who work with this vulnerable population aim to provide services that improve quality of life, therapeutic approaches that encourage individuals to accept their given body and assigned gender may inadvertently cause psychological harm (SAMHSA, 2015;Travers et al, 2012;Wallace & Russell, 2013). Despite various challenges, Singh et al (2014) noted the resilience of many TGNC youths, including the ability of each individual to define his or her own gender, access supportive resources, connect to a trans-affirming community, and hold more positive outlooks about their mental health.…”

Section: Risks Resilience and Barriers To Care For Tgnc Youthmentioning

confidence: 99%

Affirmative practice with transgender and gender nonconforming youth: Expanding the model.

Edwards-Leeper

Leibowitz

Sangganjanavanich

2016

Psychology of Sexual Orientation and Gender Diversity

119

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Affirmative care with transgender and gender nonconforming (TGNC) children and adolescents is a new framework under which many mental health clinicians now practice. It rests on a premise that appreciates diverse gender expressions and identities within society, and encourages the highest potential for individuals to follow their own paths to positive emotional well-being. Scientific understanding of the phenomenology of gender development in children and adolescents is scarce, and the gaps in knowledge limit evidence-based practice when working with these youths. Interventions span many domains within the physical and mental health realms, calling for providers to navigate differing interdisciplinary perspectives when optimizing assessment and treatment goals. In addition, interventions differ according to developmental stage, and newer approaches and treatments have become more popular within the last decade. For children, the concept of social gender transition has remained controversial, as relatively historical approaches (discouraging cross-gender behavior) have become outdated and more recent methods (supporting gender transition) have gained backing. Fully reversible pubertal suppression has been introduced for TGNC adolescents as a means of buying time for exploration without the pressures of irreversible pubertal advancement. Given the current deficits in scientific understanding of genderidentity development in youth, the affirmative provider often faces decisions that are challenging, complex, and unclear. This paper describes the theoretical approaches to TGNC youth across development, provides a brief overview of the current research, and offers providers a way to conceptualize and provide care that can be both supportive and scientifically driven when done in a thoughtful, balanced way.

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Attachment and Shame in Gender-Nonconforming Children and Their Families: Toward a Theoretical Framework for Evaluating Clinical Interventions

Cited by 43 publications

References 54 publications

Research Review: Gender identity in youth: treatment paradigms and controversies

Research Review: Gender identity in youth: treatment paradigms and controversies

A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

Affirmative practice with transgender and gender nonconforming youth: Expanding the model.

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