Bridging the gap between practice guidelines and the therapy room: Community-derived practice adaptations for psychological services with transgender and gender diverse adults in the central United States.

Abstract

Individuals who identify as transgender and gender diverse (TGD) are presenting at mental health clinicians' offices with increasing frequency. Many TGD clients are seeking care related to affirming their gender identity but also may present with anxiety, depression, trauma, substance abuse, or other problems for which a clinician may commonly provide services. Some clinicians may hesitate to accept TGD clients into their practice if they have little specialized training to work with this population in an affirming manner, especially in more underserved areas where a generalist practice is the norm. Numerous professional associations and experts have developed guidelines for affirmative behavioral health care for TGD people. However, what is needed are community-informed recommendations to bridge from the official guidelines to clinicians' in-session activities. The Trans Collaborations Practice Adaptations for Psychological Interventions for Transgender and Gender Diverse Adults are derived from iterative interviews with TGD community members and affirming mental health clinicians in the Central United States. The 12 practice adaptations are intended to guide clinicians to adapt their usual treatment approach to be TGD affirming, especially in underserved and rural areas. The practice adaptations cover numerous aspects of practice including the office setting and paperwork, understanding gender identity and incorporating it into the case conceptualization, therapist's self-awareness, and referrals. The Trans Collaborations Practice Adaptations will help

Previous mental health care and help-seeking experiences: Perspectives from sexual and gender minority survivors of near-fatal suicide attempts.

“…For example, SGM-related stigma can occur when patient units or interactions are divided by sex assigned at birth and a GM individual is not treated based on their gender identity, potentially creating additional psychological distress (Lyons et al, 2015; Walton & Baker, 2019). Examples like these raise important considerations for how providers working with SGM patients should engage in safety planning or make referrals for patients at high risk for suicidality (Hope et al, 2022). In the present study, when inpatient hospitalization was described as an effective intervention, participants noted feeling heard and supported by hospital providers or found camaraderie with other patients on their unit.…”

Preliminary evaluation of an acceptance and commitment therapy group for transgender and gender expansive adults.

“…Several ACT manuals (Forsyth & Eifert, 2016; Harris, 2019; O’Donoghue et al, 2018; Skinta & Curtin, 2016; Westrup & Wright, 2017) and other publicly available resources (e.g., https://www.actmindfully.com.au/) were referenced to inform group curriculum development. In line with recommended practices (Chen et al, 2020; Hope et al, 2022; Solness & Kivlighan, 2022), explicit attention was drawn to affirming language use, balancing transfocused and transaspect issues, creating an open and validating space, and incorporating discussion of social justice. One session was devoted to a midgroup review to consolidate and clarify concepts, and one session toward the end of the group was reserved for topics selected by group members.…”

“…Moreover, these studies neither measure common mental health constructs (e.g., depression) nor did they measure the acceptability or satisfaction of ACT using quantitative measures, both of which are critical to understanding the impacts of ACT in this population. Though several theoretical reviews, therapy guidelines, and group protocols have been published (e.g., Bennett & Dillman Taylor, 2019; Grobe, 2021; Hope et al, 2022; Solness & Kivlighan, 2022), continued psychotherapy research is needed to improve the use of ACT in serving TGE mental health needs and to support therapists in providing culturally competent ACT-based services.…”

“…Group therapy is a treatment format that not only circumvents many barriers to care but also allows opportunities to conduct exploratory research of a treatment in “hard to reach” populations (Solness & Kivlighan, 2022). Group therapy also offers the benefit of increased social connection in a space of shared collective experiences, which can be particularly relevant for TGE individuals in rural and underserved regions (Hope et al, 2022). However, group therapy literature on ACT for TGE populations remains scarce (Fowler et al, 2022; Solness & Kivlighan, 2022).…”

Clinical practice with transgender and gender diverse clients: Setting up an inclusive practice and training considerations.

“…Overall, providers should review treatment guidelines and make adaptations to therapy approaches to increase affirmation of TGD clients (APA, 2015). For a more thorough review of steps to adapt treatment to be more affirming, see Hope et al (2022). One adaptation that is particularly important is that, during the intake, it may help further a provider's understanding of the client to discuss their identity and minority stress, resilience, coping, and other unique experiences of TGD people, like gender affirmation and dysphoria (APA, 2015; Heck et al, 2013; Puckett, Barr, et al, 2018).…”