Demonstrating Attachment‐Based Family Therapy for Transgender and Gender Diverse Youth with Suicidal Thoughts and Behavior: A Case Study

Abstract

Suicide is a growing public health issue among adolescents. While the majority of transgender and gender diverse (TGD) youth are healthy, many experience suicidal thoughts and behavior (STB). Due to discrimination and stigma, TGD youth attempt suicide at higher rates then heterosexual, cisgender and even cisgender, LGBQ youth. Despite this vulnerability to suicide, few treatments have been developed and tested for this population. One treatment, attachment-based family therapy (ABFT) has been adapted to work with LGBQ youth and may be promising for TGD adolescents at risk for suicide. This article provides an overview of our ABFT modifications for TGD youth with thoughts of suicide. Specifically, we illustrate how treatment outcomes, in a single case study, relate to processes within clinical treatment tasks. The case study demonstrates the application of these ABFT modifications with a self-identified, gender nonconforming adolescent (who had recently attempted suicide) and his caregivers. Treatment evaluation measures were collected over the course of 24 weeks to illustrate the youth's clinical progress. The youth's suicidal symptoms diminished markedly by the end of treatment. Further, the family reported an increased ability for problem solving and more open communication by treatment conclusion.

How do sexual and gender minority people acquire the capability for suicide? Voices from survivors of near-fatal suicide attempts

“…ABFT was found to be associated with reductions in sexual minority adolescents’ suicidal ideation even among SGM youth with persistently rejecting parents ( Diamond et al, 2012 ). This approach may also be applicable to transgender adolescents’ suicidal thoughts and behavior ( Russon et al, 2021 ). While promising, only future testing of ABFT in a randomized-controlled trial can confirm its efficacy in reducing suicide among SGM young people who face chronic identity invalidation.…”

Implementing Attachment-Based Family Therapy for Depressed and Suicidal Adolescents and Young Adults in LGBTQ+ Services

“…Refining the approach continued as we worked with families in the pilot; therefore, our approach shifted with new information gained. These refinements are complex and further explored in another paper (Russon, Smithee et al, 2021a; Russon, Washington et al, 2021b). A 16-week model may not clinically address the complex needs of TGD families.…”

“…Until recently, transgender and gender diverse (TGD) adolescents and young adults have been absent from suicide treatment research, yet they are at even greater risk for suicidality than LGBQ young people (Grossman & D'Augelli, 2007). Unfortunately, suicide intervention research for LGBTQ+ populations remains limited (Austin & Craig, 2015; Russon, Smithee et al, 2021a; Russon, Washington et al, 2021b).…”

Repairing attachment in families with depressed adolescents: A task analysis

“…ABFT is effective with the most severely distressed youth presenting with comorbid anxiety, severe suicide ideation, a history of multiple suicide attempts, and/or a history of sexual abuse (Diamond et al, 2010, 2012). ABFT has been successful with sexual minority youth (Diamond et al, 2012) and gender minority youth (Russon et al, 2021). Furthermore, ABFT studies have shown very high retention rates of 12 or more sessions even with low income, multiproblem families (Diamond et al, 2010).…”