The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients

Rider, G. Nicole; Vencill, Jennifer A.; Becker-Warner, Rachel; Candelario-Pérez, Leonardo; Spencer, Kylee L.

doi:10.1080/15532739.2018.1485069

Cited by 42 publications

(53 citation statements)

References 51 publications

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“…Developing clinical tools that will facilitate delivering patient-centered care is important to meeting the gender affirmation needs of diverse transgender adults, including non-binary individuals. [56] As hypothesized, differences were also observed in some areas of healthcare utilization according to gender identity. Specifically, non-binary participants had increased odds of not having an annual wellness visit for primary care within the last two or more years, indicating lower levels of routine healthcare engagement.…”

Section: Discussionmentioning

confidence: 82%

Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample

2019

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Background In the U.S., non-binary refers to transgender people who have a gender identity not aligned with their assigned sex at birth, and who identify outside of the traditional male-female binary, such as genderqueer, genderfluid, or gender nonconforming. Few data are available to characterize the health of non-binary adults. Methods The current study sought to fill this gap by conducting a secondary analysis of data from a non-probability sample of transgender and/or gender nonconforming adults in Massachusetts (sample mean age 32.6 years, 63% female assigned sex at birth; 79.4% white non-Hispanic/Latinx). Multivariable models were fit to compare non-binary (e.g., genderqueer) vs. binary (e.g., man/trans man, woman/trans woman) respondents across a range of social and health indicators. Results Overall, 40.9% identified their gender identity as non-binary. Non-binary respondents significantly differed from binary respondents on (all p<0.05): demographics (younger age, more female assigned sex at birth); gender affirmation (older age of identity recognition, lower current uptake of and future desires for medical gender affirmation); healthcare utilization (lower rates of being up-to-date in annual wellness visit, less mental healthcare utilization in past year); mental health and substance use (higher past-week depressive distress, higher hazardous alcohol use); social history (more unstably housed, more current students), violence victimization (lower rates of lifetime intimate partner violence), and social support (less family support).

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Section: Discussionmentioning

confidence: 82%

Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample

2019

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“…Rather, they should deconstruct their own normative assumptions, perceiving non-binary gender identities as healthy and non-pathological, and avoiding gender binary assumptions. To our knowledge, only Nic Rider et al (2019) published a conceptual article presenting theoretical foundations of a psychotherapy model specifically addressed to NBGQ people, called the Gender Affirmative Lifespan Approach (GALA). GALA has its theoretical roots in the health disparities theory, which asserts that therapeutically working on internalized oppression has the potentiality to improve mental health and well-being in gender diverse clients.…”

Section: Discussionmentioning

confidence: 99%

Health of Non-binary and Genderqueer People: A Systematic Review

et al. 2019

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Background: Non-binary and genderqueer (NBGQ) people are those who do not identify within the gender binary system (male vs. female), not falling exclusively in man/male or woman/female normative categories. A higher proportion of NBGQ people is usually found within young persons. This population is marginalized and, as such, is at risk of stigmatization and of developing negative health outcomes. As literature on the health of NBGQ people is sparse, this study aims at systematically review the limited studies on this field. Methods: The research questions which guided the systematic review were: (1) What are the differences in the health levels between NBGQ and binary transgender (BT) individuals? (2) What are the differences in the health levels between NBGQ and cisgender individuals? (3) Which medical and psychological interventions are most suitable for improving NBGQ health? According to PRISMA guidelines, a systematic search was conducted in PubMed, PsycInfo, Web of Science, and Google Scholar. Results: Eleven studies met the inclusion criteria for the current systematic review. Among them, 9 were focused on the health differences between NBGQ and BT individuals, 4 of the latter and 1 individually were focused on the health differences between NBGQ and cisgender individuals, and 1 was focused on the evaluation of health outcomes related to medical procedures. No studies assessed psychological interventions aimed at improving health in NBGQ individuals. All studies were cross-sectional, did not generally recruit a large sample of NBGQ individuals, and used non-probability sample design. Results related to the difference in health between NBGQ and BT were mixed; indeed, some found a better health status while others a worse one. Results related to the differences in health between NBGQ and cisgender highlighted higher health needs in NBGQ than in BT individuals. The only study analyzing the effects of medical interventions on health found that NBGQ female-assigned at birth individuals improved their quality of life after chest surgery. Conclusions: Although scholars are starting to pay attention to the NBGQ health, research needs to be expanded both in terms of methodology and research contents. Clinical, health-related social policies, and research recommendations in this field are reported.

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“…9 For NB individuals, the process of a gender ''transition'' may be complex, irrelevant, or fraught with misunderstanding from providers. [9][10][11] However, many NB people pursue gender affirmation 11 and may have unique needs compared with transgender women (TW) and transgender men (TM). 12 Current clinical guidelines poorly reflect such nuances 13,14 and NB people often report barriers to affirming care, including difficulty finding affirming providers, stigma in health care encounters, and denial of coverage.…”

Section: Introductionmentioning

confidence: 99%

“…These SOC, though important, do not adequately outline guidelines for gender affirmation processes among NB people, who have often relied on providers who use an ''informed consent'' rather than a ''gatekeeping'' model to access care. [9][10][11] This study builds on limited knowledge about NB gender affirmation processes to inform future guidelines for TNB care. 23,24 Third, given associations between gender affirmation and psychological outcomes, we measure differences in transgender congruence.…”

Section: Introductionmentioning

confidence: 99%

“… 12 Current clinical guidelines poorly reflect such nuances 13 , 14 and NB people often report barriers to affirming care, including difficulty finding affirming providers, stigma in health care encounters, and denial of coverage. 11 , 15 , 16 In a 2015 national survey, for example, 70% of NB people reported a need for counseling, yet only 31% accessed care (compared with 73% among TW and TM). 17 Group disparities likely exist across all gender affirmation processes, though a few data exist regarding capturing unique needs, access, and outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Toward Nonbinary Nuance in Research and Care: Mapping Differences in Gender Affirmation and Transgender Congruence in an Online National U.S. Survey

et al. 2021

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To close gaps in transgender health research, we mapped trends in gender affirmation processes (i.e., social, legal, and psychological transitions) that are unique among nonbinary (NB) transgender adults when compared with transgender women (TW) and transgender men (TM). Methods: Data were drawn from the Columbia Trans Empowerment Survey (N = 707), an online national study conducted between 2014 and 2015 in the United States. We used one-way analysis of variance tests, chi-square tests, Kruskal-Wallis tests, and post hoc analyses to estimate differences in gender affirmation processes and transgender congruence between: (1) NB adults, n = 271, 38%; (2) TW, n = 291, 41%; and (3) TM, n = 145, 21%. We then identified bivariate correlations between variables of interest. Results: In the full sample (n = 707), we found significant positive bivariate correlations between pursuing gender affirmation and transgender congruence. In terms of demographics, NB participants were significantly more likely to be queer (42.1%), polyamorous (25.5%), unemployed (44.8%), and younger (median = 22) than TW and TM. They also reported taking significantly fewer gender affirmation processes, with significant differences between the three groups in terms of particular experiences. The NB participants also reported significantly lower rates of transgender congruence, specifically lower appearance congruence though similar gender identity acceptance. Conclusion: The NB transgender adults in this sample report unique identity-related characteristics, including significantly lower rates of medical/social transition as well as decreased transgender congruence. These data are among the first to describe unique pathways by which NB adults, TW, and TM may pursue gender affirmation and interact with providers as they navigate congruence, transition, and well-being.

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The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients

Cited by 42 publications

References 51 publications

Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample

Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample

Health of Non-binary and Genderqueer People: A Systematic Review

Toward Nonbinary Nuance in Research and Care: Mapping Differences in Gender Affirmation and Transgender Congruence in an Online National U.S. Survey

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