Doing Better Therapy

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The Importance of Family Therapy for Transgender Youth

By Irwin Krieger, LCSW


By Irwin Krieger, LCSW

Children who suffer harassment or discrimination based on race, religion or socioeconomic status generally have parents who have experienced these same challenges. The validation they get from their family for who they are helps them develop self-esteem despite any negative views that may exist in their community. Most transgender youth, in contrast, do not have parents or any extended family members who are transgender. Parents, in fact, often feel completely unprepared to offer the support and guidance these children need. And many families are initially quite rejecting of their transgender young people.

The Family Acceptance Project
The Family Acceptance Project has demonstrated the impact of family rejection on LGBT youth, including lower self-esteem, fewer people they can reach out to for help, and greater social isolation. Those whose families engaged in highly rejecting behaviors were found to have much higher rates of depression, suicide attempts, illegal drug use and sexually transmitted diseases, including HIV, than LGBT youth who experienced acceptance or only mild rejection from their families.
For these reasons, family therapy has an extremely important role in the assistance we offer transgender youth. Family therapy is a vehicle for altering rejecting behaviors as well as a way to help parents understand and advocate for their children. Other steps for teens, such as social transition require tremendous courage, effort and forbearance in the absence of family support. Some trans youth not only lack active parental involvement but have also been rejected subtly or directly by their family for being gender nonconforming. They carry a heavy emotional burden that weighs them down in the process of self-actualization.

Robb Travers and his colleagues in Ontario, Canada surveyed transgender youth 16 and older on the impact of parental support and found that “trans youth who indicated their parents were strongly supportive of their gender identity and expression were significantly more likely (72%) to report being satisfied with their lives than those with parents who were not strongly supportive (33%). Also statistically significant, 70% of those with parents strongly supportive of their gender identity and expression reported positive mental health compared to 15% of those whose parents were not strongly supportive.”Family therapy begins with the young person’s drive to embrace and express their authentic self, and the parents’ determination to proceed safely. Many trans teens are very well-informed about transgender identities and the relevant medical interventions. Some parents are shocked and confused. They have generally had little time to process this new information, while the teen has been mulling it over for months or years. Parents may have trouble believing that what their child is saying could be true. They fear for their child’s safety.

The goals of family therapy are to improve communication and understanding, and to examine the urge for an authentic life as well as the safety concerns that arise with gender transition, while keeping in mind any risks from not transitioning. Family therapy includes an evaluation of the youth and discussion with the parents of their fears and concerns. By paying 
attention to both authenticity and safety it is usually possible to reach a shared understanding between the youth, the parents and the therapist that guide any decisions moving forward.

Irwin Krieger, LCSW is a clinical social worker in CT who provides training seminars and clinical supervision focused on supporting transgender youth and adults in educational and mental health settings. He is the author of Helping Your Transgender Teen: A Guide for Parents, and Counseling Transgender and Non-Binary Youth: The Essential Guide. For more information:

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