BackgroundTransgender and/or nonbinary (TNB) youth experience elevated risk of body image concerns and disordered eating compared to their cisgender counterparts, yet drivers of this risk remain poorly understood. This exploratory community-engaged study examined longitudinal associations between gender minority stressors and protective factors and disordered eating and body image concerns among TNB youth.Methods30 TNB youth (age 13-17 years) from the U.S. New England region completed five waves of online surveys (December 2015-February 2019). Gender minority stressors included non-affirmation of gender identity and internalized cissexism. Protective factors included gender identity-related pride, community connectedness, and social support. Outcomes included disordered eating behaviors, body image concerns, body image-related avoidance, depersonalization, and trans-specific body image concerns.ResultsGender-related pride was associated with fewer trans-specific body image concerns and vomiting for weight control in TNB youth. Over the study period, 20-40% reported dieting, 4-10% reported vomiting for weight control, and 8-23% reported binge eating. Greater gender minority stressors at the previous wave were associated with greater body image-related avoidance, depersonalization, and trans-specific body image concerns at the current wave.ConclusionsElevated risk of disordered eating and body image concerns in TNB youth highlight the need for screening, prevention, and systems-level efforts to address anti-TNB discrimination.

This article reports program evaluation findings of the effectiveness of a pilot training program integrating key principles from the psychological framework for radical healing (French et al., 2020) and models aimed at decreasing internalized stigma (Israel et al., 2021). Our main goal of the training program was to increase psychotherapists' knowledge and skills related to competent and affirming practice with two-spirit, transgender, and nonbinary clients who are Black, Brown, and people of color adults. Pre- and posttraining qualitative and quantitative data were collected from 82 psychotherapist attendees to assess the acceptability of the training for learning goals and to provide preliminary evidence of training effectiveness for the training's learning objectives. Descriptive content analysis of qualitative data was used to assess the degree to which the training addressed psychotherapists' goals and increased knowledge and skills. Regression analyses of quantitative data found significant increases in psychotherapists' self-reported knowledge of key concepts and frameworks and confidence to apply new learning to psychotherapy practice. Program evaluation results largely support the acceptability and effectiveness of this training for increasing self-rated competency for psychotherapy practice with two-spirit transgender, and nonbinary Black, Brown, and people of color adult clients. Implications are discussed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Purpose: Given the notable lack of psychotherapeutic services tailored to the needs of Two Spirit, transgender, and nonbinary (2STNB) people of color (POC), this open clinical trial aimed to develop and implement the Healing through Ongoing Psychological Empowerment (HOPE) intervention, a psychotherapy intervention explicitly designed for 2STNB POC clients.Methods: Forty-nine 2STNB POC clients started and completed the HOPE intervention. Participants were provided with 15 free virtual therapy sessions by nine 2STNB POC therapists. Assessments were conducted at baseline, during the intervention, immediately following completion, and 6 months following completion. Surveys measured internalized transnegativity (IT), working alliance, and mental health symptoms and functioning.Results: The HOPE intervention demonstrated initial clinical efficacy, with significant improvements observed in both mental health symptoms and IT from pretreatment to post-treatment; improvements were sustained at the 6-month follow-up.Conclusions: These findings propose HOPE as an exciting culturally specific therapeutic approach for the 2STNB POC community. Future randomized controlled trials comparing HOPE to existing evidence-based treatments are needed.

Although studies on the dual-continua model have demonstrated that distress and well-being are two separate but interrelated factors of mental health, only limited research exists regarding these concepts for lesbian, gay, bisexual, transgender, queer, intersex, asexual+ (LGBTQIA+) individuals. The present study aimed to investigate the factor structure of mental health in the LGBTQIA+ community. The second aim was to investigate whether different correlates are relevant for the prediction of well-being and psychological distress in LGBTQIA+ individuals when these mental health outcomes are considered separately. LGBTQIA+ individuals from Germany, Austria, and Switzerland were recruited via collaborating organizations and social media to participate in a cross-sectional survey. Participants (n = 1,686, M-age = 27.74) completed self-report measures of well-being and psychological distress. Included correlates were self-esteem, social support, resilience, and various minority stress factors. Data were analyzed using structural equation modeling and latent regression analyses. A very strong correlation at the latent level (r = -.82) suggested that well-being and psychological distress refer to opposite poles of mental health in the LGBTQIA+ sample. Different minority stress factors were relevant for the prediction of well-being and distress when these factors were disentangled. The present study highlights the close inverse relation between well-being and distress in LGBTQIA+ individuals. Several correlates were found that could inform tailored counseling for LGBTQIA+ community members, irrespective of whether the focus is on positive or negative aspects of mental health.

The American Psychological Association Division 44 Science Committee created this guidance to provide support and assistance to those who conduct sexual orientation and gender diversity (SOGD) research. We aim to: (a) provide guidance to new researchers on publishing SOGD research; (b) advance the field by creating standards for publications; (c) support editors and reviewers in evaluating SOGD research; and (d) ensure that publications prioritize needs of two spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual plus (2SLGBTQIA+) communities. Throughout, we discuss important aspects of SOGD research missing from older guides, including publishing in general journals, research focused on nonbinary identities, decolonizing SOGD research, embedding work in extant SOGD and Black, Indigenous, and People of Color scholarship, attention to language beyond avoiding bias, and interacting with reviewers and editors. We acknowledge that SOGD research is a relatively new and evolving field and that gender and sexual identities are dynamic. Thus, rather than create hard-and-fast rules, we provide suggestions for thinking deeply about SOGD research and how to make ethical and informed decisions to ensure the 2SLGBTQIA+ community's needs are at the forefront. We have organized this article to highlight seven publishing considerations, including: (a) theory/framing; (b) methodological considerations; (c) reflexivity/ethics; (d) language; and (e) responding to reviewers. We include a checklist to guide researchers and reviewers in evaluating SOGD manuscripts. Although we created this guidance for psychology researchers, it may be useful for researchers in other social science and health-related fields.

In psychotherapy, emotional tears occur frequently but have received limited attention. We set out to replicate and extend findings of previous studies conducted in Italy (Genova et al., 2021) and Israel (Katz et al., 2022) with U.S. clients. We hypothesized that positive crying experiences would be associated with improvement and stronger alliance, as well as that insecurely attached patients would tend to view crying as more intense but also more meaningful. One hundred twenty-four patients completed an online survey about crying in therapy as well as measures assessing therapeutic change, working alliance, and attachment. Findings revealed that postcrying positive feelings were linked with greater reported improvement. Several crying experiences were related to both change and alliance. All significant relationships between crying experiences and change remained significant after partialing the effects of attachment, and all but one remained significant after partialing the effects of the alliance. Participants who cried in therapy reported greater improvement compared to those who denied crying in therapy. Despite greater discomfort, less securely attached clients tended to report feeling better understood by their therapists after crying. These findings replicate and extend previous international studies in a U.S. sample, providing support for their cross-cultural relevance and previous evidence that clients' crying experiences are related to both change and alliance. In conclusion, we suggest that therapists conceptualize instances of crying in therapy as a sensitive relational moment with potential positive or negative consequences, dedicate time to exploring experiences around crying, and specifically process crying experiences of insecurely attached patients.

Few studies have focused on transgender and nonbinary youths' (TNBY) gender development and even less well understood is how family members understand TNBY identity. The current study investigated: (a) how TNBY describe their gender identity over time, and (b) how family members understand TNBY gender identity over time. The baseline sample included 96 members of 33 families (33 TNBY, 48 cisgender caregivers, 15 siblings) from the United States; 30 families continued after Wave 1. Results indicated that 23 (77.7%) youth's gender identity labels remained the same throughout all five waves, with seven (23.3%) youth shifting their description more than once-all youth continuing after Wave 1 who reported shifts, shifted from one TNB identity to another TNB identity. Family agreement varied across waves amongst family members regarding gender identity, gender expression, and pronoun use. Agreement and partial agreement were primarily in the High and Moderate categories across domains, with the pronouns domain demonstrating the highest level of agreement across pairings. Disagreement amongst pairings was usually not present or coded as Low, indicating greater shared understanding for families across waves and domains. Results suggest a nuanced developmental process for TNBY and their families regarding understanding of gender identity, gender expression, and pronoun use. This study focused on how transgender and nonbinary youth and their families collectively understand the youth's gender identity over time. We also examined how youth's identity fluctuated over time. We found that while many youth indicated shifts, all but one youth identified as transgender/nonbinary by the end of the study. Findings indicate family members often share an understanding of youth identity, with the highest shared understanding for pronouns and least shared understanding for gender expression.

Abstract This article introduces The Companionship Model as a template for conducting ethical and affirming assessment sessions for transgender and nonbinary youths (TNBY) and their guardians. The Companionship Model emphasizes proactive clinical companionship as TNBY and their guardians navigate access to gender-affirming care. The model offers specific action steps for establishing a therapeutic alliance and centers TNBY and their guardians’ access to resources based on the informed consent/assent process. In this article, we provide sample session questions and illustrative clinical examples.

Trans and nonbinary (TNB) individuals cope with gender-related stress in unique ways that are not captured in existing coping measures. The present research extends prior qualitative research on these unique coping strategies to develop and validate the Trans and Nonbinary Coping Measure (TNCM). The initial developed pool of potential items was presented to two focus groups and five content experts for review. In Study 1 (N = 298), the 166 initial items hypothesized to underly an eight-factor structure were analyzed using exploratory and confirmatory factor analysis (EFA, CFA). Results from the EFA and CFA revealed a six-factor structure as the best fit with 130 items removed. Study 1 also provided preliminary construct and discriminant validity due to significant correlations between the TNCM and an existing measure of coping and nonsignificant relations with a measure of self-motivation. In Study 2 (N = 497), an independent sample of TNB participants was recruited and findings from CFA analysis indicated that the removal of an additional 8 items was statistically optimal. With the removal of these eight items, configural, metric, and partial scalar invariance between TNB gender identity groups was supported. Additionally, results from Study 2 further supported construct and predictive validity through correlations between the TNCM and measures of gender minority stress and mental health outcomes. Finally, Study 3 (N = 35) provided support for test-retest reliability with a third independent sample of TNB participants. Across the studies, the TNCM was found to be a valid measure of TNB specific ways of coping.

The gender minority stress and resilience measure (GMSRM) is the premiere measure for understanding the impacts of gender-related stress on the mental health of trans and nonbinary (TNB) individuals. However, the distal and proximal stress scales of the GMSRM have yet to be subjected to rigorous psychometric testing despite prior research identifying areas of concern regarding the factor structure. The current study utilized a sample of 468 TNB participants to assess the best fitting factor structure of the distal and proximal stress scales. Preliminary confirmatory factor analysis (CFA) of the published seven-factor model indicated that the rating scale for the gender-related discrimination, rejection, and victimization items should not be converted to dichotomous variables, as the originally published instructions indicate, and that the existing items evidence concerns of redundancy. In response, exploratory factor analyses were conducted that indicated the distal and proximal stress scales of the GMSRM should be comprised of 27 items representing four factors: gender-related prejudice, nonaffirmation of gender identity, negative expectations for the future, and internalized transphobia. Subsequent CFA of this modified structure (i.e., the modified gender minority stress measure [M-GMSM]) with a second independent sample of 564 TNB participants indicated that this model fit the data well. Results of multigroup CFA demonstrated partial metric noninvariance and dimensionality assessment supported a multidimensional measure comprised of four factors. Finally, convergent, predictive, and partial discriminant validity of the M-GMSM was supported. Collectively, the results of the present study provide support for a M-GMSM with increased psychometric validity as well as reduced item length.

Purpose: In this study, we aimed to develop and test the acceptability of a minority stress psychoeducation tool for transgender and nonbinary (TNB) people.Methods: Patients in one treatment group who were enrolled in a larger randomized controlled trial received this study's minority stress psychoeducation pre-treatment. Data on the acceptability of the tool and minority stress experiences were collected post-treatment.Results: All (100%) patients reported that the psychoeducation tool was helpful and qualitative data suggested patients experienced an increased ability to externalize minority stress experiences.Conclusion: Results support the acceptability of this minority stress psychoeducation tool for TNB patients. Clinical trial number: NCT03369054.

Background: Transnormativity refers to the accountability structure that regulates the acceptable gender presentations, narratives, and ways of being of trans and nonbinary (TNB) individuals.Aims: The present research extends prior qualitative research on transnormativity to develop and validate the Transnormativity Measure (TM).Methods: The initial developed pool of potential items was presented to a focus groups and three content experts for review. In Study 1 (N = 497), the 69 initial items of the TM hypothesized to underly a six-factor structure were analyzed using Exploratory Factor Analysis (EFA) and construct and discriminant validity were assessed. In Study 2 (N = 540), an independent sample of TNB participants' TM responses were subjected to Confirmatory Factor Analysis (CFA), invariance testing, and construct and predictive validity. Finally, in Study 3 (N = 107), an Interclass Correlation Coefficients 2-way mixed-effects model of the TM was assessed.Results: EFAs conducted in Study 1 revealed a two-factor structure as the best fit with 50 items removed. Conceptually there was considerable overlap in the items comprising the two factors and it was decided that one general factor should be utilized. Study 1 also provided preliminary construct and discriminant validity due to expected relations between the TM and existing measures of heteronormativity and internalized transphobia. In Study 2 findings from correlational tests of the remaining items revealed that four items were highly correlated and were removed. Subsequent CFA indicated that the one factor model fit the data well. Configural invariance was supported however metric noninvariance was found. Additionally, Study 2 results supported construct and predictive validity through correlations between the TM and measures of TNB community belonginess and mental health outcomes. Finally, Study 3 provided support for test-retest reliability.Discussion: Across three studies, the TM was found to be a valid measure of transnormativity.

Expanding upon the larger body of literature that focuses on adverse mental health concerns among trans and nonbinary (TNB) populations, emerging research has recently begun to investigate positive outcomes and psychological well-being among TNB people. This study contributes to this growing area of research by investigating one subjectively experienced aspect of well-being-happiness-among TNB adults residing in the central Great Plains region of the United States. For this study, 20 TNB adults participated in semistructured interviews where they were asked to reflect on how they experienced happiness generally and in relation to being TNB, and what fostered or impeded their happiness. Data were analyzed using constructivist grounded theory analysis (Charmaz, 2014). Four major themes emerged from the data that formed the core components of happiness: Authenticity, Connection to Others, Perspective Shift, and Agency. Two additional major themes included factors that fueled happiness and those that detracted from happiness. Subthemes and categories within each major theme are described. From these themes, a theoretical model of TNB happiness was developed. Theoretical and counseling implications are discussed, along with noted limitations and areas for future research.

This study explored the experiences of trans and nonbinary (TNB) individuals in relation to gender dysphoria, specifically focusing on information they have received from sociocultural agents (i.e., messages) about gender dysphoria and how their actual experiences align or differ from these messages. A sample of 104 participants responded to four prompts: what sociocultural messages have you received from others about gender dysphoria, where did you hear this information, how have your experiences of gender dysphoria been similar to these sociocultural messages, and how have your experiences been different from these sociocultural messages. Content analysis identified that the primary source of information about gender dysphoria came from online spaces. Thematic analysis was utilized to understand the content of messages and alignment with lived experiences. Thematic results indicated that six themes were present in the sociocultural messages as well as participants’ lived experience: (a) diverse expressions of gender dysphoria symptoms, (b) perspectives on the dimensions of gender dysphoria, (c) gender dysphoria is distressing, (d) the nuanced and individualized nature of gender dysphoria, (e) complex relations between medical transition and gender dysphoria, and (f) stigmatizing perceptions of individuals with gender dysphoria. Although themes were present across both sociocultural messages and lived experience, the ways participants described their experiences of gender dysphoria in comparison to the messages were complementing, conflicting, and contradicting. Taken as a whole, the results indicate that while trans medicalization and trans normativity dictate a unifying experience of gender dysphoria, TNB individuals’ experiences are more varied and nuanced. Discussion focuses on the importance of recognizing the complexity and diversity of gender dysphoria experiences.

Internalization of stigmatizing messages from society is a primary risk factor for transgender and nonbinary (TNB) people. To locate points of intervention for TNB people with a high level of internalized transnegativity, the present study examined predictors of internalized transnegativity in Korean TNB adults (N = 268) using a multiple mediator model. We hypothesized that parental attachment would predict internalized transnegativity through the mediating effect of self-shame, rejection sensitivity, and self-concept clarity. The analysis provided partial support for the mediator hypothesis. The results were consistent with a model in which self-shame fully mediates the relation between parental attachment and internalized transnegativity, with no evidence of a mediating role for self-concept clarity or rejection sensitivity. This study shows that TNB individuals reporting insecure attachment with parents are more likely to experience internalized transnegativity, and the relation is largely accounted for by the indirect effect via general self-shame. (sic)(sic)(sic) (sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic) (sic)(sic) (sic)(sic)(sic)(sic). (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic) (sic)(sic), (sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic)(N = 268)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic). (sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic). (sic)(sic) (sic)(sic), (sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic). (sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic) (sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic), (sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic). (sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic) (sic) (sic)(sic) (sic)(sic)(sic) (sic)(sic)(sic)(sic) (sic)(sic), (sic)(sic)(sic) (sic)(sic)(sic) (sic)(sic) (sic)(sic)(sic)(sic)(sic)(sic) (sic)(sic) (sic)(sic)(sic)(sic)(sic) (sic)(sic)(sic) (sic) (sic)(sic)(sic) (sic)(sic) (sic)(sic)(sic)(sic).

The present study sought to develop and validate the Masculine Sexual Entitlement Norms (MSEN) Scale. Following scale development best practices, a thorough review of the literature and existing measures was conducted. Next, the construct was operationalized with six hypothesized subscales. Items were developed with input from content experts (N = 9) and focus groups of undergraduate men (N = 9). The initial 90 items (i.e., the MSEN90) were administered to a preliminary sample (N = 281) of undergraduate men. Exploratory factor analysis indicated a five-factor structure (i.e., Prioritizing Sexual Needs of Self, Peer Norms, Sexual Deception, Gender Essentialism, and Minimization of Men's Sexual Behavior). Item analysis yielded a 40-item five-factor survey (MSEN40) that was administered to a second sample (N = 210) of undergraduate men. A confirmatory factor analysis indicated inadequate fit for the 40-item scale; however, fit was improved by reducing scale length to 25 items loading onto one global scale (MSEN25). Internal consistency reliability, construct validity, group differences, and the instrument's ability to predict self-reported sexual violence were explored with this sample. The MSEN25 demonstrated strong correlations with related measures (e.g., Sexual Narcissism Scale, Male Role Norms Inventory-Short Form) and an absence of correlation with unrelated constructs. Additionally, across both samples, the MSEN25 demonstrated adequate internal consistency for the scale overall (alpha = .90 and .90) and for the five-item subscales (i.e., alpha's ranged = .71-.82). Future directions and implications for the measure are discussed.

The aim of this study was to examine concordance and discordance in how different family members in families with transgender or nonbinary (TNB) youth described topics related to the TNB youth's gender identity and its effects on the family. TNB youth, ages 7-18 years, and their caregivers (54 family members: 20 TNB youth, 34 caregivers) participated in one-on-one qualitative interviews. Interview transcripts were analyzed to determine concordance/discordance in family members' responses (between TNB youth and each caregiver, between caregivers in two-caregiver families, and among all three family members) to 13 different interview questions. Results indicated the highest concordance was found between family members regarding how the youth's gender identity affected family relationships. The highest discordance was found in family member's descriptions of the TNB youth's gender expression and future expectations for the TNB youth. Findings from this study have implications for supporting families with TNB youth.

Objective: Goal setting is an important factor that contributes to positive outcomes in psychotherapy, yet research has not focused on this particular aspect of process and outcome of psychotherapy for transgender and nonbinary (TNB) patients. Methods: The present study used secondary data analysis from a pilot randomized controlled trial focused on trans-affirmative therapy for TNB patients (N = 19). The aims of the present study were twofold: 1) gain an indepth understanding of goals prior to the course of psychotherapy for TNB patients and 2) determine the outcome of goal setting after a 12-session course of psychotherapy with TNB patients. Content analysis and descriptive statistics were used to analyze the data. Results: Results indicated that the majority (70%) of goals were met at termination. The results also indicated that the majority of goals (73%) were not related to gender. The content analysis revealed that there were five overarching themes regarding the types of goals described by TNB patients: 1) managing mental health symptoms, stress, and distress; 2) developing skills to improve well-being; 3) working on relationships; 4) exploring and understanding of trans identity (gender identity); and 5) orienting towards positive growth and development. Patients' mean scores indicated that goals focused on developing skills to improve well-being were rated the highest regarding change over the course of 12 sessions of psychotherapy. Conclusions: This study illuminates the importance of assessing TNB patients' goals and understanding which goals resulted in the highest amount of self-reported change over 12 sessions of psychotherapy.