Transgender and Gender Diverse Youth Navigating Relationships and Sexuality: Recommendations for Affirming Clinical Practice

Healthy relationship development is critical for adolescents’ social-emotional wellbeing, and shifting social expectations and identity development in adolescence can be challenging (Kenny et al., 2013; Roach, 2018). This can be particularly complex for transgender and gender diverse (TGD) youth given the occurrence of identity development alongside navigating safety, access to affirming spaces, and limited availability of queer-inclusive education (Levitt and Ippolito, 2014; Xing et al., 2015). The positive psychosocial impacts of comprehensive sex education and the relevance of discussing relationships in therapy with adolescents situate mental health providers well to address some of the gaps in knowledge and access to resources that youth, particularly TGD youth, face. Thus, this study explored the perspectives of TGD adolescents and affirming mental health providers on how to navigate these topics in clinical settings.Semi-structured interviews were conducted with TGD adolescents ages 15–18 (n = 14) and affirming mental health providers (n = 20) aiming to understand TGD adolescents’ experiences navigating sexuality and relationships and all participants’ perspectives on engaging in sexuality- and relationship-focused conversations in therapy. Four overarching themes were identified: Cisnormativity and Transphobia as Drivers of Fear and Inequity; Community Connectedness as Protective; Power Imbalance and Empowerment in Therapy; and One-Size-Fits-None. These findings were then used to develop clinical practice recommendations focused on active learning, transparency, client autonomy and decision-making, psychoeducation, and identity development and exploration. Further, mental health providers shared resources they utilize to facilitate learning and engagement in these topics with clients, which were compiled and are provided.These findings provide a deeper understanding of TGD adolescents’ experiences and their perceptions of the utility of receiving support from mental health providers in navigating sexuality and relationship development. Further, they provide insight into the experiences and perspectives of affirming mental health providers, and by integrating these perspectives, allow for considerations of the application to clinical practice, research, and policy. These results highlight the critical need for comprehensive sex and relationship education and its implications for all youth.Advisor: David J. Hansen