“Now I know I am a survivor”: a qualitative exploration of mental health outcomes following narrative exposure therapy among transgender and gender-diverse youth

Introduction Transgender and gender-diverse (TGD) adolescents and young adults (AYA) experience high rates of trauma, including gender-based trauma (e.g. discrimination), which are associated with greater symptoms of post-traumatic stress disorder (PTSD) and poorer well-being. There are limited culturally responsive trauma-focused interventions to support TGD AYA. A pilot of Narrative Exposure Therapy (NET), a social justice-oriented exposure-based intervention tailored for TGD AYA, demonstrated reductions in PTSD symptoms and increased well-being and resilience. Still, little research has explored self-perceived changes following such interventions, which may elucidate novel understanding of outcomes from trauma-focused treatment for TGD individuals and potential mechanisms of change. The current study takes a qualitative approach to explore TGD AYA’s experiences after completing NET.Methods Fifty-six TGD AYA at an urban clinic in the Southwestern USA completed a semi-structured interview after completing NET on their therapy experiences and perceived outcomes. All interviews were coded using a Thematic Analysis approach in Dedoose 10.0. Each transcript was double-coded and discrepancies in coding were discussed until 85% consensus was reached. These codes were then organized into overarching themes and subthemes.Results Participants identified five treatment-related mechanisms of change as central to their healing journey: Increased Self-awareness, Validation of Experiences, Recalling More About Trauma and Reduced Avoidance, Reframing Their Role in the Trauma, and Reframing Role of Trauma in Their Lives. Participants identified a core domain, Redefining Healing, as well as three major subdomains highlighting major areas of change and growth: Emotional Growth, Increased Capabilities, and Openness to Life.Discussion These findings highlight the importance of gender-affirming, trauma-focused interventions using a narrative approach. Results support the use of NET in the development of Post Traumatic Growth for TGD AYA. Results also reveal potential mechanisms for treatment outcomes. Finally, findings center the “voices” of TGD youth navigating trauma healing and highlight targets for clinical focus.