Therapy for Transgender Teens and Teens Exploring Gender Identity

plenty of teens explore gender identity

In our therapy with teens, we see plenty of young people exploring gender. This can range from identifying (or considering identifying) as transgender to expressing their gender identity through clothes, art and music. While often unsatisfying for parents, teens don’t always offer the sorts of answers that fit into an easy narrative about gender.

Some individuals, who would consider themselves trans, arrive at their teenage years with a deep understanding of who they are and how they want to be seen by the world with regards to gender. Often, though, teens want and need room to explore. Questions of the “Who am I?” sort with gender exist alongside other questions about ethics, politics, sexual attraction and faith.

a note on transgender, gender fluid and other gender-related terms

Recently, there’s been a tremendous amount of attention on the question of gender identity. Therefore, it may be helpful to define some terms. Transgender (or simply, trans) can have a broad or loose definition depending on the context and the user. In its more rigid meaning, it refers to an individual who was born biologically one sex, but has come to identify as another gender. The trans community and their supporters argue for a rethinking of gender (how one understands gender presentation in the world) as distinct from sex (the biological markers typically considered to denote gender). Trans individuals may take hormones or have various sorts of surgeries, but whether they have done some, all or none of these things is a complicated and separate question from how they choose to present and understand their own gender.

More broadly, trans can refer to a whole spectrum of what are called gender fluid or gender creative presentations and experiences. Identifying as trans doesn’t mean an individual has signed up for a binary position. It also says nothing automatically about a person’s sexual orientation or the sorts of people they are interested in having sex with, if at all.

we are fluent in talking to both teens and their families about gender

What we aim to do in our therapy with teens who are examining gender is to create space where teens and their families can figure it out. However, we work to recognize that gender, like so many emotional issues we trade in, isn’t as simple as “are you or aren’t you?” or “boy versus girl.” Some of the foundational questions about what the “it” is that’s being “figured out” are worth giving our attention to.

Our task in this process isn’t to have the answers, in as much as answers exist. Our task is to create them, together, with teens who need help and to involve families in a way that helps them be involved and confident in the process. Ultimately, what matters most is that we, as a team of therapists, are fluent in talking to both teens and adults about gender.

empathy for parents: we support parents of teens who are questioning their gender

There’s so much that’s challenging for parents with teenage children that are exploring their gender identity. Obviously in some cases, there’s a struggle with acceptance. Parents may have fears and biases about what it means to be trans.

Even when there is a strong acceptance and a sincere desire to support a teenage child who is questioning their gender, parents still need a ton of support. There’s often an experience of loss–a feeling of having lost a son or daughter and the expectations that come with that. There are also decisions to make (and a teen’s decisions to be respected) about name changes, pronoun usage, legal issues, hormones and surgery.

navigating pronoun usage and name changes for trans teens

So much weight can be placed on pronoun usage for a teen and their parents. A particular parent or grandparent may refuse to use a preferred pronoun or name as an expression of dissent. It can feel confusing to both the teen and his, her or their parents for many reasons, not the least of which is that a choice of one pronoun versus another can be so significant in the eyes of others.

There isn’t a formula for how to navigate making sense of names and pronouns. A huge part of the challenge is that within our culture, a central function of names is to denote gender. A name can have a deep significance–both the significance of its choice by parents at birth, as well as the representation of who someone is who has occupied that name for years. At the same time, however, we recognize that changing a name can feel like an important part of embracing a teen’s gender identity.

Attention is also needed to questions of how relatives and family friends are informed about a name change–what sorts of questions are too private to answer and what others are needed to help friends and family make sense of what can be surprising and confusing.

ensuring the safety of trans teens

Teens need parents to be advocates, helping them both be safe from the increased violence often experienced by trans people and have their rights respected in school and on sports teams. In our therapy with teens, we are very honest with both teens and their parents about what we see as the threat to safety of trans and gender creative teens. There are concerns about self-esteem, including those that can result in suicide and self-harm, as well as concerns about both physical violence (hate crimes) and sexual violence like rape and sexual assault. All of these are known to be areas where trans individuals are at higher risk.

There are lots of ways teens can increase their safety. To begin with, we have an upfront, explicit conversation about risk and safety so that we can provide leadership to teens and families with regards to doing a safety check-in. To be clear, often the teens and parents we work with in our practice understand these risks better than we do. Of course, the area we can help the most is emotional safety–impacting self-esteem, dealing with bias from peers, school staff and strangers, and helping to make decisions about transitioning, sexual health and romantic relationships.

gender, however, may not be the central focus in therapy, even if a teen is trans or questioning their gender

Anytime we’re identifying a specific “issue” in therapy whether it’s gender or depression, there’s a risk in the focus of therapy becoming too narrow. In our therapy practice with teens, we recognize that teens, who are questioning their gender or embracing a gender presentation that is non-standard, have a particular set of needs. But, we also acknowledge that a teen’s gender identity doesn’t negate that they have all sorts of other needs too.

For example, a teen may come to us struggling with grades, while also identifying as gender creative. Is there a learning or attention issue? Is the school the right fit? Is depression or anxiety getting in the way of studying? Where does gender fit into this? It’s entirely possible that the issue of gender won’t be the central focus of therapy.

More likely, gender is at least a significant player, if not a huge factor in what’s going on. But in any instance, a teen needs a therapist who won’t need cue cards to understand how he, she or they is doing gender. That doesn’t mean that understanding exists independent from getting to know a particular teen.