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Longitudinal Effects of Psychotherapy With Transgender and Nonbinary Clients

A Randomized Controlled Pilot Trial


Minority stress has been determined to contribute to some mental health concerns for transgender, nonbinary, and gender nonconforming individuals, yet little is known regarding interventions to decrease the effects of minority stress. The purpose of this pilot study was to assess the feasibility and relative effectiveness of two interventions developed for work with transgender clients. Transgender individuals (N 20) were recruited to participate in a randomized controlled trial comparing two psychotherapy interventions for transgender adults seeking psychotherapy for a variety of concerns: (a) transgender affirmative psychotherapy (TA) and (b) Building Awareness of Minority Stressors Transgender Affirmative psychotherapy. Gender-related stress and resilience were assessed before, immediately after, and 6 months following the intervention; psychological distress and working alliance were assessed at these three time points as well as weekly during the intervention. Feasibility and acceptability of the study and psychotherapy interventions were supported. Exploratory analyses indicate improvement in both groups based on general outcome measures; targeted outcome measures indicate a trend of improvement for internalized stigma and nonaffirmation experiences. Results from this study support further evaluation of both treatment arms in a larger randomized controlled trial.

Stephanie Budge (she/her) primarily works with Two-spirit, trans, and nonbinary people with regard to research and clinical work. She is an associate professor in the Department of Counseling Psychology and the director of the Advancing Health Equity and Diversity program in the School of Medicine and Public Health at the University of Wisconsin-Madison. She is the founding member of the Trans CARE Collaborative. Her research focuses on improving of medical and psychotherapy treatments (and access to care) for Two-spirit, trans, and nonbinary (2STNB) clients. She provides clinical trainings nationally and internationally related to LGBTQ issues, focusing on practitioners’ self-efficacy, knowledge, awareness, and skills. At the University of Wisconsin-Madison, she promotes 2STNB advocacy on campus by providing workshops to students, faculty, and staff related to navigating gender identity within a university environment. As a licensed psychologist, she provides pro-bono therapy to 2STNB youth and adults. Stephanie is currently an Associate Editor of two journals: Psychotherapy and Psychology of Sexual Orientation and Gender Diversity. She is also on the editorial board of the International Journal of Transgender Health. Stephanie enjoys going on hikes with her wife and toddler, cooking (especially anything with potatoes), and rappelling down waterfalls.

Cite This Article

Budge, S. L., Sinnard, M. T., & Hoyt, W. T. (2021). Longitudinal effects of psychotherapy with transgender and nonbinary clients: A randomized controlled pilot study. Psychotherapy, 58(1), 1-11. doi:10.1037/pst0000310



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