Promoting understanding and acceptance in parents of trans and gender nonconforming youth: An adaptation of an attachment-based parent program

Gender nonconforming and trans youth experience high rates of bullying and victimization, placing them at risk for serious mental health challenges. Caregiver support is one of the most significant protective factors in this population, and parenting interventions that promote understanding and acceptance are needed to support the well-being of teens and their families. Connect (Moretti & Braber, 2013), a group attachment-based intervention for caregivers, has been shown to promote attachment security within the parent-teen relationship, increase caregiver sense of efficacy, and reduce teen emotional problems for up to two years post-treatment. During this strength-focused program, caregivers learn to “step back” in their interactions, to “step into” their teen’s shoes, and to better understand and respond to their teen’s attachment needs. This study examines the acceptance, uptake, and caregiver satisfaction of an adapted version of Connect which addresses the unique attachment related challenges and concerns of caregivers of trans and gender nonconforming youth. Adaptations were completed in consultation with a panel of mental health professionals to address relevant themes expressed by these families and to modify experiential learning content. Participants in the first three groups were 20 caregivers of 16 gender nonconforming youth (ages 12 - 18). On average, caregivers attended 9.2 sessions of the ten-week program and on questionnaires completed post intervention, reported feeling respected, safe, and welcomed in the group. They indicated that learning about attachment was helpful in enhancing their understanding of their teen and their understanding of themselves as parents. Caregivers also rated the group as helpful in increasing their understanding of their teen’s gender journey. During clinical interviews, caregivers reported feeling more confident in parenting and being able to empathize with their teen more easily. Common themes in group discussions related to gender included: coming out, finding support, affirming pronouns/names, medical transition, parental reactions (e.g. confusion, isolation, acceptance, grief), and concerns about safety and mental health. Qualitative analyses of group skills revealed that across sessions, caregivers demonstrated an increased capacity to “step back” and reflect on their teen’s experience and their own. Findings support the usefulness of this intervention, and feedback has informed further revisions of the program with the goal of co-creating a safe, helpful, gender-affirming intervention. Clinical implications and next steps are discussed.