The gender-affirmative life span approach (GALA) is an innovative therapeutic framework for promoting the mental health of transgender and gender-diverse (TGD) clients of all ages. Based in interdisciplinary philosophical foundations, GALA proposes that TGD clients can be supported in psychotherapy through (a) developing gender literacy, (b) building resiliency, (c) moving beyond the binary, (d) exploring pleasure-oriented sexuality, and (e) making connections to medical interventions. Psychotherapy incorporating these 5 core components is developmentally tailored for children, adolescents, young adults, or older adults. Developing gender literacy is the process of understanding how sex assigned at birth, gender identity, gender expression, and sexual orientation are distinct but interconnected concepts, as well as learning to identify oppressive practices in TGD people's lives. Building resiliency involves learning how to overcome adversity and effectively cope with challenging situations in life. Resiliency-building also involves having social support networks to share these difficulties and gain support. Gender and sexual binaries pathologize nonconformity and limit the full range of healthy gender and sexual expression. Moving beyond the binary to a spectrum approach allows for the inclusion and affirmation of all gender identities and expressions. Unfortunately, research and practice have largely focused on negative sexual outcomes for TGD people. Thus, age-appropriate psychotherapy aimed at developing sex-positive pleasure and satisfaction is critical. Lastly, gender-competent mental health practitioners need to have knowledge about, and skills to refer for, medical interventions, when appropriate. Clinical Impact StatementQuestion: As transgender and gender-diverse (TGD) people's needs have increasingly been included in healthcare practices, and as more TGD people affirm their identities at younger ages, it is clear that a new model of gender-affirmative mental health care is needed. Findings: The genderaffirmative life span approach (GALA) is an innovative therapeutic framework for promoting the mental health of TGD people across the life span, with broad implications for gender and sexual health. Meaning: GALA proposes that TGD people can be supported in psychotherapy through (a) developing gender literacy, (b) building resiliency, (c) moving beyond the binary, (d) exploring pleasure-based sexuality, and (e) making connections to medical interventions. Next Steps: We invite psychotherapists to adopt GALA when working with TGD clients of all ages.

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Although sexual obsessions in obsessive-compulsive disorder (OCD) are not uncommon, obsessions about sexual orientation have not been well studied. These obsessions focus on issues such as the fear of being or becoming gay, fear of being perceived by others as gay, and unwanted mental images involving homosexual acts. Sexual orientation obsessions in OCD are particularly distressing due to the ego-dystonic nature of the obsessions and, often, stigma surrounding a same-sex orientation. The purpose of this study was to better understand distress in people suffering from sexual orientation obsessions in OCD. Data were collected online (n = 1,176) and subjects were 74.6% male, 72.0% heterosexual, and 26.4% with an OCD diagnosis from a professional. The survey consisted of 70 novel questions that were assessed using a principal components analysis and the items separated into six components. These components were then correlated to distress among those with a prior OCD diagnosis and sexual orientation obsessions. Results indicated that sexual orientation obsessions in OCD were related to severe distress, including suicidal ideation. Implications of these findings and future directions for research are discussed.

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Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one's sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measure for assessing SO-OCD to help distinguish OCD from distress caused by a sexual orientation identity crisis. The current paper details two studies that established the psychometric properties and clinical utility of this measure. In Study 1, the factor structure, validity, and reliability were examined for the measure's 12 items in a sample of 1,673 university students. The results revealed a two-factor solution for the measure (Factor 1: Transformation Fears; Factor 2: Somatic Checking) and preliminary evidence of validity and reliability. In Study 2, the measure was tested with LGBTQ and heterosexual community samples and clinical samples of individuals with SO-OCD and other types of OCD. The two-factor solution and evidence of validity and reliability were supported in these samples. Cut-off points were established to distinguish between community members and SO-OCD sufferers, as well as between those experiencing SO-OCD and other types of OCD. Limitations and future directions are discussed.