Trans-affirmative narrative exposure therapy (TA-NET): A therapeutic approach for targeting minority stress, internalized stigma, and trauma reactions among gender diverse adults.

Abstract

Mental health providers working with transgender/gender nonconforming (TG/GNC) individuals must have a strong understanding of the impact of minority stressors and internalized stigma in order to provide culturally knowledgeable psychotherapy services and assist in development of a strong sense of identity. This article aims to introduce a framework for adaptation of an evidence-based trauma-focused psychotherapy, narrative exposure therapy (NET), for gender diverse people. The impact of internalized stigma is discussed through an understanding of minority stress theory with emphasis on evidence-based relationship variables and integration of interventions based upon an affirmative care stance. The article focuses specifically on the utility of NET as a model for treating the complexities of trauma-related and minority-based stress. Two case examples of the implementation of this approach is provided. transaffirmative narrative exposure therapy (TA-NET) provides a model for future empirical evaluation. Clinical Impact StatementThe article integrates the use of an evidence-based trauma therapy to address the complexities that can arise in treating minority-and trauma-related stress among transgender and gender nonconforming adults. Through providing a conceptual framework, clinicians and researchers can begin to work toward creating standardized models of affirmative mental health care.

Factors that drive mental health disparities and promote well-being in transgender and nonbinary people

“…Community, group and individual interventions and their potential influence on resilience are discussed 197 . NA Trans-affirmative narrative exposure therapy (TA-NET) Three phases: creating historical timelines and determining ‘chapters’ to be used for the second-phase homework assignments; writing chapter narratives to be read aloud and verbally processed; and concluding the autobiography and therapeutic process 194 . NA Gender affirmative lifespan approach (GALA) Therapeutic interventions designed to promote positive gender identity development through five core components: building resiliency; developing gender literacy; moving beyond the binary; promoting positive sexuality; and facilitating empowering connections to medical interventions, as desired 195 .…”

“…However, psychotherapy can be a particularly useful individual and interpersonal support for TNB identity and transition processes, supporting positive and facilitative strategies for coping with oppression and navigating minority stress. A growing body of scholarship has outlined TNB-centred interventions and treatment modalities for use with TNB individuals 194 , 195 . For example, dialectical behavioural therapy can be used with TNB clients who are working through the consequences of experiencing identity invalidation from others 196 .…”

Invalidation and mental health among nonbinary individuals.

“…Findings from this study suggest that gender identity invalidation should be understood as a pernicious minority stressor for TNB individuals, particularly those who are nonbinary, and clinicians may find it useful to assess for invalidation experiences in their practice (Matsuno, 2019). They may also want to consider incorporating the concept of invalidation into evidence-based gender-affirming interventions that target minority stress among LGBTQ+ populations (Austin & Craig, 2015; Lange, 2020; Pachankis et al, 2022; Rider et al, 2019; Sloan et al, 2017). For example, clinicians can utilize cognitive–behavioral therapy (CBT) techniques to help clients identify maladaptive thoughts and beliefs resulting from invalidation experiences and assist them in externalizing the sources of these negative messages, as well as in developing effective coping strategies to manage negative feelings resulting from invalidation experiences (Pachankis, 2014).…”

Research on evidence-based practice with transgender adults: A commentary on “A systematic review of recommendations for behavioral health services for transgender and gender diverse adults”.

“…There have also been more publications on how to adapt clinical approaches with TGD clients. For example, Lange (2020) outlines the protocol for trans-affirmative narrative exposure therapy and provides a case example of how to implement the clinical interventions described. Rider et al (2019) published “The Gender Affirmative Lifespan Approach (GALA): A Framework for Competent Clinical Care With Nonbinary Clients,” which takes a transtheoretical approach and focuses on positive gender identity development.…”