Psychotherapy Interventions to Support Transgender, Two-Spirit, and Nonbinary People of Color

Incorporating Radical Healing and Addressing Internalized Transnegativity in Psychotherapy for Transgender, Two-Spirit, and Nonbinary People of Color: An Open Clinical Trial

The proposed research will use a community-based participatory research (CBPR) approach to engage with community organizations to design and implement a project that trains therapists to provide effective, supportive, and engaged therapy to two-spirit, transgender, and nonbinary (2STNB) clients most impacted by barriers in accessing mental health care. 10 2STNB licensed mental health therapists will be identified and 50 2STNB of their clients will be enrolled and can expect to be on study for 10-20 months.

The long-term aim of this research is to ensure that therapists have access to training and engage in effective psychotherapy that ultimately reaches Two-spirit, transgender, and nonbinary (2STNB) clients who are the most impacted by unequal systems that create mental health concerns. To make real improvement in reaching TNB populations who lack the most access to mental health care, therapists must be properly trained and data from clients about their mental health experiences must be obtained. The proposed research will use a community-based participatory research (CBPR) approach to engage with community organizations to design and implement a project that trains therapists to provide effective, supportive, and engaged therapy to TNB clients most impacted by barriers in accessing mental health care.

Intervention:

• Therapist Training: The Radical Healing and Internalized Stigma (RHIS) training provides education to therapists on radical healing and internalized stress. The ten therapists employed by the study will engage in an 8 hour intensive training by consultants hired to be on this study.

• Participants:

  • T0 - baseline surveys
  • T1a to T1p - psychotherapy sessions (session complete within 11 months)
  • T2 - end intervention surveys
  • T3 - post intervention follow up (up to 6 months post intervention)

Aim 1: Determine best methods for recruiting 2STNB clients (e.g., increasing access to care), with attention to specific populations and barriers (BIPOC, lack of trust, finances, identity match, etc.)

Aim 2: Examine the feasibility/acceptability of a specialized training for therapists that focuses on healing and internalized stigma

Aim 3: Longitudinally investigate the impact of access to mental health care (e-therapy) on 2STNB people's well-being/mental health.

Endpoints:

The primary endpoint of the study is to determine if the study actually improved access to mental health care for study participants--this will be determined through qualitative interviewing. An additional endpoint is determining feasibility/acceptability of the study, which will also be assessed via qualitative methods.

A secondary endpoint for this study will be to determine if clients experienced psychological improvement in their mental health over the course of the study.

Inclusion Criteria:

• fluent in written and spoken English and/or Spanish
• willingness to participate in pre/ post/ session-by session assessments and 15 individual psychotherapy treatment sessions
• individual identifies as transgender, Two-Spirit, or nonbinary (or somewhere along the gender minority spectrum)
• individual identifies as Black, Indigenous/Native, or otherwise as a person of color
• not currently in individual therapy with another therapist

Exclusion Criteria:

• reports current, unmanaged serious/persistent mental health symptoms requiring inpatient treatment (e.g., hallucinations, delusions)
• individual does not identify as transgender, Two-Spirit, or nonbinary (or somewhere along the gender minority spectrum)
• currently in therapy with an individual therapist