The Gender-Affirmative Life Span Approach: A Developmental Model for Clinical Work With Transgender and Gender-Diverse Children, Adolescents, and Adults

• Published in: Psychotherapy (Chicago, Ill.) Ill.), 2021-03, Vol.58 (1), p.37-49
• Main Authors: Spencer, Katherine G., Berg, Dianne R., Bradford, Nova J., Vencill, Jennifer A., Tellawi, Ghazel, Rider, G. Nic
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescent Development; Adult Development; Affirmative Therapy; Aged; Child; Childhood Development; Female; Gender Identity; Human; Humans; Life Span; Longevity; Male; Psychotherapy; Sexuality; Transgender Persons; Young Adult
• ISSN: 0033-3204; 1939-1536; 1939-1536
• DOI: 10.1037/pst0000363

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 gender-affirmative 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 interven