Parental Influence on Mental Health Therapy for a Health Disparity Population: A Qualitative Study

Background Parents influence children’s access and engagement in mental health therapy, through factors like parent attitudes and session attendance. This is especially true for transgender and gender-diverse (TGD) youth, who benefit most from affirming therapy – compared to non-affirming therapy – which is tailored to support a client’s gender and linked with enhanced treatment engagement. To support TGD youth’s ability to engage in optimal treatment, it is important to understand parent’s influence on youth’s therapy experiences.Objective Analyze qualitative data from TGD youth, parents, and therapist to (1) understand how parents influence therapist’s ability to provide affirming therapy and (2) develop research-guided recommendations for therapists.Methods Mental health therapists (N = 52) who recently completed training on affirming practices for working with TGD youth responded to open-ended survey questions about how parents influence their work with TGD youth. A subset of these therapists (n = 16) completed semi-structured interviews on using affirming practices three months post-training. Interviews with TGD youth (N = 6; ages 14–22) treated by therapists trained in affirming therapy and parents (N = 3) were conducted eight months post-training. Responses and interview transcripts were analyzed via rapid and traditional content analysis, identifying ways parents influence affirming therapy and strategies to work with parents.Results Parents influenced affirming therapy in several ways, representing five overarching themes: parents’ beliefs about gender or affirming therapy; parents’ therapy involvement; parents’ emotions; parents’ knowledge about gender or affirming therapy; and family dynamics. Strategies for working with parents included: exposure, parent training, resources, support groups, and therapist training.Discussion We offer five recommendations for therapists working with parents of TGD youth to enhance their ability to provide affirming therapy: expose parents to TGD people through stories; train parents in gender affirmation; provide trustworthy resources; connect parents with support groups; and enhance therapists’ ability to navigate parent-child conflicts.