Behavior Therapy and Cognitive Behavior Therapy are types of treatment that are based firmly on research findings. These approaches aid people in achieving specific changes or goals.
Changes or goals might involve:
A way of acting: like smoking less or being more outgoing;
A way of feeling: like helping a person to be less scared, less depressed, or less anxious;
A way of thinking: like learning to problem-solve or get rid of self-defeating thoughts;
A way of dealing with physical or medical problems: like lessening back pain or helping a person stick to a doctor’s suggestions.
Behavior Therapists and Cognitive Behavior Therapists usually focus more on the current situation and its solution, rather than the past.
They concentrate on a person’s views and beliefs about their life, not on personality traits.
Behavior Therapists and Cognitive Behavior Therapists treat individuals, parents, children, couples, and families.
Replacing ways of living that do not work well with ways of living that work, and giving people more control over their lives, are common goals of behavior and cognitive behavior therapy.
HOW TO GET HELP:
If you are looking for help, either for yourself or someone else, you may be tempted to call someone who advertises in a local publication or who comes up from a search of the Internet.
You may, or may not, find a competent therapist in this manner.
It is wise to check on the credentials of a psychotherapist.
It is expected that competent therapists hold advanced academic degrees.
They should be listed as members of professional organizations, such as the Association for Behavioral and Cognitive Therapies or the American Psychological Association.
Of course, they should be licensed to practice in your state.
You can find competent specialists who are affiliated with local universities or mental health facilities or who are listed on the websites of professional organizations.
You may, of course, visit our website (www.abct.org) and click on "Find a CBT Therapist"
The Association for Behavioral and Cognitive Therapies (ABCT) is an interdisciplinary organization committed to the advancement of a scientific approach to the understanding and amelioration of problems of the human condition.
These aims are achieved through the investigation and application of behavioral, cognitive, and other evidence-based principles to assessment, prevention, and treatment.
What Does It Mean to Be Transgender or Gender
People who identify as TGNC experience their gender as something
different than what is stereotypically associated with their sex assigned at
birth. For some people, their experience of their gender fits in what is
known as the gender binary, and they may identify as male or female. For
other people, their experience of their gender does not fit in the gender
binary, and they may identify as genderqueer, gender fluid, or use one of
many other labels for diverse gender identities.
Identifying as TGNC is not a psychological disorder. Although researchers
are still working to understand the biological and developmental
components of TGNC identities, they can be best understood as
natural variations in human gender expression.
However, people who identify as TGNC can experience significant
distress associated with the incongruence between their gender and their
sex assigned at birth. When this distress leads to problems in everyday
functioning (e.g., interpersonal, academic, work) it is called Gender Dysphoria,
which is currently listed in the Diagnostic and Statistical Manual
of Mental Disorders-5 by the American Psychiatric Association. Therapists
would use this diagnosis to treat the anxiety, depression, and stress
that TGNC youth might experience.
Affirmative Care for TGNC Youth
Historically, clinicians and health care providers have used a variety of
treatment approaches in working with TGNC youth. Experts in the treatment
and care of TGNC youth are increasingly using a framework known
as the affirmative care model. In this model, clinicians support and affirm
a youth’s expressed gender. And, while validating that a youth’s understanding
and expression of their gender in any moment is true,
clinicians also recognize that gender identity development is complex
and that youths’ understanding of their gender may change over time.
Importantly, the affirmative care model recognizes that the care of TGNC
youth is highly complex and requires an individualized and interdisciplinary
approach. What this means is that there is no single treatment plan
or transition process that will work for all TGNC youth. Mental and physical
health care providers will work together to make recommendations
based on each individual’s unique situation and needs.
Information for Parents of TGNC Youth
Parents of TGNC youth have the opportunity to provide crucial support
and affirmation of their child’s identity. Research has shown that support
and acceptance from parents and families is a strong protective factor
against many of the challenges faced by TGNC youth. Parents of TGNC
youth also act as their primary advocate when interacting with school administrators,
health care providers, and other adults in their child’s life to
navigate the unique circumstances associated with a TGNC identity.
TGNC youth could benefit from seeking support from a psychologist
who has appropriate training and experience working with TGNC individuals.
Primarily, psychologists can help TGNC youth to explore their
gender identity in a supportive and affirming environment. TGNC youth
can also learn cognitive and behavioral skills in therapy that can help
them cope with stressors in their life. Stigma and discrimination associated
with TGNC identities can add additional stress to the lives of TGNC
youth on top of the typical stressors experienced by all children and ado-
lescents. Although the body of research on TGNC youth is still relatively
small, it appears that, as a result of these additional stressors,
TGNC youth may be at a higher risk for depression, anxiety, and suicidality.
Additionally, they may be more likely to be the victims of
verbal, physical, or sexual harassment or abuse. In light of TGNC
youth’s elevated risk for suicidality or abuse, it is important that
youth have a parent, psychologist, or other trusted adult that they feel
comfortable talking to if, or when, they feel unsafe.
How Is Assertiveness Training Done?
Individuals can begin to recognize, understand, and share their
TGNC identity at any age, and for many this occurs during childhood
or adolescence. The current limited data on TGNC children suggests
that from 12% to 50% of children who express a TGNC identity in
childhood will continue to express that identity after they reach puberty.
Researchers and clinicians currently cannot predict which children
will persist in their TGNC identity and which will not, but it
appears that children who experience more intense gender dysphoria
(i.e., those who are more distressed by the incongruence between
their gender and their sex assigned at birth) are more likely to persist
in their TGNC identification.
TGNC children and their parents might consider what is called socially
transitioning, which can help children live more comfortably as
their affirmed gender. A social transition can include steps such as
the child using a new name and different pronouns, wearing different
clothes, or getting a new haircut. Some TGNC children fully socially
transition in all areas of their lives, and others choose to partially
transition (e.g., wearing gender affirming clothes but using the same
name/pronouns, socially transitioning at home but not at school).
Psychologists can help support families in making decisions about
whether and when a social transition would be appropriate for TGNC
children. This decision process is unique to each family, and it should
take into account factors such as the child’s safety and where the
child is in their gender identity development. Medical interventions
to support gender transitions are not recommended for prepubertal
Once TGNC youth reach puberty, they and their families have additional
transition options to consider beyond socially transitioning.
If TGNC youth are interested in medical interventions to support
their transition, health care providers may request that a readiness
assessment be conducted by a mental health care professional who
has specialized training in working with TGNC youth. The purpose of
this comprehensive assessment is to provide TGNC youth with the
best care possible. Readiness assessments typically include an evaluation
of the youth’s gender identity development history, their current
physical and psychological functioning, their family and other social
support, and the youth’s understanding of the implications of transitioning.
It is important that TGNC youth have the support of a psychologist
before beginning a medical transition, as well as throughout
the transition process.
Medical interventions for TGNC adolescents might include puberty-
suppressing medications, gender-affirming hormone treatment,
and possibly gender-affirming surgical interventions.
Puberty-suppressing medications, also known as puberty blockers,
are a reversible intervention that provide TGNC youth with additional
time to explore their gender identity without experiencing the
irreversible and potentially highly distressing development of their
biological secondary sex characteristics. The administration of gender-
affirming hormones (i.e., testosterone or estrogen) results in
physical changes for TGNC youth such as changes in voice pitch,
muscle mass, body and facial hair, and body fat redistribution, among
others. Surgical interventions can be used to alter primary or secondary
sex characteristics, but are typically not recommended until at
least late adolescence. TGNC youth should talk with their parents,
psychologists, and physicians about the implications of medical interventions,
including the implications for their future fertility.
Outlook for TGNC Youth
TGNC youth are a diverse and resilient population. Family support
and acceptance can help TGNC youth to succeed in a world that is
still growing in its understanding and acceptance of gender diversity.
Moreover, affirmative care from psychologists and physicians can
help TGNC youth explore and live a fulfilling life as their authentic
selves. Researchers are working to expand our empirical knowledge
of TGNC youth and the development of diverse gender identities in
order to develop and provide the best possible affirmative mental and
physical health care for TGNC youth.
You might find the book The Transgender Child, by Brill & Pepper,
and published by Cleis Press, useful.
Professionals might find the following article of use: Edwards-Leeper,
L., Leibowitz, S, & Sangganjanavanich, F. (2016). Affirmative Practice
with Transgender and Gender Nonconforming Youth: Expanding the
Model. Psychology of Sexual Orientation and Gender Diversity, 3,
For more information or to find a therapist:
Please feel free to photocopy or reproduce this fact sheet, noting that this fact sheet was writen and produced by ABCT. You may also link directly to our site and/or to the
from which you took this fact sheet