Bowen Family Systems Therapy with Transgender Minors: A Case Study

Clinicians have seen a continually increasing rise in the number of children and adolescents presenting with gender dysphoria. Many are requesting gender-affirming medical interventions before they possess the legal authority to give consent. Since only legal caregivers can provide informed permission for transgender-specific medical treatment for minors, therapists who see these youths need an approach mindful of the distress inherent to the lived experience of transgender minors and respectful of the fear and hesitation most guardians of trans youth experience. Due to the partial or fully irreversible nature of medical treatment for transgender minors, parents tend to be cautious about what they may view as extreme treatments. Sometimes well-meaning parents functionally "filibuster" their adolescent's transition which can cause a harmful delay in necessary treatment. Utilizing a Bowen family systems framework, this article employs a case study to demonstrate creative strategies clinicians can apply to help families through the transition process. Although, transgender minors may bring the family to initial therapeutic encounter, they are not "holding" family dysfunction. Their distress is due to their dysphoria which is outside their control. At the same time, the family system may experience increased levels of stress resulting from an inability to support a transgender child within a cisnormative world. Successful work with these families will create a new homeostasis. Therapists must earn the trust of both the youth and parents.