“But I’m Their Parent—Why Can’t I Know?” Parental Expectations and the Ethics of Confidentiality in Family Therapy With Transgender Adolescents

Abstract

Transgender and gender-diverse individuals face significantly higher rates of mental health challenges, including suicidality, primarily due to societal stigma, discrimination, and limited access to competent, affirming healthcare. The absence of culturally responsive mental health treatment exacerbates these issues, emphasizing the need for therapists to address the unique needs of this population. However, many marriage and family therapists lack the training and tools to effectively support transgender clients. The ethical and practical challenges therapists encounter when working with transgender adolescents and their families are explored through a composite case study of Luna, a 16-year-old transgender girl. Luna's family resides in a mid-sized suburban area in the United States, with strong cultural ties to a conservative, working-class background and Catholic religious beliefs that influence their understanding of gender. Luna's parents, both first-generation immigrants from a Latin American country, struggle to accept her gender identity due to these values, creating a complex family dynamic. Practical guidance is provided for therapists to navigate these sensitive issues, with specific strategies for balancing the needs of the individual and family, including differentiation of self, boundary-setting, and family cohesion. The conclusion emphasizes the importance of culturally competent care and ethical decision-making in family therapy, highlighting the therapist's role in safeguarding the adolescent's autonomy, emotional well-being, and psychological safety while fostering family support. Closing reflections from the author further explore the personal and professional insights gained from this work.