Therapists treat millions of Americans each year, but they often fail to provide culturally sensitive support to transgender youth, says Maggi Price, a newly hired assistant professor in the Boston College School of Social Work.
Price recently teamed up with the Yale Medicine Gender Program to analyze clinical interviews and survey data to better understand the experiences transgender youth have in therapy.
She discovered that some transgender adolescents have positive experiences, citing cases in which therapists have provided educational resources to their clients and referred them to endocrinologists who have helped them develop the physical characteristics of their affirmed gender.
But she also found instances in which therapists have lacked knowledge of the particular challenges that face transgender youth, refused to provide letters of support for medical treatments such as hormone replacement therapy, and used incorrect pronouns to identify their clients.
“That’s painful and invalidating,” says Price, a psychologist who studies the mental health of youth who are stigmatized because of their race, gender, and sexual identity. “It’s the type of behavior that you don’t want in a therapy session where you’re already asked to be vulnerable and talk about the negative experiences you’ve had.”
A study published by the Centers for Disease Control and Prevention in 2019 found that transgender youth are more likely than their cisgender counterparts to attempt suicide, get bullied, and experiment with drugs and alcohol.
And psychologists like Price, who received her doctorate in counseling psychology from Boston College in 2018, say that transgender people who are stigmatized, rejected, and abused because of their identity face increased risk of anxiety and depression.
Yet transgender youth who seek therapy to improve their mental health often report that their therapists are not equipped to understand how gender-based oppression affects their overall well-being.
“Transgender youth are discriminated against in therapy rooms and medical settings,” says Price, who directs the Affirm Lab, which conducts research to improve mental health therapy for stigmatized youth. “Many see clinicians and healthcare providers who know very little about what they are going through and have biases that are revealed in a variety of ways.”
Training in gender-affirming care is important for all social workers. But it may be especially important for clinicians working in states with high levels of transphobia to learn how to address negative gender-based experiences in therapy.
Price says that her newest study will examine whether laws and policies that inhibit the rights and well-being of transgender youth increase their risk of depression.
She plans to share her findings with lawmakers and social workers, especially those who work in states in which people report high rates of transphobia. Bloomberg Law reported in 2019 that seven states had policies in place that banned Medicaid coverage for surgeries that change the sexual characteristics of people to better reflect their gender identity.
“Training in gender-affirming care is important for all social workers. But it may be especially important for clinicians working in states with high levels of transphobia to learn how to address negative gender-based experiences in therapy,” says Price, whose study will include the analysis of survey data from transgender youth published by the Centers for Disease Control and Prevention in 2019. “In the future, it will be important for researchers and clinicians to determine what treatment augmentations are most important for social workers to implement in those places.”
Price says that her work in inpatient care at a hospital in Massachusetts shaped her career path. As a psychology fellow at the hospital, Price provided therapy to teens and young adults who exhibited a variety of severe mental health problems, including suicidal thoughts and post-traumatic stress disorder. She quickly became the go-to therapist for transgender clients and later co-wrote a policy that improved care for transgender youth who needed to be admitted into the hospital.
When she started her fellowship, she says, transgender clients were placed in group meetings based on their sex assigned at birth and given hospital bracelets inscribed with their former name. “I would have to frequently advocate for what I felt were basic human rights being denied to clients,” says Price. “I got so frustrated, but with the help of my close colleague—an expert in gender-affirming healthcare—and supportive hospital leadership, we worked together to put together a policy to change the rules on the unit.”
Price comes to Boston College from Harvard University, where she served as a postdoctoral fellow in the Laboratory for Youth Mental Health. She’s authored more than two-dozen publications, including peer-reviewed articles that have appeared in School Mental Health, the Journal of Adolescence, and Development and Psychopathology. In 2018, she received an outstanding research award from the Journal of Clinical Child and Adolescent Psychology for her dissertation, which explored the relationship between bullying, mental health, and academic achievement in youth who had been victimized because of their identity.
Price says she wants to collaborate with faculty across the Boston College School of Social Work, including sociologists and epidemiologists who could help her expand the scope of her research.
“I’m really excited to work collaboratively with researchers who have studied the world in slightly different ways than I have as a psychologist,” says Price. “Together I hope we’ll be able to create really important and impactful work that is interdisciplinary and nuanced.”
She plans to teach “Cognitive Behavioral Therapy” this fall. She says she’ll check in with her students individually and ask them to evaluate the course midway through the semester.
“I really try to emphasize a reduction in hierarchy,” says Price. “We all commit so much time and effort into each class, and I’ve found that communicating about what’s going well and what’s not going so well enhances the experience for everyone.”