Benefits of Dialectical Behavior Therapy (DBT) for Teens with Gender Dysphoria

This blog is authored by Avery Brayfield, M.ED, LPC, a member of the IntraSpectrum Counseling clinical team.

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Whether you are a parent / caregiver of a transgender teen or a transgender teen yourself, it can be difficult to be confronted with intense feelings surrounding identity, specifically gender dysphoria. Gender dysphoria is a term used to describe the distress some people feel when thinking about the mismatch between their sex assigned at birth (biological sex) and their gender identity. For example, this could include feeling uncomfortable in their body, and having other people assume their gender based on how they look, speak, act, or dress. Gender dysphoria can manifest as anxiety, depression, self harm, anger, and many other intense emotional experiences. One type of psychotherapy that can be helpful for folks (especially teens) experiencing gender dysphoria – due to its focus on (1) managing intense emotions, (2) balancing change with acceptance, (3) coping with negative situations, and (4) gaining skills for regulating relationships – is Dialectical Behavior Therapy, also known as DBT.

GENDER DYSPHORIA AT SCHOOL
There are many ways gender dysphoria can impact / cause distress in teens, especially in school. For example:

• being called by an incorrect name and pronouns
• not being able to play on the sports team that matches their gender identity
• not being allowed to use the restroom that matches their gender identity

Gender dysphoria can be heightened or lessened in social environments depending on the level of support they receive. It can be a relief to have supportive friends, but at the same time be exhausting to have to educate them on transgender topics. Some transgender teens may feel isolated if they do not have access to transfriendly spaces, and may feel alone in their experiences. I promise you, they are not. There are other teens like them going through similar things!

PHYSICAL GENDER DYSPHORIA
Puberty is already a chaotic time, and being transgender adds an extra layer of complexity that can make things seem impossible. The changes that begin to occur in their body may make them feel like their body is wrong, uncomfortable, or detached from themselves. This is an example of gender dysphoria rooted in the body, or “physical gender dysphoria”. Some transgender folks are able to access medical care to lighten the intensity they may feel. However, medical care does not always make gender dysphoria go away completely. Additionally, if they are unable to access medical care related to transitioning, Dialectical Behavior Therapy may be helpful for the caregiver and their child in navigating gender dysphoria.

SOCIAL GENDER DYSPHORIA
Gender dysphoria that arises in social situations is quite common. Dialectical behavior therapy can be helpful, due to its effectiveness in teaching self-advocacy skills and navigating difficult situations in relationships; for example:

• Some people decide to change their name to one that aligns more closely with their gender identity. It can be stressful to correct people repeatedly, and some people might refuse to use the preferred name outright.
• Similarly, navigating changing pronouns to be more comfortable in social settings (changing from “he” to “she”, for example) can be difficult.
• Other examples of social gender dysphoria include navigating the use of commonly gendered terms, such as “dude”, “girl”, “bro/sis”, “girlfriend/boyfriend”, etc. When people use the wrong term that doesn’t align with their gender identity, it can feel hurtful, invalidating, or like people aren’t seeing them as their true selves. Correcting folks on these terms can also be exhausting and time consuming.

DIALECTICAL BEHAVIOR THERAPY
Dialectical Behavior Therapy is a type of psychotherapy that helps people: (1) manage their emotions, (2) accept themselves and their situations, and (3) strive to make positive changes in their lives. It combines evidence-based research with practical skills for helping folks tolerate intense emotions, challenge black and white thinking, learn social and self-advocacy techniques, and control thoughts and behaviors (instead of the thoughts and behaviors controlling them). It’s about holding space for self-acceptance and change at the same time.

For transgender people, questions that may come up include:

• How can you manage intense thoughts and emotions if transition-related medical care does not happen as quickly as you would like?
• How can you love yourself as you are now and welcome any changes that might happen? 

DBT addresses and balances seemingly opposite ideas like these.

There are several skills and activities teens with gender dysphoria might learn with a DBT therapist which can help them learn to cope with feelings gender dysphoria might bring:

• Thought logs are commonly used to record the frequency and intensity of thoughts and feelings. In this context, various life activities can be recorded to gauge which ones are linked to dysphoric thoughts and the frequency of the thoughts.
• A DBT therapist may also work with them to create a list of activities they can do to increase coping in stressful situations, an intervention used in distress tolerance.
• Another distress tolerance method called “TIPP” (because DBT loves acronyms!) is sometimes employed as well. Using temperature, usually cold water or ice packs on the skin, intense exercise, paced breathing or meditation, and progressive muscle relaxation (or squeezing all the muscles from the top of their body to the bottom and releasing them), a grounding or calming response is created in the body that helps folks feel more present and prevents harmful, impulsive behaviors that may occur when emotions become too intense to manage.
• Finally, mindfulness (staying in the present moment and observing feelings without judgment) can help teens ride the waves of difficult emotions they may feel related to gender.

Working with a DBT therapist can help by normalizing the feelings transgender young people often feel and helping then equip themselves to deal with hardships related to transitioning. Ultimately, this kind of therapy helps teens know they are not alone and helps them cope by tracking emotions to lower the prevalence of intense emotions, while also accepting and being okay with the intense emotions that arise anyway.

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This blog is authored by Avery Brayfield, M.ED, LPC, a member of the IntraSpectrum Counseling clinical team. IntraSpectrum Counseling is Chicago’s leading psychotherapy practice dedicated to the LGBTQ+ community, and we strive to provide the highest quality mental health care for multicultural, identity, kink, polyamorous, and intersectional issues. For anyone needing affirming and validating support, please click here or contact us at help@intraspectrum-chicago.com.