The need for emotional support is a foundational concern for parents of gender-nonconforming youth and one of the greatest tools for therapeutic healing (Hillier & Torg, 2019; Malpas et al., 2022). Parents of gender-diverse children face real fears for the health and well-being of their children and are made increasingly more aware of the stigma, discrimination, and adverse health impacts that minority stress, bullying, mental health issues, and other challenges their children are more likely to face than their cis-gender peers (Katz-Wise et al., 2018; Morgan et al., 2023). Here in Canada we see the struggle for gender equality and the way that gender-diverse individuals' bodily autonomy has been politicized (Morgan et al., 2023). In our neighbouring country of The United States, parents in 22 states face possible child welfare involvement and in some cases jail time if they seek gender-affirming care for their children and many have been forced to choose between moving to other areas that can provide supportive treatments and legal rights of their loved ones (Human Rights Campaign, 2023). It is a scary time for parents everywhere, and more so for parents whose children have a set of oppressive forces against them. Additionally stressful for parents of transgender or non-binary youth is the guilt and isolation they may feel about grief associated with their child changing and feeling as though this and other complicated experiences will be judged as taboo (Katz-Wise et al., 2018). Inside the private space of Caring Connections family members are given time to adjust, process, and use language to describe their experience that feels genuine as honesty is an important place to create authentic connections within the group (Malpas et al., 2022).

2) Knowledge

Providing psychoeducation to group members is a cornerstone of our program at Caring Connections. Learning basic to eventually more complex information about gender diversity is a positive, compassionate, and necessary part of  better understanding what their child is going through and how they can best support them (Malpas et al., 2022). Engagement in conversations and educational programming about some of the more complex aspects of their child's gender identity such as social and medical transition, learning advocacy skills and what that means, and challenging group members to acknowledge their strengths in a group setting can feel less overwhelming (Hillier & Torg, 2019; Malapas et al., 2022). Teaching parents about the positive impact their support and understanding can have on their children through learning about concepts like gender affirmation, non violent communication skills, and self-care practices and having other people on the learning journey with them are important needs that Caring Connections aims to meet (Malapas et al., 2022; SAMSHA, 2014).

Chappell (2021) wrote a guide for the Canadian Mental Health Association that identifies some of the many emotional challenges parents face when first learning their child is non-binary or transgender. Emotional responses can range from sadness and confusion to a deep sense of shame and also grief stemming from who a parent thought or expected their child to be/become (Chappell, 2021). One of the greatest barriers in moving forward and joining a support group in the first place for many parents is the guilt they feel over either not being supportive enough, knowing enough, or feeling inadequate (Matsuno et al., 2022). Firstly it is crucial for group members that these feelings are not judged but rather normalized and shared with others who understand and can validate these emotional fluctuations (Malpas et al., 2022).  

Strengths 

Parents and caregivers of gender diverse youth who join educational, support based groups bring multiple strengths with them that positively impact their other group members, their own well being, and their children. Among them are:

Open-Mindedness: Any individual who is willing to do the hard work of getting vulnerable, asking for help, and seeking new knowledge that will support them and their child throughout this period of change shows a great level of open mindedness. Willingness to learn and shift one's thinking is an invaluable strength that takes a lot of courage. Seeing as one of the main challenges group members will face is understanding new concepts, language, and social systems they may need to navigate as their child explores their gender identity, an open mind will benefit them as they explore these new areas of knowledge and share previous wisdom with other participants.

Love: Caregivers who attend support groups like Caring Connections typically show a deep love and compassion for their gender-nonconforming children despite how difficult it may be for them (Miller & Elin, 2015). There is almost no greater internal resource than love for these parents who find themselves challenging their previously held beliefs and attitudes. Many parents never anticipated this change in their child and sadly up to 60% of gender-nonconforming youth who are not supported by their families become unhoused which can lead to further disadvantages and challenges spiritually, physically, financially, and emotionally (Miller & Elin, 2015; Matsuno et al., 2022). Parents who choose to challenge themselves and show up for their children no matter where they are on the spectrum of gender show that love is a powerful force of strength and a motivator for others on a similar path (Hillier & Torg, 2019).

Adaptability: The ability to be adaptable to new circumstances and pivot from one frame of reference to learning another takes a remarkable amount of strength, flexibility, and adaptability for family members of gender expansive youth. As previously discussed, it is not an easy thing for parents to cope with unexpected changes with their child and the emotional roller coaster of learning a ton of new information and putting themselves 'out there' to share personal thoughts, feelings, and ways of coping (Aramburu, 2018; Miller & Elin, 2015).

MORE ON SAFETY

Parker (2018) urges readers to think of their gathering's purpose as their bouncer (what comes in and what stays out). With this in mind, we have created a screening process to ensure the safety of group members. In order to determine who is best suited for our program there will be a telephone interview process that each participant will go through before our first in person session. The questions are meant to determine each individual's level of commitment to the group and ensure that our values of safety, privacy, and a desire to both receive and give support to other group members. Due to the level of stigma around gender identity and a rising tide of fear and discrimination, especially regarding gender affirmation in Canada, we wish not to exclude anyone who is confused, grieving, or feels conflicted as many parents and caregivers feel this way when their loved one comes out to them (Chappel, 2021; SAMSA, 2014). We simply wish to ensure that all who attend will be non-judgemental of how each group member is doing emotionally, that each parent's child and their gender identity will be respected, and that everyone is safe from harm (Matsuno et al., 2022).

*See Below for an Example of Screening Questions

*Gender nonconforming refers to individuals who do not present, express, or identify their gender identity based on society's assumptions or views – they dress, act, and express gender through clothing and other ways according to how they feel rather than the gender they were assigned at birth.

Type of Group Selected:

For the family members of gender non-conforming children who join the group, the common concern of learning to cope with their emotions, the crucial role of confidentiality, and the hybrid style of educational and therapeutic elements give this group mainly elements of a treatment group with some task oriented interaction in the first half of each meeting. Due to the great need of parents to gain knowledge about gender diversity, advocacy skills, and coping strategies the first hour of group will be facilitator led in a lecture type model with interactive elements. Knowledge is certainly important however there is also the great need for emotional support, building community, and having a non judgemental space to share with others. This is why the second part of the group will have a facilitator guided support group format where individuals can discuss their thoughts and feelings about the content from the first half of the group or anything else related to the group's purpose. Due to the nature of moving through a standard set of manualized learning modules in addition to the need for trust and confidentiality each group will be closed. It is our hope at Caring Connections that keeping the group closed each cycle will foster a greater sense of safety, stability, and commitment to each session (Schiller, 2007).

Although this is not the case in Canada, it is easy to understand why many parents feel concerned about their child's safety. This a great video showcasing the challenges, resiliency, and bravery in the face of discrimination among families who support and affirm their child's gender.

Although the first portion of group is allocated for a more manualized set of learning modules and content needing to be covered in order to provide psychoeducation to the group, facilitators will have a strong leadership role and is required to be a knowledge/resource giver, and additionally a question asker. Even though the facilitator is leading the group through topics and discussions it will be important for them to keep in mind that group members are coming into this space with their own knowledge and should include interactive elements and inclusion when appropriate. It may also be appropriate, especially during the initial stages of group, to also disclose a little about themselves, why they are invested in the group and its purpose, and show their authentic selves in order to dismantle power imbalance between themselves and group members.

In a therapeutic/support group for individuals who are likely to be experiencing emotional distress and feelings of fear and isolation, one of the greatest roles a facilitator has is to acknowledge and commend members when they share something deeply personal with encouragement and empathy (Schiller, 2007). Schiller (2007) raises a really important point about the influence that group facilitators personalities, biases, and energy states have on group members. Facilitators must be highly aware of the ways their words, approach, and reactions can have when parents are sharing their perspectives and remember that group is a place to explore with others (Schiller, 2007). It will also be important for facilitators to keep in mind that group members are likely in a stage of life where they may feel powerless, stigmatized, or afraid to speak their minds and so paying close attention to power imbalances inside the group will be crucial (Chappel, 2021; Schiller, 2007; Pelech, 2016). Each group member's voice is equally important and a principle of Caring Connections is inclusion. If a facilitator notices domineering behaviour, taking control over the group, or group members being singled out for their opinions or even where their child is at on their journey then gentle confrontation, redirection, and possible mediation skills for resolving conflict will be highly important (Schiller, 2007). In addition to scanning the group for tension it is very important for group members to see modelling of pointing out resiliency, risk taking, and courage when a group member speaks up about something upsetting to them, shares about progress, or shows empathy and compassion to other members. Schiller (2007) reminds facilitators that taking the time during group to reflect on and acknowledge strength within the group can lead to greater cohesion and encourage members to develop empathic connections in this newfound community.

Usually caregivers are the ones to take charge and have a great amount of responsibility and control in their children's lives. While participants are attending this group they will learn the value and potentially life-saving benefits of considering their child's bodily autonomy and gender identity as their own and choosing to give up some of that control (Lawlis et al., 2020). Parents of gender minority children are often unfamiliar with how to best advocate for their child and their may be differences of opinion and stages of acceptance around difficult topics like hormone blockers or learning about pronouns (Matsuno et al., 2022; Lawlis et al., 2020). Discussions about these difficult topics will be encouraged in the group but it is the facilitator's responsibility to help remind group members that everyone is on their own journey and that differing opinions and experiences are all opportunities to reflect and hear differing perspectives. One way a facilitator can diffuse conflict is by gently pointing out what they notice and seeing how group members respond from there. Another way to contain and manage power imbalances caused by cultural differences or other divides among participants would be to shift up dynamics by asking group members to share how they are feeling about what is going on one at a time so each person's voice is heard (Pelech, 2016).

Even though there is the commonality of each individual wishing to learn more about their child's gender identity, what their role is in supporting them, and needing a safe space to discuss their emotions, each individual will react differently to certain topics and have a variety of emotions coming into group which is why facilitators must be able to use gentle confrontation skills if disrespectful language or other safety guidelines are breached (Matsuno et al., 2022; Pelech, 2016). It is important for facilitators to bring groups back to their purpose and guidelines in order to remind everyone why they are here and what is motivating their participation in the first place (Pelech, 2016).

It is equally important for the facilitator to be aware of the power they hold in group and understand that group members are often in a place where they feel powerless over what is taking place with their child and their own emotions (Schiller, 2007; Morgan et al., 2023). In order to foster a sense of safety and trust within the group, facilitators must be open to feedback and reflecting on what energy and attitudes they are bringing to group if they wish to model that behaviour for participants (Schiller, 2007).

The entire family system can benefit from an increase in mental health and a new level of connection between caregiver and child (Aramburu, 2018). With the new knowledge and relationships acquired by participating in group parents are able to plan for the future with less fear and a community of peers to reach out to when needed.

The final potential benefit that Caring Connections hopes will be an outcome for group members is a better understanding of how to cope with stigma and oppression in school and medical settings through the learning material and wisdom of their peers (Katz-Wise et al., 2021). There is a great need for parents whose children are gender diverse to be readily equipped with the knowledge of their rights, ways of navigating barriers within social settings, and advocate on behalf of their children and even teach them some self advocacy skills too (Katz-Wise et al., 2021).

Size of Group

 At Caring Connections groups will be limited to 8 members. Smaller groups generally allow individuals to feel safer and build trust as there will be adequate time to get to know one another. As stated in the section about group purpose, it is our hope that the bonds formed over going through similar challenges with a close-knit group will give group members the chance to make lasting connections that will become a part of their future support system which is another reason for a smaller group size. Diversity is important as is hearing the perspectives of a variety of caregivers when deciding group size for Caring Connections. Due to the sensitive nature of what our participants are experiencing we believe that a more intimate setting where attention can be given to individual members and the group as a whole in a meaningful and thorough way is so crucial (Lindsay & Orton, 2014).

In addition to the group size's impact on group members, facilitators will be better able to provide attention to group dynamics, individual members needing direction, attend to cultural sensitivity and respectful communication, and assist the group in staying on track when challenging moments arise (Pelech, 2016). Commitment to the group is an important aspect of Caring Connections and it is often easier in smaller groups to notice when a member is absent as their lack of presence will be noticed. Having this accountability to other group members not only helps to foster a sense of security in the work the group is doing together but it can also help group members build the confidence to take up space as they are needed (Schiller, 2007). It is important to remember that the individuals attending this group have sought out support for what some experience as a deeply personal and emotional aspect of their lives thus keeping group membership to a manageable size helps with overall safety aspects of the group (Lindsay & Orton, 2014). 

Length of Group:

Group will be held once a week for 3 hours with the addition of a mid-week 30 minute online check in space. Most parents and caregivers that will be attending the group have busy schedules which is why we have created the group to serve members on Saturday afternoons from 1-4 pm (Lawlis et al., 2020). Three hours with two 15 minute breaks allows time for both the psychoeducational piece that will start off each group, allow people to connect or practice some self care during break time and then reconvene for the more intimate sharing and holding space for each other portion of the second half of group time (Lindsay & Orton, 2014).

An ideal setting would be somewhere in the community with ample privacy, free parking and close to bus stations, and with enough space to allow for our equipment or rental space that has a conference room with a projector and enough furniture to create a circular shape format for the sharing part of group. 

Activities

Educational

Ice breakers

Creative projects

Poetry

Endings for a group who have learned so much together and supported one another through highs and lows is a crucial step of the group process and is sometimes a very difficult part of the work (Mayadas & Glasser, 1981). Endings are an opportunity to reflect on the growth group members have achieved and to acknowledge the bonds that are likely to form among parents who in the initial phase might have felt that they were the only people they knew coping with the changes brought on after learning about their child's gender diversity (Lawlis et al., 2020; Mayadas & Glasser, 1981).

Fostering a feeling of closure among the group (and facilitators too!) will allow group members to feel and celebrate what they have accomplished and processed together (Mayadas & Glasser, 1981). Ritualizing a group termination is a lovely way to close off the last session and is especially important for groups that have been coping with feelings of loss, grief, and change. This is yet another change in group members' lives and signifies a period where they will be moving into the future with more independence regarding the support of themselves and their children. At Caring Connections we do not overlook this milestone and welcome all of the feelings that come with it as in many ways group endings can be experienced as a loss in and of themselves (Mayadas & Glasser, 1981). There will be a time set aside during the second last group for members who wish to stay connected in the future to exchange their contact information and because we designed the group to serve the local community the hope is that staying connected is a genuine possibility (Lindsay & Orton, 2014).

Symbolizing Closure and Showing Gratitude

During our final session (which group members will be reminded of frequently so that everyone feels prepared) group members will have the opportunity to get creative, put aside the confines of language, forget their roles and speak from the heart through an exercise where each person has a piece of paper, paint and brushes will be supplied, and every member will get to write, draw, or leave any kind of creative message, word of gratitude, or other kind of message on each other's paper. This ritual will leave group members with a memento of their shared experience and give them all an opportunity to share in a way they may not have otherwise felt able to. Creative expression is a healing modality and hopefully, this exercise leaves group members feeling cared for and with a sense of closure.

Aramburu, A. C. (2018). Supporting families of transgender children/youth: Parents speak on their experiences, identity, and views. International Journal of Transgenderism, 19(2), 132-143. https://doi.org/10.1080/15532739.2018.1450798

Chappell, C. (2021, March 9). Parents whose children identify as transgender: Guide. CMHA York Region. Retrieved October 5, 2023, from https://cmha-yr.on.ca/a-guide-for-parents-whose-children-identify-as-transgender/

Hillier, A., & Torg, E. (2019). Parent participation in a support group for families with transgender and gender-nonconforming children: "Being in the company of others who do not question the reality of our experience". Transgender health, 4(1), 168–175. https://doi.org/10.1089/trgh.2018.0018

Human Rights Campaign. (2023, November). Attacks on gender affirming care by state map. https://www.hrc.org/resources/attacks-on-gender-affirming-care-by-state-map

Katz-Wise, S. L., Ehrensaft, D., Vetters, R., Forcier, M., & Austin, S. B. (2018). Family functioning and mental health of transgender and gender-nonconforming youth in the trans teen and family narratives project. Journal of Sex Research, 55(4-5), 582–590. https://doi.org/10.1080/00224499.2017.1415291

Katz-Wise S.L., Galman S.C., Friedman L.E., Kidd K.M. (2021). Parent/caregiver narratives of challenges related to raising transgender and/or nonbinary youth. J. Fam. Issues. 0:1–25. doi: 10.1177/0192513X211044484

Lawlis, S.M., Butler, P., & Middleman, A. (2020). Evaluating transgender youth and parent interest and preferences regarding support groups. Global Pediatric Health. 7. doi:10.1177/2333794X20954680

Lindsay, T. & Orton, S. (2014). Groupwork practice in social work, Chapter 6 programming and activities (p. 99-107), 3rd ed. Sage Publications.

Malpas, J., Pellicane, M. J., & Glaeser, E. (2022). Family-based interventions with transgender and gender expansive youth: Systematic review and best practice recommendations. Transgender Health, 7(1), 7-29. https://doi.org/10.1089/trgh.2020.0165

Matsuno, E., McConnell, E., Dolan, C. V., & Israel, T. (2022). "I am fortunate to have a transgender child": An investigation into the barriers and facilitators to support among parents of trans and nonbinary youth. Journal of GLBT Family Studies, 1-19. https://doi.org/10.1080/1550428X.2021.1991541

Mayadas, S.N. & Glasser, P. (1981). Termination: A neglected aspect of social group work. Social Work With Groups, 4(1-2), 193-204. https://doi.org/10.1300/J009v04n01_17

Morgan, H., Wells, L., Lin, A., Strauss, P. & Yael Perry (2023). Parental challenges, facilitators and needs associated with supporting and accepting their trans child’s gender. LGBTQ+ Family: An Interdisciplinary Journal, 19(1), 70-86, DOI: 10.1080/27703371.2022.2142717

Parker, P. (2018). The art of gathering. Riverhead Books.

Pelech, W., Basso, R., Lee, C.D. & Gandarilla, M. (2016). Inclusive group work. New York, N.Y.: Oxford University Press.

SAMHSA. (2014). A practitioner's resource guide: Helping families to support their LGBT children. SAMHSA Publications. https://store.samhsa.gov/sites/default/files/d7/priv/pep14-lgbtkids.pdf

Schiller, Y. L. (2007). Not for women only: Applying the relational model of group development with vulnerable populations. Social Work With Groups, 30(2), 11-26. https://doi.org/10.1300/J009v30n02_03

Shulman, L. (2012). The skills of helping individuals, families, groups and communities, 7thed. Chpt 13, Working with the individual in the group (p. 502-531) in Belmont, CA: Brooks Cole Publishing.

Another important aspect of this phase of group is to assess and evaluate the changes and overall well-being of group members. As Caring Connections sessions begin with educational elements, there will be greater opportunities for facilitators to ask the group how they are feeling and what has emerged for them during the week. 

One of the potential conflicts that could emerge in the group are raised by subgroups or smaller groups within the larger group that can form over the differences between a nonbinary child and a transgender child or the fact that mothers are more commonly involved in

During this phase of working together through challenges and issues group members will be giving feedback to one another. Our facilitators will be there to gently ensure that everyone is maintaining respectful communication, no one feels excluded or becomes the scapegoat, and will be ready to step in and raise awareness when bullying, exclusion, or maladaptive behaviours arise Pelech (2016). Schiller (2007) also reminds facilitators to thank group members when they share and reveal roles weather they are 'helpful' or not as these individuals are sharing about vulnerable topics and have likely dealt with feeling shut down or secondarily stigmatized in other situations in their lives.

This phase is also where storming (conflict) occurs the most usually because group members have developed enough trust amongst one another to take risks and say whats on their minds (Schiller, 2007;Shulman 2012; Pelech, 2016). This phase is characterized by increased conflict and competition for influence and power within the group at times because emotions can be strongly felt and buttons can be pressed as caregivers are challenged by the learning content and one another (Matsuno et al., 2022). This conflict, if managed effectively, can lead to resolution and the establishment of norms and a group culture of safety and added trust in addition to confidence for group members (Schiller, 2007). Resolving conflicts during this stage is vital for the group's overall cohesion and functionality.

During the middle stage, group members negotiate and solidify their roles and responsibilities within the group (Shulman, 2012). This process is essential for establishing a structure that allows the group to operate efficiently and for members to understand their individual contributions to the group's goals which are mainly to be heard, validated, and free to express themselves honestly as they move through each weeks learning and sharing aspects (Hillier & Torg, 2019 & Pelech, 2016). This dynamic phase of group process will hopefully be an opportunity for parents to address some of the bigger issues, fears, and challenges they are facing and begin to achieve some of their personal goals (Pelech, 2016). The middle phase is also likely to be when trust of the other caregivers has formed and the groups cultural norms have stabilized (Pelech, 2016).

By starting off our first meeting in a non-threatening and encouraging way by having snacks, beverages, icebreakers, and introductions will hopefully allow group members to settle in and feel encouraged to share what brought them to the group without feeling pressure to disclose more than they are comfortable with and give members a sense of who they will be meeting with over the next 5 weeks (Lindsay & Orton, 2014; Malpas et al., 2022).

One of the most important considerations for this initial stage of group is contracting or coming up with group guidelines to ensure confidentiality is emphasized, respectful communication is discussed, and goals are mutually agreed upon as group members are given space to contribute to the guidelines and what they need to feel safe and secure (Schiller, 2007).

The formation of groups is a multifaceted process, marked by distinct stages that shape the foundation for subsequent interactions and collaborations. This section delves into the initial stages of group formation, shedding light on the pivotal moments that set the tone for roles to emerge, culture and norms to develop, and group dynamics to evolve and change (Pelech et al., 2016).

The first stage, commonly referred to as the "forming" stage, marks the initial gathering of individuals wherein members exhibit a mix of curiosity, anticipation, and perhaps even some apprehension (Baird & Alaggia, 2021). Ice-breaking activities can often start a smoother transition from individual entities evolving into a cohesive group, and they play a crucial role during this forming stage, breaking down initial barriers and fostering a more relaxed atmosphere that is so important for these caregivers (Matsuno et al., 2022). Through shared laughter or challenges, group members begin to glimpse the unique contributions each individual brings to the collective which is what our participants are longing for (Lawlis et al., 2020)! Next, Building Trust emerges during the forming stage. As individuals begin to bond and share personal stories of what they have gone through during this stressful time, a foundation of trust begins to take shape. This trust is vital for creating an environment where members can feel secure in expressing their ideas and concerns (that may or may not be the same as everyones), laying the groundwork for open communication. Finally, a solid group identity begins to crystallize during the forming stage. Whether through appointed or unofficial leaders and emerging influencers, the group begins to identify key figures who help guide and shape its identity. This early stage sets the tone for how decision-making processes will unfold, and even how the group will ultimately navigate challenges as it moves along. This is why facilitators will always be present and making sure each member is included and feels welcome (Schiller, 2007).