You’re invited to join us on THURSDAY JUNE 4TH AT 1PM ET for our latest webinar with Systemic & Family Psychotherapist, Anastassis Spiliadis.

This webinar explores how psychological thinking and psychotherapeutic interventions may support adolescents experiencing co-occurring eating disorders (primarily of a restricting type) and gender-related distress. Emerging practice-based evidence suggests that individuals experiencing gender-related distress may also present with eating difficulties or eating disorders. At the same time, clinicians working in independent practice or in public mental health services have observed that some adolescents presenting for eating disorder treatment may also identify as trans and/or experiencing gender-related distress. While eating disorders and gender-related distress are not symmetrical phenomena, both may involve the body becoming a source of distress.

When working with adolescents, whose bodies, brains, relationships, and identities are in a state of developmental flux, a range of factors may further complicate both hypothesizing/formulating and psychotherapeutic interventions. The session will include a presentation focusing on the evolving evidence base, the integration of systemic family therapy and psychodynamic thinking, and considerations relating to safety, risk, and the development of a safe therapeutic alliance. It will also introduce the concepts of double-blocking and systemic embodiment. There will be space for discussion and reflection, with the aim of supporting clinicians working across different contexts to think more integratively about psychotherapeutic work with co-occurring presentations and experiences. No prior clinical experience with eating disorders is required.

No prior clinical experience with eating disorders is required.

Book Your Space

What will be covered?

Learning objectives for the webinar are:

1. Describe links between theory and practice in relation to co-occurring eating disorders and gender-related distress in adolescence.

2. Identify areas of overlap and difference between these presentations, formulate complexity and risk, and consider stage-appropriate psychotherapeutic interventions.

3. Discuss the evidence base relating to embodied distress in adolescence.

Meet Anastassis Spiliadis

Anastassis Spiliadis is a Family and Systemic Psychotherapist and UK-registered Supervisor with a background in Psychology (MSc) and Organizational Management (MSc). His professional interests include embodied distress across the lifespan, the integration of developmental processes within family therapy contexts, and the development of psychotherapeutic interventions.

He works clinically with individuals, couples, and families, and also consults with public and third-sector organizations in the United Kingdom and Greece. He has worked for more than ten years within the UK National Health Service across specialist and generic mental health services. He teaches as a Visiting Lecturer across psychology, psychotherapy, and sexology training programs at university level, and provides supervision to teams and individual clinicians.

He is Vice Chair of the Equality, Diversity and Inclusion (EDI) Committee at the Association for Family and Systemic Psychotherapy (UK), and is currently a Doctoral Candidate exploring how female detransitioners experience and make sense of changes in their bodies.

Who should come to the webinar?

Therapy First webinars are open to the public. Parents, clinicians, teachers, and interested people are all welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar. Please share this email with anyone you think might benefit from attending!

Therapy First Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Members.

Tickets Here

Therapy First is approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provides 1.5 hours of CE credits.

Therapy First webinars are open to the public. Parents, clinicians, teachers, and all those interested are welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar (attendance for the entire length of the program is required to receive CE credits).

The model was developed in response to real and serious harm. The mental health profession has a long history of pathologising gender nonconformity, and the damage done to gender-diverse and LGBT people by those approaches has been substantial and well-documented. The affirmative model sought to correct this, and to keep identity and gender in clinical view as meaningful and important rather than as anything to be pathologized or treated. With time, some proponents went further, proposing that the model should actively challenge cisnormativity, binary conceptions of sex and gender, and even the legitimacy of assessment and diagnosis itself, to ensure the profession did not repeat its past mistakes. The emergence of affirmative practice in psychotherapy was a response to a history of harm to the LGBT community, and Hutchinson takes them seriously.

What Hutchinson asks clinicians to hold is the full complexity: the legitimate value of an affirming stance alongside the legitimate clinical risks of applying it without psychological rigour. The risks of non-affirming practice are real and should not be minimized, including a return to conversion therapy practices, the erosion of trust between LGBT people and the mental health profession, and the re-pathologization of gender nonconformity. Therapists have an ethical obligation to work with subjective experience as meaningful, which means holding an affirming stance towards a patient’s identity is not optional - it is foundational to good clinical practice.

But Hutchinson draws an important distinction between affirming and confirming, and argues that one can slide into the other if clinicians aren’t careful. An affirming stance means that the clinician holds a young person’s experience as meaningful, worthy of respect and serious engagement, and is emotionally supportive and encouraging. Confirmation means treating a particular account as settled and beyond further exploration - agreeing, for example, that your client’s current identity is fixed for life and won’t change, even though they’re in a developmental stage where identity is still forming and is likely to be in flux. The latter risks becoming a psychological intervention that interrupts rather than supports the unfolding of identity development. Clinicians should be careful to avoid that, especially with youth whose sense of self is still forming and whose capacity for decision-making is still developing.

The central tension Hutchinson encourages clinicians to sit with is this: how do you affirm a young person's subjective and lived experience, and genuinely reduce the harm that comes from stigma and prejudice, without that affirmation becoming reductionistic, foreclosing exploration and risking a clinical pathway that causes iatrogenic harm? Because a purely affirmative model, she argues, is predominantly medical and social in its orientation. And when that is the dominant frame, all the psychological understanding of how humans develop, and how identity forms can be overshadowed. We can lose sight of the whole person and the complexity of psychology and human development.

Hutchinson sees the Cass Review’s call to bring gender-distressed young people back into mainstream thinking about child development as a necessary corrective.

We’re excited to invite you to attend our April webinar, led by clinical psychologist Dr. Libby Nugent, who will discuss Stories of Transformation: Fairy Tales as a Clinical Lens on Embodiment, Gender and Psychological Change.

Learn More

The webinar will explore how fairy tales and myths can function as symbolic scaffolds in psychotherapy, with particular attention to embodiment, transformation, and gender.

Participants will engage with recurring motifs through specific tales such as:

• The Ugly Duckling (misrecognition and belonging)

• The Handless Maiden (bodily wounding and reclamation)

• The Frog Prince (disgust, contact, and metamorphosis), and

• The Emperor’s New Clothes (legitimacy, conformity, and group process).

Drawing on psychodynamic, group analytic, and narrative approaches, the session considers how motifs such as exile, metamorphosis, disguise, and recognition can illuminate the ways bodily experience becomes meaningful within psychological life.

The workshop approaches the body as both materially real and psychologically lived. Rather than reducing distress to either biological or identity-based explanations, it introduces a symbolic perspective that supports clinicians in exploring how experiences of the body are shaped, interpreted, and communicated within relational and cultural contexts.

Fairy tales offer a language through which experiences of bodily difference, discomfort, and transformation can be explored without premature closure.

Participants will consider how symbolic thinking can support therapists in maintaining curiosity, tolerating ambiguity, and working thoughtfully with complex presentations involving gender and embodiment.

The session integrates contemporary research on gender-related distress and mental health with established psychological approaches to narrative, play, and symbolization, offering clinicians practical ways to apply these ideas in therapeutic work.

At its core, the workshop asks how the body can be understood not only in biological terms, but also as a place where experience, meaning, and relationship meet.

Tickets Here

Learning objectives

By the end of this webinar, participants will be able to:

1. Describe how narrative and symbolic processes (e.g., myth and fairy tale) contribute to the psychological experience of embodiment.

2. Identify key themes (e.g., bodily experience, belonging, relational context, and integration) in presentations of gender-related and body-related distress.

3. Apply a reflective, narrative-informed approach to clinical work that supports exploration of embodiment, meaning-making, and therapeutic dialogue.

Meet Dr. Libby Nugent

Dr. Libby Nugent is a Clinical Psychologist and Group Analyst whose work integrates psychodynamic, group analytic, and narrative approaches. Her interests include symbolic processes in groups, the role of language in shaping psychological experience, and the use of myth and fairy tale as clinical tools for engaging complexity.

She works across clinical, organisational, and teaching contexts, with a particular focus on how contemporary conditions can both support and constrain symbolic thought within therapeutic practice.

Her clinical work includes experience with complex trauma and embodied distress, informing her interest in how highly charged material can be thought about symbolically rather than prematurely resolved.

Who should come to the webinar?

Therapy First webinars are open to the public. Parents, clinicians, teachers, and interested people are all welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar. Please share this email with anyone you think might benefit from attending!

Therapy First Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Members.

Book Your Space

Therapy First is approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provides 1.5 hours of CE credits.

Much of the current conversation has framed these experiences as “transition regret.” Garcia-Ryan explains that this framing can be misleading because regret implies agency. It assumes that someone had a genuine choice. In medical systems that promote a single treatment option, that is not possible.

As Garcia-Ryan emphasizes, TRG is a newly emerging clinical issue. Our knowledge base is still developing and we do not yet have reliable ways to identify or measure how this grief is experienced or expressed. It reminds clinicians, researchers, and the broader healthcare community that the conversation about transition-related grief is just beginning and that understanding it will require humility and respect for the diversity of lived experiences.

You’re invited to join us on MONDAY MARCH 30TH AT 6PM ET for our latest webinar with clinical psychologist and Therapy First member, Dr. Lisa Anllo.

This webinar will draw attention to unmet needs relating to iatrogenic harm to sexual function for individuals who have a history of transgender identity and have received medical interventions that they later regret. Some of them choose to socially and medically detransition. In addition there are individuals who may similarly regret their medical transitions, but do not feel they are able to socially or medically detransition.

Grief is a normal reaction to a range of irreversible sexual side effects that are experienced as a form of medical trauma that many feel they were inadequately prepared for and had not anticipated.

Dr. Anllo will draw from the available research on detransition, personal accounts by detransitioners, and her clinical work with cancer survivors to make the comparison to the experience of coping with unanticipated and unacknowledged grief associated with iatrogenic harms of cancer treatment on sexual function. Much like cancer survivors, detransitioners who have shared their stories publicly report that they often struggle alone with significant trauma associated with loss of sexual function that is not routinely recognized within the medical or mental healthcare system. They deserve to be offered compassionate and trauma-informed care that is not currently accessible to them due to multiple barriers to care that will be highlighted.

Dr. Anllo will make the case that psychosexual recovery is a long-term process that will not restore what has been lost, but nonetheless can be facilitated via access to culturally informed and existentially focused psychotherapy to promote post-traumatic growth and healing.

Book Your Space

What will be covered?

Learning objectives for the webinar are:

1. Recognize potential adverse impacts of medical transition on sexual function and how they may contribute to psychological experiences of grief.

2. Identify obstacles to addressing needs for sexual rehabilitation among those who report being adversely impacted by medical transition including appropriateness of referrals for sexual medicine and reconstructive plastic surgery.

3. Describe a trauma-informed approach to caring for psychosexual issues among individuals with experience of medical transition that utilizes an existential framework in which cultural competence is paramount.

Meet Dr. Lisa Anllo

Dr. Anllo is a clinical psychologist in private practice in Buffalo NY. She has advanced training and nearly 30 years of experience in clinical sex therapy and couples therapy including gender-related challenges. She is also an expert in managing emotional distress and sexual side effects of cancer treatment and has provided educational presentations on this topic for both survivor support groups and healthcare professionals. She is the author of a peer reviewed article on sexual life after breast cancer and a book chapter on sexual life after breast and prostate cancer, and more recently has published a new article on the topic of sexuality after detransition.

Who should come to the webinar?

Therapy First webinars are open to the public. Parents, clinicians, teachers, and interested people are all welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar. Please share this email with anyone you think might benefit from attending!

Therapy First Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Members.

Tickets Here

Therapy First is approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provides 1.5 hours of CE credits.

Fa’afafine and muxe are neither raised as girls nor created as substitute daughters in families lacking female children; evidence shows they often have more older sisters than heterosexual men. They do not occupy institutionalized religious or specialized societal roles, though they exhibit individual preferences for people-oriented and aesthetic occupations similar to those favored by women and gay men in Western contexts. Dysphoria related to sexed bodies remains relatively uncommon in these societies, and body modifications, when pursued, are understood locally as enhancements rather than transformations into female sex or womanhood.

Applying modern Western transgender concepts to fa’afafine, muxe, and similar third-gender roles risks masking objective biological reality and conflating individual subjective experiences with shared cultural belief systems. While these groups enjoy significant social acceptance within their communities—including annual parades and celebrations—they face ordinary discrimination outside ceremonial contexts and are viewed as regular community members rather than revered or sanctified figures.

Careful anthropological documentation highlights the importance of distinguishing culturally specific gender frameworks from universal claims about transgender existence throughout history.

Follow Up

• Learn more about Professor Paul L. Vasey’s work here.

• Clinicians can join Therapy First for an annual membership fee of just $50. You’ll access monthly clinical case conferences, a supportive online community, a library of previous webinars such as this one with Professor Vasey, and early access to events - learn more here.

You’re invited to join us on Sunday February 22nd at 1pm EST for our latest webinar with Clinical Professor of Psychiatry Dr. Stephen B. Levine.

This webinar will be a 90-minute lecture and discussion describing the poles of disagreement about how psychotherapy should be purposed, constructed, and conducted for gender distressed youth.

The lecture will comprise approximately half of the session and will highlight the diversity of both psychotherapists and the young people they serve.

It will review ongoing clinical questions regarding the development and etiologies of gender distress and present a psychodynamic organizing hypothesis intended to help clinicians, patients, parents, and researchers.

It will conclude with cautious optimism about the power and limitations of psychotherapy in improving mental health and functioning for gender distressed youth.

BOOK YOUR SPACE

What will be covered?

Learning objectives for the webinar are:

1. Analyze developmental psychosocial antecedents that may impact youth who begin identifying as transgender.

2. Apply the understanding of this topic to understand the nature of psychodynamics in general.

3. Describe general transient characteristics of adolescents and how they predispose them to a creative escape from the pain of their existence.

Meet Stephen B. Levine M.D.

Dr. Levine is Clinical Professor of Psychiatry at Case Western Reserve University School of Medicine. He is the solo author of five books, Sex Is Not Simple in 1989 (translated to German in 1992 and reissued in English in 1997 as Solving Common Sexual Problems); Sexual Life: A clinician’s guide in 1992; Sexuality in Midlife in 1998 and Demystifying Love: Plain talk for the mental health professional in 2006; Barriers to Loving: A clinician’s perspective in 2013; Psychotherapeutic Approaches to Sexual Problems: An Essential Guide for Mental Health Professionals in 2020. He is the Senior Editor of the first (2003), second (2010) and third (2016) editions of the Handbook of Clinical Sexuality for Mental Health Professionals.

Dr. Levine has been teaching, providing clinical care, and writing since 1973 and has generated original research, invited papers, commentaries, chapters, and book reviews. He has served as a journal manuscript and book prospectus reviewer for many years. He was co-director of the Center for Marital and Sexual Health/ Levine, Risen & Associates, Inc. in Beachwood, Ohio from 1992-2017. He and two colleagues received a lifetime achievement Masters and Johnson’s Award from the Society for Sex Therapy and Research in March 2005. He was given his Department of Psychiatry’s Hall of Fame Award in 2021.

Who should come to the webinar?

Therapy First webinars are open to the public. Parents, clinicians, teachers, and interested people are all welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar. Please share this email with anyone you think might benefit from attending!

Therapy First Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Members.

TICKETS HERE

Therapy First is approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provides 1.5 hours of CE credits.

Dr. Julia Mason is a board-certified pediatrician and Fellow of the American Academy of Pediatrics. She is a graduate of the University of Illinois (MS in Nutritional Science, MD). She completed residency training in Pediatrics at Children’s Hospital Los Angeles.

Brain development in adolescence

Adolescence represents the second most intensive period of brain maturation after early childhood, with full prefrontal cortex development often extending into the mid-20s (and beyond age 30 in neurodiverse individuals).

Sex hormones play a role in synaptic pruning, myelination, and maturation of executive function, emotional regulation, and social cognition.

The limbic system matures earlier than the prefrontal cortex, resulting in heightened emotional volatility, novelty-seeking, and sensitivity to social rejection. Meanwhile, impulse control and the ability to evaluate long-term consequences remain underdeveloped.

This raises important questions regarding young people and their capacity for informed consent to irreversible medical intervention.

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ADHD and autism spectrum conditions

ADHD and autism spectrum conditions delay prefrontal maturation by years, and impair typical adolescent gains in executive function, social cognition, and emotional recognition.

Up to 25% of ADHD youth and 50–70% of autistic youth present with co-morbid conditions, which are likely to increase their vulnerability to identity-related distress.

In today’s cultural landscape, some neurodivergent youth appear to approach gender identity as an explanation for experiences of social struggle and emotional pain. While this can provide a sense of belonging and meaning, it also raises concerns about whether complex developmental needs are being simplified solely through an identity-based lens, with other issues being sidelined and unaddressed.

Evidence and the gender affirming medical treatment

Dr. Mason discusses registry data from Finland, which demonstrate that:

• Psychiatric comorbidities persist despite gender affirming medical treatment

• Suicide risk appears to track with the broader mental health challenges present in this population, rather than showing clear reduction following medical transition.

Dr Mason notes that major US pediatric guidelines are not based on systematic reviews of evidence that would support the prescription of puberty blockers and cross-sex hormones to minors (although some professionals have been calling for this since 2018).

Follow Up

• Clinicians can join Therapy First for an annual membership fee of just $50. You’ll access monthly clinical case conferences, a supportive online community, a library of previous webinars and early access to events - learn more here.

• If you’re a parent, request a referral for a therapist here.

This webinar explores cultural competence in psychotherapy with gender-distressed and gender-questioning youth, with a focus on how cultural, social, developmental, and professional contexts shape both distress and clinical responses. Cultural competence is understood not as a fixed body of knowledge, but as an ongoing, dynamic practice requiring awareness of positionality, power, bias, and wider societal narratives influencing young people and clinicians alike.

Drawing on developmental psychology, systemic thinking, and how the concept of cultural competence has developed in psychotherapy, the talk examines how factors such as intersectionality, generational culture, online and peer influences, professional ideologies, and minority stress might interact with gender-related distress. Particular attention is given to the risks of diagnostic overshadowing, the challenges posed by competing narratives about sex and gender, and the importance of maintaining clinical humility and therapeutic candor.

The webinar also addresses the contemporary mental health context, including increased youth distress, contested evidence bases, and the pressures clinicians face when working in a polarized and highly scrutinized field. Emphasis is placed on how culturally competent, developmentally informed psychotherapy can support thoughtful formulation, safeguard young people, and enable ethical, effective care without foreclosing exploration or outcomes.

Learning Objectives

By the end of this webinar, participants will be able to:

• Define and understand key terms relevant to ethical psychotherapeutic practice with gender-distressed and gender-questioning youth, including i) cultural competence, ii) cultural humility and iii) structural competence

• Identify key cultural, social, and developmental influences that might shape gender-related distress in young people, including i) intersectionality, ii) generational factors, and iii) minority stress.

• Apply principles of culturally competent formulation, including: i) consideration of therapist positionality, ii) the impact of our wider professional cultures, and iii) the risk of ‘diagnostic overshadowing’.

• Incorporate these principles into clinical practice with young people experiencing gender-related distress with the aim of ensuring psychotherapy is: i) respectful of and responsive to the dignity, autonomy, and diversity of the client group; ii) consistent with standard best practice; iii) developmentally informed; iv) transparent, allowing for informed consent; and v) adheres to relevant professional ethical guidelines.

BOOKINGS & INFO

Meet Dr. Anna Hutchinson

Dr. Anna Hutchinson is a Therapy First board member, and a clinical psychologist with 25 years of frontline experience, specializing in adolescent mental and physical health.

From 2013 to 2017, Anna was a senior clinician at the Tavistock Gender Identity Development Service (GIDS), which had become the world’s largest pediatric gender clinic prior to its closure in 2023.

In recent years, her work has focused on education and training addressing the complex needs of young people experiencing gender-related distress, including co-leading the induction training for the NHS Children and Young People’s Gender Service in collaboration with the Academy of Medical Royal Colleges.

She has presented internationally on psychotherapy for gender distressed youth, including at the American Academy of Child and Adolescent Psychiatry Annual Meeting, and her publications include Cass-Informed Psychotherapy for Gender-Distressed Youth in the European Journal of Developmental Psychology.

Who Should Attend the Webinar?

Therapy First webinars are open to the public. Parents, clinicians, teachers, and all those interested are welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar.

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provide 1.5 hours of CE credits.

Therapy First is approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

BOOK YOUR TICKET

We look forward to seeing you on Friday 30th January!

We have just published our Annual Report for 2025 and we invite you to read it here. The report charts our growth from a small group of concerned mental health professionals back in 2021, into a uniquely positioned organization making meaningful positive change in the profession.

What began as a simple conviction is now a movement of more than 400 dedicated mental health professionals, all committed to one guiding principle: that young people experiencing gender dysphoria deserve psychotherapy grounded in developmental psychology and the best available evidence.

These are some of the of the achievements detailed in the Report:

• In 2025, Therapy First hosted 12 professional webinars; 10 clinical case conferences; 96 peer supervision groups; and 48 membership meetings.

• We made an average of 60 direct referrals for families to therapists per month.

• We were approved by the American Psychological Association to sponsor continuing education for psychologists.

• We launched a new certificate training pilot designed for private practice clinicians seeking advanced skills in working with youth experiencing

  gender dysphoria.

• We delivered a new six week, nine hour training series for a large community mental health clinic, which serves as a model for trainings that can be done nationwide.

• And we brought a grounded perspective into public conversations by attending and presenting at conferences nationally and internationally, and continuing to be a go-to resource for journalists.

This work is only possible because of our many supporters who believe in protecting and promoting thoughtful clinical care, and who understand that respect and curiosity must guide us when supporting young people at their most vulnerable. We are so thankful for those of you who have helped us get here.

In 2026, we will be focusing on our ongoing mission to bring treatment approaches in line with developmental psychology and the best available evidence. To really shift the current trajectory, we must grow our core programs and build on our operational foundation to sustain our work.

This year we plan to grow our reach, provide more resources for clinicians and families; and, most importantly, increase our capacity to help meet the needs of youth experiencing gender dysphoria. If you’re interested in these plans, please do read the Annual Report in full.

Read our Annual Report

If you’d like to be more involved with our work, you can also:

• Join Therapy First (if you’re a mental health clinician)

• Make a donation to support our work.

• Request a therapist referral if you’re a concerned parent who believes your child needs support.

Thank you for reading, and we wish you all a happy and productive start to 2026.

Our last webinar for 2025 will be presented by our Executive Director, Paul Garcia-Ryan. Paul will provide a comprehensive overview of Transition-Related Grief (TRG), including the ways in which it is distinct from detransition, as well as the clinical themes involved in therapeutic work with those experiencing TRG.

Special attention will be given to the preparation clinicians need to work effectively in this area and the relevance of TRG to the mental health care provided to youth experiencing gender dysphoria.

Book Your Space

What will be covered?

Learning objectives for the webinar are:

1. Define Transition-Related Grief (TRG) and differentiate it from detransition and regret.

2. Explore the emotional, physical, and developmental challenges experienced by individuals facing TRG.

3. Recognize the therapist competencies required for effectively providing therapy to individuals experiencing TRG.

4. Understand implications of TRG on mental health care as it pertains to youth gender dysphoria.

Meet Paul Garcia-Ryan

Paul is the Executive Director of Therapy First and a licensed clinical social worker based in New York City. He earned his Master of Social Work from Hunter College’s Silberman School of Social Work and received advanced graduate training in LGBT behavioral health at Callen-Lorde Community Health Center. Paul has spoken and lectured both nationally and internationally on developmental approaches to youth gender dysphoria. He maintains a private practice, trains clinicians, and provides supervision in this specialized area of clinical care.

Who should come to the webinar?

Therapy First webinars are open to the public. Parents, clinicians, teachers, and interested people are all welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar. Please share this email with anyone you think might benefit from attending!

Therapy First Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Members.

Tickets Available Here

Therapy First is approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provides 1.5 hours of CE credits.

Self-reported doubts arise at every stage of this process, from initial questioning of one’s gender, through to post-surgical reflection. How communities respond to these doubts offers insight into the norms and expectations that guide conversation in these spaces.

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Concepts such as imposter syndrome and internalized stigma function as socially accepted ways to talk about concerns regarding dysphoria, the impact and efficacy of transition-related decisions, and the risks or limits of various interventions. These frameworks can be reassuring, yet they may also contain or redirect doubts that could challenge group norms or personal narratives.

Community members sometimes describe declining wellbeing as expected or typical, attributing distress to internalized stigma rather than to possible difficulties with interventions themselves. Alternative explanations for dysphoria tend to be minimized.

Clinicians are likely to meet clients who have spent substantial time in these online spaces. They can support such clients by recognizing the online experiences their clients may be having, by validating their distress, and by exploring the many possible contributors to dysphoria, which can foster broader, more adaptive identity development while meeting each client where they are, with dignity, and with respect for their particular experience.

Follow Up

• Attend our latest webinar with psychotherapist Claire Salisbury: “Untangling Gender: Exploring Identity with Clients Through a CBT Lens” - information and details here.

• Learn more about Sarah Mittermaier’s work: subscribe to her Substack here.

• Clinicians can join Therapy First for an annual membership fee of just $50. You’ll access monthly clinical case conferences, a supportive online community, a library of previous webinars and early access to events - learn more here.

A client shares with you in session that they are questioning their gender identity…now what? This webinar is designed to provide you, the clinician, with insight, guidance and practical tools to help your clients explore their gender identity.

Drawing on over a decade of clinical experience leading a psychotherapy private practice focused on gender identity and grounded in a cognitive behavioral therapy (CBT) framework, Claire shares her knowledge and insight as to how you can hold space for a client exploring the question, “am I trans?”.

Tickets & Info

This webinar will provide attendees with a variety of resources that could be integrated immediately into practice. Attendees are assumed to have at least a basic-level understanding of various terms and concepts related to gender and sexuality to get the most out of this webinar. No training in CBT is required.

What will be covered?

1. Review treatment approaches to working with gender dysphoria, from a historical, political, and practical lens.

2. Understand how a CBT-based approach can facilitate the process of gender identity and presentation exploration.

3. Learn specific points of discussion, areas of psychoeducation, and handouts to review in session that provide opportunities for further exploration of gender identity.

4. Explore how to discuss the feeling of gender dysphoria with a client – including measuring the experience, the feeling versus the diagnosis, and differentiating dysphoria from dysmorphia.

Meet Claire Salisbury

Claire Salisbury, MSc (Clinical Psychology), RP, CCC is a Canadian-based, Registered Psychotherapist specializing in the areas of gender identity and sexuality. Her private practice focuses on providing psychotherapy for trans and gender questioning individuals across the lifespan, as well as working with family members (parents, siblings, partners) who may be struggling with a loved one’s gender exploration and (potential) transition.

Employing an evidence-based, cognitive-behavioural (CBT) lens to her approach, Claire’s clinical work extends to knowledge dissemination through the provision of peer consultation and talks focused on gender identity/dysphoria. Operating out of Southern Ontario, she recently served as a panel member for the inaugural Ontario Health West 2SLGBTQIA+ Health Forum in 2024, and served on her alma mater, Western University’s, Trans Care Team overseeing mental health care for undergraduate and graduate students.

Who should come to the webinar?

Therapy First webinars are open to the public. Parents, clinicians, teachers, and interested people are all welcome to attend. Psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar.

Therapy First Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join HERE.

Webinar tickets are $20, or $10 for Therapy First members.

Tickets Available Here

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provide 1.5 hours of CE credits.

Therapy First is approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

Our October webinar will address The Distinction Between Conversion Therapy and Psychotherapy for Those Experiencing Gender Dysphoria.

We’re also pleased to share with our members and supporters that Therapy First is now approved by the American Psychological Association to sponsor continuing education for psychologists. Therapy First maintains responsibility for this program and its content.

This means that both psychologists and professional counselors are eligible to earn 1.5 CE credits for participating in the live webinar. Members of the public - whether parents, clinicians, teachers, or interested people - are also very welcome to attend all Therapy First webinars.

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What will the webinar cover?

Psychiatry has a problematic history in terms of its approach to homosexuality. This history is often invoked as a warning that we must not make the same mistakes in the way we respond to people experiencing gender dysphoria and those who identify as trans.

A brief review of the 20th-century psychoanalytic approach to homosexuality will show how psychoanalysis was used as a form of conversion therapy for individuals with same-sex attraction.

This historical context will highlight the important differences between contemporary psychotherapy for those experiencing gender dysphoria, and practices historically associated with gay conversion therapy.

The presentation will consider how therapists might best work with individuals who are struggling with ambivalently held parts of the self, whether related to same-sex desire or gender.

Depth psychotherapies aim to support the acceptance and integration of parts of the self that are unwanted or difficult to tolerate. Concerns have been raised that the gender affirming model may inadvertently preclude this process of integration by reinforcing internal divisions. This possibility warrants serious professional consideration.

Finally, the presentation will reflect on how professional certainty and arrogance, coupled with the rejection of science, have historically led to harm for many homosexual and bisexual people. If similar dynamics are at play today, then without careful reflection, the mental health field is at risk of repeating the very harms it is eager to avoid.

Learning objectives

Learning objectives for the webinar are:

• Identify and summarize historical factors in psychiatry’s treatment of homosexuality, including the ways in which psychoanalysis was used as a form of conversion therapy.

• Differentiate between historical conversion therapy practices and contemporary psychotherapeutic approaches for individuals experiencing gender dysphoria.

• Explain the basic goals of psychotherapeutic work with people with ambivalently held parts of the self and how the gender affirming model can work against good psychological outcomes.

• Compare the response of mainstream psychiatry to homosexuality with its current refusal to acknowledge the weak evidence base for gender affirming medical treatments

Meet Dr Roberto D’Angelo

Dr. Roberto D’Angelo is a training and supervising analyst at the Institute of Contemporary Psychoanalysis, Los Angeles. He has written and contributed to publications raising ethical questions about gender-affirming therapies. Dr. D’Angelo has an interest in non-medicalized approaches to gender issues and has written about the psychotherapeutic treatment of gender dysphoria. He is in private practice in Sydney and Byron Bay, Australia, where he sees adolescents and adults with gender issues.

How Do I Attend the Webinar?

Therapy First webinars are open to the public - just buy your ticket on our website and you’ll be sent a Zoom link prior to the event. Therapy First Professional Level Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Professional members - buy your tickets by clicking the button below.

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We look forward to seeing you on Saturday October 25th!

Welcome to our summary of new developments and insights in the field of pediatric gender medicine. We’ve tried to highlight here the most substantive, practical and helpful contributions - we particularly recommend the first article below for clinicians and families seeking a deeper understanding of how a child develops gender dysphoria.

Can we better understand trans identity development?

Dame Hilary Cass stated in her seminal review for NHS England that “there are many pathways into gender dysphoria and many pathways out”. Given its connection to gender dysphoria, considering how trans identity develops for a young person can offer valuable insight for clinicians working with young people navigating this form of distress.

Psychiatrists Jillian Spencer, Roberto d’Angelo and Patrick Clark made an important contribution to this task with their August 2025 paper “Formulation concepts in the care of children and adolescents identifying as transgender or gender diverse”.

The authors present seven factors they suggest inform trans identity development in youth:

• Body dissatisfaction - young people identifying as trans “frequently express hatred, disgust or shame about aspects of their body...In the authors’ experience, trans identification can provide an explanation which makes sense of this distress...”

• Social reinforcement and the online world - “a trans identity can provide entry to a welcoming online social network”.

• Gender non-conformity and homophobia - “...homophobia remains prominent in schools. Adolescents struggling with discomfort or shame about same-sex attraction may pursue gender transition to avoid homosexuality”.

• Political trans identification - “A trans identification may be considered part of a social justice movement which seeks to undermine traditional power structures of ‘cisheteronormativity’”.

• Adverse childhood experiences - “Trans identification can be a way for adolescents to make sense of traumatic sequelae...The body becomes the source of distress and the solution therefore involves eliminating aspects of the body that feel ‘wrong’”.

• Autism-spectrum disorders - “Autistic traits may also lead to rigidity in thinking, and reduced abstract thinking, which may make a child or adolescent susceptible to viewing gender stereotypes quite literally, for example, ‘I don’t like traditional masculine activities, so I must not be a boy’”.

• Family dynamics - “Parents’ individual psychologies and developmental histories may be a contributing factor to how their children experience gender”.

The paper is available here: “Formulation concepts in the care of children and adolescents identifying as transgender or gender diverse”, Jillian Spencer, Roberto d’Angelo and Patrick Clark, Australasian Psychiatry, August 2025.

How stable are the gender identities of young children?

The latest results from the longitudinal TransYouth Project suggest one in five children who transition change their mind. Whilst the majority of children in the study had stable gender identities, the one fifth who did not reinforce the need for caution.

The Economist reported that this also complicated another finding of the project. An earlier study, from 2022, found just 7% experienced change in gender identity over a 5-year period. The two studies, read together, suggest that over time an increasing proportion of children will develop different feelings about their gender identities. Dr Stephen Levine told The Economist, “The longer the observation, the greater the instability”.

Read the results here: “Stability and Change in Gender Identity and Sexual Orientation Across Childhood and Adolescence”, Benjamin E. deMayo et al., Monographs of the Society for Research in Child Development, August 2025.

Read The Economist’s analysis here: “How stable are the gender identities of younger children?” 9/18/2025.

Why has Finland moved away from the gender affirming model?

Finland offers the rest of the world a template for meaningful action based on evidence, not ideology. Gender identity assessments have been available there since 2011, sometimes leading to medical transition for minors. Data showed, however, that outcomes for medical transition were “more modest than anticipated, despite internationally optimistic expectations”. At the same time, the numbers seeking these medical treatments escalated.

In a context of weak evidence and increased demand, Finland issued new national guidelines in 2020, which “designate psychosocial interventions as the primary approach to treating gender dysphoria (GD) among minors”.

Read Dr Riittakerttu Kaltiala’s account of Finland’s experiences here: “Medical gender reassignment in minors – why are we cautious in Finland?”, Riittakerttu Kaltiala, European Journal of Developmental Psychology, July 2025.

The vulnerability of children in foster care

Children who live with parents or family have adult advocates as they negotiate the treatment of their gender dysphoria. Those in the care system are more vulnerable, and far more likely to have experienced abuse, neglect and other mental health issues.

They are also more likely to be referred to gender clinics. The London-based Policy Exchange has produced a new report stating that 4.9% of referrals to England’s national gender identity clinic were children from the care system, whilst those children made up just 0.58% of the general population.

This new report suggests young people from the care system are not being effectively protected. The authors state:

The care system is failing gender questioning children…the most vulnerable children in the country are being failed by the authorities entrusted with their care… Local authorities are outsourcing the development of guidance to activist groups or allowing a child to transition without consulting anyone…We must urgently reform the way we safeguard gender questioning children in care.

You can read the report here: “In Absentia Parentis: How the care system has become captured by Gender Ideology”, Policy Exchange, London, 2025.

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Medical treatments for non-binary children

As the gender affirming model has taken hold in society and medicine, it has presented numerous challenges and contradictions for even its supporters to grapple with. One of the more concerning of these is an emerging demand for puberty blockers and hormones from children who identify as non-binary.

Scotland’s youth gender clinic, the Sandyford Clinic in Glasgow, recently reported that it is struggling to deal with the surging numbers of children who identify as neither male nor female. An anonymous health professional told The Times:

We’re following a 2012 protocol that doesn’t talk at all about non-binary people, which is actually becoming a much bigger proportion of our cases. ...And [there are] non-binary people asking for hormones, but of course hormones are only either feminising or masculinising. So how does that fit for a person who identifies as non-binary?”

You can read the article here: “Gender clinic struggling with rise in non-binary children”, The Times, August 7 2025.

An increased risk of kidney stones

When young people are treated medically for gender dysphoria, they incur significantly higher medical risks that can persist throughout their lives. The latest in a long list of health concerns is a higher chance of suffering from kidney stones.

New research has found that males on feminizing hormones face more than double the risk of kidney stones. 10.3% of males taking these hormones experienced kidney stones, compared to 4.8% of the those who were not. The risk was 2.5 times higher for males taking both estrogen and antiandrogens.

You can read the research here: E. Frangopoulos, Z. Savin, K. Gupta, V. Durbhakula, B. Gallante, W.M Atallah, & M. Gupta (2025), “Increased Risk of Kidney Stones in Transgender Women and Gender-Diverse Adults on Gender-Affirming Hormone Therapy: Insights from a Large Database Study”, Journal of Endourology.

If you’d like to be more involved with Therapy First and our work, you can:

• Join Therapy First (if you’re a mental health clinician), or

• Find a Therapist using our Directory, if you’re a concerned parent.

Thank you for reading, and we wish you all a happy and productive start to the fall!

Developing cognitive flexibility has long been a cornerstone in therapeutic work, as it enhances resilience and the ability to adapt to change, and clinicians have found it to be of particular importance for youth at this time.

Many therapists working in this field find themselves navigating challenges posed by the rigid narratives and social pressures surrounding gender-affirming medical treatments.

Now more than ever, therapists must strive towards creating a safe, empathetic environment that maintains therapeutic neutrality and prioritizes psychological needs and a client-centered process.

This is a disorienting and painful time for many young people and their families, as well as for therapists navigating a rapidly shifting and politically charged landscape. In the midst of cultural and clinical uncertainty, the therapeutic relationship remains a vital anchor.

One of the most meaningful contributions clinicians can offer is to hold space for nuance, for discomfort, and for exploration, without rushing to categorize or resolve. Amid the noise outside the therapy office, therapists continue the quiet work of listening, validating, and being present with what is.

If you’re a mental health clinician and have found this video helpful, please consider signing up as a Therapy First member at therapyfirst.org/join. Families in search of a therapist can get in touch via our contact form here.

At our upcoming September webinar, Professor Paul L. Vasey will explore the variety of ways in which male same-sex sexuality is expressed and conceptualized cross-culturally, and what aspects of this might be universal.

Professor Vasey's talk will examine how male same-sex sexuality is expressed and conceptualized in two different cultures, Samoa and among the Istmo Zapotec in Oaxaca, Mexico, contrasting this with Euro-American culture.

Book Your Ticket

Meet Professor Paul L. Vasey

Paul L. Vasey is a Professor and Research Chair at the University of Lethbridge. His research focuses on sexual orientation, sex differences, and gender diversity from a comparative perspective.

He has conducted long-term research on female homosexual behavior in Japanese macaques from Arahiyama, Japan. For over two decades he has also conducted fieldwork in Samoa, where he works with a group of feminine, same-sex attracted males, known locally as fa’afafine.

In 2015, he launched yet another field-site in the Istmo region of Oaxaca, Mexico, where he works with another group of feminine, same-sex attracted males, known locally as muxes.

He has published well over 100 refereed articles in journals such as Archives of Sexual Behavior, Proceedings of the National Academy of Science and Proceedings of the Royal Society. He is funded by Canada’s social science (SSHRC) and natural science (NSERC) research agencies. His work has been featured in hundreds of newspapers and magazines such as The New York Times and Oprah, as well as in various documentaries such as National Geographic and Discovery Channel.

Who Should Come to the Webinar?

Therapy First members, clinicians, parents, teachers and interested people are all welcome to attend all Therapy First webinars. Please share this email with anyone you think might benefit from attending!

Therapy First Professional Level Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Professional members.

Book Your Ticket

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provides 1.5 hours of CE credits.

Please join us this MONDAY 11 AUGUST at 4pm EDT for the latest in our Therapy First webinar series.

This webinar will review the history of what people have believed about estrogen and testosterone, how they acted on those beliefs, how those beliefs changed over time, and how we arrived at the beliefs commonly held today.

Drawing from his book, Sex Science Self: A Social History of Estrogen, Testosterone, and Identity, Bob Ostertag will trace the often overlooked story of how estrogen and testosterone became powerful pharmaceutical tools, and how they came to be deeply entangled with ideas of gender and sexuality.

Tickets Here

What will be covered?

Learning objectives for the webinar include:

• The long history of medical scandals involving estrogen and testosterone

• How estrogen and testosterone have been used to treat homosexuality

• How estrogen and testosterone have been seen and used by the LGBT community

• The role of estrogen and testosterone in the creation of Big Pharma

Meet Bob Ostertag

Bob Ostertag is an author, musician, and filmmaker whose interdisciplinary work spans journalism, music, and social issues. He is the author of Sex Science Self: A Social History of Estrogen and Testosterone, among six other books, and began his career reporting on the civil war in El Salvador in the 1980s.

As a composer and performer, he has collaborated with artists such as the Kronos Quartet, John Zorn, and Justin Vivian Bond, and has performed at major venues including Lincoln Center and the Shanghai Conservatory. He directed the documentary Thanks to Hank and was a founding member of the media collective The Yes Men.

His recent work includes podcasts on poverty and queer oral history, along with volunteer efforts with grassroots organizations in Mexico and Indonesia.

Who Should Come to the Webinar?

Therapy First members, clinicians, parents, teachers and interested people are all welcome to attend. Please share this with anyone you think might benefit from attending!

Therapy First Professional Level Members attend at a discounted price, and have access to recordings of all our previous webinars in the Therapy First Community. Membership is open to clinicians from any country, and is just USD$50 per year. Apply to join here.

Webinar tickets are $20, or $10 for Therapy First Professional members.

Webinar Tickets Here

Therapy First has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7505. Programs that do not qualify for NBCC credit are clearly identified. Therapy First is solely responsible for all aspects of the programs. This webinar provides 1.5 hours of CE credits.

This is a disorienting and painful time for many young people and their families, as well as for therapists now navigating a rapidly shifting and politically charged environment. In response to pressure from the Trump administration, including executive orders, funding threats, and legal action, a growing number of pediatric gender clinics across the United States are either fully shutting down or significantly reducing medical interventions–puberty blockers, cross-sex hormones, and surgeries–for youth experiencing gender dysphoria. 

Perhaps most notably, Children’s Hospital Los Angeles has closed its Center for Transyouth Health and Development entirely. This clinic was among the oldest and largest of its kind in the country. Others, including Yale New Haven Hospital, Stanford Medicine, and Children’s National Hospital in D.C., have sharply curtailed services.

The scale and speed of these changes are unprecedented in healthcare. But so too was the rapid evolution of “gender-affirming” medical interventions for youth in the United States. Based on a protocol developed in the Netherlands and introduced to the United States in 2007 with the opening of the first pediatric gender clinic at Boston Children’s Hospital, what began as the “Dutch Protocol” quickly evolved into what is now known as the gender-affirming model—a model that was adopted widely without the standard set of developmental or diagnostic safeguards typically required in pediatric care. 

At Therapy First, we have long recognized that the gender-affirming model is inadequate to meet the complexity of youth gender dysphoria and the developmental and mental health needs of children, adolescents, and young adults. Those presenting with gender-related distress are, first and foremost, individuals deserving the same evidence-based, ethical, and personalized approach that defines responsible care in every other area of youth mental health. 

Now that hospitals are scaling back these medical interventions, the mental health field is being asked to step in. It will face growing pressure, heightened scrutiny, and an urgent need to respond. This moment will test the field and its capacity to reflect on its own practices, acknowledge missteps, and undertake the difficult work of systems-level recalibration. 

We are closely monitoring these developments and remain committed to helping lead the national mental health response to youth with gender dysphoria. We recognize that this is a time of great uncertainty and distress for families whose children sought help from gender clinics. We will continue building bridges in the field, training clinicians, supporting families, and working to raise standards of care so that treatment is individualized, developmentally appropriate, and grounded in dignity and respect. 

Clinicians are invited to join as a member at therapyfirst.org/join

Inquiries from families seeking therapy referrals, clinics and schools in need of training, and members of the media can be directed to therapyfirst.org/contact 

Paul Garcia-Ryan, Executive Director, Therapy First

Highly differentiated individuals maintain clarity in their thinking, pursue personal goals, and foster intimate relationships without being swayed by approval or rejection.

This concept, often misunderstood as aloofness, actually enables deeper emotional connections while preserving autonomy, making it essential for therapists, counselors, and individuals interested in emotional maturity and mental health.

In clinical settings, particularly when addressing challenges like gender dysphoria, differentiation of self guides individuals to act from their principles rather than anxiety-driven reactions.

In Bowen family systems theory, psychotherapists are referred to as coaches. Clinicians using Bowen theory focus on helping clients modify their own behaviors within family systems, emphasizing systems thinking over cause-and-effect perspectives.

By working on their own emotional maturity, often within their family of origin, clients learn to tolerate short-term tension for long-term stability, fostering healthier relationships and personal growth.

Bowen theory views individuals within the context of their family systems, both nuclear and extended, assessing family functioning through dimensions like resourcefulness, connection, tension management, systems thinking, and goal structure.

Clinicians must also work on their own differentiation, gaining objectivity about their family dynamics to better support clients. This approach helps therapists guide families toward more mature responses, enhancing overall family functioning and individual well-being, making it a valuable framework for mental health professionals and families alike.

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