Introduction
There is a type of loss that does not involve death, yet makes individuals who face it suffer. This loss is called ambiguous, and it may occur in instances of surrogacy, divorce, adoption, and gender transition. The latter is highly complex, with many parents unable to cope without professional help. Therefore, there is a need for such parents to engage in group therapy to manage their psychological state.
Grief and Bereavement within the Field of Counselling
The area of interest is the grief and bereavement of the parents whose children are transitioning gender. The subcategory of an ambiguous loss to which the selected issue belongs is psychological absence with physical presence (Boss, 2020). Such a loss is ongoing and may persist for the rest of the parents’ lives, even though the moment of coming out is time-limited (Harris, 2020).
The realization of a constant need to adjust to the experience that they did not wish for and did not expect makes the parents of transitioning children highly vulnerable (Harris, 2020). Such a kind of loss leads to grieving over one’s “shattered hopes and dreams” and may be non-finite (Germany, 2020, p. 300). Hence, counselors must help such parents.
Common Approaches to Groupwork in the Area of Grief and Bereavement
The practices utilized to work with groups dealing with the selected type of ambiguous loss include creating a safe and inclusive space, expert help and professional guidance, open dialogue, cultural sensitivity, and resource sharing. Common affirming interventions include providing psychoeducation, encouraging parents to share their stories, using multiple support modalities, and connecting with community resources (Malpas et al., 2022). It is necessary to highlight the protective power of family acceptance explicitly.
Scholars note that transgender children frequently face stigmatization, which very often comes from their closest family, including parents (Abreu et al., 2019). Family rejection is considered to have the most detrimental effect on transgender youths (Pullen Sansfaçon et al., 2019). Parents often do not know where to start upon realizing that many things are going to change in their and their child’s lives(Germany et al., 2020). Therefore, it is the ultimate goal of a counselor to help parents cope with their ambiguous loss so that they can maintain positive relationships and avoid the destruction of their child’s personality.
The most viable approaches for groupwork sessions are offering relevant psychoeducation, giving families space to express reactions to their child’s transition, and explaining the protective benefits of family acceptance. As evidenced by the research of Malpas et al. (2022), the chosen practices have the potential to help parents of transitioning children cope with their apprehensions. Furthermore, these approaches can mitigate misunderstandings within the family stemming from ambiguous loss.
By offering psychoeducation, the group counselor will enable parents to understand that they are not alone in their situation and that there is nothing wrong with their child. Frequently, parents are unable or unwilling to accept and embrace the changes occurring in their child’s life. However, without their support, the child will not be able to gain access to the necessary medications for hormone therapy or, ultimately, to gender-affirming surgery (Germany et al., 2020). Hence, offering parents relevant educational materials in a calm, reassuring, and comfortable manner can be a real life-changer for many transitioning children.
Allowing parents to share and exchange their experiences is another beneficial approach, as it enables them to see they are not alone and to seek support from one another. Having someone to relate one’s experience to is of utmost importance in counselling practice (Malpas et al., 2022). Finally, there is a need to explain the overarching benefits of family support for the transitioning children’s present and future. Without such support, they are bound to lead a life full of rejection and isolation (Malpas et al., 2022). The three approaches that will form the core of the groupwork plan will help instill understanding among parents and promote their acceptance of transitioning children.
The chosen practices do not seem to have any limitations; when used properly, they will yield positive outcomes for parents and, ultimately, for their families’ dynamics. However, it is necessary to consider that some parents may be too obstinate to face the challenge of change and may provoke others to follow their lead. To address this potential limitation, the group counselor should carefully monitor each participant’s behavior during sessions and prevent any outbursts of negative statements.
The three selected approaches are designed to meet the principles of social justice, inclusivity, and equity. The principle of social justice will be pursued as the acceptance of transgender children by their families will allow them to have equal access to the services they need. Transgender children’s human rights and anti-discrimination policies will also be bolstered by this principle. Meanwhile, inclusivity will ensure the acceptance of the identity of transgender individuals and promote their representation in various processes. Finally, the equity principle will be manifested through intersectionality, fair treatment, and elimination of disparities.
Managing Cultural Sensitivity
The work in the sphere of psychological counselling is quite challenging, but these challenges can be further exacerbated by various factors, including the specific area or culturally sensitive clients. The specialist needs to consider all aspects of the group members to anticipate potential cultural sensitivity issues and prevent them. A significant step in this process is identifying the population’s characteristics (Perera et al., 2020).
No less crucial are the processes of pinpointing the components for adaptation and verifying them. It is necessary to take into account the dynamic intercommunication between the person or group in psychotherapy and the context of the sessions. In fact, scholars emphasize that all psychotherapy should be centered on the cultural features of individuals and groups (Lee et al., 2021). This approach promotes the alleviation of clients’ suffering and enables better empowerment.
Potential Ethical and Legal Issues
The field of psychology is highly sensitive in terms of fulfilling numerous ethical obligations and adhering to principles. Guided by the Australian Counselling Association’s (ACA, 2022) Code of Ethics, counselors are to fulfill their responsibilities to clients, be careful on social media, and ensure that all their practices are anti-discriminatory. Above all, psychologists must ensure their clients’ confidentiality is maintained at all stages of collaboration (ACA, 2022).
Significant ethical and legal challenges that can arise in group counselling include a lack of informed consent, breaches of confidentiality, and poor management of group dynamics (ACA, 2022). To eliminate these threats, the counselor should outline the goals and expectations of the sessions in the informed consent form and ask all clients to sign it before engaging in therapy. Also, the therapist must establish clear confidentiality guidelines and ensure that each group member understands and agrees to follow them. Finally, it is essential to screen group participants and track their progress to be fully aware of any disruptions or conflicts in the group.
The Use of Technology
The growing expansion of technology into all spheres of people’s lives, communication, and professional activities has not left the field of psychotherapy untouched. Counselors consider technologies to be helpful in their work, provided they are thoughtfully selected and effectively implemented (Nagarajan & Patil, 2019). The so-called blended care, which combines face-to-face treatment with technology, is gaining increasing attention in the field of psychology (Bagarić & Jokić-Begić, 2020). In the present group counselling sessions, technology can be introduced through slides with additional information presented via a projector, regular emails to clients, and video conferencing.
Sending emails to clients is the best way to keep them updated on the session schedule, to address any concerns they might have, and to receive timely feedback that does not require an immediate answer. Emails can be sent regularly, such as on the same day of the week, to promote consistency and structure. The projector will be utilised during in-class meetings to illustrate additional material, such as numerical data, graphs, pictures, and other material that cannot be presented orally or is challenging to comprehend without visual support. Finally, video conferencing can be used when some clients cannot attend the group session but do not want to miss it, or when weather conditions are bad, and all participants want to join online.
Confidentiality will be maintained by carefully checking email addresses and ensuring that only group members join video conferences. In the event of a projector breakdown, handouts will be provided. When the internet connection is poor or unavailable, and a video conference cannot be held, the group will set a date that suits everyone to make up for the missed session.
Conclusion
Grief and bereavement of the parents who encountered an ambiguous loss associated with their child’s gender transitioning require special attention and treatment. Group counselling is an excellent means for such parents to cope with their issues. They can meet individuals with similar experiences and exchange their apprehensions and feelings. Above all, the group counselor’s careful planning of each session will help such parents to manage their grief over the ambiguous loss.
References
Abreu, R. L., Rosenkrantz, D. E., Ryser-Oatman, J. T., Rostosky, S. S., & Riggle, E. D. B. (2019). Parental reactions to transgender and gender diverse children: A literature review. Journal of GLBT Family Studies, 15(5), 461-485.
Australian Counselling Association. (2022). Code of ethics and practice of the Australian Counselling Association.
Bagarić, B., & Jokić-Begić, N. (2020). Measuring therapists’ attitudes toward integration of technology in psychotherapy and predicting their use of technology. Journal of Clinical Psychology, 76(6), 1151-1172.
Boss, P. (2020). Understanding and treating the unresolved grief of ambiguous loss: A research-based theory to guide therapists and counselors. In D. L. Harris (Ed.), Non-death loss and grief: Context and clinical implications (pp. 73-79). Routledge.
Germany, M.-L. (2020). Where’s the grief in non-death loss research? In D. L. Harris (Ed.), Non-death loss and grief: Context and clinical implications (pp. 297-311). Routledge.
Germany, M.-L., Pederson, A. C., & Bridges, S. K. (2020). Ambiguous loss in coming out and trans*itioning. In D. L. Harris (Ed.), Non-death loss and grief: Context and clinical implications (pp. 112-127). Routledge.
Harris, D. L. (2020). Nonfinite loss: Living with ongoing loss and grief. In D. L. Harris (Ed.), Non-death loss and grief: Context and clinical implications (pp. 139-146). Routledge.
Lee, E., Greenblatt, A., & Hu, R. (2021). A knowledge synthesis of cross-cultural psychotherapy research: A critical review. Journal of Cross-Cultural Psychology, 52(6), 511-532.
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.
Nagarajan, M., & Patil, Y. S. (2019). Mental health counsellors’ perceptions on use of technology in counselling. Current Psychology, 40, 1760-1766.
Perera, C., Salamanca-Sanabria, A., Caballero-Bernal, J., Feldman, L., Hansen, M., Bird, M., Hansen, P., Dinesen, C., Wiedemann, N., & Vallières, F. (2020). No implementation without cultural adaptation: A process for culturally adapting low-intensity psychological interventions in humanitarian settings. Conflict and Health, 14.
Pullen Sansfaçon, A., Kirichenko, V., Holmes, C., Feder, S., Lawson, M. L., Ghosh, S, Ducharme, J., Temple Newhook, J., & Suerich-Gulick, F. (2019). Parents’ journeys to acceptance and support of gender-diverse and trans children and youth. Journal of Family Issues, 41(8).
Appendix: Group Development Plan
Session 1: Introduction and Building Trust
- Introducing group members
- Establishing a confidential environment
- Building trust within the group
- Sharing experiences
- Providing psychoeducation on gender identity
Session 2: Learning to Discern and Process Emotions
- Arranging a platform for parents to share emotions
- Fostering empathy and understanding
- Homework discussion: checking reflections
- Discerning common topics and issues of concern
Session 3: Family Dynamics and Communication
- Discussing the influence of a child’s gender transition on the family
- Sharing challenges and successes
Session 4: Advocacy and Navigating Challenges
- Providing empowerment
- Checking communication exercises
- Overviewing educational and legal rights of transgender children
- Homework: a self-advocacy exercise
Session 5: Building an Accepting and Supporting Community
- Checking homework
- Discussing the role of community support
- Collaborative exercises for group members
Session 6: Reflecting and Moving Forward
- Summing up and reflecting on the progress
- Providing resources for further support
- Sharing steps for the future
- Expressing gratitude for participation and sincerity.