Incorporating Radical Healing and Addressing Internalized Transnegativity in Psychotherapy for Two-Spirit, Transgender, and Nonbinary People of Color

For Two-Spirit, transgender, and nonbinary Black and Brown people of color, mental health care does not unfold in a social vacuum. Experiences of racialized transphobia, discrimination, and chronic marginalization shape psychological distress and influence whether therapy feels affirming or harmful. Traditional therapeutic models that bracket sociopolitical context risk overlooking central mechanisms of suffering. The empirical question, then, is not only whether therapy reduces symptoms, but whether it addresses internalized stigma and oppression-based stress in culturally grounded ways.

In the MRI-funded project Incorporating Radical Healing and Addressing Internalized Transnegativity in Psychotherapy for Two-Spirit, Transgender, and Nonbinary People of Color: An Open Clinical Trial, Dr. Stephanie Budge (University of Wisconsin–Madison) evaluates a psychotherapy model designed explicitly for this purpose. The intervention, Healing through Ongoing Psychological Empowerment (HOPE), integrates radical healing principles with strategies to reduce internalized transnegativity and foster critical consciousness.

The study employed a mixed-methods open clinical trial with 49 Two-Spirit, transgender, and nonbinary people of color who participated in up to 15 sessions of psychotherapy. Therapists were licensed clinicians with intersecting marginalized identities, enhancing cultural attunement and shared contextual understanding. Qualitative interviews conducted pre-treatment, post-treatment, and at six-month follow-up explored therapy goals, lived experiences of change, and prior encounters with mental health care.

Participants articulated goals extending beyond symptom reduction, including cultivating authenticity, deepening self-acceptance, repairing relational wounds, strengthening coping strategies, and actively resisting oppressive narratives. These aims underscore that identity affirmation and sociopolitical analysis are central—not peripheral—to well-being.

Qualitative analyses identified two primary mechanisms of change. First, therapist validation grounded in shared identity and critical awareness fostered safety and relational trust. Second, participants described developing their own critical consciousness, reframing distress as situated within systemic racism and transphobia rather than personal deficiency. This shift facilitated self-compassion and empowerment, reducing internalized stigma.

The study also documented prior therapeutic harms, particularly when clinicians failed to acknowledge race and gender or adopted ostensibly neutral stances that minimized structural oppression. These findings reinforce the necessity of clinician training that explicitly addresses intersectional stress and internalized stigma.

By integrating radical healing theory with empirical evaluation, this MRI-supported project advances culturally responsive psychotherapy science. The work offers a theoretically grounded and practice-informed framework for training clinicians, informing future controlled trials, and strengthening pathways to affirming, contextually attuned mental health care for Two-Spirit, transgender, and nonbinary people of color.