Incorporating Radical Healing and Addressing Internalized Transnegativity in Psychotherapy for Two Spirit, Transgender, and Nonbinary People of Color: An Open Clinical Trial

Mental health care often fails the people who need it most—especially Two Spirit, transgender, and nonbinary (2STNB) People of Color (POC), who face compounded barriers rooted in racism, transphobia, and systemic neglect. The Trans CARE Collaborative is changing that narrative through an innovative, community-centered psychotherapy trial that centers radical healing and challenges internalized stigma.

From 2022 to 2023, the team trained 2STNB POC therapists across the U.S. in a tailored intervention called HOPE (Healing through Ongoing Psychological Empowerment). These therapists provided up to 15 sessions of culturally responsive therapy to 49 2STNB POC clients—achieving zero dropouts. Participants engaged in pre-, post-, and follow-up assessments to track change and evaluate how therapy impacted their mental health, self-perception, and access to care.

Dr. Stephanie Budge of The University of Wisconsin-Madison is using an MRI grant to carry out the next phase of the project, exploring deeper questions such as:

  • What systemic and interpersonal barriers block access to affirming mental health services?

  • How do clients describe the psychological change they experienced in this uniquely affirming therapy model?

  • What clinical strategies best address oppression-related stress?

Using qualitative interviews, thematic analysis, and observational coding of therapy sessions, the research team will examine what healing really looks like when power, identity, and justice are centered in clinical work.

This project doesn't just fill a massive gap in the literature—it also points toward a future where 2STNB POC can access affirming, effective, and transformative care. With plans for new PCORI-funded studies, therapist trainings, and community resources, the Trans CARE Collaborative is building not only knowledge, but also capacity and care infrastructures for a more fair and healing mental health system.

Sophie Suberville