Impact | 2STNB Therapy Study

What We Learned

What Did We Do?

Our major goal for this study was to contribute to the well-being of Two Spirit, trans, and nonbinary Black, Brown, and People of Color clients and communities by decreasing barriers to healing and affirming mental health services. In this study, we worked to address some of the financial, geographic, language, and cultural barriers many Two Spirit, trans and nonbinary Black, Brown, and People of Color clients experience when seeking out and receiving therapy. Towards this end, 15 free sessions of online therapy were provided to clients in the study. The nine therapists for this study were Black, Brown, and People of Color who were also Two Spirit, trans, and nonbinary. They received training in liberatory psychotherapy practices that directly acknowledge, address, and help individuals move through structural, interpersonal, and internalized oppression (see Psychological Framework for Radical Healing).

In all, 51 participants were enrolled in the study, with 49 participants (who we also refer to in this summary as clients) beginning and ending therapy. Throughout the study, we we collected data about mental health and wellbeing from surveys. We also interviewed everyone who participated in the study. Clients in the study were compensated for their participation in data collection. Therapists employed by this study were also compensated for each therapy session at a rate commensurate with psychotherapy practice.

What Was New, Innovative, or Notable?

Virtual therapy is becoming recognized as a great alternative to in-person psychotherapy. In addressing geographic barriers to care (i.e., no or limited providers available in one’s community), this study’s use of virtual therapy allowed for clients to be connected to therapists who they may not otherwise have been able to connect with. The therapists in this study were also members of the Black, Brown, and People of Color and Two Spirit, trans, and nonbinary communities, which allowed for a foundational level of connection. This was unique to many of the clients in this study, who had never had that experience before.

The training that we provided to therapists prior to the study also provided specific knowledge and skills in liberatory psychology practice. This allowed therapists and clients to address together the larger contexts of oppression (such as racism, misogyny, and transphobia) in which clients in this study exist, and that so often drive mental health inequities that occur for communities harmed by structural and interpersonal discrimination.

What Did We Learn?

The main goals of our study were to figure out the best ways to let people know about studies like ours, to understand why people signed up for the study, and to see what we could learn about therapy focused on radical healing for clients who were Two Spirit, trans, and nonbinary and Black, Brown, and People of Color.

We had a goal of enrolling 50 people for the study—we enrolled 51 people. There were 49 people who started and ended therapy in the study.

People who enrolled in the study were between the ages of 21 and 51 (with an average age of 28).

Clients resided all over the United States and covered 8 out of 9 census regions of the United States (the only region not included was East South Central [Mississippi, Alabama, Tennessee, Kentucky]).

Most (78%) of the people in the study had a primary identity of nonbinary, with 14% identifying as trans men, and 8% identifying as trans women. When we asked a broader question about gender identity, the categories become much more expansive and diverse (for example: “gender fluid, beyond gender, unfuckwithable,” “all of them”).

All clients in the study identified as a Black or Brown person and/or a Person of Color. The single largest racial category included multiracial identities (between 2-5 racial identities, primarily including Indigenous people) (33%), followed by Black (27%), Asian (24%), and Latine (16%).

There were a total of 680 free sessions of psychotherapy that were provided as part of this study.

Clients were offered up to 15 sessions of therapy—clients attended a range of 7-15 sessions, with the average number of sessions being 14 (there were only 5 clients in the study who attended 10 or fewer sessions; one client ended voluntarily at 7 sessions due to moving out of the United States).

When we calculated all of the totals for the questions that focused on clients’ mental health from the beginning of the study to the end of the study, we found that in general, clients’ mental health improved throughout the duration of the study, and that clients had more improvement if they attended more sessions.

Another goal of ours was to see if it made a difference if clients had more similarities in regards to identity with the therapist (for example, a Black therapist with a Black client). The statistics indicate that improvement in mental health or trust in the therapist were not impacted by having more similar identities to their therapist.

When we asked clients 6 months later about their mental health, the findings demonstrate that people continued to show improvement in mental health.

Finally, our results also showed that internalized transnegativity (basically, taking in harmful messages about your trans identity and believing those messages) was also reduced throughout the study.

What Does This Mean for Our Communities?

Before we launched this project, we were not sure if it was even possible to do a study where we were able to offer free therapy that focused on radical healing. Based on this experience and initial results, the answer is that it definitely IS possible! We can create a study that involves community at every level, and that Two Spirit, trans, and nonbinary clients who are Black, Brown, and People of Color can participate in therapy with therapists who also share similar identities.

Even more exciting, the fact that people felt better as they participated in our study is helpful information to share with our communities. This can increase hope for what is possible for fostering connections with therapists, and also help us learn how to train therapists to include radical healing and liberatory psychology approaches in their therapy sessions.

What’s Next?

We are still analyzing data and can’t wait to continue to share that with the community. We are hoping to find interesting answers to the following questions (and more!):

What were clients’ experiences like with therapists before they participated?
What were clients’ goals in the study and how well were those goals met?
What kind of change did clients experience as a direct result of participating in the therapy in the study?
What were clients’ experiences of using telehealth during the study?
What techniques did the therapists use that were particularly effective in sessions?

Action Steps:

We plan to provide information sessions at community centers with the hope that this information can assist those centers with matching clients and therapists together.

We are going to apply for more funding to expand upon the training we provided to the therapists in this study. We hope to have the resources to train more therapists, so that they can provide better therapy to Two Spirit, trans, and nonbinary clients who are Black, Brown, and People of Color.

What Clients Had to Say About Therapy and the Study:

Sometimes it was hard to remember that I was even part of a study, which I guess is a good thing. The therapy was awesome, looking back I don't even feel like I'm the same person. I feel like I have grown so much. It feels really cool…It just is really special. (Hispanic/White, nonbinary person)

It was really neat to be able to be paired with a therapist who focused on elements of radical healing and is also a nonbinary person and is a person of color. Before I started the study, I spent a really really long time searching for a therapist. And I went through different phases where I would search and do a bunch of consultations to get a feel for it. And then I would try someone out and just like would not work out… and [my therapist] was amazing and I'm really thankful that through the study I was able to connect with them. It was just really easy to be able to talk about the things that I was going through, within a range of topics. And that's just how like a baseline of understanding, because they have some kind of experience that, like parallels to how I see the world and how I experience things. (Indian American, nonbinary person)

I thought [the study] was great. Honestly, if I were in my own graduate program and I were doing therapy, like this would be something similar to what I would wanna do… a great use of government money just to send me out there and to talk to them and do the thing. And I'm glad that you know there are folks that are specifically trying to–how do you call that? Like a critical need right? Deal with that critical need and try to get the government to apply some grant funds to this critical need. That's really my biggest feelings about the whole study, right? There's admiration, there's pride, there is just actually you know personally having enjoyed the experience with the project. And you know my therapist was wonderful. And I've never had a therapist quite like them. So it was overall 10 out of 10. Like no points of improvement whatsoever. This honestly–like there's–I don't think that it could have happened 10 years ago but I wish that it did. Right? (AfroLatine Dominican, nonbinary person)

Any time I meet someone new…it takes a little time for me to get comfortable with that person. But with [therapist] you know it just took a few sessions. So in the first session I got really comfortable with them. I was crying in front of them and I don't cry in front of people unless I really really feel bad. But I think that me opening up on that level, that's a change right there, because it’s a change in comfortability within me. (Black woman of trans experience)

It was great, [therapist’s name] is great. We get along well. They're really helpful. And I feel like I leave the sessions with solutions. Whereas I feel like a lot of my other therapists that I met with I would leave the session feeling better about the situation because like I had talked about it, but if the situation were to arise again, I wasn't necessarily equipped with the tools to handle it any differently. Whereas I felt like with [therapist’s name] I was actually getting tools to handle things differently and like do things differently to like make my life less anxiety inducing. (Black trans man)