Graduate Studies

 

First Advisor

Debra A. Hope

Degree Name

Doctor of Philosophy (Ph.D.)

Committee Members

Dennis McChargue, Emily Kazyak, Michael Dodd

Department

Psychology

Date of this Version

8-2025

Document Type

Dissertation

Citation

A dissertation presented to the Graduate College of the University of Nebraska in partial fulfillment of requirements for the degree of Doctor of Philosophy

Major: Psychology

Under the supervision of Professor Debra A. Hope

Lincoln, Nebraska, August 2025

Comments

Copyright 2025, Brenna Rose Lash. Used by permission

Abstract

Transgender and gender diverse (TGD) adults in the United States experience high rates of discrimination and marginalization, contributing to adverse mental health outcomes. While clinical guidelines for gender affirming care have been developed, these guidelines often lack empirical grounding or specific, actionable strategies for clinicians. Although theoretical models such as the marginalization stress model and the psychological mediation framework offer useful foundations for case conceptualization, they do not fully capture the lived experiences or the resilience mechanisms of TGD individuals in therapeutic contexts. This project aims to bridge the gap between research and clinical practice through thematic analysis of therapy sessions conducted as part of a cognitive behavioral therapy (CBT) clinical intervention with 23 TGD-identified adults living in the Midwestern United States. Grounded in cognitive behavioral and broader sociocultural models of marginalization stress, this study explores how research-identified constructs, such as stigma, identity pride, and social support, manifest in clients' own words and experiences. Results showed that participants described themes of internalized stigma, anticipated and experienced marginalization, gender expression distress, perceived shortcomings, isolation, and life stress as activating for distress. Core beliefs about the self and related automatic thoughts were grouped into themes of negative self-perception, social disconnection and isolation, and gender-related stress and identity challenges. Finally, participants developed rational responses as they re-appraised original thoughts, resulting in themes of self-compassion and letting go, self-worth and inherent value, and identity validation. Findings from this analysis are intended to inform and refine affirming clinical approaches, offering insight into the translation of empirical evidence into therapeutic practice for TGD individuals. These results reveal the nature of external and internal experiences which lead to further distress and the content of core beliefs and automatic thoughts, including beliefs about self-worth and value, safety as a TGD person, likability, and identity validity. Results also demonstrate the content of rational responses in relation to these beliefs and thoughts, including rejection of others’ opinions and re-affirmation of value to the self, which might be leveraged in a clinical context to promote wellbeing.

Advisor: Debra A. Hope

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