The Professional Counselor | Volume 11, Issue 4 449 region, recounted that her ex-partner’s reluctance to give consent affected the cost of treatment, stating, “All we could do was a prescription to stop periods, which [was] about three or four times more expensive than hormones.” Contributors to Consent Participants identified four factors that contributed to giving consent: (a) parental attunement to the experiences and emotions of the youth in their care, (b) parental autonomy from their family of origin and religious communities, (c) access to affirming education about TGD issues and GCEI, (d) the presence and/or development of affirming relationships and community, and (e) affirming religious beliefs and/or community. Parental Attunement to Youth’s Experience The construct of parental attunement has been defined as a relational dynamic between parent and child that surpasses what is typically included in the construct of empathy. Erskine (1998) posited that attunement is a two-part process that includes (a) the ability to sense and to identify with another person’s sensations, needs, and feelings: and (b) communicating that sensitivity to the other person. A parent’s ability to attune to their child’s experience and emotional world has been prominently associated with the fostering of secure attachment and personality development (Ainsworth & Bowlby, 1991; Bowlby, 1988; Siegel, 2013; Wallin, 2007). Participants in the present study conveyed their ability to demonstrate parental attunement by describing their wishes for their TGD youth’s social and emotional well-being as a primary motivator for granting informed consent for them to undergo GCEI. Furthermore, participants implied respect for their youth’s autonomy, their recognition of their youth’s gender non-conformity, and their recognition of their youth’s mental health symptoms. Participants also recognized their own position of privilege that facilitated granting consent and a sense of their own autonomy from their families of origin or religious backgrounds. One of the more striking examples of parental attunement in this sample was provided by Tony (61), a White, cisgender man married to his child’s mother and living in the Mid-Atlantic region, who tearfully recounted a conversation with his then–16-year-old child following a support group meeting: I said, “You know, what would really help me is, could you write down your goals, what you want, and be honest with everything. We want to support you.” So, after we got home, within about two hours, [child] brought me something that I still have. . . . It says “Trans with the Plans.” And that was when I knew that this kid I love so much knew what they wanted, and I had to support them. A notable subset of participants (n = 16) reported that they recognized their child’s rejection of binary gender norms prior to their child coming out to them. This recognition often came during early childhood. Hilda remembered noticing her child’s “Sunday best”: I had [child] in her little dress shirt and tie and dress pants, and I told her to go get her dress shoes, and her little face lit up. She ran down the hall and came back in those little Cinderella shoes—so, [child] was always [child]. It just took us awhile to catch on. Every participant recounted a recognition of and concern for their child’s mental health. Prudence (46), a mixed-race, cisgender woman married to her child’s father and living in the Southwest region, said that her child “came to us in the middle of the night, and I said, ‘Are you feeling suicidal?’ He didn’t respond verbally, but he just started crying. So I just pulled him in bed with me and I snuggled him.”
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