Research Spotlight: Sexual Minorities in Therapy

Gender- and sexuality-minoritized adolescents in DBT

How can therapy better support gender and sexuality-minoritized (GSM) adolescents? A recent study explored the unique challenges faced by GSM youth in the context of dialectical behaviour therapy (DBT). Three overarching themes emerged: identity, the impact of others, and space for sexual and gender identity in DBT. The study presents a number of useful intervention tasks and corresponding DBT skills/principles for addressing these issues. Importantly, it highlights the importance of therapist awareness, safe therapeutic spaces, and integrating GSM-related difficulties into DBT. The findings offer crucial insights for therapists who work with GSM youth, highlighting the need for knowledge, competence, and sensitivity.

“GSM young people felt issues related to identity confusion and acceptance, alongside how to cope with and change cis-heterosexist behaviours and reactions by others, contributed to their distress and thus were important to target in DBT. Participants also reported that it was important for DBT therapists to provide support and promote a sense of safety in order to help bring sexual- and gender-identity-related issues into therapy. These represent important recommendations for DBT therapists when supporting GSM adolescents.”

Camp J, Morris A, Wilde H, Smith P, Rimes KA. Gender- and sexuality-minoritised adolescents in DBT: a reflexive thematic analysis of minority-specific treatment targets and experience. The Cognitive Behaviour Therapist. 2023;16:e36. doi:10.1017/S1754470X23000326

Internalized sexual stigma in sexual minority individuals

Internalized sexual stigma negatively impacts the mental health of sexual minority individuals but lacks a comprehensive synthesis regarding its development over time. This systematic review examined 31 studies and identified several distal minority stressors (e.g., discrimination), proximal stressors (e.g., outness, concealment), and psychological factors (e.g., depression, anxiety) that influence subsequent internalized sexual stigma. However, only three out of eight psychological interventions lead to a significant reduction in this experience. The authors present a theory-driven model of internalized stigma that is helpful to clinicians and highlight the need for interventions that address both individual-level factors and key structural factors.

Nguyen, J., Anderson, J., & Pepping, C. A. (2023). A systematic review and research agenda of internalized sexual stigma in sexual minority individuals: Evidence from longitudinal and intervention studies. Clinical Psychology Review, 102376.

Implementing LGBTQ-affirmative cognitive-behavioral therapy

LGBTQ-affirmative CBT is an effective intervention, but ensuring its success in real-world practice requires thoughtful implementation. This study examined five clinical trials to identify the most essential strategies for therapists and organizations. Key priorities include engaging clients in LGBTQ-affirmative CBT, ensuring there is sufficient demand, and receiving appropriate training. Ongoing supervision and committed LGBTQ leadership support can strengthen implementation, while optional strategies (e.g., showing LGBTQ-affirming visual cues in therapy spaces) might depend on available resources. Implementation needs and priorities are also likely to vary depending on the therapy format, intended recipients, and cultural/organization context. This research highlights practical and flexible strategies to help therapists deliver LGBTQ-affirmative CBT effectively, laying the groundwork for further improvements in training and accessibility.

"LGBTQ-affirmative CBT is a complex intervention requiring a package of implementation strategies. Our findings provide guidance for implementers in settings with different levels of resources regarding the highest priority strategies that may be needed to preserve the effectiveness of LGBTQ-affirmative CBT as it is translated into real-world settings."

Harkness, A., Soulliard, Z. A., Layland, E. K., Behari, K., Rogers, B. G., Bharat, B., Safren, S. A., & Pachankis, J. E. (2024). Implementing LGBTQ-affirmative cognitive-behavioral therapy: implementation strategies across five clinical trials. Implementation science communications, 5(1), 124.  https://doi.org/10.1186/s43058-024-00657-x