LGBTQ Affirmative Therapy

What is Queer Affirmative Psychotherapy?

Many lesbian, gay, bisexual, transgender, and queer (or questioning) individuals seek counseling for reasons similar to those of non-LGBTQ individuals, such as depression, anxiety, grief, couples therapy, work stress, and so on. While some issues may have little to do with sexuality, gender, or identity, the LGBTQIA community also faces its own set of unique challenges.

Over the past several years, the general public seems to have become more aware and accepting of the issues faced by the LGBTQ community. With this greater acceptance, mental health services have become more tailored to this population’s specific needs. One way this is being carried out is through LGBTQ affirmative therapy. This therapeutic approach to psychotherapy is focused on the empowerment of LGBTQ individuals in all areas of life and relationships. Therapists working from an affirmative treatment approach seek to honor the unique challenges faced by LGBTQ individuals and help them navigate challenges effectively.

Historically, many in the LGBTQ community who sought mental health services found counselors and therapists were uneducated about issues around sexuality, gender, and identity. Unfortunately, this often resulted in LGBTQ clients ending their treatment prematurely or never actually seeking the treatment and support needed. And, in some cases, the client would end up being the one to educate the therapist on the struggles unique to the LGBTQ population.

Thankfully, with the emergence of LGBTQ affirmative therapy, intersectionality and an increase in cultural competence, this gap has begun to close. Specifically, psychotherapist are seeking continuing education (CE credits) via online training in LGBTQ Affirmative CBT. This recent option is a low-cost and efficient way to spread evidence-based treatment methods to mental health professionals. In fact, recent studies find that LGBTQ  clients who engage in LGBTQ  affirmative therapy report positive experiences and reductions in stress disorder, depression, panic attacks, and social anxiety disorders. Over the past several years, there has been a significant increase in awareness and effectiveness of mental health treatment for the LGBTQ community.

By taking an affirmative stance in their psychological practice, mental health professionals can make a significant impact on the mental well-being of LGBTIA clients.

Mental Health Issues & Coping with Stigma

Research suggests that LGBTQIA individuals seek mental health treatment at a higher rate than their non-LGBTQ counterparts. This may be due to the social stress and discrimination LGBTQ individuals often face on a regular basis, from society, family members, peers, co-workers, and even classmates. This dynamic is called the minority stress theory. This discrimination contributes to the higher rates of depression, anxiety, and other mental health struggles seen amongst LGBTQ people. Those in the LGBTQ community are also much more likely to have a substance use or abuse problem, engage in self-harm behaviors, and/or experience suicidal thoughts. Thus, it is not surprising this population seeks mental health services at higher rates.

Below are some alarming statistics from the 2022 National Survey on LGBTQ Youth Mental Health, highlighting the vulnerability of this population for mental health issues, and the potential impact social acceptance and LGBTQIA+ Affirmative Psychotherapy can make on improving mental health services in the LGBTIA community.

“Although our data continue to show high rates of mental health and suicide risk among LGBTQ young people, it is crucial to note that these rates vary widely based on the way LGBTQ youth are treated.”

– Dr. Myeshia Price (she/her or they/them)
Senior Research Scientist, The Trevor Project

• 45% of LGBTQ youth seriously considered attempting suicide in the past year.
• LGBTQ youth who felt high social support from their family reported attempting suicide at less than half the rate of those who felt low or moderate social support.
• 60% of LGBTQ youth who wanted mental health care in the past year were not able to get it.
• 73% of LGBTQ youth reported experiencing symptoms of anxiety.

In addition to the effects of stigma and discrimination, the LGBTQ population also often obtains mental health support for:

Gender dysphoria

According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), gender dysphoria (previously gender identity disorder) is a psychological condition experienced by individuals whose gender identity and expression does not match with the gender assigned at birth. Gender dysphoria can cause significant distress and affect a person’s overall mental wellbeing. Although new, Gender-affirming therapy is considered the standard of care for the TGNC community. However, according to the APA (American Psychiatric Association), “it is critical more psychiatrists become familiar with the history and culture of this population and best practices for treatment.”

Additionally, the purpose of the movement by many individuals, affirmative therapists, and organizations to proactively share pronouns is to normalize the discussion around gender expression and destigmatize this social norm for transgender and non-binary individuals. Get involved in the conversation; here is a helpful guide to gender identity terms.

Sexual identity issues

Sexual identity issues can refer to numerous concerns. Sexual identity (or sexual orientation) refers to the emotions, thoughts, feelings, and fantasies that contribute to a person’s sexual or romantic attraction to another person. LGBTQ individuals often go through periods of questioning their sexual identity, which can cause confusion and stress. As a sexual minority, there can be fear of isolation, or internalized homonegativity (IH).

Also pertinent to the LGBTQ community and sexual identity issues is the “coming out” process, and coping with the reactions of friends and family. Learn more about the unique challenges of LGBTQ individuals in this free resource: “The Coming Out Handbook” by The Trevor Project.

Help fight stigma and discrimination

Discrimination and stigma, in any form, can seriously impact the well-being of those who experience it. Inclusivity matters, and has a direct impact on mental health needs.

In order to begin to combat some of this (or cope with the stigma if it is directed at you), here are things you can do to help fight stigma and discrimination of queer individuals:

• Get a queer education. Learn more about the LGBTQ community and their struggles. Education is a way to increase understanding and raise awareness about the unique issues this population often faces (socially, economically, financially, etc.)
• Know your rights. Educate yourself on human rights laws and how they pertain to the LGBTQ population.
• Keep good company. Surround yourself with healthy people, such as supportive and encouraging family members, friends, and peers. Whether or not they are dealing with the same issues as you (or someone you know), it is important to have people with whom you feel safe to express yourself and be open with.
• Speak up if you witness (or are the victim of) discrimination. Although it can be scary to share these kinds of experiences, it is one of the best ways to advocate for yourself, the LGBTQ community, and fight back at the discrimination.
• Seek professional help. If you are facing a mental illness as a result of the stress from stigma and/or discrimination, getting support from a professional can help you learn ways to better cope, feel less isolated, and establish overall mental health and wellbeing.
• Share your experiences with others. Whether you are part of the LGBTQ community yourself or have friends or family who identify as LGBTQ, share what you can with others. The more the stigma surrounding this population is talked about, the more awareness it can gain.
• Get political. Join a political or advocacy group to combat unjust policies and/or unfair treatment of the LGBTQ community.
• Join a support group. Find a support group in your area, or join an online support community to connect with others that can relate. The Tribe, free wellness community has a dedicated support group for the LQBTQ community called: LGBTribe.

Given the stressors that LGBTQ groups must confront, such as homophobia, societal discrimination and prejudice, coming out, and negotiating family relationships, finding a therapist that is openly LGBTQ affirmative or specializes in working with lesbians, gay men, bisexuals, or transgender people can offer a safe space for healing. Remember, you are not limited by your geography. LGBTQ Affirmative CBT practices can be equally effective through in-person or online therapy.

If you are going through such stress and anxiety that you are considering hurting yourself please seek help right away.

Search TherapyTribe to find a therapist who is openly LGBTQ, LGBTQ-friendly, or specializes in LGBTQ issues. Find a LGBTQ Affirmative Therapist today.

References

1. Ulrike, B. (2002). Twenty years of public health research: Inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health 92(7), 1125-1130.
2. Mustanski, B., Garofalo, R., & Emerson, E. (2010). Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health, 100(12): 2426–2432.
3. Wolford-Clevenger, C., Cannon, C. J., Flores, L. Y., Smith, P. N., & Stuart, G. L. (2017). Suicide Risk Among Transgender People: A Prevalent Problem in Critical Need of Empirical and Theoretical Research. Violence and gender, 4(3), 69-72.
4. Proujansky RA, Pachankis JE. Toward Formulating Evidence-Based Principles of LGB-Affirmative Psychotherapy. Pragmat Case Stud Psychother. 2014;10(2):117-131. PMID: 26617475; PMCID: PMC4662552.
5. Millar, B. M., Wang, K., & Pachankis, J. E. (2016). The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: Results from a randomized controlled trial with young adult gay and bisexual men. Journal of Consulting and Clinical Psychology, 84(7), 565–570. https://doi.org/10.1037/ccp0000113
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8. Freeman-Coppadge, D.J., Langroudi, K.F. (2021). Beyond LGBTQ-Affirmative Therapy: Fostering Growth and Healing Through Intersectionality. In: Nadal, K.L., Scharrón-del Río, M.R. (eds) Queer Psychology. Springer, Cham. https://doi.org/10.1007/978-3-030-74146-4_9
9. Pachankis, John & Soulliard, Zachary & Morris, Faithlynn & Seager van Dyk, Ilana. (2022). A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice. Cognitive and Behavioral Practice. 30. 10.1016/j.cbpra.2021.11.005.
10. Pachankis JE, Soulliard ZA, Seager van Dyk I, Layland EK, Clark KA, Levine DS, Jackson SD. Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. J Consult Clin Psychol. 2022 Jul;90(7):582-599. doi: 10.1037/ccp0000745. PMID: 35901370; PMCID: PMC9434976.
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