Psychotherapy
In many ways, conducting effective psychotherapy with an LGBTQ patient requires skills that a psychiatric practitioner uses with every patient: empathic listening, reflection on the patient’s words, affect, and the transference/countertransference, as well as the appropriate psychotherapeutic intervention. In other ways, the therapist must adapt his or her approach to tailor it to the needs of the LGBTQ identity of the patient.
One overarching approach to psychotherapy with LGBTQ patients is called LGBT Affirmative therapy. This therapeutic approach advocates creating an open, welcoming, and non-judgmental environment as a basic frame for therapy. An LGBT affirmative therapist is expected to actively examine the internalized biases that he/she/they hold regarding minority sexual orientations and gender identities so that they can be more aware of unconscious countertransferential reactions (Stevenson, n.d.). Affirmative psychotherapy also calls for ensuring that the office space is a welcoming environment, with LGBTQ-friendly reading materials and forms that allow the patient to specify their preferred gender and pronouns.
Maintaining a welcoming and affirming stance should not lead to the therapist encouraging the patient to prematurely come out. Many sources note a risk of the therapist assuming a blanket “gay is OK” stance and in so doing not acknowledging the very real risks that LGBTQ patients face as a result of a public coming out about their gender or sexual identity (Lev et al., 2014). Instead, most important is taking an open and empathetic therapeutic stance that recognizes the complexity of the issues surrounding identity and disclosure that this patient population faces.
Obviously, therapy with an LGBTQ patient will follow the needs of that particular patient. All forms of established therapy are theoretically adaptable to the care of the LGBTQ patient depending upon the context, including the psychoanalytic framework (Drescher, 2001). The therapist should expect to encounter, however, a higher frequency of many of the issues mentioned previously in this review, given the higher prevalence of mood, anxiety, and substance use disorders in LGBTQ people as compared to the general population. Review of the topics covered in this curriculum should prepare any therapist, regardless of experience level or sexual orientation, to address the myriad issues faced by the LGBTQ population with care, compassion, and effectiveness.
CME Question:
Which of the following is NOT a component of LGBTQ affirmative therapy?
Encouraging self-disclosure of sexual and gender identity (coming out) in most or all cases
Forming awareness of the therapist’s countertransference to the patient
Providing LGBTQ-specific literature and brochures in the office space
Modifying forms to allow for accurate representation of patient gender identity
Answer: 1