The September 2020 issue of Practice Innovationsopens in new window examines the role of evidence-based relationship variables (EBRV) in facilitating change, healing, and therapeutic corrective experiences in working with affectional and gender minorities (AGM; i.e., LGBTQ+ individuals). Guest editor Amy E. Ellis discusses the issue's significance and practical implications.
What is the special issue about?
The special issue is about the foundational role that EBRVs (that is, therapeutic alliance, empathy, warmth, unconditional positive regard, etc.) play in providing trauma-informed affirmative care for LGBTQ+ clients. Each of the articles in the special issue describes the importance of emphasizing EBRVs in treating a minoritized population at disproportionate risk for traumatization and minority stress and how the therapeutic relationship can be an intervention that fosters therapeutic change.
What is the significance of the issue?
According to the Williams Institute, 4.5% of the population identifies as lesbian, gay, bisexual, or transgender; more specifically, 0.6% of the population identifies as transgender. Within the community, 40% of transgender adults and 33% of lesbian, gay, bisexual, and questioning adults experience mental health symptoms and distress. The literature remains mixed about how many LGBTQ+ individuals engage in therapy. Some researchers have suggested higher rates of engagement compared to cisgender and heterosexual counterparts, and others have reported lower rates. Regardless of initial engagement, retention of participation is difficult, as many LGBTQ+ individuals report dissatisfaction with and stigmatization by their providers. Thus, determining what factors can foster treatment engagement and retention is necessary to adequately address the mental health needs of affectional and gender minority clients.
Tell us about a few key takeaways.
The special issue begins by describing an approach to clinical care with LGBTQ+ individuals using trauma-informed and affirmative care principles. This entails a two-pronged approach: building a strong, supportive, and secure relationship between client and provider, and tailoring and adapting interventions.
One article focuses on trans and nonbinary clients and the need to clearly establish goals for therapeutic work, as well as how social justice both within and outside of session is a necessary part of formulating an alliance, building trust, and fostering empathy. Another article is a systematic review of the research exploring EBRVs in working with affectional and gender minorities.
A third article focuses on interdisciplinary care within an affirmative care framework for trans youth and their families around medical, nursing, psychological, and psychiatric care. This can only be accomplished when the system, the providers, the family, and the youth are working collaboratively to achieve cohesion and alliance.
Another article explores how to tailor a trauma-focused treatment—narrative exposure therapy—to transgender clients. The final article discusses the role of countertransference and transference in working with LGBTQ+ clients with intersectional identities.
What are some practical implications of the articles featured in the issue?
The intersection of minority stress and increased risk for traumatization uniquely affects LGBTQ+ individuals. Understanding and tailoring treatment interventions are paramount in building a safe, strongly aligned, nonjudgmental environment characterized by a trauma-informed affirmative care approach. For clinicians, there are practical suggestions for how to modify and tailor interventions to the unique treatment needs of LGBTQ+ clients. Further information on how and why the relationship is so pivotal in working with this population is provided.
Note: This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.