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Critical issues in cognitive behavioural therapy (CBT) with gender and sexual minorities (GSMs)

Published online by Cambridge University Press:  12 January 2022

Sérgio A. Carvalho ,
Paula Castilho ,
Daniel Seabra ,
Céu Salvador ,
Daniel Rijo  and
Carlos Carona
Sérgio A. Carvalho*
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal HEI-Lab: Digital Human-Environment Interaction Lab, School of Psychology and Life Sciences (EPCV), Lusófona University, Lisbon, Portugal
Paula Castilho
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Daniel Seabra
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Céu Salvador
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Daniel Rijo
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
Carlos Carona
Affiliation:
University of Coimbra, Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Coimbra, Portugal
*
*Corresponding author. Email: sergiocarvalho@fpce.uc.pt
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Abstract

In a cisheteronormative culture, gender and sexual minorities (GSMs) may experience additional challenges that get in the way of a meaningful life. It is crucial that clinicians are mindful of these challenges and cognizant about the specificities of clinical work with GSMs. This article points out how societal structure interferes with mental health, and clarifies what clinicians must take into account when using affirmative cognitive behavioural therapy (CBT) interventions. Knowledge of up-to-date terminology and use of affirmative language are the first steps that contribute to clients’ experience of respect, which is paramount for the development of a good therapeutic relationship. Considering a conceptual framework of minority stress to understand vulnerability in GSM, specificities in formulation and key psychological processes are discussed. Moreover, guidelines and practical tools for intervention are presented within a CBT approach. Some reflections on therapists’ own personal biases are encouraged, in order to increase the efficacy of interventions.

Key learning aims

After reading this article you will be able to:

  1. (1) Recognize the uniqueness of gender and sexual minorities (GSM) stressors in broad and specific contexts, and their impact on mental health.

  2. (2) Identify the underlying key processes and specificities in therapeutic work with GSMs, from a CBT perspective.

  3. (3) Recognize the importance of a culturally sensitive approach in affirmative CBT interventions.

Keywords

affirmativecognitive behavioural therapygender and sexual minoritiesLGBT+minority stress
Type
Empirically Grounded Clinical Guidance Paper
Information
the Cognitive Behaviour Therapist , Volume 15 , 2022 , e3
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Further reading

For further information on the American Psychological Association (APA) guidelines for psychological practice with sexual minority persons, see https://www.apa.org/about/policy/psychological-sexual-minority-persons.pdf Google Scholar
For further information on the World Professional Association for Transgender Health (WPATH) standards of care, see https://www.wpath.org/publications/soc Google Scholar
For further reading on contextual behavioural approaches with GSMs, see Skinta, M. D. (2020). Contextual Behavior Therapy for Sexual and Gender Minority Clients: A Practical Guide to Treatment. New York, USA: Routledge. https://doi.org/10.4324/9780429030307.CrossRefGoogle Scholar

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