LGBTQ+-affirmative therapy

Domain III · Humanistic, existential & experiential · John Pachankis

What it is

"LGBTQ+-affirmative therapy" is first a stance and framework, not one branded therapy. It means practising so that lesbian, gay, bisexual, transgender, queer and other sexual- and gender-minority identities are treated as healthy variations. It is the explicit alternative to sexual-orientation and…

Format

• Format.
• ESTEEM: 10 individual sessions, held weekly, finished within 4 months. Two sessions in one week are allowed to catch up. It is an adaptation of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Barlow et al.), whose workbook served as the base manual.

Who practises it, and how they are trained or regulated

• How change happens. The model rests on minority stress theory (Meyer, 2003) and on Hatzenbuehler's (2009) account of how stigma "gets under the skin". The theory names two kinds of stressor. Distal stressors are external: discrimination, victimisation and microaggressions. Proximal stressors are internal: internalised stigma, expecting rejection, and concealing one's identity. Both feed general psychological…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Lecturing. Keep it exploratory.
• Logs that are incomplete. Shrink the form, or do it in session.
• Advocacy that overrides what the client wants, or exposes them to risk.
• Clients correcting the forms, or leaving fields blank, which tells you an option is missing.
• Repeated urges at the same trigger, such as loneliness at night. Address that trigger directly.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.