by Ry Testa, PhD, Newport Healthcare LGBTQ+ Consultant and Trainer
Over the past few years, Newport Healthcare’s clients are voicing more diverse sexual and gender identities than in the past. Last year, over half of teens and young adults in our treatment identified as being part of a LGBTQ+ (lesbian, gay, bisexual, transgender, queer) group, as detailed in our annual outcomes report.
What do mental health professionals need to know about working with LGTBQ patients? Two main areas to consider are stress and resilience.
Our clients have family members with different understandings of and responses to sexual and gender minorities and transgender issues. Therefore, it is appropriate to explore how these experiences may be stressors (and even part of their reason for being in treatment), which can be broken down into external and internal types of minority stress.
Two Types of Stress in LGBTQ Patients
External stressors are what these teens and young adults receive from the world, such as discrimination and even being violently attacked. But experiences of rejection and/or dismissal of one’s gender identity or sexual orientation can be just as harmful, and are significantly related to higher rates of mental health issues such as depression, anxiety, substance use disorders, in addition to risky behaviors and suicidality. Therefore, when counseling LGBTQ+ clients, it is essential to make sure they are feeling physically and emotionally safe in the mental health milieu, as well as at home, and to respond promptly to any signs of bullying. Further, clients and family relationship ruptures related to sexual and gender identity can become a focus of mental health treatment.
(It is important to note that Attachment-Based Family Therapy (ABFT), the family therapy model utilized by Newport, has demonstrated efficacy for working through such issues in families with LGBTQ+ youth. Through ABFT, clinicians working with LGBTQ patients can keep family relational repair as the primary goal, without needing to have treatment goals related to the clients’ sexual or gender identity.)
Individuals engaged in identity-related communities show more self-confidence and ability to handle stress.
Internal stress factors refer to what our clients receive from themselves, such as a belief that there is something wrong about who they are, and that they can expect negative outcomes in the future. A second practice recommendation is to assess for these maladaptive beliefs. In individual therapy, these can be directly addressed through several therapies, including traditional cognitive and behavioral therapy, as well as more process-oriented approaches, such as Acceptance and Commitment Therapy.
Resilience Factors in LGBTQ Teens and Young Adults
However, being a part of a minority group can also foster resilience and lead to a sense of purpose and belonging. Resilience factors include being connected to a community and having pride in one’s sexual and gender identity, as well as cultural identities. Indeed, individuals engaged in identity-related communities show more self-confidence and ability to handle stress.
Learning about positive role models and inspiring social movements also helps with resilience. Thus, another supportive mental health intervention is helping patients to connect with others who share a similar identity. That’s why Newport is currently developing LGBTQ+ support groups to create safe spaces for open discussion, education, and community for patients as well as parents/caregivers.
Dr. Testa, Newport Healthcare’s LGBTQ+ Consultant and Trainer, is a research affiliate of the Center for LGBTQ Evidence-based Applied Research (CLEAR). He is a clinical psychologist whose research focuses on understanding and preventing self-destructive behaviors and health disparities, particularly among transgender and gender-nonconforming people. Dr. Testa is highly respected for his work in both the field of psychology and in the transgender and gender-nonconforming community.
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