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Applying dialectical behaviour therapy to structural and internalized stigma with LGBTQ+ clients

Published online by Cambridge University Press:  10 January 2019

Kim Skerven ,
Dane R. Whicker  and
Kelly L. LeMaire
Kim Skerven
Affiliation:
Center for Behavioral Medicine, 250 N. Sunnyslope Road, #203, Brookfield, WI 53005, USA
Dane R. Whicker
Affiliation:
Duke University Medical Center, Cognitive Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Office 105, Durham, NC 27705, USA
Kelly L. LeMaire
Affiliation:
Duke University Medical Center, Cognitive Behavioral Research and Treatment Program, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2213 Elba Street, Office 105, Durham, NC 27705, USA
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Abstract

Delivering research-supported intervention is increasingly important, given the growing emphasis on evidence-based practice in mental health treatment. When working with clients who hold marginalized identities, however, therapists may have questions about how to best tailor interventions, as treatments may not yet have demonstrated efficacy with under-represented populations. This paper describes potential strategies for using dialectical behaviour therapy (DBT) skills to help LGBTQ+ clients, guided by a theoretical model for understanding sexual stigma. Joining these two paradigms, suggestions are made for applications of skills that can help LGBTQ+ clients who are in DBT effectively interact with invalidating environments characterized by structural stigma. DBT-based strategies aimed at buffering clients from environmental invalidation and enhancing their skills in self-validation can help provide them with pathways towards affirming their own sexual orientation and gender identity. Examples from clinical cases are used to enhance understanding of skills application in practice.

Keywords

DBTheterosexisminternalized stigmaLGBTQstructural stigma

Information

Type
Special Issue: Cultural Adaptations of CBT
Information
the Cognitive Behaviour Therapist , Volume 12 , 2019 , e9
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2019 

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Footnotes

*

Authors’ note: Dane R. Whicker, PhD and Kelly L. LeMaire, PhD contributed equally and share second authorship; the order listed was chosen randomly.

References

Suggested follow-up reading

Herek, GM, Gillis, JR, Cogan, JC (2009). Internalized stigma among sexual minority adults:insights from a social psychological perspective. Journal of Counseling Psychology 56, 32–43.Google Scholar
Koerner, K (2012). Doing Dialectical Behavior Therapy. New York: The Guilford Press.Google Scholar
Linehan, MM (2015). DBT Skills Training Manual, 2nd edn. New York: The Guilford Press.Google Scholar
Millar, BM, Wang, K, Pachankis, JE (2016). The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: results from a randomized controlled trial with young adult gay and bisexual men. Journal of Consulting and Clinical Psychology 84, 565.Google Scholar
Pachankis, JE, Hatzenbuehler, ML, Rendine, HJ, Safren, SA, Parsons, JT (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology 83, 875–889.Google Scholar

References

American Psychiatric Association (APA) (1987). Diagnostic and Statistical Manual of Mental Disorders; Revised (DSM-III-R). Washington DC: American Psychiatric Publications.Google Scholar
Berg, RC, Munthe-Kaas, HM, Ross, MW (2016). Internalized homonegativity: a systematic mapping review of empirical research. Journal of Homosexuality 63, 541–558.Google Scholar
Blanchard, FA, Crandall, CS, Brigham, JC, Vaughn, LA (1994). Condemning and condoning racism: a social context approach to interracial settings. Journal of Applied Psychology 79, 993–997.Google Scholar
Bradford Reich, D, Zanarini, MC (2008). Sexual orientation and relationship choice in borderline personality disorder over ten years of prospective follow-up. Journal of Personality Disorders 22, 564–572.Google Scholar
Busa, S, Janssen, A, Lakshman, M (2018). A review of evidence based treatments for transgender youth diagnosed with social anxiety disorder. Transgender Health 3, 27–33.Google Scholar
Chaudoir, SR, Wang, K, Pachankis, JE (2017). What reduces sexual minority stress? A review of the intervention ‘toolkit’. Journal of Social Issues, 73, 586–617.Google Scholar
Coleman, E, Bockting, W, Botzer, M, Cohen-Kettenis, P, DeCuypere, G, Feldman, J, Fraser, L, Green, J, Knudson, G, Meyer, WJ, Monstrey, S, Adler, RK, Brown, GR, Devor, AH, Ehrbar, R, Ettner, R, Eyler, E, Garofalo, R, Karasic, DH, Lev, AI, Mayer, G, Meyer-Bahlburg, H, Hall, BP, Pfaefflin, F, Rachlin, K, Robinson, B, Schechter, LS, Tangpricha, V, van Trotsenburg, M, Vitale, A, Winter, S, Whittle, S, Wylie, KR, Zucker, K (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism 13, 165–232.Google Scholar
Czopp, AM, Monteith, MJ, Mark, AY (2006). Standing up for a change: reducing bias through interpersonal confrontation. Journal of Personality and Social Psychology 90, 784–803.Google Scholar
Dickter, CL (2012). Confronting hate: heterosexuals’ responses to anti-gay comments. Journal of Homosexuality 59, 1113–1130.Google Scholar
Dickter, CL, Kittel, JA, Gyurovski, II (2012). Perceptions of non-target confronters in response to racist and heterosexist remarks. European Journal of Social Psychology 42, 112–119.Google Scholar
Dimeff, LA, Koerner, KE (2007). Dialectical Behavior Therapy in Clinical Practice: Applications Across Disorders and Settings. New York: The Guilford Press.Google Scholar
Eubanks-Carter, C, Goldfried, MR (2006). The impact of client sexual orientation and gender on clinical judgments and diagnosis of borderline personality disorder. Journal of Clinical Psychology 62, 751–770.Google Scholar
Gulker, JE, Mark, AY, Monteith, MJ (2013). Confronting prejudice: the who, what, and why of confrontation effectiveness. Social Influence 8, 280–293.Google Scholar
Haas, AP, Eliason, M, Mays, VM, Mathy, RM, Cochran, SD, D'Augelli, AR, Silverman, MM, Fisher, PW, Hughes, T, Rosario, M, Russell, ST, Malley, E, Reed, J, Litts, DA, Haller, E, Sell, RL, Remafedi, G, Bradford, J, Beautrais, AL, Brown, GK, Diamond, GM, Friedman, MS, Garofalo, R, Turner, MS, Hollibaugh, A, Clayton, PJ (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. Journal of Homosexuality 58, 10–51.Google Scholar
Hatzenbuehler, ML, Bellatorre, A, Lee, Y, Finch, BK, Muennig, P, Fiscella, K (2014). Structural stigma and all-cause mortality in sexual minority populations. Social Science and Medicine 103, 33–41.Google Scholar
Heck, NC, Mirabito, LA, LeMaire, KL, Livingston, NA, Flentje, A (2017). Omitted data in randomized controlled trials for anxiety and depression: a systematic review of the inclusion of sexual orientation and gender identity. Journal of Consulting and Clinical Psychology 85, 72.Google Scholar
Hendricks, ML, Testa, RJ (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Professional Psychology: Research and Practice 43, 460–467.Google Scholar
Herek, GM, Chopp, R, Strohl, D (2007). Sexual stigma: putting sexual minority health issues in context. In The Health of Sexual Minorities (ed. Meyer, IH, Northridge, ME), pp. 171–208. New York, NY: Springer.Google Scholar
Herek, GM, Gillis, JR, Cogan, JC (2009). Internalized stigma among sexual minority adults: insights from a social psychological perspective. Journal of Counseling Psychology 56, 32–43.Google Scholar
Hope, DA, Mocarski, R, Bautista, CL, Holt, NR (2016). Culturally competent evidence-based behavioral health services for the transgender community: progress and challenges. American Journal of Orthopsychiatry 86, 361–365.Google Scholar
King, M, Semlyen, J, See Tai, S, Killapsy, H, Osborn, D, Popelyuk, D, Nazareth, I (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people. BMC Psychiatry 8: 70. doi: 10.1186/1471-244X-8-70Google Scholar
Koerner, K (2012). Doing Dialectical Behavior Therapy. New York: The Guilford Press.Google Scholar
Linehan, MM (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York: The Guilford Press.Google Scholar
Linehan, MM (2015). DBT Skills Training Manual, 2nd edn. New York: The Guilford Press.Google Scholar
McLemore, KA (2018). A minority stress perspective on transgender individuals’ experiences with misgendering. Stigma and Health 3, 53–64.Google Scholar
Meyer, IH (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin 129, 674–697.Google Scholar
Millar, BM, Wang, K, Pachankis, JE (2016). The moderating role of internalized homonegativity on the efficacy of LGB-affirmative psychotherapy: results from a randomized controlled trial with young adult gay and bisexual men. Journal of Consulting and Clinical Psychology 84, 565.Google Scholar
Nadal, KL (2013). That's so Gay! Microaggressions and the Lesbian, Gay, Bisexual, and Transgender Community. Washington, DC: American Psychological Association.Google Scholar
Nadal, KL (2018). Microaggressions and Traumatic Stress: Theory, Research, and Clinical Treatment. Washington, DC: American Psychological Association.Google Scholar
Nadal, KL, Issa, M, Leon, J, Meterko, V, Wideman, M, Wong, Y (2011). Sexual orientation microaggression: ‘death by a thousand cuts’ for lesbian, gay, bisexual youth. Journal of LBGT Youth 8, 234–259.Google Scholar
Neacsiu, AD, Linehan, MM (2014). Borderline personality disorder. In Barlow, DH (ed), Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual, 5th edn (pp. 394–461). New York: The Guilford Press.Google Scholar
Newcomb, ME, Mustanski, B (2010). Internalized homophobia and internalizing mental health problems: a meta-analytic review. Clinical Psychology Review 30, 1019–1029.Google Scholar
Newcomb, ME, Mustanski, B (2011). Moderators of the relationship between internalized homophobia and risky sexual behavior in men who have sex with men: a meta-analysis. Archives of Sexual Behavior 40, 189–199.Google Scholar
O'Shaughnessy, T, Speir, Z (2018). The state of LGBQ affirmative therapy clinical research: a mixed-methods systematic synthesis. Psychology of Sexual Orientation and Gender Diversity 5, 82–98.Google Scholar
Oransky, M, Burke, EZ, Steever, J (2018). An interdisciplinary model for meeting the mental health needs of transgender adolescents and young adults: the Mount Sinai Adolescent Health Center approach. Cognitive and Behavioral Practice (2018), https://doi.org/10.1016/j.cbpra.2018.03.00Google Scholar
Pachankis, JE, Hatzenbuehler, ML, Rendine, HJ, Safren, SA, Parsons, JT (2015). LGB-affirmative cognitive-behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology 83, 875–889.Google Scholar
Rasinski, HM, Czopp, AM (2010). The effect of target status on witnesses’ reactions to confrontations of bias. Basic and Applied Social Psychology 32, 8–16.Google Scholar
Shelton, K, Delgado-Romero, EA (2011). Sexual orientation microaggression: the experience of lesbian, gay, bisexual, and queer clients in psychotherapy. Journal of Counseling Psychology 58, 210–221.Google Scholar
Sloan, CA, Berke, DS, Shipherd, JC (2017). Utilizing a dialectical framework to inform conceptualization and treatment of clinical distress in transgender individuals. Professional Psychology: Research and Practice 48, 301–309.Google Scholar
Sue, DW, Sue, D (2013). Counseling the Culturally Diverse: Theory and Practice. Hoboken, NJ: John Wiley and Sons, Inc.Google Scholar
Szymanski, DM, Mikorski, R (2016). External and internalized heterosexism, meaning in life, and psychological distress. Psychology of Sexual Orientation and Gender Diversity 3, 265.Google Scholar
Testa, RJ, Habarth, J, Peta, J, Balsam, K, Bockting, W (2015). Development of the gender minority stress and resilience measure. Psychology of Sexual Orientation and Gender Diversity 2, 65–77.Google Scholar
White Hughto, JM, Reisner, SL, Pachankis, JE (2015). Transgender stigma and health: a critical review of stigma determinants, mechanisms and interventions. Social Science and Medicine 147, 222–231.Google Scholar
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