A systematic review of therapist perspectives on cognitive behavioral therapy with gender and sexual minorities

BackgroundSexual and gender minority (SGM) individuals such as those who identify as lesbian, bisexual, pansexual, transgender or nonbinary, uniquely experience heightened stress as compared to their heterosexual and cisgender cohorts. Cognitive behavioural therapy (CBT) can address the cognitive, affective and interpersonal pathways via which minority stress adversely impacts mental health among SGM individuals.ObjectiveThis systematic review aims to explore the qualitative evidence about the experiences of CBT therapists working with SGM individuals, focusing on the challenges they encounter and the strategies they employ to deliver effective care.MethodElectronic searches were conducted across APA Psychnet, Web of Science, Medline, Embase, PubMed and Google Scholar using specific keywords related to SGM populations and CBT. Included studies were qualitative, published between 2000 and 2023, and focused on therapists' experiences with SGM clients. Seven studies met the inclusion criteria and were analysed.ResultsThe review identified several challenges faced by CBT therapists, including issues related to cultural competency, stigma, discrimination, and the need for culturally adapted interventions. Therapists reported difficulties in acknowledging and integrating the unique aspects of their clients' sexual and gender identities into therapy, which sometimes resulted in microaggressions and therapeutic neglect. Therapists who sought additional training and incorporated frameworks such as minority stress and intersectional stigma reported more effective therapeutic outcomes.ConclusionsThis review underscores the importance of enhancing training programs and delineating comprehensive guidelines to equip therapists with the requisite skills for providing culturally competent and individualised care to SGM clients. Despite the challenges, CBT holds promise for effectively addressing minority stress and promoting resilience among SGM populations when therapists are adequately prepared. Future studies must bridge the gap between theoretical recommendations and practical applications to improve outcomes for SGM clients.