The Significance of LGB-Affirmative Training and Supervision in Improving Clinical Outcomes of LGB Clients

It is becoming increasingly common for psychologists to have clients who identify as LGB. Murphy, Rawlings, and Howe (2002) found “Fifty-six percent of participants had seen at least one LGB client in the past week. Among these participants, the mean percentage of LGB clients was 12%” (p. 185).  LGB affirmative practice is highly essential for clinicians due to health disparities of LGB individuals. LGB individuals are “disproportionately exposed to victimization, discrimination, and peer and parental rejection against a societal backdrop of unequal access to the same opportunities afforded to heterosexual individuals, such as marriage, adoption, and employment nondiscrimination” (Panchankis, 2011). This minority stress experienced by LGB individuals can increase the risk of mental health problems. Despite the strides made in clinical training and supervision, there is more work to be done. One study found clinicians in training had LGB topics covered in less than 25% of their courses, and they reported strong heterosexual bias in textbooks and course content (Bukkard, Knox, Hess & Schultz, 2009). McGeorge, Carlson, Erickson, and Guttormson, 2006 argue that for training to be genuinely LGB affirmative, it must intentionally integrate LGB affirmative attitudes, content, and practices into every aspect of training.

Pett (2000) describes LGB affirmative supervision as a style of supervision that recognizes the pathology of heterosexism. The supervisor is aware of countertransference feelings toward LGB individuals. Furthermore, affirmative supervisors treat their LGB supervisees with respect and acknowledge challenging aspects of LGB people’s lives, such as heterosexism and the coming out process. Supervision is also used to educate trainees and challenge their negative biases. Bukkard et al. (2009) contend that LGB affirmative supervision also celebrates and advocates the validity of LGB persons. Their study found that supervisees who had LGB-affirming supervision reported a higher quality of supervision and more positive client outcomes relative to clinicians with non-affirming supervision. Therefore, this is an integral part of the training process to improve clinical outcomes for clients experiencing minority stress-induced mental dysfunction.

Pachankis, Rendina, Hatzenbuehler, Safren, and Parsons (2015) found that clinicians who used affirmative treatment clients with “significantly reduced depressive symptoms, alcohol use problems, sexual compulsivity, and condomless anal sex with casual partners” compared to the waitlist control group (p. 883). The approach utilized was called Effective Skills to Empower Effective Men (ESTEEM) and helped participants “target the cognitive, affective, and interpersonal pathways through which minority stress impairs mental health” (Pachankis, 2014, p. 325). Training efficacy in LGB affirming treatment like ESTEEM follows the APA (2012) Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients. There is still a subset of faculty who believe that reparative therapy is an appropriate treatment (McGeorge, Carlson, & Maier, 2016). Therefore, it is crucial to focus on training future clinicians in empirically validated LGB affirmative techniques.

Psychology students who have specific classroom instruction, training, and supervision in LGB affirmative therapy perceive higher competence when working with LGB clients (Carlson, McGeorge, & Toomey, 2013). Clinical training programs should address LGB client needs and systemic heterosexism throughout their curriculum and training. Doing so improves clinical outcomes and cultural competency and may reduce some of the health disparities faced by the LGB community.

About the Author

Jared Boot-Haury is a clinical psychology PsyD student at the Michigan School of Psychology. He hails from Ann Arbor, MI where he graduated with a BA in Political Science from the University of Michigan. His primary research interests include LGBTQIA+ communities and the sociopolitical issues that affect the psychological well-being of marginalized communities.

References Cited

American Psychological Association. (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. American Psychologist, 67(1), 10-42.

Burkard, A. W., Knox, S., Hess, S. A., & Schultz, J. (2009). Lesbian, gay, and bisexual supervisees’ experiences of LGB-affirmative and nonaffirmative supervision. Journal of Counseling Psychology, 56(1), 176-188.

Carlson, T. S., McGeorge, C. R., & Toomey, R. B. (2012). Establishing the validity of the affirmative training inventory: Assessing the relationship between lesbian, gay, and bisexual affirmative training and students’ clinical competence. Journal of Marital and Family Therapy, 39(2), 209-222.

McGeorge, C. R., Carlson, T. S., & Maier, C. A. (2016). Are we there yet? Faculty members’ beliefs and teaching practices related to the ethical treatment of lesbian, gay, and bisexual clients. Journal of Marital and Family Therapy, 43(2), 322-337.

Murphy, J. A. (2002). A survey of clinical psychologists on treating lesbian, gay, and bisexual clients. Professional Psychology: Research and Practice, 33(2), 183-189.

Pachankis, J. E. (2014). Uncovering clinical principles and techniques to address minority stress, mental health, and related health risks among gay and bisexual men. Clinical Psychology: Science and Practice, 21(4), 313-330.

Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A., & Parsons, J. T. (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(5), 875-889.