Skip to main content

Advertisement

SpringerLink
Log in

Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation

  • Original Paper
  • Published:
Clinical Social Work Journal Aims and scope Submit manuscript

Abstract

Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Baer, S., & Garland, E. (2005). Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 258–264.

    Article  PubMed  Google Scholar 

  • Balsam, K., & Szymanski, D. (2005). Relationship quality and domestic violence in women’s same-sex relationships: The role of minority stress. Psychology of Women Quarterly, 29, 258–269.

    Article  Google Scholar 

  • Beck, A. T. (1993). Cognitive therapy: Past, present, and future. Journal of Consulting and Clinical Psychology, 61, 194–198.

    Article  PubMed  Google Scholar 

  • Beck, A. T. (2006). Depression: Causes and treatment. Philadelphia: University of Pennsylvania Press.

    Google Scholar 

  • Callahan, P., Liu, P., Purcell, R., Parker, A., & Hetrick, S. (2012). Evidence map of prevention and treatment interventions for depression in young people. Depression Research and Treatment, 10, 1–11.

    Article  Google Scholar 

  • Center for Disease Control and Prevention (2011). Health risks among sexual minority youth. Retrieved August 30, 2012 from http://www.cdc.gov/healthyyouth/disparities/smy.htm.

  • Compton, S., March, J., Brent, D., Albano, A., Weersling, R., & Curry, J. (2004). Cognitive-behavioral psychotherapy for anxiety and depressive disorders in children and adolescents: An evidence-based medicine review. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 930–959.

    Article  PubMed  Google Scholar 

  • Cowger, C. D. (1994). Assessing client strengths: Clinical assessment for client empowerment. Social Work, 39, 262–268.

    PubMed  Google Scholar 

  • Crisp, C., & McCave, E. L. (2007). Gay affirmative practice: A model for social work practice with gay, lesbian, and bisexual youth. Child and Adolescent Social Work Journal, 24, 403–421.

    Article  Google Scholar 

  • D’Augelli, A. R., Pilkington, N. W., & Hershberger, S. L. (2002). Incidence and mental health impact of sexual orientation victimization of lesbian, gay, and bisexual youths in high school. School Psychology Quarterly, 17, 148–167.

    Article  Google Scholar 

  • Davies, D. (1996). Towards a model of gay-affirmative therapy. In D. Davis & C. Neal (Eds.), Pink therapy: A guide for counselors and therapists working with lesbian, gay, and bisexual clients (pp. 51–68). Buckingham: Open University Press.

    Google Scholar 

  • DiPlacido, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. Herek (Ed.), Psychological perspectives on lesbian and gay issues: Vol. 4. Stigma and sexual orientation: Understanding prejudice against lesbians, gay men, and bisexuals (pp. 138–159). Thousand Oaks, CA: Sage.

    Chapter  Google Scholar 

  • Duarté -Vélez, Y., Bernal, G., & Bonilla, K. (2010). Culturally adapted cognitive-behavioral therapy: Integrating sexual, spiritual, and family identities in an evidence-based treatment of a depressed Latino. Adolescent Journal of Clinical Psychology, 66, 895–906.

  • Eamon, M. K. (2008). Empowering vulnerable populations: Cognitive-behavioral interventions. Chicago, IL: Lyceum Books.

    Google Scholar 

  • Fergusson, D. M., Horwood, J. L., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people?. Archives of General Psychiatry, 56, 876–880.

    Article  PubMed  Google Scholar 

  • Gibson, P. (1994). Gay male and lesbian youth suicide. In G. Remafedi (Ed.), Death by denial (pp. 15–68). Boston: Alyson Publications.

    Google Scholar 

  • Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., et al. (2011). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58(1), 10–51.

    Article  PubMed  Google Scholar 

  • Hays, P. (2009). Integrating evidence-based practice, cognitive–behavior therapy, and multicultural therapy: Ten steps for culturally competent practice. Professional Psychology: Research and Practice, 40, 354–360.

    Article  Google Scholar 

  • Heck, N. C., Flentje, A., & Cochran, B. N. (2011). Offsetting risks: High school gay-straight alliances and sexual minority youth. School Psychology Quarterly, 26, 161–174.

    Article  Google Scholar 

  • Hyun, M. S., Chung, H. I. C., & Lee, Y. J. (2005). The effect of cognitive-behavioral group therapy on the self-esteem, depression, and self-efficacy of runaway adolescents in a shelter in South Korea. Applied Nursing Research, 18, 160–166.

    Article  PubMed  Google Scholar 

  • Interian, A., Martinex, I., Rios, L., Krejci, J., & Guarnaccia, P. J. (2010). Adaptation of a motivational interviewing intervention to improve antidepressant adherence among Latinos. Cultural Diversity and Ethnic Minority Psychology, 16, 215–225.

    Article  PubMed  Google Scholar 

  • Kelly, S. (2006). Cognitive—behavioral therapy with African Americans. In P. A. Hays & G. Y. Iwamasa (Eds.), Culturally responsive cognitive—behavioral therapy: Assessment, practice, and supervision (pp. 97–116). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • King, M., Semlyen, J., Tai, S. S., Killaspy, 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). Retrieved August 31, 2011, from http://www.biomedcentral.com/1471-244X/8/70.

  • Langdridge, D. (2007). Gay affirmative therapy: A theoretical framework and defense. Journal of Gay and Lesbian Psychotherapy, 11(1/2), 27–43.

    Article  Google Scholar 

  • Leahy, R. (2006). Roadblocks in CBT. New York: Guilford Press.

    Google Scholar 

  • Lebolt, J. (1999). Gay affirmative psychotherapy: A phenomenological study. Clinical Social Work Journal, 27, 335–370.

    Article  Google Scholar 

  • Marshal, M., Dietz, L., Friedman, M., Stall, R., Smith, H., McGinley, J., et al. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. The Journal of Adolescent Health, 49, 115–123.

    Article  PubMed  Google Scholar 

  • Martell, C. R., Safren, S. A., & Prince, S. E. (2004). Cognitive-behavioral therapies with lesbian, gay, and bisexual clients. New York: Guilford.

    Google Scholar 

  • Melvin, G. A., Tonge, B. J., King, N. J., Heyne, D., Gordon, M. S., & Klimkeit, E. (2006). A comparison of cognitive-behavioral therapy, sertraline, and their combination for adolescent depression. Journal of American Academy for Child and Adolescent Psychiatry, 45, 1151–1161.

    Article  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

    Article  PubMed  Google Scholar 

  • Meyer, I., Dietrich, J., & Schwartz, S. (2007). Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. American Journal of Public Health, 97, 1–4.

    Google Scholar 

  • Pence, S., Aldea, M., Sulkowski, M. & Storch, E.(2011). Cognitive behavioral therapy in adults with obsessive–compulsive disorder and borderline intellectual functioning: A case series of three patients. Journal of Developmental and Physical Disabilities, 23, 271–85.

    Google Scholar 

  • Ray, N. (2007) Lesbian, gay, bisexual and transgender youth: An epidemic of homelessness. National Gay and Lesbian Task Force. Retrieved from: http://www.thetaskforce.org/reports_and_research/homeless_youth.

  • Rigby, L., & Waite, S. (2007). Group therapy for self-esteem, using creative approaches and metaphor as clinical tools. Behavioural and Cognitive Psychotherapy, 35, 361–364.

    Article  Google Scholar 

  • Ross, L. E., Doctor, F., Dimito, A., Kuehl, D., & Armstrong, M. S. (2007). Can talking about oppression reduce depression? Modified CBT group treatment for LGBT people with depression. Journal of Gay & Lesbian Social Services, 19, 1–15.

    Article  Google Scholar 

  • Rosselló, J., & Bernal, G. (2009). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67, 734–745.

    Article  Google Scholar 

  • Rosselló, J., Bernal, G., & Rivera-Medina, C. (2008). Individual and group CBT and IPT for Puerto Rican adolescents with depressive symptoms. Cultural Diversity and Ethnic Minority Psychology, 14, 234–245.

    Article  PubMed  Google Scholar 

  • Rotheram-Borus, M. J., Piacentini, J., Miller, S., Graae, F., & Castro-Blanco, D. (1994). Brief Cognitive-Behavioral treatment for adolescent suicide attempters and their families. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 508–517.

    Article  PubMed  Google Scholar 

  • Rothman, J. (1989). Client self-determination: Untangling the knot. Social Service Review, 64, 589–612.

    Google Scholar 

  • Safren, S. A., & Rogers, T. (2001). Cognitive behavioural therapy with gay, lesbian and bisexual clients. Psychotherapy in Practice, 57, 629–643.

    Google Scholar 

  • Saleebey, D. (1996). The strengths perspective in social work practice: Extensions and cautions. Social Work, 41, 296–305.

    PubMed  Google Scholar 

  • Saleebey, D. (2002). Power in the people. In: D. Saleebey (Ed.), The strengths perspective in social work practice (3rd edn.) (pp. 1–22). Boston, MA. Allyn & Bacon.

  • Selvidge, M., Matthews, C., & Bridges, S. (2008). The relationship of minority stress and flexible coping to psychological well-being in lesbian and bisexual women. Journal of Homosexuality, 55(3), 450–470.

    Article  PubMed  Google Scholar 

  • Stanley, B., Brown, G., Brent, D., Wells, K., Poling, K., Curry, J., et al. (2009). Cognitive behavior therapy for suicide prevention (CBT-SP): Treatment model, feasibility and acceptability. Journal American Academy of Child Adolescent Psychiatry, 48, 1005–1013.

    Article  Google Scholar 

  • Townsend, E., Walker, D., Sargeant, S., Vostanis, P., Hawton, K., Stocker, O., et al. (2010). Systematic review and meta-analysis of interventions relevant for young offenders with mood disorders, anxiety disorders, or self-harm. Journal of Adolescence, 33, 1–15.

    Article  Google Scholar 

  • Tozer, E. E., & McClanahan, M. K. (1999). Treating the purple menace: Ethical considerations of conversion therapy and affirmative alternatives. Counseling Psychologist, 27, 722–742.

    Article  Google Scholar 

  • Treatment for Adolescents with Depression Study (TADS). (2004). Fluoxetine, cognitive-behavioral therapy, and the combination for adolescents with depression. JAMA, 292, 807–821.

    Article  Google Scholar 

  • Van Den Bergh, N. (2002). Feminist social work practice: Where have we been…Where are we going? In N. Van Den Bergh (Ed.), Feminist practice in the 21st century (pp. xi–xxxix). Washington, DC: National Association of Social Workers.

  • Wariki, W., Ota, E., Mori, R., Koyanagi, A., Hori, N., Shibuya, K. (2012). Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries (Review). The Cochrane Collaboration. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005272.pub3.

  • Wood, P., & Mallinckrodt, B. (1990). Culturally sensitive assertiveness training for ethnic minority clients. Professional Psychology: Research and Practice, 21, 5–11.

    Article  Google Scholar 

Download references

Conflict of interest

The authors declare that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5V 1V4, Canada

    Shelley L. Craig

  2. School of Social Work, Barry University, 11300 NE 2nd Avenue, Miami Shores, FL, 33161-6695, USA

    Ashley Austin

  3. Rutgers, The State University of New Jersey, 536 George Street, New Brunswick, NJ, 08901, USA

    Edward Alessi

Authors
  1. Shelley L. Craig
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashley Austin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Edward Alessi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shelley L. Craig.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Craig, S.L., Austin, A. & Alessi, E. Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation. Clin Soc Work J 41, 258–266 (2013). https://doi.org/10.1007/s10615-012-0427-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10615-012-0427-9

Keywords

Search

Navigation