Learning Objectives
1. To describe the three dimensions of evidence-based practice (EBP) in counseling and how to adapt EBP to be relevant with LGBTQ+ youth and adults.
2. To compare the effectiveness of various EBPs with LGBTQ+ youth and adults, including cognitive behavioral therapy, acceptance and commitment therapy, mindfulness-based cognitive therapy, and group modalities.
3. To describe how to address issues of self-acceptance, self-esteem, and career development using EBP.
4. To adapt EBP to a relevant clinical case study.
Evidence-based practice (EBP) enhances mental health outcomes by synthesizing the best available research, clinical expertise, and client characteristics into optimal counseling care (American Psychological Association, 2006). It has the potential to mitigate harmful and ineffective clinical practices, reduce the risk of bias during clinical decision-making, guide the reduction of distressing symptomology, and promote wellness and overall quality of life for clients (American Psychological Association, 2006; Reference Holt, Ralston, Hope, Mocarski and WoodruffHolt et al., 2021). Evidence-based practice combines three different domains: (1) the best available research evidence (e.g., randomized controlled trials, well-designed nonexperimental research, and qualitative research); (2) clinical judgment (e.g., knowledge, interpretation, and decision-making); and (3) client characteristics, values, and contexts that ensure treatment is culturally sensitive and individually tailored (Reference Holt, Ralston, Hope, Mocarski and WoodruffHolt et al., 2021). Mental health professionals (MHPs) utilizing EBP in their clinical work with LGBTQ+ persons need to understand some of the limitations and emerging trends that nuance the three domains of EBP with LGBTQ+ individuals.
The first domain – best possible research evidence – requires MHPs to identify well-designed research studies that provide beneficial findings that can be applied to assessment and counseling. Randomized controlled trials are considered the gold standard for EBP. Mental health professionals need to be aware that there have been more randomized controlled trials with LGBQ persons than with transgender or gender-diverse individuals (Reference PachankisPachankis, 2018). Only recently have randomized controlled trials examining the effectiveness of transgender affirmative psychotherapy interventions been published (see Reference Budge, Sinnard and HoytBudge et al., 2021). In the absence of randomized controlled trials, MHPs could carefully consider rigorous quasiexperimental, nonexperimental, qualitative, and mixed-method studies as viable options to substantiate clinical assessment and practices with LGBTQ+ individuals. Mental health professionals are especially encouraged to consult the results of systematic reviews and meta-analyses and must carefully examine all aspects of a study to determine whether the evidence is appropriate for their LGBTQ+ client.
Another important consideration is the use of culturally responsive and validated assessments when evaluating research evidence for clinical use with LGBTQ+ clients (Reference Holt, Ralston, Hope, Mocarski and WoodruffHolt et al., 2021). There are very few assessments created specifically for transgender and gender-diverse individuals, and those that do exist largely measure gender dysphoria (Reference Holt, Ralston, Hope, Mocarski and WoodruffHolt et al., 2021). Studies validating existing psychological measures with transgender and gender-diverse individuals are also few (Reference Shulman, Holt, Hope, Mocarski, Eyer and WoodruffShulman et al., 2017). There are more measures and validation studies with LGBQ individual, but growth is still necessary in this area, as many measures perpetuate heteronormative and cisnormative biases (Reference Moe, Finnerty, Sparkman and YatesMoe et al., 2015).
The second domain of EBP is clinical expertise. Mental health professionals need to rely on their clinical expertise to seek, evaluate, and apply the best available evidence – often by locating scholarly, peer-reviewed scholarship published in reputable journals. However, clinical judgment can be limited and subject to bias. Thus, the wisdom of experienced clinicians is an invaluable aspect of EBP, and MHPs should consult with LGBTQ+ competent clinical supervisors and colleagues to ensure that they are delivering affirmative care to LGBTQ+ persons.
The third domain of EBP pertains to client characteristics and emphasizes the importance of sociocultural identities and contexts in treatment. Research highlighting the intersecting identities of LGBTQ+ clients (e.g., race, ethnicity, developmental lifespan, disability status) is limited. For example, Reference Barnett, Del Río-González, Parchem, Pinho, Aguayo-Romero, Nakamura, Calabrese, Poppen and ZeaBarnett and colleagues (2019) found that transgender men of color and older LGBT people of color were largely invisible in the research literature. Consideration of factors such as race/ethnicity, socioeconomic status, age, and disability, and the intersections of those factors is a key area for future research and continued clinical work. Furthermore, research on how intersecting client characteristics influence treatment outcomes is an essential area of growth to expand EBPs for LGBTQ+ persons. Thus, MHPs must be cautious when generalizing the results of a study with culturally diverse LGBTQ+ clients and tailor their assessment and counseling according to an individual’s cultural contexts and needs to increase treatment effectiveness (Reference Pachankis and GoldfriedPachankis & Goldfried, 2013).
Policymakers, government agencies, and insurance companies increasingly emphasize EBP (Reference Gaudiano and MillerGaudiano & Miller, 2013). However, EBPs are sparse for LGBTQ+ individuals due to the relative lack of population-based studies, as well as the limited availability of studies testing the efficacy and implementation of affirmative counseling practices for specific mental health or behavioral concerns with this population. In response to this need, several scholars have offered models to adapt existing EBPs to use with LGBTQ+ individuals. For instance, Reference Pachankis, Soulliard, Morris and Seager van DykPachankis et al. (2023) grounded a model in minority stress theory to adapt EBPs to be more LGBQ affirmative. The model emphasizes acknowledging the effects of minority stress, individuals’ strengths, and the importance of supportive relationships (Reference Pachankis, Soulliard, Morris and Seager van DykPachankis et al., 2023). The model also highlights the importance of intersecting identities as sources of resilience and stress for sexual minorities (Reference Pachankis, Soulliard, Morris and Seager van DykPachankis et al., 2023). Relatedly, Reference Hope, Holt, Woodruff, Mocarski, Meyer, Puckett, Eyer, Craig, Feldman, Irwin, Pachankis, Rawson, Sevelius and ButlerHope et al. (2022) offered 12 adaptation recommendations when implementing psychological interventions for transgender and gender-diverse persons. The practice adaptations provide guidance for making various aspects of clinical practice more affirming, such as inclusive paperwork, holistic perspectives on case conceptualization, the importance of managing transgender stigma, providing proper referrals, and considerations for intervening via advocacy (see Reference Hope, Holt, Woodruff, Mocarski, Meyer, Puckett, Eyer, Craig, Feldman, Irwin, Pachankis, Rawson, Sevelius and ButlerHope et al., 2022). To address the prevailing constraints of EBP and to align with the evolving requirements for effective treatment of the LGBTQ+ population in health care, the following section will explore diverse EBPs suitable for addressing common concerns with LGBTQ+ youth and adults.
Evidence-Based Practices for Common Concerns of LGBTQ+ Persons
Mental and Behavioral Health-Related Concerns
As a result of social stigma, discrimination, and victimization (i.e., minority stress), LGBTQ+ adolescents and adults are at a high risk of experiencing a variety of mental and behavioral health concerns, including anxiety, depression, suicidality, post-traumatic stress disorder, substance use disorders, and other mood-related concerns (Reference Nakamura, Dispenza, Abreu, Ollen, Pantalone, Canillas, Gormley and VencillNakamura et al., 2022; Reference Van Der Pol-Harney and McAloonVan Der Pol-Harney & McAloon, 2019). LGBTQ+ individuals with mental and behavioral health concerns may also present with increased negative affect, cognitive rumination, varying manifestations of behavioral avoidance, and maladaptive coping strategies, and they may further struggle with isolation, rejection, and feelings of invalidation (Reference Pachankis, McConocha, Clark, Wang, Behari, Fetzner, Brisbin, Scheer and LehavotPachankis et al., 2020).
A review of various databases (e.g., PsychINFO, EBSCO) revealed hundreds of scholarly papers and studies reporting on the effects of cognitive behavioral therapy (CBT) with LGBTQ+ individuals. Systematic reviews have generally concluded that CBT interventions effectively decrease psychological distress, anxiety, depression, and substance-related risk behaviors among LGBTQ+ youth and adults (see Reference Expósito-Campos, Pérez-Fernández and SalaberriaExpósito-Campos et al., 2023; Reference Van Der Pol-Harney and McAloonVan Der Pol-Harney & McAloon, 2019). Cognitive behavioral therapy aims to identify and modify dysfunctional patterns of thinking and behavior that contribute to emotional distress while improving mental health and well-being (Reference BeckBeck, 1979). Cognitive restructuring – a specific technique unique to CBT – involves identifying and challenging negative, dysfunctional, or irrational thought processes, whereas behavioral experiments involve testing new behaviors to challenge dysfunctional beliefs (Reference BeckBeck, 1979). Mental health professionals contemplating CBT to address mental and behavioral health concerns could consider several book-length resources, such as Transdiagnostic LGBTQ+-Affirmative Cognitive-Behavioral Therapy (Reference Pachankis, Soulliard, Morris and Seager van DykPachankis et al., 2021), LGBTQI Workbook for CBT (Reference SchottSchott, 2021), and Cognitive-Behavioral Therapies with Lesbian, Gay, and Bisexual Clients (Reference Martell, Safren and PrinceMartell et al., 2003) as comprehensive guides that provide theory, practical applications, and therapeutic techniques.
Acceptance and commitment therapy (ACT) is an alternative cognitive behavioral, transdiagnostic framework that researchers have studied rigorously in over 1,000 randomized controlled trials (Association for Contextual Behavioral Science, 2023). Acceptance and commitment therapy emphasizes developing psychological flexibility (i.e., remaining in contact with the present moment) by adapting to changing situational demands while staying committed to one’s values (Reference Hayes, Strosahl and WilsonHayes et al., 2012). Practical implications of ACT include developing mindfulness skills, identifying values and setting goals that align with these values, fostering acceptance and willingness to experience uncomfortable emotions, using metaphors and exercises to develop cognitive diffusion skills, and encouraging clients to take committed action toward their goals and values, even in the face of difficult thoughts and emotions (Reference Hayes, Strosahl and WilsonHayes et al., 2012; Reference SkintaSkinta, 2021). In a small systematic review, Reference Fowler, Viskovich, Buckley and DeanFowler et al. (2022) reported that various facets of ACT effectively addressed interpersonal religious conflict, work-related stress, HIV-related shame, maladaptive eating beliefs and behaviors, substance misuse, suicidality, depression, anxiety, psychological distress, and sexual orientation self-stigma among LGBTQ+ persons. Mental health professionals interested in applying ACT with LGBTQ+ clients should consider both Contextual Behavior Therapy for Sexual and Gender Minority Clients (Reference SkintaSkinta, 2021) and ACT for Gender Identity (Reference StittStitt, 2020).
Lastly, mindfulness-based cognitive therapy (MBCT) is another CBT alternative, combining both cognitive therapy with mindfulness practices. Mindfulness-based cognitive therapy involves developing awareness of the present moment through mindfulness practices, such as body scans, mindful breathing, and learning to disengage from distressing or dysfunctional thought patterns (Reference Segal, Williams and TeasdaleSegal et al., 2018). Mindfulness-based cognitive therapy can help individuals develop self-compassion and positively relate to themselves and their experiences through cultivating a nonjudgmental attitude toward their thoughts and emotions, ultimately fostering a compassionate relationship with themselves (Reference Kuyken, Warren, Taylor, Whalley, Crane, Bondolfi, Hayes, Huijbers, Ma, Schweizer, Segal, Speckens, Teasdale, Van Heeringen, Williams, Byford, Byng and DalgleishKuyken et al., 2016). Mindfulness-based cognitive therapy interventions have shown promising results in reducing symptoms of depression, anxiety, stress, and post-traumatic stress disorder, as well as improving quality of life, self-esteem, and resilience among LGBTQ+ populations (Reference Sun, Nardi, Loucks and OperarioSun et al., 2021). Mental health professionals interested in learning how to incorporate mindfulness practices into their counseling with LGBTQ+ clients can consider Mindfulness and Acceptance for Gender and Sexual Minorities (Reference Skinta and CurtinSkinta & Curtin, 2016).
Self-Acceptance and Self-Esteem-Related Concerns
Whereas self-acceptance includes embracing one’s own strengths and growth edges without judgment, self-esteem is regarded as the global evaluative component of one’s self-concept and worth (Reference Bridge, Smith and RimesBridge et al., 2019; Reference Camp, Vitoratou and RimesCamp et al., 2020). Both are associated with psychological well-being, but the nefarious nature of minority stress could have deleterious effects on both self-acceptance and self-esteem (Reference Bridge, Smith and RimesBridge et al., 2019; Reference Camp, Vitoratou and RimesCamp et al., 2020). Reference Camp, Vitoratou and RimesCamp et al. (2020) found that lower ratings of self-acceptance among LGBQ individuals were associated with depression, lower psychological well-being, and greater psychological distress. When studied in conjunction with sexual orientation, LGB individuals report significantly lower levels of self-esteem than heterosexual-identified persons (Reference Bridge, Smith and RimesBridge et al., 2019), and meta-analyses have demonstrated that low self-esteem is associated with depression and anxiety in the general population (e.g., Reference Sowislo and OrthSowislo & Orth, 2013).
Researchers have recommended CBT to help address issues of self-acceptance (Reference Camp, Vitoratou and RimesCamp et al., 2020) and self-esteem (Reference Bridge, Smith and RimesBridge et al., 2019). Alternatively, compassion-focused interventions could be effective for improving self-esteem more specifically, especially as these interventions attempt to alleviate distress and suffering related to one’s own sense of self (Reference Thomason and MoghaddamThomason & Moghaddam, 2021). However, researchers have not exclusively examined these interventions with LGBTQ+ persons. For this reason, we recommend MHPs consider cognitive behavioral and compassion-focused interventions in conjunction with a transdiagnostic minority stress approach when addressing both self-acceptance and self-esteem with LGBTQ+ persons. Transdiagnostic approaches address self-concept issues central to LGBTQ+ persons related to minority stress, including: (1) normalizing and increasing critical consciousness of the adverse influence of minority stress on mental health and well-being; (2) facilitating emotional regulation and acceptance of negative affect; (3) helping LGBTQ+ persons address painful psychological processes while reducing behavioral and psychological avoidance; (4) empowering assertive communication skills that affirm LGBTQ+ identity and expression; (5) addressing the ways in which minority stress negatively influences cognitions and helping restructure those cognitions to facilitate more adaptative beliefs; (6) identifying and validating strengths and pride in LGBTQ+ identity and expression; (7) bolstering supportive interpersonal relationships and connections; and (8) affirming diverse sexualities and forms of expression (Reference PachankisPachankis, 2015).
Career and Vocation-Related Concerns
A review of career development and vocational research indicates that some of the most prevalent concerns for LGBTQ+ persons include: (1) heterosexism in the organizational workplace and workplace climate (e.g., policies, procedures, and supports); (2) career functioning (e.g., job satisfaction, job commitment, and work–life interface); (3) career development concerns that overlap with LGBTQ+ identity (e.g., decision-making, self-efficacy, and career choice); (4) minority stress and discrimination across the career development trajectory; and (5) LGBTQ+ identity management and disclosure in the workplace (Reference Dispenza, Brown and ChastainDispenza et al., 2016; Reference McFaddenMcFadden, 2015; Reference Velez, Adames, Lei and KermanVelez et al., 2021). Mental health professionals can choose individual, group, or couples and family interventions based on the presenting concern. Couples and family counseling is especially helpful if addressing the work–life interface for LGBTQ+ couples and families (Reference Dispenza, Brown and ChastainDispenza et al., 2016). As part of any intervention, MHPs need to appraise the presence, frequency, and history of these career-related issues, along with the degree to which they contribute to stress or distress in the lives of their LGBTQ+ clients (Reference Dispenza, Brown and ChastainDispenza et al., 2016).
Although empirically validated interventions and approaches for career counseling with LGBTQ+ populations are lacking, researchers have successfully tested the applicability of contemporary career development theories with the LGBTQ+ population, including the theory of work adjustment (Reference Velez and MoradiVelez & Moradi, 2012), the psychology of working theory (Reference Douglass, Velez, Conlin, Duffy and EnglandDouglass et al., 2017), and the social cognitive career theory (Reference Lent, Morris, Tatum, Wang, Moturu and IrelandLent et al., 2021). Mental health professionals may find it beneficial to use these theories of career development as approaches to assess, conceptualize, and deliver career interventions. Mental health professionals should also factor in tenets of minority stress theory as well as career adaptability, coping, and various psychological processes (e.g., emotional regulation, intrapersonal functioning, cognitive factors) when tailoring career-related interventions for LGBTQ+ persons, as these may help promote better vocational functioning (Reference Dispenza, Brown and ChastainDispenza et al., 2016). Further, researchers have identified additional career-related factors that may prove beneficial when providing career counseling services. For instance, social support (e.g., close friends, family relatives), one’s connection to the LGBTQ+ community, and self-compassion toward one’s own identity could help facilitate positive career decision-making for LGBTQ+ persons (Reference Jang, Woo and LeeJang et al., 2020; Reference Winderman, Martin and SmithWinderman et al., 2018).
For MHPs considering organizational or advocacy-based career interventions, Reference McFaddenMcFadden (2015) offered the following suggestions: (1) develop policies and practices that affirm sexual orientation diversity and protect gender identity/expression in the workplace (e.g., same-gender partner benefits, dismantle anti-LGBTQ+ policies and procedures); (2) encourage diversity training and workshops that educate employees about LGBTQ+ populations; (3) develop mentoring opportunities to assist LGBTQ+ persons with their career trajectories; (4) increase recruitment of LGBTQ+ individuals to the workplace; and (5) increase administrative transparency to reduce bias and discriminatory practices in the workplace.
Evidence for Group Modalities
Affirmative and strength-based integrated group interventions (e.g., counseling, psychotherapy, support, education) are valuable treatment modalities with LGBTQ+ persons, offering benefits that promote therapeutic wellness, social connection, and personal growth (Reference Ali and LambieAli & Lambie, 2019; Reference Chen, Boyd and CunninghamChen et al., 2020; Reference Expósito-Campos, Pérez-Fernández and SalaberriaExpósito-Campos et al., 2023; Reference Hambrook, Aries, Benjamin and RimesHambrook et al., 2022; Reference Hobaica, Alman, Jackowich and KwonHobaica et al., 2018; Reference Skinta, Lezama, Wells and DilleySkinta et al., 2015). LGBTQ+ affirmative and strengths-based frameworks contend that LGBTQ+ identities and expressions are normative and not pathological and that LGBTQ+ individuals are inherently resourceful and resilient, and they counter negative messages and narratives of stigma and oppression (Reference Nakamura, Dispenza, Abreu, Ollen, Pantalone, Canillas, Gormley and VencillNakamura et al., 2022). Group modalities can also be cost-effective means for LGBTQ+ persons needing services across a variety of agencies, such as schools, colleges/universities, veterans’ affairs hospitals, medical centers, rehabilitation agencies, community clinics, and private practices. However, these interventions are only effective if the MHPs offering these services are critical, self-reflective, mitigate any implicit and explicit bias that may contribute to their therapeutic work, and promote wellness and resilience when working with LGBTQ+ persons in group contexts (Reference Chen, Boyd and CunninghamChen et al., 2020; Reference Nakamura, Dispenza, Abreu, Ollen, Pantalone, Canillas, Gormley and VencillNakamura et al., 2022).
Group modalities can be highly effective with LGBTQ+ youth and adults to improve mental health symptomology, coping, and self-esteem (Reference Hobaica, Alman, Jackowich and KwonHobaica et al., 2018). Among LGB adults, empirical studies have shown that group modalities can help facilitate the coming-out process (Reference Ali and LambieAli & Lambie, 2019), reduce depression, anxiety, and mental health-related functional impairments (Reference Hambrook, Aries, Benjamin and RimesHambrook et al., 2022), promote healthy weight among lesbian and bisexual women (Reference Fogel, McElroy, Garbers, McDonnell, Brooks, Eliason, Ingraham, Osborn, Rayyes, Redman, Wood and HaynesFogel et al., 2016), and reduce HIV-related stigma and distress among gay and bisexual men living with HIV (Reference Skinta, Lezama, Wells and DilleySkinta et al., 2015). From a systematic review that included 12 empirical studies that evaluated the effectiveness of group modalities with transgender and gender-nonbinary persons, Reference Expósito-Campos, Pérez-Fernández and SalaberriaExpósito-Campos et al. (2023) reported that group modalities were effective at decreasing symptoms of depression, anxiety, gender-related minority stress, suicidality, and post-traumatic stress disorder. Further, group interventions facilitated improvements in resilience, positive identity development, self-esteem, support, and coping.
A Guided Case Study: Thinking About EBP with Kaleem McKnight
Kaleem McKnight is a 20-year-old Black, cisgender, queer male. He grew up Methodist in the suburbs of Atlanta, Georgia. During Kaleem’s freshman year of college, he experienced a spinal cord injury (SCI) below the waist. After 6 months of intensive physical and psychosocial rehabilitation, Kaleem decided to return to college as an undeclared major with an unclear career goal. In his intake paperwork, Kaleem stated: “I need help with my transition back into college. I really need help managing my anxiety and depression. I feel nervous, on edge, have difficulty focusing and sleeping, and have many days that I feel sad. I’m also scared that I’ll be by myself for the rest of my life because of my disability.” Thinking of the first three steps identified in Table 11.1, what might be one area of clinical focus in this case? How would you go about searching for the best available evidence to support your clinical focus? What factors would you consider as you appraise the available evidence and research?
Table 11.1 Guide to implementing evidence-based practice with LGBTQ+ clients
| Step | Description | Adapting evidence-based practice to be LGBTQ+ affirmative |
|---|---|---|
| (1) Identify a focus, population, or clinical question | Identify and operationalize the clinical area of focus or clinical question that needs empirical attention (e.g., population issue, best counseling intervention) | Critically reflect on how cisnormativity and heteronormativity may influence your initial approach to identifying, questioning, and operationalizing your clinical focus |
| (2) Search for best available evidence | Conduct comprehensive literature reviews (peer-reviewed scholarship) using available databases, electronic search engines, and reputable websites. Identify systematic reviews, meta-analyses, and randomized controlled trials from peer-reviewed sources | Review clinical guidelines released by professional associations (e.g., American Counseling Association, American Psychological Association, Society for Sexual, Affectional, Intersex, and Gender Expansive Identities in Counseling) and use appropriate identifiers when using search engines for research-based resources (e.g., gay, bi+, lesbian, transgender, minority stress, cisgender, queer) |
| (3) Appraise the available evidence | Consider relevant study methods, results, and interpretations, including internal validity. Determine the generalizability of findings and results with your specific clinical focus, clinical question, or population | Critically analyze the potential influence of minority stress on the mental health and well-being of LGBTQ+ individuals when appraising the evidence, validity, and generalizability of a study’s results |
| (4) Integrate client contexts and cultural identities | Critically consider sociocultural contexts (e.g., gender, race, ethnicity, socioeconomic status, disability status, religion/spirituality), personality characteristics, and values of the client and how these factor into clinical assessment and counseling | Identify strengths of LGBTQ+ identity and expression first. Consider intersecting identities, interpersonal relationships, connections, and community supports. Identify social and institutional barriers, including stigma and minority stress |
| (5) Case concept and treatment plan | Integrate and synthesize all available clinical and research evidence to develop a culturally sustaining, responsive, and holistic case conceptualization. Afterward, begin identifying treatment goals and objectives and integrate evidence into treatment interventions and strategies | Consider interventions that address minority stress, emotional regulation, and painful psychological experiences. Monitor minority stress influences on cognitions and help restructure those cognitions to facilitate adaptive belief systems. Empower assertive communication skills that affirm LGBTQ+ identity and expression |
| (6) Monitor progress and treatment outcomes | Utilize culturally valid and evidence-based (if available) appraisal measures (e.g., clinical inventories, subjective ratings, symptom ratings) to track counseling process and outcomes. Use clinical data to modify treatment plan accordingly | Review measures, inventories, and scales for LGBTQ+ appropriateness and modify them accordingly. Ensure the LGBTQ+ client is included in all aspects of treatment planning and implementation |
| (7) Seek consultation and supervision and engage in reflection | Engage in self-reflection. Seek consultation and supervision from colleagues and professionals who possess relevant expertise | Reflect on how cisnormativity and heteronormativity may be influencing the counseling processes and outcomes. Develop a referral log of affirmative providers |
| (8) Seek continuing education and training | In addition to reading emerging research from peer-reviewed journals, attend conferences and workshops to stay up to date on evidence-based trends in clinical practice | Read relevant LGBTQ+ counseling and psychology journals. Attending LGBTQ+ focused workshops and conferences. Join LGBTQ+ professional organizations |
During the intake session, the MHP learns that Kaleem’s parents divorced when he was 12 years old, and Kaleem took on many household responsibilities and duties as he was the eldest child. He was active in sports and high school extracurriculars, and he volunteered as a big brother mentor at his church. However, after coming out as queer, he participated less in church functions. Kaleem’s mother was incredibly supportive of him after he came out as queer, but his father did not support “his lifestyle choice.” At the time of the injury, Kaleem was living with his mother and siblings.
After his SCI, Kaleem experienced a dramatic shift in his family system. Kaleem’s mother became his caregiver, providing support for his activities of daily living, while his younger siblings were asked to take on more household responsibilities. Although he had a large friendship group during his first year of college, he had only a very small group of queer friends. He is unaware of any of his friends living with a disability. During the intake session, Kaleem described feeling isolated and having little desire to connect with others, and he described a sense of hopelessness for his future. Thinking of steps (4)–(8) identified in Table 11.1, what identity and cultural context would be important to critically synthesize in this case? How would you begin to conceptualize Kaleem’s presenting issues, and what initial considerations would you factor into his treatment plan? What would you monitor in treatment, and how would you monitor progress? Lastly, what type of consultation/supervision and training would you seek at this time?
1. How might sociocultural, political, and institutional values of heteronormativity, cisnormativity, and the gender binary influence the way you engage in EBP with LGBTQ+ clients?
2. How do you currently access research and EBP? Which resources would you need to improve such access? What strategies and procedures could you adopt to integrate EBP into your counseling practice with LGBTQ+ clients?
3. Identify and describe the strategies you would develop to effectively implement EBP with LGBTQ+ clients. Who can you consult with to help you grow in terms of your EBP with LGBTQ+ clients?
