Strengthening the Therapeutic Alliance: A Qualitative Study on LGTBQ people's experiences of trauma therapy

This session is not available for CE credit.

Authors: Cassandra Wyers, Leah Keating and Robert T. Muller

Abstract
Background
LGBTQ+ individuals are more vulnerable to trauma exposure across the lifespan than heterosexual individuals (Flores et al., 2020). According to the minority stress model, the additive nature of sexual identity-based discrimination and increased trauma exposure puts LGBTQ+ individuals at greater risk of developing severe mental health problems, including PTSD (Meyer, 2013). As a result, LGTBQ+ individuals report an increased need for trauma support and are more likely to consult a mental health professional (Gnan et al., 2019). While LGBTQ+ individuals encounter several barriers to accessing trauma services, they are also at higher risk of experiencing discrimination within the therapeutic relationship (Keating et al., 2021), which can weaken therapeutic outcomes (Nadal et al., 2016). Making trauma-specific services more affirmative for LGBTQ+ individuals is critical, and can be done effectively using qualitative research methods to understand the unique context of the therapeutic alliance (Rees et al., 2021).

Method
Participants (N=40) were recruited from a larger quantitative study at York University which investigated the frequency of trauma in the LGBTQ+ community (Keating et al., 2021; Keating & Muller, 2019). Participants had to identify as LGBTQ+, have experienced trauma, and have attended at least one therapy session after their trauma exposure. Participants were asked open-ended questions about their sexual and gender identities, their definition of trauma, and their positive and negative experiences of accessing trauma therapy.
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Analysis
Results were analyzed using thematic content analysis; interviews were assessed for codes (i.e., factors that identify content and meaning within the data), which were then categorized and sorted into themes, which highlight patterned features of responses (Braun & Clarke, 2006).

Results
While formal analyses are still ongoing, initial results highlighted several key topics: (1) the importance of representation in mental health care professionals, (2) the perceived role-reversal between therapist and client, (3) the impact of heteronormative assumptions (e.g., rigid assumptions of trauma, nonverbal cues, assuming gender and identities), (4) the balancing act of protecting their community while being vulnerable about traumatic experiences, and (5) having their coping skills being pathologized by therapists. Implications: This study will help identify positive and negative factors that LGBTQ+ individuals experience within the therapeutic relationship, with the hope of increasing mental health care professionals’ awareness of their assumptions and behaviours. It also hopes to contribute to the use of an anti-oppression framework in research by being data-driven rather than ascribing data to heteronormative theories and understandings. Lastly, it hopes to bridge the gap between the study of trauma and LGBTQ+ issues.