When therapies for psychological trauma are adapted for sexual and gender minorities and delivered by therapists with high levels of sensitivity to their experiences, outcomes are better, according to a scoping review by McGill University researchers. In particular, there are fewer post-traumatic stress symptoms such as nightmares and intrusive thoughts, as well as risk-taking behaviours (e.g., self-harm, drug use), the researchers said.
The researchers highlighted the importance of considering the stress associated with the stigma and discrimination experienced by many members of these minorities, alongside directly addressing traumatic experiences.
"Folks from sexual and gender minorities have much higher rates of trauma exposure than the general population yet often experience discrimination when trying to gain access to therapy," said Zoë Thomas, Assistant Professor in the Department of Psychiatry and the study's senior author. "This research helps us understand how to better serve these communities. It may also help policymakers support the development of more inclusive clinical practice guidelines."
Examples of inclusive interventions identified in the review include using gender-neutral language, asking for pronouns, displaying visible signs of affirmation in therapy settings and being knowledgeable about community resources and issues affecting sexual and gender minorities.
"It is paramount to repair ruptures in the therapy relationship that can occur from unintentional discrimination," Thomas said.
Research gaps remain
The researchers searched four major databases for studies examining trauma-focused therapies for sexual and gender minorities. They then analyzed and summarized findings from 10 studies that met their criteria.
The trauma-focused therapies they found to have the most promise included Seeking Safety, Dialectical Behavioural Therapy-Prolonged Exposure, Narrative Exposure Therapy, Trauma-Focused Psychodynamic Psychotherapy and Cognitive-Behaviour Therapy for Trauma and Self-Care.
However, the authors caution that the available evidence remains limited, with most studies involving small samples and relatively few controlled comparisons.
"Unsurprisingly, we found that there is not much research on the topic," Thomas said. "More studies are needed, with robust methodology. We hope these findings will inform clinical practice guidelines to encourage widespread inclusive practices for folks from sexual and gender minorities."
The researchers said they plan to integrate the results into the Trauma-Focused Therapy Program they offer at the Jewish General Hospital.
About the study
"Trauma-Focused Therapy in Sexual and Gender Minority Individuals: A Scoping Review of Therapeutic Interventions Contributing to Accessibility and Outcomes," by Audrey Le, Lauren Kay, Gaëlle Cyr, Lucie Dubes, Jill Boruff, Jann Tomaro, Jackson Hagner, Rachel Langevin, and Zoë Thomas, was published in Trauma, Violence & Abuse.
