(PS7-A8) i’ve Been Failed so Horrifically: Qualitative Exploration of Negative or Harmful Therapeutic Practices Experienced by Sexual and Gender Minority Individuals

While many professional psychological associations strive to promote affirmative therapeutic techniques, many sexual and gender minority (SGM) individuals continue to encounter harmful stereotypes, ignorance, or discrimination when seeking mental healthcare. Whether or not practitioners are aware of their biases, negative experiences in therapy present significant barriers to treatment progress and perpetuate mistrust in the mental health field. It is imperative to understand the lived experiences of SGM individuals who have sought therapy in order to identify targets for improved provider education and continue to tailor affirming interventions to meet the unique needs and experiences of SGM individuals. The present study aimed to explore the negative experiences of SGM individuals as they have sought mental health intervention, with the ultimate goal of reducing existing barriers to widespread affirming treatment.

As part of a larger online survey of SGM adults, participants were asked to report and describe negative experiences that they have had with mental health professionals based on their SGM identity. Sixty-one participants (M_age = 30.15, SD = 7.95) representing a diversity of sexual orientations (75.4% bi/pan/asexual or queer) and gender identities (60.7% transgender or gender diverse) responded to this question. Responses were coded and thematically analyzed to better understand common factors that negatively impact SGM individuals’ experience of mental health treatment.

Five overarching themes were identified: 1) Identity invalidation (e.g., misgendering, denying existence or permanency of stated identities), 2) Identity pathologization (e.g., attributing identity to mental illness/trauma, overemphasis on identity in treatment) 3) ignorance of SGM experiences (e.g., making inaccurate assumptions, requiring excessive explanation of SGM identities or intersectionality), 4) non-affirming practices (e.g., denial of services, efforts to change SGM identity), and 5) poor therapeutic relationship (e.g., rapport ruptures, breaches of confidentiality, harmful advice). Themes were found to occur differentially across SGM identities. For instance, while people of all SGM identities reported experiencing some degree of identity invalidation, this was most prevalent for gender minority and asexual individuals, who reported high rates of misgendering (i.e. use of incorrect pronouns) and denied existence of their identities, respectively.

The present findings provide further insight into the experiences of SGM individuals as they seek mental health treatment. Negative experiences in therapy can harm the therapeutic alliance, create ruptures in rapport, and present a barrier to effective intervention. The themes identified through this analysis indicate future directions for the training of mental health professionals in order to promote competent, affirming mental health intervention for SGM individuals.