(PS7-A7) Retrospective Comparison of Actual versus Predicted Benefit of Therapy During Adolescence in Sexual and Gender Minority Adults

Substantial evidence suggests that sexual and gender minority (SGM) individuals are at increased risk for adverse mental health outcomes but often encounter barriers to treatment. As adolescents often rely on guardians who may not support their identity, SGM youth may be particularly at-risk but unable to seek care. Further, research indicates that SGM individuals may be less likely to perceive benefit from therapy, and many report negative experiences with providers. The present study sought to expand upon existing research by allowing SGM adults to reflect on their past experiences with or desire for therapy during adolescence.

Researchers utilized mixed methods to explore discrepancies between perceived benefit of therapy during adolescence in those who received it and predicted benefit in those who did not. A sample of 383 SGM adults (M_age = 30.64, SD = 10.02) representing diverse SGM identities (76.4% bi/pan/asexual or queer; 55.8% transgender or gender diverse) completed an online survey. Participants were divided into two groups based on whether they received therapy during adolescence. Therapy recipients (N = 145) were asked to rate the degree to which they feel that therapy benefitted them at that time on a 5-point Likert scale (1 = not at all, 5 = very much). Non-recipients (N = 238) were asked to rate perceived benefit of therapy at that time on the same scale. Participants were also asked to rate actual/perceived benefit of therapy for specific topics, including improving relationships, coming out, identity acceptance, coping, and improving mental health. Participants were provided optional space to elaborate on responses.

Independent samples t-tests were conducted to assess differences between perceived benefit of therapy during adolescence in recipients and predicted benefit of therapy in non-recipients. Results indicate that recipients reported lower overall therapeutic benefit (M = 2.48, SD = 1.26) than predicted benefit as reported by non-recipients (M = 3.92, SD = 1.27), t(381) = -6.15, p < .001, Cohen’s d = -.648. This pattern remained for each specific topic. Participants’ elaborative responses were thematically analyzed. Among recipients who rated their experiences less positively, common themes included parental overinvolvement, identity invalidation, lack of confidentiality, SGM stereotypes, misdiagnosis, and poor therapeutic relationships. Non-recipients who predicted greater benefit felt that therapy would have been helpful to combat burgeoning mental health concerns, receive general support, and explore/accept their identity.

Results suggest that many SGM adults feel they would have benefitted from therapy during adolescence but did not receive it. Further, many SGM adults who did receive treatment in their youth report negative experiences. While these results are likely influenced by the retrospective design, as participants may have rated perceptions of therapeutic benefit from a contemporary lens, they also suggest that many SGM adults believe they would have benefitted from affirming intervention with trusted providers earlier in life. These results emphasize the need for continued efforts to reduce treatment barriers and promote clinical competence in providers working with SGM youth.