Recommendations for Use of Affirmative Psychotherapy With LGBT Older Adults

Abstract

Affirmative therapy is a type of psychotherapy used to validate and advocate for the needs of sexual and gender minority clients. Therapists use verbal and nonverbal means to demonstrate an affirming stance toward lesbian, gay, bisexual, and transgender (LGBT) clients. Although this therapeutic approach can be used with LGBT individuals across the lifespan, the case presented in this paper highlights the benefit of using this approach with older LGBT individuals. Discussion of the unique challenges faced by older LGBT people will be followed with an illustrative case that shows ways that affirmative therapy can help individuals achieve greater self-actualization. The case formulation and conclusion will highlight specific ways that therapists can convey an affirmative stance and help clients feel welcome and accepted in the therapeutic setting. Recommendations for environmental cues, intake questions, and treatment skills will be offered at the conclusion.

The mental health needs and concerns of older people who identify as LGBTQ+: A narrative review of the international evidence

“…Conforming to heteronormative living was fundamental to physical, social, and economic survival. This would often lead to internalized homophobia and a denial of one's authentic identity (D'Augelli & Grossman, ; Fredriksen‐Goldsen, Kim, et al, ; Hinrichs & Donaldson, ).…”

“…These factors can have a significant cumulative negative effect on psychosocial outcomes (McCann et al, ). There can be a genuine fear of disclosure of LGBTQ + identity in aged care settings with some older people deciding to remain or return to the safety of ‘the closet’ (Hinrichs & Donaldson, ; Hoy‐Ellis & Fredriksen‐Goldsen, ). In one study, 43% of participants said that they did not feel respected by practitioners and 26% did not reveal their LGBTQ + status for fear of a negative response (McCann et al, ).…”

“…The provision of and access to appropriate talking therapies is often limited. This is despite clear benefits demonstrated in the use of affirmative psychotherapy with older LGBT people with clients reporting improvements in self‐esteem, well‐being, and ‘greater self‐actualization’ (Hinrichs & Donaldson, ). Treatments and interventions uptake for substance use were found to be relatively low among LGBTQ + older people (Jessup & Dibble, ).…”

“…Nurses therefore have a role to play in developing and implementing national and local policies that recognizes and reflects the specific health needs, including the requisite for access to effective nursing and mental health care, treatment, and support. Nurse policy makers and leaders need to ensure that there is adequate provision of care and access to culturally competent assessment and treatment options including non‐drug‐based therapeutic interventions, such as cognitive behavioural therapy (CBT), to address past and present mental health issues (Elder, ; Hinrichs & Donaldson, ).…”

“…A moderate score (14–16) was achieved by two of the studies (D'Augelli & Grossman, ; Grossman, D'augelli, & O'connell, ). One study scored 12 points (Hinrichs & Donaldson, ) indicating that there were shortcomings in relation to recruitment procedures, ethical considerations, and data analysis. Two members of the research team (EM and MB) independently rated each paper and then compared results until unanimity was reached.…”