A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients' mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients' cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common asso-ciations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to deter-mine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.

Automated summary

The mental health field has conducted clinical trials that prove the effectiveness of affirmative practice with sexual minority individuals. This paper presents a model for adapting evidence-based practices to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative in order to bring the results of these clinical trials into real-world clinical practice efficiently. The model incorporates six LGBQ-affirmative transtheoretical principles of change and offers a transtheoretical approach to case conceptualization. The principles aim to raise awareness of the impact of minority stress, utilize sexual minority resilience, and consider the role of ongoing minority stress in maintaining distress.