Targeting Sexual Stigma: The Hybrid Case Study of "Adam"


  • Sarah Hope Mandel



sexual stigma, internalized homophobia, identity formation, LGB clients, LGB-affirmative therapy, multicultural theories, cognitive-behavioral therapy, client-centered therapy, hybrid case study, case study, clinical case study


The purpose of this case study is to explore the effects of sexual stigma on mental health and corresponding therapy implications when working with lesbian, gay, and bisexual (LGB) clients during the coming-out process.  This case study provides a literature review of sexual stigma and its consequences, describes multicultural considerations, and illustrates what are currently thought of as the best treatment practices when working with sexual minority clients.  Treatment considerations are demonstrated via the hybrid case example of "Adam," who serves as a vivid portrayal of a psychotherapy client who struggles with research-consistent symptomatology and a crisis in identity formation.  In addition to being informed by clinical examples in relevant psychological literature, Adam’s composite case is assembled from actual psychotherapy cases.  Demonstrating Adam’s course of treatment provides an avenue for describing key clinical issues related to LGB mental health and the coming-out process.  By adopting a qualitative, disciplined inquiry approach, I illustrate how, theoretically, treatment can be tailored to a potential client’s unique psychological struggles within the context of historical, contextual, and cultural factors.  Following a pragmatic case study research format (Fishman, 1999), Adam’s case material is analyzed both qualitatively and quantitatively.  It is proposed that the hybrid case of Adam demonstrates the potential for an integrative treatment approach, combining cognitive-behavioral, client-centered, and multicultural theories, in an effort to assist in the treatment of sexual minority patients who struggle with minority-stress, internalized homophobia, and identity formation concerns.  The composite case study of Adam is designed to be used as a resource for therapists who seek to gain additional understanding of how to provide effective and affirmative treatment for LGB clients.  The case study concludes with a critical discussion of the advantages and limitations of employing hybrid cases in lieu of actual ones.

Author Biography

Sarah Hope Mandel

San Fishman, Ph.D. Editor-in-Chief, Pragmatic Case Studies in Psychotherapy Professor of Clinical and Organizational Psychology Graduate School of Applied and Professional Psychology Rutgers University Mailing address: 57 Jaffray Court Irvington, NY 10533 914-693-8549 fax: 603-917-2567 email:




How to Cite

Mandel, S. H. (2014). Targeting Sexual Stigma: The Hybrid Case Study of "Adam". Pragmatic Case Studies in Psychotherapy, 10(2), 48–105.