Toward Formulating Evidence-Based Principles of LGB-Affirmative Psychotherapy


  • Rachel A. Proujansky
  • John E. Pachankis



minority stress, gay and bisexual men, stigma, intervention, psychotherapy, mental health, cognitive-behavior therapy, case study, clinical case study


In this commentary, we review eight potential LGB-affirmative psychotherapy principles for improving minority stress coping among sexual minority clients.  We illustrate these principles with examples from both Mandel’s (2014) treatment approach and our clinical research team’s recent attempt to create and test the efficacy of a treatment employing these principles in an ongoing randomized controlled trial.  These principles are grounded in empirical research regarding the mechanisms through which minority stress compromises the mental health of sexual minority individuals and are supported by clinical expert consensus.  The specific principles that we review include: 1) normalizing the mental health impact of minority stress, 2) facilitating emotion awareness, regulation, and acceptance, 3) decreasing avoidance, 4) restructuring minority stress cognitions, 5) empowering sexual minority clients to communicate assertively, 6) validating sexual minority individuals’ unique strengths, 7) building supportive relationships, and 8) affirming healthy, rewarding expressions of sexuality.  We believe that Mandel’s skillful approach to helping her hybrid client Adam cope with minority stressors, such as internalized homophobia, and associated mental health problems such as substance abuse and depression, to form a healthy identity as a gay man represents an exemplary demonstration of these principles in action.

Author Biographies

Rachel A. Proujansky

Ran 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:

John E. Pachankis

John E. Pachankis  




How to Cite

Proujansky, R. A., & Pachankis, J. E. (2014). Toward Formulating Evidence-Based Principles of LGB-Affirmative Psychotherapy. Pragmatic Case Studies in Psychotherapy, 10(2), 117–131.