Clinical Considerations in Working with Clients in the Coming Out Process
Keywords:coming out, affirmative therapy, intersectionality, sexual minorities, LGBT, sexual orientation, case formulation, psychotherapy, case study, clinical case study
Mandel (2014) describes the conceptualization, assessment, and treatment of "Adam," a hybrid client presenting with depression, cannabis abuse, perfectionism, and distress related to his sexual orientation, which appeared to be fueling these psychological problems. In this commentary, we examine theoretical and clinical issues raised by this case regarding clients’ experiences with coming out. Drawing on the case and pertinent research, we highlight clinical challenges involved in helping clients navigate issues of identity development and intersection, interpersonal disclosure, internalized homophobia, and community connectedness. We present specific strategies for tailoring interventions to the diverse experiences and needs of sexual minority clients. Throughout the commentary, we reflect on potential intrapersonal, interpersonal, and systemic processes that may impact clients’ identity integration and psychological well-being.
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