Why Some Therapists Consistently See Better Results with LGBTQ Clients

Overall therapy outcomes for LGBTQ clients are comparable to their heterosexual peers but some therapists consistently see better results.


A recent study published in the Journal of Counseling Psychology examined how sexual orientation-related psychotherapy treatment outcomes varied between therapists. The results suggest that certain therapists consistently have better treatment outcomes with LGBTQ clients while other therapists see more improvement in their heterosexual clients.

According to Dr. Drinane and colleagues, the results highlight the importance of developing and training mental health professionals in cultural and structural competencies:

“Therapists bring their personhood and individual strengths and weaknesses to the work they do. In general, therapists have been found to account for 5%–10% of the variance in treatment outcomes, with some therapists producing more change than others. However, within the past ten years, and as cultural competency has been brought into the foreground of the lexicon of therapeutic practices, researchers have begun to look more deeply. They have found that some therapists yield differing outcomes depending on their clients’ identities.”

In recent decades there has been a focus on the understanding that therapists are cultural beings and, as such, their beliefs and attitudes influence how they interact with clients and how they make sense of their psychological distress and lived experiences. The American Psychological Association developed multicultural guidelines to address these influences in interventions and research. In addition, the medical field developed guidelines in cultural competencies (which have been adopted by the mental health professions), making the medical and mental health professionals and their training programs responsible for learning about how to best treat people of a diversity of races, cultures, sexual orientations, genders, and gender identities, socioeconomic statuses, functionality, among other forms of diversity.

Regardless of these ongoing efforts, a recent national survey demonstrated that psychiatry residents in the United States are rarely being taught about LGBTQ cultural competence. Failing to understand the particularities lived by LGBTQ people may lead to intentionally or unintentionally reproducing stigma, providing less-than-adequate treatment, and might explain why overdiagnoses of particular psychiatric disorders (e.g., Borderline Personality Disorder). For this reason, LGBTQ groups continue to advocate for improved psychiatric treatment without stigma and that value diversity and inclusion.

Research also suggests that LGBTQ individuals experience mental health disparities due to different forms of anti-LGBTQ discrimination, harassment, and abuse. The constant bombardment of negative messages about their identities leads to internalized homophobia, which increases the risk of suicide. Minority stress, or the stress resulting from discrimination, has also been found to be a risk of cognitive decline in aging LGBTQ people. Yet, many protective factors help prevent psychological distress and suicide in LGBT children and adults. Among them are pro-LGBTQ policies, experiencing acceptance from others, community support, and engaging in collective action.

Psychotherapy is another way LGBTQ people attempt to improve their mental health and well-being and are more likely to seek mental health services than heterosexuals. Unfortunately, there has been no prior research on individual therapists’ outcome differences between clients’ sexual orientation. However, various research projects have found that some therapists yield better treatment results with white clients while others achieve better results with people of color.

Due to the lack of research in this area and a recent call for research on the possible differences involving the development of the therapeutic relationship between sexual minority and heterosexual clients, the researchers aimed to study differences in therapists’ outcomes between their clients’ sexual orientations. They hypothesized that (1) SGM clients would have less well-being, life functioning, mental health, and more symptom severity than heterosexual clients and (2) that only clients’ sexual orientation would influence therapeutic outcomes.

For four years, the researchers collected data from 1725 clients who received services (short-term individual therapy, group therapy, psychoeducational workshops, and crisis counseling) at a university campus. 82.6% identified as heterosexual and 17.4% identified as sexual minorities. These 1725 clients were seen by 1 of 50 therapists included in the study and were either full-time or part-time psychologists, doctoral interns, externs, and practicum students. Each therapist saw about 35 clients and provided interpersonal process, relational-cultural, cognitive-behavioral, psychodynamic, or other approaches to psychotherapy.

Unfortunately, to maintain therapist anonymity, demographic information was not recorded, including details about their sex, gender, race, ethnicity, or sexual orientation. The Behavioral Health Measure-20 (BHM-20) was sued to measure wellbeing, symptoms, and life functioning before starting treatment (pre-treatment) and after culminating treatment (post-treatment).

Contrary to researchers’ expectations, the study’s results did not suggest that sexual minority clients had worse outcomes by the end of therapy than heterosexual clients. Regarding the second hypothesis, the results indicated that clients of some of the therapists in the study experienced differences in symptom reduction and improvement of mental health depending on their sexual orientation (but no differences were found in outcomes regarding wellbeing and life functioning). The researchers summarize these findings:

“…it is not that sexual minority clients experienced worse outcomes at the end of therapy than did heterosexual clients on the whole, but rather that certain therapists may have differentially influenced their clients’ outcomes based on clients’ sexual orientation.”

Drinane and colleagues suggest that these findings indicate that it is the therapist and not the client’s sexual orientation (be it heterosexual or not) that influences treatment outcomes, especially outcomes regarding mental health and symptom reduction. Finding no differences in well-being and life functioning between groups after treatment, the researchers believe that therapists might be more adept at instilling hope and generating general changes in clients’ lives but might be less efficient around the particularities related to their client’s sexual orientation.

This might be due to therapists’ engagement in “value-based sharing that has the potential to communicate their bias, preferences, or personal identities.” For this reason, it is essential to use the client’s values and identities rather than one’s own, and not to use standardized approaches to treatment and instead adapt therapy to the client’s unique needs, values, and identities.




Drinane, J.M., Roberts, T., Winderman, K., Fiereson Freeman, V., Wang, Y-W. (2022). The Myth of the Safe Space: Sexual Orientation Disparities in Therapist Effectiveness. Journal of Counseling Psychology, 69(3), p.268-275 (Link)


  1. I am in a hetero relationship but do not consider myself hetero. I see clients and I can make a comment about why LGBQT+++ may respond better in therapy. My humble opinion is that this group is already one level of consciousness ahead of the same hetero group due the fact they already stepped out of the cultural zones that they were brought up for the mere fact of having different sexual orientation. That resilience to stand on their ground against their own parents (the biggest influence) – is a great indication and prognosis that they are more open to change and imagine outside of the box.

    Hetero (again as general since I am not talking about anyone particular) have not challenged their basic templates so the support for them to make a change is a bit steeper.
    One of the biggest issue in therapy is most people cannot differentiate their thoughts and the reality of their parents or childhood experiences. A typical hetero client will spend years defending “thoughts” of a good parent rather than accepting the parents who raised them and (maybe did some bad decision) can be same parent that love them today. They fight against guilt of having a bad thought or saying a bad thing about the parents who are not in the room.

    Most LGBQT+++ have a sense of difference about their parents because at some point very young – they realize how different they truly are not only from their parents but from their peers too. That deep growth of the mind is priceless.

    A general statement.

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    • Why assume the parents are villains? If all parents were then buses would not run on time, cinemas would not open, pubs would not serve beer, schòols would be closed. In short, society is only convenient to your trip to buy barbecue beans because most of the people you meet had good enough parents. If all parents were vile then everyone would be so traumatized that nothing would function. Presumably you mean some parents? I will go along with that. Some parents are despicable. It is set to get worse. But that is why we NEED to hold on to the reality that there ar great parents. Mine were FANTASTIC.

      A community needs to hold on to the possibility that an adult can be a HERO.

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      • Parents don’t have to be monsters to cause harm to their children’s psyches.

        No one is all good or all bad. We are all human and make errors and do good things and mess up and recover. It’s not about good or bad parents. It’s a lot about what adults went through when they were kids and pass on, and about what adults/parents are expected to do in our society and what they are supposed to do with their kids.

        Most people would say my parents were fine people. They did a lot of things right. But they did some things wrong, too. Additionally, schools were full of well-meaning folks who often did a lot of harm because “that’s how we do it.”

        An example: Good parents were expected to leave their kids to “cry it out” in their cribs when I was a baby. They were expected NOT to nurse their babies and to feed them solid food at way too young an age. Some were told that taking Thalidomide was safe and ended up with hydrocephalic babies or other birth defects. All were expected to send their kids to schools without question, even though some of my teachers were absolutely crazy and dangerous. One hit me in the head after she tossed a book across the classroom in second grade and I protested. Was that my parents’ fault? The teacher’s fault? The school’s fault? Society’s fault? It doesn’t matter whose “fault” it was or whether the teacher was a monster or just a sad old lady who never was loved. What matters is that I had experiences that were not healthy for me. They hurt me, whether they were intended to or not. It was helpful to recall those hurts and what decisions I made at the time, so I could learn to make different decisions today. There were no monsters. Just adults trying to do their best. But I still got hurt, and I don’t have to make excuses for them. I can take care of my own needs and let them be upset about it if they want to. Which my parents were, but we healed some as I grew up and was better able to express myself. I loved them, they loved me, and we were better off facing up to the painful moments where things didn’t go so well.

        No blame or monsters or heroes required.

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      • https://youtube.com/shorts/UhImIj1YQm0?feature=share

        The human is an animal that has forgotten they are one.

        Animals know best.

        It might not look great to a psychoanalytically indoctrinated populace of humans who live in their rationalist enlightened minds all day but this primate mother who has never read the DSM nor a church bible nor the full works of Alice Millar nor seen a Disney film is instinctually behaving NORMALLY.

        When human abnormal idealized perfect parenting is proselytized it means…



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    • My point about the parents is being taken out of context, maybe. Parents cannot teach ‘everything’ to the child. Parents are not perfect either – sickness, mis-attunement, busyness, divorce, life…can all make a parent not to be 100% attending to a child – so the child’s subjective experience may need other minds to develop fully and healthly.

      The first experience of humanity for anyone is their parents/caretakers so they leave an imprint of something – the experience.

      A simple parent going back to work after having a child can be a huge deal for a baby’s subjective experience. All these things (the good and the bad) show up in therapy in various and clever ways.

      My point was most likely a LGBTQ client already found how different they are from a parent or a sibling so their mind or their identification is unique in some ways or is ignited earlier in the development. Since that pathway has already been laid, I would not be surprised if going through therapy, they are more prone to appreciate their unique human being experience in many different ways than a hetero person who lives in the majority society.

      To add a bit more about the parent. My point is the parent start the socialization, followed by extended families, friends/adults (school or daycare age), and then the socialization goes on …

      The group in this article, most likely have at least one of this group invalidating their existence, identification, and/or personhood….that experience can make or a break a person. So in therapy is another validating, identifying and socialization process.

      That is all. The “hero” thing is very American. There is no hero journey…it is very masculine idea born out of the wild wild west of the American settlers!

      Thank you for responding.

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