151: Treating LGBTQ Patients–What’s the TEAM Approach?

Are there some special techniques therapists need
to use when working with LGBTQ patients?

Does the therapeutic approach have to be different?

In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients.

To get the interview started, Kyle defines LGBTQ:

L = lesbian

G = gay

B = bisexual

T = transgender

Q = questioning, or queer.

Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle’s research reveal about the important factors in the treatment of LGBTQ individuals?

Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s gayness, while some tend to sweep this “uncomfortable” issue under the rug.

Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of LGBTQ people. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s LGBTQ identity, while some tend to sweep this “uncomfortable” topic under the rug.

Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with?

In other words, there is no special “agenda” that the therapist should impose on the treatment simply because the patient is gay, bisexual, transgender or queer. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some “correct” way one should treat LGBTQ people, or some “correct” set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow “different” or special. However, the therapist using knowledge of the LGBTQ community skillfully in therapy is important.

In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction.

Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias, as well as the question of whether gay therapists are obligated to announce this to the patient, and they come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question therapists face with all patients, and that the goal of the self-disclosure should be on how best to help the patient.

Kyle and David reflect on some of the personal work Kyle did during his training program, and how important that work has been to Kyle as he has evolved into a dynamic, compassionate therapist and teacher. They reminisce about the first personal work Kyle did with David on one of the Sunday hikes. Kyle was feeling depressed because he’d just been rejected, unexpectedly, by his boyfriend, and was able to turn the situation around dramatically and quickly using TEAM-CBT. Kyle also describes his own discovery during college that he was gay, and what happened when he shared his sexual orientation with his parents and brother.

The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept themselves. In fact, acceptance seems to be the path to recovery and enlightenment for all of us!

For those interested in more depth and breadth (non-TEAM related) on this topic, Kyle recommends the following resources, or feel free to reach out to him at:

Balsam, K.F., Martell, C.R., Jones K.P., & Safren S.A., (2019) Affirmative cognitive-behavior therapy with sexual and gender minority people. In Culturally responsive cognitive-behavioral therapy: Assessment, practice, and supervision.  Washington, DC: American Psychological Association Press

Pachankis, J. E., & Safren, S. A. (Eds.). (2019). Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities. Oxford University Press, USA.

David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (PhD candidate)


You can reach Dr. Burns at Dr. Rhonda Barovsky practices in Walnut Creek, California, and can be reached at

If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

* * *

You may have missed the Calgary and South San Francisco intensives, but there will be two more awesome workshops
for you this fall.

High-Speed Treatment of Depression
and Anxiety Disorders

A Four-Day TEAM-CBT Advanced Intensive

November 4 – 7, 2019
The Atlanta, Georgia Intensive

Sponsored by Praxis

* * *

I also have a tremendous one-day workshops scheduled with my colleague, Dr. Jill Levitt, that will be potentially life- and career-changing experiences (really!) You will learn powerful skills that will boost your clinical effectiveness and improve your relationships with your patients as well as the people you care about.

Advanced Empathy Tools for Connecting
with Challenging Patients,
Colleagues, Friends, and Loved Ones

With Drs. David Burns and Jill Levitt

Oct 6, 2019 | 7 CE hours, $135

Do you have a patient, colleague, friend or loved one who:

  • Complains endlessly but does listen to any of your good advice?
  • Appears irate, but insists s/he isn’t upset?
  • Refuses to express his / her feelings?
  • Never listens?
  • Argues, and always has to be right?
  • Always has to be in control?
  • Is relentlessly critical?
  • Insists you don’t really care—or understand—when you think you do?

Then you’re going to LOVE this workshop with David and Jill. You’ll learn about–

  • The Powerful “Law of Opposites”
  • How to find out how your patients really feel about you–if you dare!
  • How to transform therapeutic failure into success
  • How to talk to people who refuse to talk to you
  • Why your worst therapeutic failure is actually your greatest success in disguise
  • The fine points of the Five Secrets of Effective Communication
  • Three Advanced Empathy Techniques: Multiple Choice Empathy / Disarming, Changing the Focus, and Positive Reframing
  • And more, including lots of small group practice with expert feedback and mentoring to refine your skills!

Attend in person or
from your home via Live Streaming

Sign up early because we nearly always sell-out for the in-person seats. Of course, there will be lots of skilled trainers to help the online participants with the small group exercises, so you will win either way.

My one-day workshops with Dr. Levitt are usually pretty awesome! It is always an honor to teach with Jill!

Learn More & Register

* * *

Coming up in 2020

High Speed Methods to Reduce Resistance
and Boost Motivation

With Drs. David Burns and Jill Levitt

Feb 9. 2020 |  7 CE hours. $135

Learn More & Register

 The Cognitive Distortion Starter Kit:
How to Crush Negative Thoughts

With Drs. David Burns and Jill Levitt

May 17, 2020 | 7 CE hours. $135

Learn More & Register

%d bloggers like this: