A systematic review to determine how service provider practises impact effective service provision to lesbian, gay and bisexual consumers in a mental health setting

Abstract

Lesbian, gay and bisexual (LGB) consumers utilize mental health services at a similar rate to their heterosexual counterparts yet report greater dissatisfaction with service quality. This dissatisfaction may be explained by service provider's microaggressions, stemming from a lack of cultural competence in working with LGB consumers. This systematic review examines how the practises of mental health service providers impacted effective service provision to LGB people in a clinical practice. Five health databases (Scopus, MEDLINE, PsycINFO, Web of Science and CINAHL) were examined to determine relevant studies for this review. Twenty four qualitative and quantitative studies between 2000 and 2020 examining data related to how service provider practises impacted effective service provision to LGB people were included in the final review. A narrative synthesis, thematic summary approach was employed to account for the multi-method nature of the data. Themes developed in our analysis are organized under the three components of cultural competence, service provider attitudes, knowledge and skills. Provider attitudes ranged from positive to negative towards LGB people and heterosexism were present in several services.Poor service provider knowledge about the issues impacting LGB consumers leads to a weakened therapeutic alliance and service providers often lacked a comprehensive understanding of the issues impacting LGB people. Service providers were seen as more skilful if they were LGB, created a safe space and had completed cultural competence training. Trends within the characteristics (explorative nature, mixed service provider samples, potential for bias) of the 24 studies included in the review are discussed. Based on the results, recommendations are included to ensure services demonstrate cultural competence in working with LGB consumers.

Bisexual women's experiences of receiving help for mental health difficulties through psychological therapy: A qualitative exploration.

“…Likewise, our results indicate that therapists must acknowledge the wide-ranging impact of social and systemic injustice relating to bisexual women's multiple marginalized identities when creating a clinical formulation of their mental health difficulties. Previous research has, however, found that practitioners from a range of healthcare professions, including clinical and counseling psychology, report feeling unsure of ways to communicate with LGBTQ+ clients (Bishop et al, 2022). To do this, it is strongly recommended that therapists ask about clients' marginalized identities within assessments (Dunlop, Woods, et al, 2022).…”

Bridging the multicultural orientation framework with sexual and gender minority psychotherapy: A mixed studies systematic review.

“…King et al, 2007;McNamara & Wilson, 2020;O'Shaughnessy & Speir, 2018;Singh & Shelton, 2011). These reviews have added to our understanding of what facilitates psychotherapy with SGM clients including (a) the importance of therapists' attitudes and knowledge about SGM clients in delivering beneficial psychotherapy (Bieschke et al, 2007;Bishop et al, 2022;Compton & Morgan, 2022; M. B. King et al, 2007;McNamara & Wilson, 2020;O'Shaughnessy & Speir, 2018); (b) that there is minimal evidence to support the hypothesis that matching clients and therapists on sexual or gender identities improves outcomes (Compton & Morgan, 2022; A. E. Ellis et al, 2020; M. B.…”

“We are better and happier if we are inclusive.” Therapist perspectives on the importance of LGB cultural competence in a mental health setting

“…The tripartite model of cultural competence describes three core components of cultural competence: awareness of one's own beliefs, biases and attitudes; knowledge and understanding of the cultural group including expectations for the therapeutic relationship and how one's own cultural background comes into play; and skills and tools to provide culturally sensitive assessment and intervention (Crisp, 2006; Sue et al, 1982). A systematic review examining how culturally affirming practices impact service provision to LGB people has highlighted that poor cultural competence often results from negative attitudes towards LGB people, lack of knowledge about the impact of minority stress on LGB and poor practitioner skill in demonstrating affirming care (Bishop et al, 2021b). Understanding the impact of cultural competence on therapeutic outcomes is important because it allows therapists to provide best practice care to LGB clients.…”

“…Limited research has explored the challenges that exist for therapists to attain the cultural competence to inform their inclusive practice (Bishop et al, 2021b). Previous research on a cohort of graduate counsellors demonstrated that passive lectures on culturally affirming practice were insufficient to promote the use of cultural competence practices in a clinical setting (Graham et al, 2012).…”