Adapting Clinical Skills to Telehealth: Applications of Affirmative Cognitive-Behavioral Therapy with LGBTQ+ Youth

Abstract

Online social work services (e.g., telemental health; telebehavioral health; virtual care; telehealth) present significant opportunities for clinical social workers to provide effective care to marginalized populations, such as LGBTQ+ youth. The COVID-19 pandemic has led to an increased focus on telehealth, and while there are excellent resources to guide ethics, standards, and legal decisions (NASW, n.d.), there is less guidance in the literature to specifically inform the adaptation of offline clinical skills to telehealth, particularly for LGBTQ+ youth. To address this gap, we present examples from our experience offering AFFIRM, an affirmative cognitive behavioral therapy (CBT) group intervention now being delivered through telehealth. Specifically, this paper will: (a) describe the key considerations for the delivery of CBT via telehealth to youth; (b) detail specific clinical skills and strategies to enable successful online implementation; (c) describe the adaptation approach through a case study of cognitive restructuring with a transgender youth; (d) and offer specific guidance to support clinicians to adapt their clinical skills to the virtual environment.

Social Work Practice During COVID-19: Client Needs and Boundary Challenges

“…A practitioner considered texting effective with LGBTQ + youth, which they found "simpler" to "say certain things writing it down, especially around fragile identities, queer identities." The practitioner attributed this to experiences of a "world not so accepting of variety, diversity," which aligns with research findings (Craig et al, 2021).…”

The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis

“…There appears to be a general consensus in the literature that younger children and older adults, who may be less familiar with technology, may find it more difficult to access the benefits of e-mental health [ 59 ]. However, the flexible and remote nature of e-mental health may offer a more viable option to certain populations who may have historically fallen through the cracks or struggled to engage with traditional psychology service provision, for example, marginalized populations, such as those identifying as LGBTQ+ (lesbian, gay, bisexual, transgender, queer, questioning) [ 60 ], and young adults who prefer to seek help anonymously and at a time that suits them via smartphone apps [ 61 ].…”

Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint

“…Other stigmas of diagnosis, gender, sexuality, ethnicity, body image, criminal history, and others similarly compromise health care utilization and outcomes [166][167][168][169][170]. Telehealth provides a beneficial distance that can make patients with stigmatized conditions feel confident and comfortable seeking services from their own homes [171][172][173]. XR can further enhance telehealth to include temporary, therapeutic distance from stigmatized bodies or identities.…”