Security Amidst Stigma: Exploring HIV and Sexual Minority Stressors Through an Attachment-Based Psychotherapy Group

Despite strides in HIV prevention and lesbian, gay, bisexual, and transgender care, comprehensive care centers are of critical importance for lesbian, gay, bisexual, and transgender communities and people with HIV/AIDS who continue to contend with intersecting stigmas and chronic minority stressors. Building on the integrated attachment and sexual minority stress model, we discuss these themes by highlighting a group vignette from an urban psychiatric clinic that has provided affirmative psychotherapy to marginalized communities affected by HIV/AIDS for over 2 decades. The authors have rotated at the clinic as cofacilitators of a weekly, process-oriented group for sexual minority men who are HIV positive or are affected by HIV. In this article, we provide a theoretical foundation for HIV-affirming group psychotherapy and clinical integration of minority stress and attachment-based interventions. Group psychotherapy provides a rare opportunity to bond an often-isolated community by evoking factors of universality, cohesiveness, and catharsis. It simultaneously enables us to confront individual existential concerns with serostatus disclosure, grief, and feelings of victimization, as well as challenge internalized stigma and rejection sensitivity. We apply these issues to a verbatim clinical exchange, analyzing attachment-related themes and issues pertaining to minority stress and stigma, as well as discuss group mechanisms for attachment interventions. Clinical Impact Statement Question: How can group therapists integrate attachment and minority stress theories to build resilience and cohesion with sexual minority and HIV-affected clients? Findings: Attachment-based group psychotherapy is well suited to address the mutually reinforcing effects of distal and proximal minority stress in people with HIV/AIDS (PWHA). Meaning: Group clinicians would benefit from utilization of an integrated attachment-minority stress approach to group therapy with PWHA. Next Steps: More applied clinical research on the combined utilization of attachment-based group psychotherapy and minority stress theory for PWHA is needed.