"Therapy Can Be Restorative, but Can Also Be Really Harmful": Therapy Experiences of QTBIPOC Clients

Research suggests that queer and/or trans Black people, Indigenous people, and other People of Color (QTBIPOC) generally experience higher levels of psychological distress and depression, leading to poorer mental health outcomes (e.g., Lim & Hewitt, 2018; Sutter et al., 2018). However, little is known about the experiences of QTBIPOC individuals in therapy. The purpose of this grounded theory study was to understand the nuanced narratives of QTBIPOC individuals in therapy. Twelve QTBIPOC individuals were interviewed about their experiences in therapy, as well as their suggestions for how therapists can improve mental health treatment. Using minority stress and intersectional theories as frameworks, the following core category was identified: An optimal therapy experience is contingent on the intentional dismantling of systemic oppression in therapy. The six categories that comprise this core category included therapy microskills encourage continued help-seeking despite cultural barriers, proximal stress leads to hesitation in the therapy room, ignorant therapist reactions exemplify distal stress, explicit validation of identity and experiences of oppression strengthens the therapeutic experience, shared identity facilitates the therapeutic bond, and therapy must be decolonized and center nontraditional healing practices. Results of the present study suggest that therapy can be ineffective-or even harmful-for QTBIPOC individuals when systems of oppression are not adequately dismantled in the therapy room. Our findings prompt important directions for practice with QTBIPOC individuals as well as institutional advocacy. Clinical Impact Statement Question : What are the experiences of QTBIPOC individuals in therapy? What are the recommendations of QTBIPOC individuals for therapists based on these experiences? Findings : Using a grounded theory analysis, our categories highlight that an optimal therapy experience is contingent on the intentional dismantling of systemic oppression in therapy. Meaning : There is a need to transform the institution of therapy to center liberatory and nontraditional practices by decolonizing training and increasing representation of QTIBPOC therapists. Next Steps : Future studies should assess the therapy experiences and outcomes of QTBIPOC individuals on a larger scale and focus on how specific liberatory interventions can contribute to improved mental health for this group.