- Developed and validated the LADI observational measure; independent raters showed reliable agreement assessing therapists' LGBTQ affirmation and in-session discussion.
- Greater therapist LGBTQ affirmation on the LADI predicted reductions in observer-rated depression, self-reported substance-use consequences, and internalised heterosexism; latter may be outlier-sensitive.
- LADI did not predict changes in HIV-risk behaviour, alcohol use, anxiety, suicidal ideation, rejection sensitivity, concealment, or identity affirmation.
Psychother Res. 2026 Oct 15:1-16. doi: 10.1080/10503307.2026.2743594. Online ahead of print.
ABSTRACT
OBJECTIVE: The within-session processes that constitute LGBTQ-affirmative psychotherapy remain under-specified.
METHODS: We developed and validated an observational measure of therapists’ LGBTQ affirmation and discussion in-session (LADI) in a study of 57 gay and bisexual men who received 10 sessions of treatment-as-usual in two LGBTQ community organizations as part of a larger trial.
RESULTS: Independent raters reliably agreed on the presence of LGBTQ affirmation and discussion in sessions when using the LADI. Even when controlling for the therapeutic alliance, clients exhibited greater change in observer-rated depressive symptoms, self-reported substance use consequences, and internalized heterosexism when they had a therapist who displayed more LGBTQ affirmation on the LADI, although results for internalized heterosexism may have been sensitive to an outlier. The LADI did not predict changes in HIV-risk-transmission behavior, alcohol use, anxiety symptoms, suicidal ideation, rejection sensitivity, sexual orientation concealment, or identity affirmation.
CONCLUSIONS: The LADI can facilitate future research on LGBTQ-affirmative psychotherapy.
PMID:42877969 | DOI:10.1080/10503307.2026.2743594
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