A Proposed Stage Model of LGBTQ People’s Selection of and Engagement with Therapists

Psychotherapy research often centers therapists’ perspectives, and thus there is minimal exigent research on selection of or engagement with practice from the client perspective, limiting therapists’ ability to incorporate the client’s perspective into treatment. This is particularly relevant for clients with marginalized identities, like lesbian, gay, bisexual, transgender, and queer (LGBTQ) people, whose experiences of oppression may mediate the therapist selection and engagement process. This article proposes a six-stage model describing LGBTQ clients’ process of selection of and engagement with therapists. This model emphasizes the importance of client and therapist identities and identity-congruence, therapist’s self-reported treatment modalities, and the effects of system-level barriers, such as costs, in mental health care. Awareness of these factors enables therapists to anticipate clients’ needs, potentially increasing the effectiveness of care.