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Quaderni di Psicoterapia Cognitiva - Open Access

La sessualità in psicoterapia cognitivo-comportamentale

No. 57 (2025)

LGBTQIA+ and Intersectionality: Inclusivity in Therapy

DOI
https://doi.org/10.3280/qpc57-2025oa23133
Submitted
giugno 24, 2026
Published
2026-07-16

Abstract

A cognitivebehavioral therapy that is sensitive to contemporary social transformations is called today to reflect on how to more accurately welcome the experience that LGBTQIA+ individuals bring into the therapy room. The present work illustrates how the integration of these themes may be understood as a refinement of therapeutic techniques, useful for better understanding the context in which people’s specific ways of seeing and feeling the world are constructed and reinforced. Through the minority stress and intersectionality models, the mechanisms by which the social environment becomes embedded in the patient’s cognitive and emotional structure are explored. Particular attention is given to integrating Guidano’s postrationalist perspective (Guidano, 1991) and Liotti’s theory of motivational systems (Liotti, 2004), showing how experiences of discrimination become intertwined with attachment patterns and personal meaning organizations. The work underscores the importance of a clear ethical positioning on the part of the therapist and of a balance between the validation of discriminatory experiences and the promoting of patient agency.

References

  1. Craig S., Iacono G., Pascoe R. & Austin A. (2021). Adapting clinical skills to telehealth: Applications of affirmative cognitivebehavioral therapy with LGBTQ+ youth. Clinical Social Work Journal, 49, 471483. DOI: 10.1007/s1061502100796x.
  2. Crenshaw K. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1: Article 8. chicagounbound.uchicago.edu/uclf/vol1989/iss1/8.
  3. Di Fini G., Civilotti C., Bolognino A., Einaudi G., Molo M., Veglia F., Gandino G. & Finzi S. (2025). The burden of the past: A systematic review of childhood trauma and mental health in transgender and gender nonconforming individuals. European Journal of Investigation in Health, Psychology and Education, 15(9): 183. DOI: 10.3390/ejihpe15090183.
  4. Dunn I., Power E., Casey L. & Wootton B. (2024). Cognitive behavioural therapy for internalizing symptoms in LGBTQ+ people: A preliminary metaanalysis. Cognitive Behaviour Therapy, 54: 246275. DOI: 10.1080/16506073.2024.2434021.
  5. Flentje A., Capriotti M.R. & Cochran B.N. (2020). AWARENESS: Development of a cognitive behavioral intervention to address intersectional minority stress for sexual minority men living with HIV and using substances. Psychotherapy, 57(1): 103113. DOI: 10.1037/pst0000243.
  6. Funer F. (2023). Admitting the heterogeneity of social inequalities: Intersectionality as a framework and (self)critical tool in mental health care. Philosophy, Ethics, and Humanities in Medicine, 18(21). DOI: 10.1186/s13010023001446.
  7. Guidano V.F. (1987). Complexity of the self: A developmental approach to psychopathology and therapy. New York: Guilford Press.
  8. Guidano V.F. (1991). The self in process: Toward a postrationalist cognitive therapy. New York: Guilford Press.
  9. Guidano V.F. (2007). Psicoterapia cognitiva postrazionalista. Una ricognizione dalla teoria alla pratica clinica, a cura di A.T. Quiñones). Milano: FrancoAngeli.
  10. Guidano V.F. & Liotti G. (1983). Cognitive processes and emotional disorders: A structural approach to psychotherapy. New York: Guilford Press.
  11. Liotti G. (2005). La dimensione interpersonale della coscienza (II ed.). Roma: Carocci. Liotti G. & Monticelli F. (2008). I sistemi motivazionali nel dialogo clinico. Milano: Raffaello Cortina Editore.
  12. Meyer I.H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1): 3856. DOI: 10.2307/2137286.
  13. Meyer I.H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5): 674697. DOI: 10.1037/00332909.129.5.674.
  14. Nicholson A., Siegel M., Wolf J., Narikuzhy S., Roth S., Hatchard T., Lanius R., Schneider M., Lloyd C., McKinnon M., Heber A., Smith P. & LuegerSchuster B. (2022). A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda. European Journal of Psychotraumatology, 13. DOI: 10.1080/20008198.2021.2002572.
  15. Pachankis J., Chiaramonte D., Baldwin H., Prachniak C., Levine D., Van S., Hobbs R., Ankrum H., Wilkins L., Harvey T., Harkness A., Jackson S., Matsuno E., Soulliard Z., Last B., Burger J., Delehant M., Zhou X., Hagaman A., … Mustanski B. (2025). Implementing LGBTQaffirmative CBT: study protocol for an effectivenessimplementation trial at 90 LGBTQ community centers. BMC Health Services Research, 25. DOI: 10.1186/s12913025131363.
  16. Pachankis J., Hatzenbuehler M., Klein D. & Bränström R. (2023). The Role of Shame in the SexualOrientation Disparity in Mental Health: A Prospective PopulationBased Study of Multimodal Emotional Reactions to Stigma. Clinical Psychological Science, 12: 486504. DOI: 10.1177/21677026231177714.
  17. Richey R. & Pointer O. (2021). A brief cognitive behavioral therapy case study through an intersectional lens for women healthcare workers during the COVID19 era. Psychotherapy, 58(4): 555563. DOI: 10.1037/pst0000385.
  18. Seabra D., Carvalho S., Gato J., Petrocchi N. & Salvador M. (2024). (Self)tainted love: Shame and selfcriticism as selfdiscriminatory processes underlying psychological suffering in sexual minority individuals. Journal of Human Behavior in the Social Environment, 35: 714732. DOI: 10.1080/10911359.2024.2333777.
  19. Shali S. (2024). A systematic review of therapist perspectives on cognitive behavioral therapy with gender and sexual minorities. Discover Psychology, 4(133). DOI: 10.1007/s4420202400264w.
  20. Weiss M.D., Daniolos P.T., Coughlin K., MulvaneyDay N., Cook B. & Rosenblum D. (2024). A scoping review of the intersectionality of autism and intellectual and developmental disability with social inequality in diagnosis and treatment. Journal of Child and Adolescent Psychopharmacology, 34(2): 7384. DOI: 10.1089/cap.2023.0058