Group Therapy As A Way to Increase Resilience in LGBTQ+ Patients

Margot J. Delery College of Arts & Science, New York University

LGBTQ+ individuals are 2.5 times more likely to experience depression, anxiety, and substance abuse compared with heterosexual individuals (Kates, et al., 2016). Many queer patients have reported that they have experienced discrimination from both medical and mental healthcare providers, often causing them to delay or forgo necessary treatments (Safer, et al., 2016). To prevent this, healthcare providers must be educated on and qualified to treat the specific needs of LGBTQ patients. Research done at The Rainbow Heights Club in Brooklyn suggests that peer-led, community-run group therapy is a highly effective way to address these needs, as it focuses on strengthening resilience factors such as community support, which LGBTQ individuals often lack.

Resilience-Based Therapy (RBT) is a branch of Cognitive-Behavioral Therapy (CBT) that focuses on building resilience factors (Joyce et al., 2018). Sadhbh Joyce defines resilience as the “process of bouncing back from difficult experiences and adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress” (Joyce et al., 2018). There are many factors in someone’s life that boost or improve resilience and these are called resilience factors (Kwon, 2013). There are a number of different resilience factors but not all are equally important. The most important factors are a supportive environment, high self-esteem, wealth, and interpersonal connections (Kwon, 2013). While all of these factors are of great interest, the focus here will be on interpersonal connections as this is likely the factor most directly and successfully addressed in RBT.

Resilience-based therapy is often used to treat victims of traumatic events and it has, for instance, been particularly successful in the treatment of women in abusive relationships (Anderson, et al., 2012). This success is promising for queer populations because they often lack the same resilience factors the women in these situations lack such as self-worth and community support. Abusers will make attempts to isolate their victims, chip away at their self-esteem, and even gain control of their finances. They create an environment designed to trap these women (Anderson, et al., 2012). This same study found that treatment of these women is most effective when it builds up the specific resilience factors the abuser deliberately tore down. They found that the most important resilience factor was that of interpersonal support. The women in the study consistently stated that their recoveries would not have been possible without the support of the other members of the program (Anderson, et al., 2012). Targeting interpersonal resilience factors creates a domino effect of positive changes to one’s resilience. Each interpersonal connection provided an additional resilience factor to the patient (money, self-esteem, supportive environments, etc.) and catalyzed their recovery (Anderson, et al., 2012). The same results were found in children suffering from sexual abuse (Flett, Flett, and Wekerle, 2015), homeless populations suffering from substance abuse (Lewis, Hopper, Healion, 2012), and interestingly, in children with severe Generalized Anxiety Disorder (Watson et al., 2013). Study after study found that interpersonal support systems and relationships helped patients recover in ways they could not have without these connections.

So where do queer people fit into this equation? This directs one’s attention toward Ilan Meyer’s groundbreaking study on stress in the LGB community and the minority stress model. The Minority Stress Model describes different kinds of stressors experienced by sexual identity minorities and how they interact with each other as a system (Meyer, 2003). The initial stressor comes from firsthand experiences with bigotry and exposure to hate. These experiences cause persistent states of anxiety in queer populations as they then fear they will experience bigotry again in their day to day lives. They then incorporate these experiences with bigotry and negative expectations into their idea of self-worth (Meyer, 2003). In this way a bigoted society acts as a trauma or stressor that has the ability to exacerbate or trigger mental illnesses. This situation is only made worse by the fact that LGBTQ+ people generally have fewer resilience factors than cisgender and heterosexual populations. This discrepancy in resilience is influenced by their social isolation in heteronormative groups which influences interpersonal connection, internalized shame which affects self-esteem, and economic disadvantages through biased hiring practices which is a determining factor in wealth and socioeconomic status (SES) (Kertzner, et al., 2009). As such, queer people are not only under more stress than heterosexual populations, but they also have fewer defenses against the stressors. Parallels between victims of domestic abuse and queer people include unsafe home lives, a reduced sense of self-worth, social isolation, and a tendency toward maladaptive coping mechanisms like substance abuse along with their increased rates of depression, anxiety, and post traumatic stress disorder (PTSD) (Klien, 2017). Both groups lack the same resilience factors. The stressors are different but the handicaps are the same, so when a domestic abuse patient and a queer patient are met with significant trauma, as they are likely to experience, they will likely exhibit and develop the same conditions and maladaptive coping mechanisms[7] .It would be reasonable to suggest that treatments that worked for victims of domestic abuse might also be effective in treating queer patients. So what worked and what does this treatment look like? As previously stated, resilience-based therapy that focuses on developing interpersonal relationships has been shown to be successful in treating trauma. Therapists will often encourage women leaving abusive relationships to reconnect with their families and old friends who can support them in this difficult, and often dangerous, transitional period (Anderson, et al., 2012). This can be more difficult for queer patients who often cannot rely on their families for any form of support and have to build their own network of support through members of the LGBTQ+ community (McCann, Brown, 2019). Queer communities are often communities of transplants, people who have left their hometowns and home states in favor of typically more open-minded cities. Many LGBTQ+ individuals experience a vulnerable period of time wherein they are new to a city and do not have any close interpersonal connections. Group therapy serves to substitute their lack of family ties and provide another form of social support. This is the basis for a program called the Rainbow Heights Club (RHC) studied by Eileen Klein.

As social animals, humans need social relationships. Queer people growing up in heteronormative environments especially flourish once they find LGBTQ+ connections, though his often does not happen until adulthood.

“Perceived social support was found to correlate moderately to highly with greater life satisfaction, less depression, and less loneliness in samples of these lesbian individuals [who had a close friendship with at least two other LGB individuals] from both university and community samples” (Kwon, 2013). Findings like these encouraged the formation of the Rainbow Heights Club. The club combined the mental healthcare of therapy with the community-based activities of an adult summer camp. The main appeal of the club is its peer-run group therapy sessions that help patients form social connections

The New York University Integrative Psychology Review wp.nyu.edu/nyuipr with other patients. Klein’s research on the efficacy of the organization “concluded that in a peer-run and supportive culture, clients can feel they have authentic relationships based on honesty and mutual accountability.” (Klein, 2017). This mutual concern and accountability is not only between peer leaders and their patients but also between the patients themselves. Research has consistently shown that social support is a vital factor in resilience, and it is the factor most targeted by this type of therapy.

In peer-led group therapy (PLGT), mental health professionals who “have experienced mental illness themselves and share the lived experience of the clients in the agency” facilitate sessions (Klien, 2017). If the session is about dealing with anxiety in healthy ways, patients can be assured that the therapist leading the discussion at the Rainbow Heights Club is a queer person with an anxiety disorder. Patients are able to better connect with these providers and regard them as positive role models because of their similarities. Traditional individualized therapy has limitations, as all treatments do. It may give patients knowledge of the basic tools to improve their resilience, but this does not necessarily translate to any skill at using these tools. Whereas, PLGT practices in RHC are focused not only on providing knowledge of these tools, but also active development of them. It helps instill individual resilience but cannot, by itself, bring about community or interpersonal resilience. This type of therapy helps people develop healthy coping mechanisms and manage their stress but it is only one gear in the immense clockwork of psychological well-being. A person’s mental health is directly tied to their environment, and it is difficult to make lasting change without addressing these underlying problems. Individualized therapy doesn’t actively change someone’s environment but it does help them deal with problems in their environment. As mentioned earlier, group therapy can create social connections for its patients. If a patient’s presenting problem is that they feel alone but don’t know how to talk to people and form relationships, individualized therapy can teach them how to improve their social skills and alleviate social anxiety. In group therapy, however, that same patient has the opportunity to talk to similar people in an accepting and supportive environment.

Discussion

The use of resilience-based therapy within LGBTQ+ populations has the ability to bridge the gap between providers and the community, allowing a therapeutic experience that is more tailored to LGBTQ needs. The peer-led group therapy approach pioneered at the Rainbow Heights Club seeks to address the prominent feelings of isolation in the queer community as well as the widespread distrust in mental and medical health practitioners. This approach allows the clinic to change a patient’s environment into one more supportive to their needs by placing isolated people into communities rife with proof that their situations can improve.

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