Integrating GSRD in clinical practice

There is now more awareness that the professions of psychotherapy, psychology and sexology are based on heteronormative, mononormative and cisnormative assumptions. Although it is changing with more textbooks and research dedicated to LGBTQ+ people, these populations are still approached as “special populations”, usually discussed in only one chapter of textbooks or only one module/ class in clinical training programmes colluding with the othering of people who are not heterosexual, with the “them and us” approach.

Now that there is more visibility of LGBTQ+ people, diverse sexual orientations, erotic orientations, gender identities and relationship styles, more people identify outside of the mainstream of heterosexuality, monogamy and Vanilla. Therefore it is time for our professions to catch up with the modern times and weave in human diversities in all textbook chapters and modules in clinical training programmes to truly grasp the realities of all the intersectional identities that patients bring in the consulting room. Heterosexuality is not excluded in that, because it is not a monolith either, there is vast diversities within heterosexuality.

While there is more visibility of LGBTQ+ people, we also currently live in a world that is becoming increasingly extreme in the political right wing again, with more homophobic, biphobic and transphobic rhetorics (alongside racism, antisemitism, misogyny, xenophobia, etc.). It means that more LGBTQ+ people and heterosexual who do not fit in the rigid heteronormative scripts will come for help. We, as professionals, have to be ready.

Gender, sex and relationship diversity (GSRD) therapy (Davies, Neves & Prunas, 2026) has now developed into more than just a few techniques and some diversity awareness. It is now a legitimate modality with its own philosophy, that can be integrated in all other existing psychotherapeutic modalities. Here are the seven components as a guide to integrate GSRD therapy in your existing clinical practice:

1. Practicing a commitment to social justice

This component helps to identify where a client’s distress comes from. Many LGBTQ+ clients will feel “broken”, “not good enough” and even “worthless”. This is often due to the harsh queerphobic world we live in where being LGBTQ+ is not desirable. Not colluding with clients’ sense of “brokenness” and externalising some of their distress into society’s prejudice can be healing. This component encourages us to use a systemic lens of understanding mental wellbeing. Professionals have to be aware of the norms that are embedded in our society that we believe to be true to help clients unpack the negative effects of heteronormativity, mononormativity and cisnormativity, for example: binary gender roles, monogamy, boxed up sexualities, patriarchy, misogyny, racism, othering people, etc.

2. Demonstrating cultural humility and cultural competence

There is a vast diversity of queer cultures, and numerous subcultures within it. Although it is not possible for therapists to know them all, we do need to take the responsibility to learn as we go along, rather than waiting for clients to educate us. I suggest that all need to do continuous professional developments on GSRD. Being culturally humble keeps us curious too, which avoids becoming clinically arrogant believing we know it all. We all have blind spots!

3. Understanding the specific adverse effects of oppression

If the practitioner has the heterosexuality, cisgender and white privileges, it might be easy to unintentionally dismiss the struggles of people who live without those privileges. For example, heterosexual therapists may not be aware that there are 65 countries in the world that have anti-LGBTQ+ laws, 12 of which impose the death penalty. A therapist living within the dominant societal construct may not understand how distressing it is to be misgendered. Holding your romantic partner’s hand in the street is a simple gesture that heterosexual people can do without even needing to think about it, while this simple gesture for a queer couple is anxiety-provoking, requiring to scan the environment for threats, and can be dangerous. It is important for therapists to know that life is different for queer people so that we can be attuned to their struggles and pay attention to minority stress, a type of stress that is specific to minoritised populations encompassing distal stress (society’s prejudices) and proximal stress (internalised social stigma), which are often a major factor to LGBTQ+ clients’ mental and sexual health struggles.

4. Being trauma, grief and shame informed

Most LGBTQ+ clients have a specific history and current, ongoing feelings of grief, shame and trauma. LGBTQ+ people often describe past trauma such as bullying, or parental rejection at the “coming out” stage, and many experience ongoing oppression because of the pervasive queerphobia in the world, so it is important for therapists to be trauma-informed. Grief is a common emotion because many LGBTQ+ people lost time in their youth when they had to hide for protection while their heterosexual peers could freely experience the world. Now that we have good television programmes showing great positive queer stories, grief can emerge for those who had to grow up with no queer representations, when they felt like they were “weird” and “broken”. Shame is often omnipresent with the LGBTQ+ populations because they are often told repeatedly that they are not desirable or wanted by society and religious groups. LGBTQ+ people do not often mention that shame is a problem because it is not detected as it is so much part of the “normal” in their lives. But shame silently influences mental health and sexual health problems.

5. Knowing contemporary sexology

The topic of sex is important for queer people because much of the societal discrimination is focused on their sex lives, calling them “sinful”, “dirty”, “an abomination”. Therapists must be able to talk about sex explicitly and be equipped with up-to-date sexological information. Sex education is poor, and queer sex education is almost non-existent. So, part of the work in GSRD therapy is to inform clients about sexological knowledge. For example, therapists need to challenge the constructs of “sex/porn addiction” because these concepts are not evidence-based, and they come from Christian-centred, heteronormative and mononormative assumptions. When those assumptions are imposed on queer people, it could be harmful. Moreover, queer porn for queer people could be a source of wellbeing, meaningful connection and belonging. Heterosexual clients can benefit from good sex education too, for example, informing them that a heterosexual man who enjoys penetrative anal sex (pegging) does not mean he is gay. Being kink-aware is also an essential aspects of this component.

6. Integrating core GSRD theories

Therapists need to stay updated with the crucial theories that are specific to LGBTQ+ clients, for example, minority stress (Meyer, 2003), as mentioned above, and other core theories such as intraminority stress (Pachankis et al, 2020) and intersectionality (Dunlop, 2022).

7. Fostering joy

While it is important not to dismiss the pain and struggles of LGBTQ+ people, it is equally important to invite them in discussing joy, because I believe that being queer is not only about surviving a heterosexist world, it is also about thriving in queer joy. There are multiple things that can contribute to queer joy, including attending Pride events, having fulfilling sex, developing good resilience, living life unapologetically, connecting with queer art and queer history, and creating a “Chosen Family”. I believe that queer joy can be an essential protective factor against the ongoing societal oppression.

Integrating the GSRD knowledge in your clinical practice will help be attuned to the vast diversity of humans of all sexual and erotic orientations, gender identities and relationship styles , and will contribute to establishing and maintaining a truly anti-oppressive practice.

By Silva Neves

 

References:

Davies, D., Neves, S., and Prunas, A. (2026). Gender, Sex, and Relationship Diversity Therapy. Theory and Practice. Routledge.

Dunlop, B.J. (2022). The Queer Mental Health Workbook. A creative self-help guide using CBT, CFT and DBT. Jessica Kingsley Publishers.

Meyer, I.H. (2003) Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003 Sep;129(5):674-697. doi: 10.1037/0033-2909.129.5.674.

Pachankis, J. E., Clark, K. A., Burton, C. L., Hughto, J. M. W., Bränström, R., & Keene, D. E. (2020). Sex, status, competition, and exclusion: Intraminority stress from within the gay community and gay and bisexual men’s mental health. Journal of personality and social psychology, 119(3), 713. doi: 10.1037/pspp0000282