Analysis of the Case with the LGBTQ+ Community

Overview of Basis for Treatment

Many members of the LGBTQ+ community tend to have issues linked to mental health because of the inability to be in line with general societal views of gender and sexuality. This particular challenge is presented in the following case in rich detail. For the most part, such issues transpire when LGBTQ+ individuals are making attempts to reintegrate into society and develop a positive image for themselves (Astramovich et al., 2017; Luke & Goodrich, 2017). Therefore, Sam requires treatment because they are severely unsure about their future and engage in antisocial and self-destroying behavior in order to unconsciously attract more attention to themselves and seek help.

Brief Case Introduction

Sam is a 22-year-old non-binary individual from a majorly conservative Christian family living in a small rural area. They came out at the age of 15, but the family did not support them in any way. In college, Sam was too afraid to disclose their gender and sexuality to other students, as they were exceptionally worried about their college future and relationships with other students. Gradually, Sam’s concerns grew into severe anxiety and paranoia, leading them to even more self-destructive behaviors.

Presenting Complaints

At the moment, the key Sam’s complaint is that they are not accepted by society, and their parents do not seem to help. Because of this, Sam needs support and assistance, as their interactions with others tend to be irrational and affected by Sam’s paranoia. The lack of proper sleep and unwillingness to perform in terms of academics also contribute to their overall state of mental health. Secondary complaints include depressive symptoms and the inability to regulate emotions properly.


Sam’s family history hints at the fact that their gender and sexuality choices are always under serious scrutiny due to the conservative views displayed by every member of the family except Sam. Even during college, Sam has not developed close friendships or intimate relationships with anyone due to their fear of being canceled. Even though they were successful in academic terms at first, their growing anxiety took away their ability to think rationally. Sam has a history of psychiatric help and recidivist behaviors, causing them to experience a serious relapse. There is no history of substance or sexual abuse, but it may be hypothesized that Sam was most likely affected by verbal abuse since they decided to come out as queer at the age of 15.

Initial Impression

Sam is a well-developed individual with no specific difficulties related to physical health or interactions with the external environment. Their family history and socio-economic background add more depth to Sam’s willingness to come out as queer and somewhat protest the conservative gender standards. Despite heavy emotional dysregulation, Sam has the capability of curbing their severest outbreaks. Sam’s self-destructive behaviors stem from their inability to build partnerships with the external world and find inner peace at once. No antagonistic behaviors were identified in Sam either.

Case Conceptualization

Even though Sam position themselves as inappropriately judged and victimized by their closest relatives, most of their fears stem from being misunderstood by their peers. The biggest issue for Sam is their unwillingness to embrace their inner self and capitalize on their strength instead of continually focusing on the hardships that the members of the LGBTQ+ have to experience. This may lead the counselor to the idea that existential therapy could be the best choice for Sam. They would have the opportunity to change their way of thinking and demonstrate that their worldviews are different, but others could reckon with such unconventional opinions nonetheless (Luke & Goodrich, 2017). Judging by Sam’s behaviors, they never intended to turn antisocial or cause harm to anyone from their surroundings, as their self-destruction motives can be found deep inside themselves, among the inability to accept parents’ reluctance and the fear of being misinterpreted by peers.

Course of Treatment

To begin the treatment, the counselor should be aiming to develop a therapeutic alliance with Sam. The rationale behind this is that without an emotional connection, Sam and the counselor would not be able to understand each other and take a closer look at how they both perceive the case at hand (Solomonov & Barber, 2018). Previous emotional dysregulations might have had a negative impact on Sam, causing them to pay less attention to how they are functioning and what could be the possible consequences of their actions. The therapeutic alliance would also be helpful for the course of treatment (Flores & Sheely-Moore, 2020; Lybbert et al., 2019).

It would help Sam and the counselor share their latest views and opinions without any judgment or bias. The nature of Sam’s mental health issues is one of the main motives why an empathy-based therapeutic alliance is necessary. Knowing that Sam’s parents lack acceptance and cannot validate the fact that their child came out as queer, the counselor could become the main source of support for Sam through the interface of empathy and emotional connection. In addition, it would improve Sam’s empathetic capabilities, making them one step closer to realizing their strengths.

The main course of treatment would revolve around existential therapy and the counselor’s attempts to alter the client’s negative judgments. The biggest misconception that has to be addressed first is that Sam is not a problem or source of shame for their family (Watter, 2018). Accordingly, Sam could have the opportunity to see themselves as an adventurer and not a victim of verbal abuse, social disapproval, or any other particular issue that they might have mentioned or hinted at before.

It would also make perfect sense to help Sam finally identify themselves and accept their nature without resorting to the issues of gender or sexuality. Existential therapy would be exceptionally helpful here, as it would protect Sam from shifting their misconceptions to other persons (Watter, 2018). Through existential therapy, Sam would also get a chance to align their gender identity against their everyday life and accept the fact that there may be people who do not choose to have positive experiences with members of the LGBTQ+ community. Sam would become more flexible in terms of how they approach their sex life, relationships with family members, and their own gender identity.

The possible list of challenges and barriers to effective counseling, in this case, includes the influence of human feelings and instincts on the process of therapy. Sexual preconceptions might be hard to understand or support, especially if the counselor has never had any similar experiences before. The lack of training and expertise could become the key issue affecting the therapeutic alliance and decreasing the quality of client-therapist interactions (Correia et al., 2017). Another potential challenge that cannot be ignored is the lack of open-mindedness that could be addressed with the help of prolonged exposure to LGBTQ+ community members. Sexuality issues bring a different layer of difficulty to the process of counseling because they do not only test one’s acceptance and commitment, but also push oneself beyond their personal boundaries (Lybbert et al., 2019). The presence of LGBTQ+ clients might also be challenging because of their unwillingness to create a therapeutic bond with a counselor that does not take part in the LGBTQ+ community themselves.

Treatment Considerations

While existential therapy could be one of the best choices for the counselor to approach Sam’s mental health issues, there are several options that could be helpful as well. These two therapies are Cognitive Behavioral Therapy and Acceptance and Commitment Therapy. The rationale behind extending the existing treatment with the help of these two additional therapies is that Sam often falls into the lap of black-and-white thinking (Pepping et al., 2018). As the client cannot perceive the world as a mere succession of events, the counselor will have to help them confront this irrational belief. Another important reason for exploring the benefits of these two therapies is that they support various gender expressions and roles while motivating clients to explore the realm of gender expectations (Rosenkrantz et al., 2020). With a developed sense of acceptance, Sam could have a better chance of building effective partnerships with peers and family members. The counselor would have to explore all the expectations and expressions together with the client in order to provide a reasonable amount of empathy and support.


Astramovich, R. L., Chan, C. D., & Marasco, V. M. (2017). Advocacy evaluation for counselors serving LGBTQ populations. Journal of LGBT Issues in Counseling, 11(4), 319-329. Web.

Correia, E. A., Cooper, M., Berdondini, L., & Correia, K. (2017). Characteristic practices of existential psychotherapy: A worldwide survey of practitioners’ perspectives. The Humanistic Psychologist, 45(3), 217. Web.

Flores, C. A., & Sheely‐Moore, A. I. (2020). Relational‐cultural theory-based interventions with LGBTQ college students. Journal of College Counseling, 23(1), 71-84. Web.

Luke, M., & Goodrich, K. M. (2017). Assessing an LGBTQ responsive training intervention for school counselor trainees. Journal of Child and Adolescent Counseling, 3(2), 103-119. Web.

Lybbert, R., Ryland, S., & Bean, R. (2019). Existential interventions for adolescent suicidality: Practical interventions to target the root causes of adolescent distress. Children and Youth Services Review, 100, 98-104. Web.

Pepping, C. A., Lyons, A., & Morris, E. M. (2018). Affirmative LGBT psychotherapy: Outcomes of a therapist training protocol. Psychotherapy, 55(1), 52. Web.

Rosenkrantz, D. E., Rostosky, S. S., Toland, M. D., & Dueber, D. M. (2020). Cognitive-affective and religious values are associated with parental acceptance of an LGBT child. Psychology of Sexual Orientation and Gender Diversity, 7(1), 55. Web.

Solomonov, N., & Barber, J. P. (2018). Patients’ perspectives on political self‐disclosure, the therapeutic alliance, and the infiltration of politics into the therapy room in the Trump era. Journal of Clinical Psychology, 74(5), 779-787. Web.

Watter, D. N. (2018). Existential issues in sexual medicine: The relation between death anxiety and hypersexuality. Sexual Medicine Reviews, 6(1), 3-10. Web.

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