Objectives: Sexual minority adolescents experience elevated rates of psychological distress, influenced by societal stigma and heteronormativity. Psychological therapists can play a key role in supporting identity development and advocating for systemic change. This study explored therapists' lived experiences of working with sexual minority adolescents, attending to both reported experiences and deeper social mechanisms. Design: A qualitative study using a critical realist approach to thematic analysis that integrated inductive coding with abductive and retroductive theorising. Methods: Seven UK-based psychological therapists participated in semi-structured interviews conducted between January and March 2024. Analysis examined both dispositional and inferential themes, exploring both surface experiences and deeper social mechanisms shaping participants' experiences. Results: Three dispositional themes were generated: (1) therapists' experiences of socio-environmental forces shaping adolescent sexuality; (2) the striving to offer attuned, responsive therapy; and (3) the influence of socio-political tensions on navigating identity-related work. The analysis suggests that the therapeutic process functions as a relational shield against conflicting structural forces. By centring this relational process to navigate developmental fluidity, effective practice relied on agential striving to protect the adolescent's narrative from external agendas. This involved fundamental clinical skills: creating a non-judgemental space, using compassionate curiosity, and maintaining awareness of relational pulls and assumptions. Conclusions: Socio-political structures are often enacted within the therapy room, presenting both challenges and opportunities for therapeutic work. The findings suggest that therapy functions as a mediating space, shielding adolescents' developing identities from polarisation and stigma. This highlights the ethical necessity of maintaining a protected process in a politicised climate.

Abstract Transgender and gender diverse (TGD) young people face elevated risk of emotion dysregulation, depression, anxiety, and self-harm and suicide, likely due to chronic invalidation leading to emotion dysregulation. Dialectical Behaviour Therapy (DBT) is an effective intervention for these difficulties, but has not been fully optimised for TGD-specific experiences. TGD-specific charities may be viewed as safer and more accessible than NHS services, though they may lack resources for evidence-based interventions. This study aimed to optimise DBT skills training for TGD young people (DBT-TGD+) and assess the feasibility and acceptability of delivering this intervention within a TGD charity. Early indicators of effectiveness were also examined. An open pilot trial, with a case series design and qualitative methods, was conducted. TGD young people (aged 16–25 years) with self-reported emotion regulation difficulties attended a 16-week DBT skills training group co-facilitated by a psychologist and two TGD charity youth workers. Quantitative and qualitative data assessed feasibility, acceptability, mental health (emotion dysregulation, depression, anxiety), and TGD-specific outcomes. Reliable change and clinically significant change were calculated where norms existed. Qualitative data underwent reflexive thematic analysis. Twelve participants were recruited, with 75% retention and 80% average attendance. Participants and facilitators rated the intervention as feasible and acceptable. Qualitative findings highlighted perceived benefits. Reliable and clinically significant change ranged from 25% to 75% across mental health outcomes, with additional positive trends in some TGD-specific measures. DBT-TGD+ was feasible and acceptable to deliver in a TGD charity setting. Findings inform future intervention refinement and research. Key learning aims (1) To learn about the acceptability and feasibility of a dialectical behaviour therapy (DBT) skills training group intervention optimised for transgender and gender diverse (TGD) young people and delivered within a TGD charity. (2) To learn about the adaptations made to optimise the DBT skills training protocol (DBT-TGD+) to meet the needs of TGD young people. (3) To explore whether there are initial indicators of effectiveness of the skills training intervention.

This study aimed to understand young gay men's experiences of social support, relationships, community networks, talking about psychological distress, and their impact on distress and wellbeing. Eight verbatim transcriptions from semi-structured interviews with gay men aged 18-35 years were analyzed using Interpretative Phenomenological Analysis. Three super-ordinate themes were developed; 1) Growing up gay in a straight world: Developmental traumas, regarding men's experiences of homophobic abuse and exclusion and the internalized impact on their identities and identity concealment. 2) Belonging and not belonging within LGBTQ+ communities, encompassing men's varied experiences of LGBTQ+ communities and the corresponding impacts upon their wellbeing. 3) Relational responses to rejection, describing how men made sense of and managed their relationships within the context of the developmental traumas they had experienced growing up as gay men. These findings illuminate the psychological impact of experiencing multiple developmental traumas related to one's identity as a gay man, and how this influences lifelong relational behavior; and how experiences of social support, relationships and LGBTQ+ communities influence men's mental health. They provide a strong rationale for psychological interventions to acknowledge and address gay men's unique and adverse social experiences within their relationships, communities and societies.

IntroductionLesbian and Gay People (LGP) and people of the Global Majority (GM) experience minority stressors. Identifying as a Lesbian and Gay Person of the Global Majority (LGP-GM) creates complex minority stressors.MethodA thematic synthesis of 16 qualitative studies exploring LGP-GM experiences of minority stressors using the lens of Minority Stress Theory was conducted.ResultsFour analytical themes emerged: Intersectionality: Navigating the queer scene as an LGP-GM, Intersectionality: Navigating GM spaces as an LGP-GM, Internal intersectional identity conflict and Lack of connection to culture, religion, and others.Conclusion:Unique minority stressors are identified for LGP-GM, clinical implications and future research are discussed.

This review explored how currently and/or formerly suicidal men perceived masculinities to contribute to, and/or protect against, their suicidal thoughts and/or behaviors and help-seeking. Nine databases were searched using predefined search terms (e.g., masculin*, man, men, boy, suicid*, qualitative), supplemented by searches of key journals, reference and citation lists, and Google Scholar. Twenty-five English-language articles containing qualitative data were obtained. Studies were conducted in Australia, Bangladesh, Canada, Ghana, Ireland, Norway, Pakistan, South Africa, and the United Kingdom. The articles were appraised for quality and thematically synthesized, resulting in three themes. The findings suggest multifaceted roles of masculinities in influencing suicidal ideation, intent, attempts, and help-seeking. Men linked failure to attain socially powerful positions of provision and status to experiencing suicidal thoughts and behaviors. Viewing suicide as courageous and decisive, thus adhering to masculine expectations, appeared contributory to suicidal behaviors. Men described potential protective factors against suicidal behaviors, including perceived masculine expectations to protect and provide for their families, a view of suicide as cowardly and therefore un-masculine, and drawing upon "positive" masculine norms to facilitate help-seeking for suicidal ideation and distress. There was, however, substantial evidence of men describing not seeking help for suicidal ideation and distress due to adhering to "traditional" masculine norms. Clinical implications and future research directions for incorporating masculinities into male suicide prevention theory and practice are discussed, emphasizing the importance of further research into the experiences of higher risk groups of men and of men with diverse and intersecting identities.

OBJECTIVES:Lesbian and Gay people (LGP) experience higher rates of mental health difficulties, including self-harm, suicidal behaviours, as well as inequalities in health care, than their heterosexual peers. Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviours, though there is little research on LGP's experiences of DBT. This research aims to explore LGP's experiences of completing a full DBT programme. DESIGN:A qualitative design with semi-structured individual interviews was utilised. The results were analysed using Interpretative Phenomenological Analysis. METHODS:Six lesbian and two gay adults, aged between 22 and 47 years, living in the United Kingdom took part. All participants had completed a full programme of DBT within the 2 years prior to the interview. RESULTS:Four superordinate themes emerged from the data: (1) The DBT journey; (2) Connections and Sense of Community during DBT; (3) Sexuality both visible and invisible in DBT and (4) A Gender, Sexuality and Relationship Diverse (GSRD) affirmative future for DBT. CONCLUSIONS:Several clinical implications are suggested to improve DBT for LGP, for example to consider having other LGP within DBT groups, to create a more GSRD-affirming DBT (changes to the DBT manual, DBT therapists, DBT programme and physical DBT space), to adapt DBT techniques to manage sexuality-related difficulties and to adopt a GSRD-centric framework. Overall, DBT appears to be beneficial for LGP.

The evidence base for psychological interventions for suicidal individuals is limited and the delivery of longer-term therapy within mental health crisis services is confronted by several barriers. For these reasons, identifying briefer techniques that can be delivered to at-risk groups is pertinent. This study provides a preliminary evaluation of the Broad Minded Affective Coping (BMAC) technique, a brief positive mental imagery intervention, for suicidal adults. Of 32 individuals referred by mental health crisis services, 14 adults with experience of suicidal ideation in the past three months took part. All participants received a one-session BMAC brief intervention, and invited to practice the BMAC independently for the next seven days and provide logbook ratings of pre-post BMAC mood states. Suicidal ideation and depression were assessed at baseline and at the end of the week of imagery practice. Nine participants (64%) completed the study by providing baseline and follow-up assessments of depression and suicidal ideation, completing a logbook and participating in a feedback interview. The BMAC appeared acceptable to participants and showed promise in improving mood and suicidal thoughts. We discuss the implications of these findings for future investigations of a one-session BMAC brief intervention.

Introduction: This study aims to gain a greater understanding of self-harm amongst non-binary young adults and what helps to manage these urges. Method: Data was collected from 11 participant interviews and analyzed in line with grounded theory principles. Results: Findings highlighted how factors associated with growing up feeling outside of the binary, family discord, and the pain of living in a cisnormative society were associated with self-harm. Results describe what helps to manage selfharm and the impact of COVID-19. Conclusion: Findings extend existing research and offer clinical implications and highlight a need for increased understanding and acceptance of non-binary identities.

BACKGROUND:The impact of Minority Stress (MS) upon suicidal ideation and behaviours amongst Transgender and Gender Non-Conforming (TGNC) adults is not sufficiently understood, hence our intervention efforts on an individual and societal level are limited. This review aims to evaluate recent literature that reports on the association between MS and suicidal ideation and behaviours amongst TGNC adults. METHODS:PsycINFO, Web of Science, MEDLINE, CINAHL and EMBASE were systematically searched for relevant articles. Peer reviewed and grey literature were considered. Included papers reported quantitative analyses on associations between MS factors and suicidal ideation and behaviours amongst TGNC adults. The quality of papers was assessed. RESULTS:28 papers were identified as eligible. Findings suggested positive associations between external and internal minority stressors and suicidal ideation and behaviour. Dysfunctional individual coping was associated with a greater likelihood of suicide attempts. Community resilience was negatively associated with suicidal outcomes, but did not consistently buffer the effects of minority stress. LIMITATIONS:Overall quality of included papers was 'poor'. Almost all papers were cross-sectional by design, therefore causality cannot be inferred. Many papers measured variables using non-standardised measures undermining the reliability and validity of reported results. CONCLUSIONS:Findings offer support to the application of MS theory to the understanding of suicidal ideation and behaviour amongst TGNC. Future research should use standardised measures and longitudinal designs to better support the investigation of directionality and causality. More research is needed to understand the complex interactions between minority stress factors and the role of resilience in this population.

BACKGROUND:The mental health and well-being of gender and sexuality diverse (GSD) people needs to be understood within a socio-political and cultural context. AIMS:In this paper, an intersectional, social and system-based framework for understanding the mental health and well-being of GSD people is presented, for practitioners within this field to consider GSD mental health experiences and challenges within context. MATERIALS AND METHODS:Starting with a consideration of the current landscape of understanding, pivotal theories and understandings within the field are outlined. The need for a framework that centralises intersectionality and broader systemic considerations is presented. RESULTS:The framework provided has an explicit focus on four key features: (1) intersectionality, (2) institutions, policies and laws, (3) people and groups and (4) social stories. DISCUSSION:Consideration of each of these 'circles of influence' can help practitioners to understand the multi-layered and intersectional experience of GSD folk and allows for an understanding of potential intervention at both an individual and systemic and societal level. CONCLUSION:Use of such a framework in practice goes above and beyond what is currently available by centralising the role and impact of such wider systemic variables through an intersectional lens. The framework can be applicable worldwide given its flexibility to consider and apply pertinent policies, laws, people, groups and social stories within a particular country or culture.

Night Eating Syndrome (NES), as a diagnosis, presents as a combination of disordered eating, sleep and mood. Patients identified as having both NES and obesity demonstrate poorer outcomes in terms of weight loss compared to those with NES only. However, research focusing on psychological factors associated with NES remains relatively underdeveloped. This study aimed to explore the relationship between NES and the experience of emotion from the perspective of patients accessing a weight management service. Ten adults who met diagnostic criteria for moderate or full NES took part in a semi-structured interview. Data were analysed using a constructivist approach to grounded theory. A core concept to emerge from the analysis was termed 'emotional hunger'; reflecting an urge or need to satiate a set of underlying unmet emotional needs. It was underpinned by the following interrelated themes: (1) Cultivating a dependency on food; (2) Relying on food to regulate emotions; (3) Understanding the significance of night-time; (4) Acknowledging the consequences of night eating. This study provides an in-depth understanding of the relationship between NES and the experience of emotion from the perspective of patients attending a weight management service. Results have potential to inform future service development, particularly around the adoption of a more holistic approach to night eating behaviours.

Therapist self-disclosure of sexuality can be therapeutically beneficial when both therapist and client identify as gay. This study attempted to explore the views and experiences of gay male clinical psychologists disclosing their sexuality to gay male clients. Five gay male clinical psychologists were interviewed, and subsequent transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). Six main themes emerged from the data: Being gay in a straight world; Disclosure and the therapeutic agenda; Contexts of disclosure; Other ways of knowing; Disclosure of sexuality: a big deal?; and The invisible curriculum. Overall, the study highlighted the participants’ thoughtfulness regarding their decisions and reasons to disclose, suggesting that disclosing their sexuality could be beneficial, but also potentially unhelpful to their gay clients. It is hoped that these findings will generate discussion and reflection, and in a small way help make gay issues more visible within clinical psychology, psychotherapy and counselling training.