Microaggressions and Dropout When Working With Sexual Minority Parents in Clinical Settings: The Working Alliance as a Mediating Mechanism

The present study investigated how the working alliance mediated the influence of therapists’ microaggressions on sexual minority parent patient dropout. The potential moderating roles of therapists’ sexual orientation and training on lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) issues were also examined. The study sample was 71 White cisgender therapists (Mage = 39.50; SD = 7.84; 67.6% women; 66.2% heterosexual) of different theoretical orientations who had treated a sexual minority parent and whose therapy had ended (spontaneously vs. dropped out). Moderated mediation analyses showed that, for heterosexual therapists and therapists who were not trained on LGBTQ+ issues, those who found microaggressive questions more relevant to understanding the child symptomatology described by a sexual minority parent couple reported a poorer working alliance; this, in turn, was associated with their sexual minority parent patient’s dropout. Therapists must identify and monitor microaggressions when working with sexual minority parents, to reduce the risk of damaging the working alliance and compromising patient retention. The results emphasize the importance of therapists building knowledge and developing competence on LGBTQ+ issues, to shift from microaggressive to microaffirmative models of psychotherapeutic care.