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Restoring Trust and Bridging the Gap: Exploring the History of LGBT+ Marginalization in the Field of Psychology
Sophie Camilleri & Katie Statema
Professional Psychology Program, The George Washington University
Amidst Pride month celebrations, LGBT+ people across the country are reminded of their ongoing fight for safety, dignity, and a right to exist. In the past year, the FBI has documented over 2,400 LGBT+ hate crime offenses while the ACLU is currently tracking over 530 anti-LGBT+ bills in 2026, so far (Federal Bureu of Investigations, 2026; American Civil Liberties Union, 2026). These attacks on LGBT+ individuals are accompanied by limited funding and education dedicated to understanding the unique health needs of this community, as a result of heterosexist and homophobic biases (Treharne & Adams, 2017). In order to respond to this persistent mistreatment, psychologists must take a proactive stance in supporting and defending the rights of their LGBT+ clients and colleagues. Psychology has played a pivotal role in shaping public perceptions of LGBT+ individuals, contributing to harmful, and even life-threatening, narratives. Despite increased access to LGBT+-affirming care, the community’s distrust of mental health professionals prevails. In order to create equitable treatment and meet the needs of the LGBT+ population, clinicians must first reckon with the role the psychological field played in shaping stigmatizing social norms.
LGBT+ History and Development
As psychologists fought to establish themselves as a distinctive field in the 1800s, early theorists challenged themselves with the identification and treatment of homosexuals, who posed a predominant threat to established social and cultural norms of gender. Research from the University of California, Santa Cruz identified this stage in psychological narratives and attitudes towards LGBT+ individuals as the sickness script (Hammack et al., 2011). During this period, psychological assessments such as the Rorschach and the Thematic Apperception Test were popularized as tools to identify homosexuality, utilizing severely flawed and biased research methods to legitimize this technique. For example, most of the participants in psychological research on homosexuality were institutionalized, creating a false narrative of same sex attraction as pathological. Psychologists and sexologists, such as Evelyn Hooker and Alfred Kinsey, played a critical role in dismantling this narrative and reframing the way that psychologists conceptualized human sexuality, with Hooker’s research demonstrating the inability to detect sexual orientation using the Rorschach; findings that proved monumental in the removal of homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (Hammack et al., 2011; Hubbard, 2019).
As research progressed, psychologists gradually abandoned the sickness script in conjunction with social movements and the sexual revolution of the mid-1900s (Hammack et al., 2011). The American Psychiatric Association (APA) reflected the transition from pathology to a minority identity through official statements regarding their stance on the LGBT+ community. In 1964, the APA firmly stated that homosexuality does not imply impaired judgement, stability, or other qualities that a person may possess to be considered a functional member of society or the vocational world (Spitzer, 1974). The APA further combatted its previous influence toward discrimination against the LGBT+ community by successfully opposing the inclusion of homosexuality as a mental illness by the Immigration and Naturalization Service (“Position Statement: Homosexuality and the Immigration and Naturalization Service,” 1991). While the powerful remnants of the APAs earlier pathologization of LGBT+ individuals inevitably remained within society and institutions, the APA’s statements demonstrated a desire for a shift away from the damaging ideology of the past.
Although changing, remnants of the sickness narrative prevailed, as LGBT+ bodies became highly medicalized. Psychologists no longer saw homosexuality as an illness, but rather an inconvenient variation of the human experience that should be studied, rationalized, and cured. LGBT health psychology emerged as a subfield of psychology in response to the unique experiences of sexual minorities, focusing predominantly on STI prevention and biological determinants (Peel & Thomson, 2009). This research was commonly criticized in social movements for over-sexualizing the LGBT+ experience, focusing predominantly on white, gay men, silencing the voices of LGBT+ people, and identifying issues without providing solutions (Hammack et al., 2011). Researchers, such as John Money, played a monumental role in pioneering gender identity and establishing psychology as a critical voice in the treatment of intersex and gender diverse children (Reis, 2021). His controversial experiments on intersex children serve as an example of the lasting impacts that psychologists had on gender rhetoric and the pathologization of transgender individuals.
Lasting Impact of Historical Narratives
Despite cultural advances, psychological assessment and clinical theories have yet to catch up. Even “state of the art” psychologist training programs can not ensure that a graduating clinician will be effective in treating and supporting LGBT+ clients. For example, Washington, D.C is the only state that requires specific training in LGBT+ health since their groundbreaking LGBT+ Cultural Competency Continuing Education Act was established in 2016 (Jauregui & Harper, 2025). Despite LGBT+ clients experiencing heightened symptoms of depression and anxiety and receiving therapy at higher rates than their straight counterparts, therapeutic outcomes for LGBT+ clients are subpar (McGeough & Aguilera, 2020; Platt et al., 2017). For LGBT+ individuals to regain trust in a field and institution that has pathologized and othered them for so long, meaningful change including and reaching beyond continuing cultural competency must be demonstrated system wide.
Psychologists in training are exposed to both historical and contemporary theories. Sexuality and gender aspects of these theories, however, have yet to be updated. The Oedipal complex and “penis envy” are examples of classic psychological theories that can reinforce trans-exclusionary, heteronormative assumptions about clients. (Dess et al., 2018). Application of these theories to case conceptualization and treatment with LGBT+ clients proves ineffective and damaging, yet established alternatives are scarce. New or LGBT+-intended treatment approaches are minimally seen while most affirming approaches are adaptations of existing frameworks in cognitive behavioral, psychodynamic, and humanistic therapies (McGeough & Aguilera, 2020). When LGBT+ perspectives are missing from psychological theory, a sense of unimportance is communicated that ultimately perpetuates the dismissal of LGBT+ clients’ unique challenges, strengths, and needs.
As a field, it is critical that we make the importance of attending to LGBT+ client’s unique and complex needs explicit. The present gap in clinical guidance for working with LGBT+ clients has strengthened the notion that competency with LGBT+ clients is an optional add-on, and the clinical implications of this are evident. A clinician’s own belief in the importance of using a sexual and gender minority lens when assisting an LGBT+ client has been shown to motivate them to act in affirming ways that attend to the client’s needs (Leitch et al., 2023). In a 2023 study looking at social worker’s and psychologist’s views and behavior of work with LGBT+ clients, many clinicians reported a focus on “fairness” in which they minimized the challenges of being part of a marginalized community and left sexuality unaddressed in an attempt to keep the work as similar as possible to treatment with cisgender, heterosexual clients. One statement by a participant illustrates this limiting approach well: “While I am supportive and respectful of all people regardless of their race, religion, ethnic background, sexual orientation, etc.—I do not currently feel the need to become involved with specific issues” (Leitch et al., 2023).
Recommendations
In the realms of education, clinician practices, and theories, the field of psychology has many possible routes forward. Those involved in education can foster empathy and curiosity about LBGT+ patients in emerging clinicians by thoughtful selection of course materials. Whether or not LGBT+-affirming content was shown to psychologists during their training can impact therapeutic alliance with LGBT+ clients (Jauregui & Harper, 2025). Challenges can occur when a client feels they need to educate their therapist on their lived experience, or clinicians commit micro aggressions against the client. Trainee engagement with current research, client accounts, LGBT+-affirming psychological theories, and media may raise trainee awareness of how implicit bias could be affecting their clinical practice. LGBT+ cultural sensitivity should also be implemented in training for all mental health clinicians, and a policy could be created to incorporate this into licensure requirements for more than just DC (Jauregui & Harper, 2025). Furthermore, education on the history of harm against the LGBT+ community by psychology as an institution may provide contextual information to trainees and inspire critical thinking on this topic.
At a wider level, some psychologists are calling for a paradigm shift that moves past the consideration of gender and sexuality diversity as indicative of minority identity (Hammack, 2025). Advancements in cultural and scientific conceptions of gender and sexuality have been motivated by four empirical trends: “(1) the proliferation of new language to describe gender and sexuality; (2) the rising identification with any form of sexual and gender diversity, especially among people born this century; (3) growing evidence of sexuality as flexible and fluid across the life course; and (4) rising visibility of forms of intimate diversity such as consensual nonmonogamies and kink” (Hammack, 2025). Moving away from tenets that endorse meaningful categories of human variability in sexuality and gender and that cisgender and heterosexual status are held by most people may necessitate creation of a new institutional structure and provide opportunities for incorporation of LGBT+ individuals across the board.
In the clinical setting, there are existing practices that LGBT+ clients have indicated as effective and supportive. In addition to general factors of warmth and trustworthiness of a clinician, LGBT+ clients have named that being addressed by their indicated name and pronouns, personal choices around coming out being respected, and an understanding that each individuals’ relationship to their LGBT+ identity has a different quality as specifically supportive. Group members of an LGBT+-affirmative CBT-based group therapy intervention called SAAHAS in Mumbai, India reported reduced loneliness and feelings of safety within their year long-group, among other benefits (Wandrekar & Nigudkar, 2019). Furthermore, an interpersonally-based, process-oriented framework for group therapy with LGBT+ clients has been provided as a guide for clinicians (Lefevor & Williams, 2020).
Conclusion
While psychologists have played a major role in the pathologizing and medicalization of LGBT+ individuals, the field now aims to treat LGBT+ studies and clinical work as a valuable area. The remnants of early perceptions of the LGBT+ community remain, sustaining challenges for individuals wanting to access services. Truly meeting the needs of LGBT+ clients requires clinical, educational, and theoretical changes across the institution of Psychology.
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