Mindfulness and Acceptance for Gender and Sexual
Minorities A Clinician's Guide to Fostering Compassion,
Connection, and Equality Using Contextual Strategies
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“Skinta, Curtin, and the chapter authors respond to the need in the
field to articulate ways in which mindfulness-based approaches can
address many specific challenges faced by gender and sexual minority
(GSM) individuals. It is increasingly important to ensure that GSM
(and other minority) populations are able to access mental health
treatments that are both evidenced-based and follow culturally com-
petent, affirmative care. This book is a unique intellectually stimulat-
ing resource for clinicians to have in our tool box, both those who are
familiar with mindfulness-based approaches and desire information
about how to work with GSM, as well as those who work with this
population and require information about mindfulness- based
approaches to care.”
—Steven Safren, clinical psychologist and professor of psychology
at the University of Miami
“I finished this book feeling both humbled and at the same time
empowered in my work with GSM clients. It provides a very approach-
able overview of the theoretical foundations central to contextual
behavioral science, while at the same time being extremely practical
and directly applicable for clinicians, offering numerous clinical
examples and suggested exercises. This book is an essential read for
any clinician working with issues of sexuality, gender and gender iden-
tity, stigma, and shame from a functional contextual perspective.”
—Jenna LeJeune, PhD, licensed clinical psychologist, and
cofounder and director of clinical services at Portland
Psychotherapy Clinic, Research, and Training Center in
Portland, OR
“This volume includes the latest thinking and therapeutic interven-
tions in our field to help guide clinicians in their work with gender
and sexual minorities. Each of the chapters includes the nuts and
bolts involved in helping GSM clients. No stone is left unturned in the
array of chapters that include such topics as coming out, same-sex
parenting, shame, and being a minority in GSM communities. The
book is clearly aimed at detailing therapeutic interventions for clini-
cians, including compassion- , acceptance-, and mindfulness- based
treatments as both standalone as well as integrated with other
approaches such as acceptance and commitment therapy (ACT), dia-
lectical behavior therapy (DBT), and functional analytic psychother-
apy (FAP). This volume includes specific suggestions as well as case
examples that clinicians can apply in their work. It even includes a
chapter to address the issues confronting straight therapists working
with GSM clients. Their goals are not only to help clinicians be effec-
tive with GSM clients, but also address implications for society. I
highly recommend this extremely interesting, timely, and well-written
and edited book.”
—Robert J. Kohlenberg, PhD, ABPP, professor in the department
of psychology at the Center for the Science of Social Connection
at the University of Washington
“Matthew Skinta and Aisling Curtin have edited the preeminent
book on GSM-affirmative treatment. Writing from their core per-
sonal and professional experiences, the chapter contributors inspire
readers to become not only more insightful and effective therapists,
but to strive for cultural humility and societal equality. This deeply
thoughtful and heart-stirring treasure trove will guide clinicians for
generations to come.”
—Mavis Tsai, PhD, coauthor of A Guide to Functional Analytic
Psychotherapy, and research scientist and clinical faculty at the
University of Washington
“Mindfulness and Acceptance for Gender and Sexual Minorities is an
important contribution to the next wave of therapies for GSM. As we
move beyond a focus on affirmative and non-pathologizing therapies,
it is crucial that we begin to adapt evidence-based therapies to meet
the needs of the diverse populations that we treat. Mindfulness and
acceptance are approaches are especially suited for GSM clients strug-
gling not only to accept themselves, but also to live effectively in a
changing, and at times, hostile culture. This book is essential for any
clinician treating GSM clients.”
—Jayme L. Peta, PhD, coauthor of The Gender Quest Workbook
“There is a kind of violence that occurs when we tell people, in bold
headlines and in small, quiet ways: do not express your difference, do
not wonder about who you are, certainly not out loud, but really not
even to yourself. Just be quiet and fit in. The palette of human sexual-
ity is broad, and that breadth is largely unknown because we have
suppressed the knowing of it, even among individuals who have a
sense of these differences from the inside out. We have a choice. We
can create a kinder, more curious, and more thoughtful context for
our clients to come to know themselves and to help us to know them.
This is an important book if you want to be part of that kinder
context.”
—Kelly G. Wilson, PhD, professor of psychology at the University
of Mississippi
“This is a groundbreaking book on several levels. The expert authors
bring the light of cutting-edge behavioral research to people and chal-
lenges that are often overlooked by mainstream clinical approaches.
Furthermore, the book places compassion front and center in the
development of new strategies. This is a must-read book.”
—Dennis Tirch PhD, coauthor of The ACT Practitioner’s Guide
to the Science of Compassion, and founder of The Center for
Compassion Focused Therapy
“The evolved human brain carries multiple possibilities for experienc-
ing and acting in the world. Our capacity for love coexists with our
capacity for hatred and cruelty; our capacity for joy lives with our
capacity for depression; we are multidimensional beings. Such rich-
ness of our potential multiplicities is especially manifest in our sexuali-
ties, where many combinations of with whom and how are possible.
Tragically, for complex psychocultural reasons we have sought to
limit, suppress, and constrain this richness. Shaming and stigma have
confined and narrowed choices, and not always in favor of the hetero-
sexual, e.g. Sparta. We are oppressed by the repressed. This excellent
book brings together a group of insightful and knowledgeable authors
that address the personal and social costs of shame and stigma on
sexual variations…. Sensitive, wise, and compassionate, this will be a
classic in the field for many years.”
—Paul Gilbert, PhD, FBPsS, OBE, professor of clinical
psychology at the University of Derby, and author of Human
Nature and Suffering and The Compassionate Mind
“This book is an indispensable resource for any evidence-minded cli-
nician who wants to bring acceptance, compassion, and effective
change to the lives of all of those they work with. This long-awaited,
seminal work provides practical guidance through GSM-affirming,
evidence-based treatments with care and precision. The authors and
editors of this volume honor the diversity and real-world applicability
of these treatment approaches with a depth and scope that is bound
to be greatly appreciated by any mental health provider working with
GSM clients and communities.”
—Laura Silberstein, PsyD, director and clinical psychologist at
The Center for Compassion Focused Therapy in New York
City, NY, and coauthor of The ACT Practitioner’s Guide to the
Science of Compassion and Buddhist Psychology and Cognitive-
Behavioral Therapy
“Mindfulness and Acceptance for Gender and Sexual Minorities is a
thought-provoking journey for those who serve the lesbian, gay, bisexual,
and transgender (LGBT) community. It is also a self-reflecting glimpse
for those who are learning how to understand, develop, and manage the
many facets of being a part of the LGBT identity, and the joys and strug-
gles related to the process of owning your sense of self.”
—Robin McGehee, cofounder of GetEQUAL
“I had the pleasure of attending a few ACT workshops, both daylong and
brief, and found ACT’s way of pinpointing, relating, and neutralizing the
deeply ingrained patterns of negative self-identity as wholly refreshing. It
was as if facilitator Aisling Curtin coaxed what we didn’t realize we’d
always known, regarding how the world can cause us to feel displaced,
dysfunctional, and othered. What Curtin and coeditor Matthew Skinta
have done here is apply these individuated, gentle, and psychically loos-
ening techniques to identity groups currently in the maelstrom of public
scrutiny, as they incrementally gain equal rights across the West.”
—Clara Rose Thornton, culture journalist and radio and television
broadcaster focusing on identity politics; InkBlot Complex
“Skinta and Curtin have achieved a rare feat in this volume: along with
their contributors, they have delivered a book that captures the zeitgeist
of today’s contextual psychology with as much depth and nuance as they
bring to their discussion of clinical issues and approaches with LGBT
clients. The result is a text that speaks equally to experts in contextual
psychology who are eager to increase their cultural competence with
LGBT clients, as well as those who are keenly familiar with LGBT popu-
lations who are eager to learn and incorporate acceptance and mindful-
ness approaches within their work. No matter which end of the spectrum
the reader comes from, they will walk away with a thorough, practical,
and immediately applicable knowledge base in both arenas.”
—Mary P. Loudon, PhD, licensed clinical psychologist and certified
functional analytic psychotherapy (FAP) trainer
The
Mindfulness & Acceptance
Practica Series
As mindfulness and acceptance-based therapies gain
momentum in the field of mental health, it is increas-
ingly important for professionals to understand the full
range of their applications. To keep up with the growing
demand for authoritative resources on these treatments,
The Mindfulness and Acceptance Practica Series was
created. These edited books cover a range of evidence-
based treatments, such as acceptance and commitment
therapy (ACT), cognitive behavioral therapy (CBT),
compassion-focused therapy (CFT), dialectical behav-
ioral therapy (DBT), and mindfulness-based stress re-
duction (MBSR) therapy. Incorporating new research in
the field of psychology, these books are powerful tools for
mental health clinicians, researchers, advanced students,
and anyone interested in the growth of mindfulness and
acceptance strategies.
Visit www.newharbinger.com for
more books in this series.
MINDFULNESS &
ACCEPTANCE for GENDER
& SEXUAL MINORITIES
A Clinician’s Guide to Fostering
Compassion, Connection & Equality
Using Contextual Strategies
Edited by
MATTHEW D. SKINTA, PD, ABPP
AISLING CURTIN, MS
CONTEXT PRESS
An Imprint of New Harbinger Publications, Inc.
Publisher’s Note
This publication is designed to provide accurate and authoritative information in regard to the subject
matter covered. It is sold with the understanding that the publisher is not engaged in rendering psycho-
logical, financial, legal, or other professional services. If expert assistance or counseling is needed, the
services of a competent professional should be sought.
Distributed in Canada by Raincoast Books
Copyright © 2016 by Matthew Skinta and Aisling Curtin
Context Press
An imprint of New Harbinger Publications, Inc.
5674 Shattuck Avenue
Oakland, CA 94609
www.newharbinger.com
Excerpt from [He knows her cunning she knows him hungry] from RED DOC> by Anne Carson,
copyright © 2013 by Anne Carson. Used by permission of Alfred A. Knopf, an imprint of the Knopf
Doubleday Publishing Group, a division of Penguin Random House LLC. All rights reserved. Any
third party use of this material, outside of this publication, is prohibited. Interested parties must
apply directly to Random House LLC and Penguin Random House UK for permission.
Excerpt from “A Litany for Survival” from THE BLACK UNICORN by Audre Lorde. Copyright
© 1978 by Audre Lorde. Used by permission of W. W. Norton & Company, Inc. and the Charlotte
Sheedy Lit Agency.
“Inner Voices Exercise” adapted from A GUIDE TO FUNCTIONAL ANALYTIC PSYCHO
THERAPY by Mavis Tsai, Robert J. Kohlenberg, Jonathan W. Kanter, Barbara Kohlenberg,
William C. Follette, and Glenn M. Callaghan, with permission of Springer Science+Business
Media, LLC. Copyright © 2009 by Mavis Tsai, Robert J. Kohlenberg, Jonathan W. Kanter, Barbara
Kohlenberg, William C. Follette, and Glenn M. Callaghan.
Cover design by Amy Shoup; Acquired by Melissa Valentine;
Edited by Jasmine Star; Indexed by James Minkin
All Rights Reserved
Library of Congress Cataloging-in-Publication Data to come
For Barthélémy, who constantly reminds me by his presence just how
powerful a constant source of love is in mending the pains of the world.
—MDS
For Trish, the love of my life, my rock and secure base.
—AC
Contents
Foreword������������������������������������������������������������������������������������ xi
Acknowledgments��������������������������������������������������������������������xv
Introduction��������������������������������������������������������������������������������1
Matthew D. Skinta, Palo Alto University; and Aisling Curtin,
ACT Now Ireland
Part I:
Mindfulness and Acceptance for Coming Out and Shame
1 Self and Perspective Taking for Sexual Minorities in
a Heteronormative World ������������������������������������������������������11
Aisling Curtin, ACT Now Ireland; Lisa Diamond,
University of Utah; and Louise McHugh, University College Dublin
2 Using ACT Interventions to Help Clients Explore the
Possibilities of Gender Identity����������������������������������������������29
Trish Leonard, ACT Now Ireland; and Lauren Grousd,
private practice
3 Coming Out with Compassion����������������������������������������������49
Aisling Curtin, ACT Now Ireland; Danielle (Danny) Ryu, PGSP-
Stanford PsyD Consortium; and Lisa Diamond, University of Utah
Mindfulness and Acceptance for Gender and Sexual Minorities
4 Compassion-Focused Therapy in the Treatment of Shame-
Based Difficulties in Gender and Sexual Minorities����������69
Nicola Petrocchi, John Cabot University, Rome; Marcela Matos
and Sérgio Carvalho, University of Coimbra; and Roberto Baiocco,
Sapienza, University of Rome
5 Mindfulness and Acceptance for Malignant Shame����������87
Matthew D. Skinta, Palo Alto University; and Paul D’Alton,
University College Dublin
6 Treating Disordered Eating in Gay Men and Other GSM
Clients Using DBT and ACT������������������������������������������������109
Joseph C. Walloch, University of Nevada, Reno; and Mary L. Hill,
Georgia State University
Part II:
Building and Rebuilding Relationships
7 Healing the Wounds of Rejection: Deepening Vulnerability
and Intimacy with Functional Analytic Psychotherapy��131
Matthew D. Skinta and Kimberly Balsam, Palo Alto University;
and R. Sonia Singh, Bowling Green State University
8 Elephants in the Room: Straight Therapists’
Microaggressions with GSM Couples��������������������������������149
Joanne Steinwachs, private practice; and Thomas G. Szabo,
Florida Institute of Technology
9 Starting a Family: Same-Sex Parenting������������������������������171
Amy Murrell, University of North Texas; Fredrik Livheim,
Karolinska Institute; and Danielle Moyer, Melissa Connally,
and Kinsie Dunham, University of North Texas
viii
Contents
10 Religion, Spirituality, and Gender and Sexual Minorities:
What Clinicians Need to Know������������������������������������������187
Finn Reygan, Wits Centre for Diversity Studies (WiCDS),
University of the Witwatersrand; Aisling Curtin, ACT Now Ireland;
and Geraldine Moane, University College Dublin
11 Minority Stress and Resilience������������������������������������������� 207
Brian A. Feinstein, Northwestern University; and Brian P. Marx,
National Center for PTSD
Part III:
Life in Context: Challenges in the World
12 The Lasting Impact of HIV/AIDS�������������������������������������� 227
C. Virginia O’Hayer, David S. Bennett, and Jeffrey M. Jacobson,
Drexel University
13 Doubly Disenfranchised: An Acceptance-and
Compassion-Based Approach to Being a Minority Within
GSM Communities��������������������������������������������������������������� 247
Khashayar Farhadi-Langroudi, American School of Professional
Psychology at Argosy University–San Francisco Bay Area;
and Kayla Sargent and Akihiko Masuda, Georgia State University
14 Flexible Organizations: Creating a Healthy and Productive
Context for GSM Employees����������������������������������������������� 265
Frank W. Bond and Joda Lloyd, Goldsmiths, University of London
15 Queering the Globe: Promoting Equality, Connection, and
Community ��������������������������������������������������������������������������� 283
Matthew D. Skinta, Palo Alto University; and Kip Williams,
Market Street Center for Psychotherapy
Index��������������������������������������������������������������������������������������� 303
ix
Foreword
One of the most urgent tasks facing scholars interested in the mental
health of gender and sexual minorities (GSM) is the identification of
treatments that can improve the well-being of this population. Given
the significant mental health disparities that exist, which depend on
sexual orientation and gender identity, one could argue that this task
represents an ethical imperative. Evidence-minded mental health clini-
cians have been fully aware of this imperative for decades now. In fact,
over the past few decades it has become almost habitual for authors of
clinical research papers and conference presentations on stigma,
minority stress, and mental health to conclude by calling for the trans-
lation of this knowledge into evidence-based practice. However, for
reasons that probably have to do with stigma itself, the needed research
and evidence have been slow to arrive. In the United States and else-
where, few research funds have been devoted to developing treatments
that can improve the mental health of GSM individuals.
Evidence-based treatments are typically an outgrowth of random-
ized controlled trials wherein the treatment under investigation is
compared to a control treatment. Unfortunately, very few randomized
controlled trials have examined the efficacy of psychotherapies spe-
cifically for GSM clients. And even if resources and social attitudes
did allow for more such research, the sheer diversity of GSM commu-
nities would present a formidable, if not insurmountable, barrier to
conducting clinical trials of treatments for each specific subgroup. So
clinicians would still lack guidance on how to approach the diverse
needs of diverse GSM clients. Further, psychotherapy practitioners
have long bemoaned the fact that randomized controlled trials do not
adequately address the needs of real-world clinical practice. Given
these dilemmas, how can our field ever provide adequate guidance—
with a foundation in the real world, yet also evidence based—for clini-
cians working across the many diverse segments of the GSM
community?
