The Therapeutic Relationship Mediates the Association Between Affirmative Practice and Psychological Well- Being Among Lesbian, Gay, Bisexual, and Queer Clients

Edward J. Alessi, Frank Dillon, Rebecca Van Der Horn

Research output: Contribution to journalArticle

1 Scopus citations


In this study, we tested a conceptual model through which lesbian, gay, bisexual, and queer (LGBQ) clients' perceptions of their therapists' affirmative practices and the therapeutic relationship (i.e., working alliance and the real relationship) would correlate with psychological well-being. We hypothesized that the therapeutic relationship would mediate the relation between clients' perceptions of their therapists' affirmative practices and psychological well-being while controlling for precounseling distress, client age, client race/ethnicity, number of psychotherapy sessions, and therapist gender. A nationwide sample of 184 LGBQ individuals was recruited through the Internet. Participants ranged in age from 18 to 64 years old (Mage = 27.57; SD = 8.50), and the majority identified as female (65.8%) and White (77.2%). Structural equation modeling showed that participants' perceptions of their therapists' affirmative practices were associated with psychological well-being (β = .21, p < .01). Findings also indicated that the therapeutic relationship mediated the association between clients' perceptions of therapists' affirmative practices and psychological well-being (β =. 34, p < .001, 95% confidence interval [.15, .52]). More specifically, practicing affirmatively was correlated with a stronger therapeutic relationship, which was associated with higher levels of psychological well-being for LGBQ clients. Hence, these findings inform and encourage advancements in LGBQ affirmative psychotherapy research, practice, and training.

Original languageEnglish (US)
StatePublished - Jan 1 2019



  • LGBQ-affirmative psychotherapy
  • Sexual minority clients
  • The real relationship
  • The working alliance
  • Therapeutic relationship

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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