A Clinical Framework for Sexual Minority Couple Therapy

Sexual minority (SM) couples share similar predictors of relationship distress and dissolution with couples with two heterosexual partners, highlighting a need for quality couple therapy. Though many SM couples desire culturally tailored couple care and most couple and family therapists have worked with SM clients, most therapists report feeling underprepared to deliver tailored couple therapy that best meets SM couples’ needs. Effective, evidence-based couple therapies exist to treat relationship distress, yet these treatments have been overwhelmingly developed for and studied with mixed-gender, heterosexual couples. Consequently, most couple therapists are left tailoring therapy for SM couples ad hoc, without a guiding framework. This article offers a clinical framework to guide the systematic tailoring of evidence-based couple therapy for SM couples, specifically encouraging couple therapists to attend to (a) universal factors relevant to all couples’ relationship functioning, (b) SM-specific factors impacting couple functioning including differentiating between the environmental-level origin of SM stress and its multilevel impact on couple well-being, and (c) within-group diversity and meaningful subgroups of SM couples to ensure we do not view SM couples as monolithic. We highlight key nonspecific/common factors that underlie SM-affirming couple therapy. Finally, we discuss the couples field’s progress in offering tailored SM couple care and consider broader clinical implications of this framework in expanding the reach of evidence-based couple therapy to historically underserved groups.