Measuring LGBTQ-affirmative therapist behavior: Development of the LGBTQ Affirmation and Discussion In-Session (LADI) Inventory

Objective The within-session processes that constitute LGBTQ-affirmative psychotherapy remain under-specified.Methods We developed and validated an observational measure of therapists’ LGBTQ affirmation and discussion in-session (LADI) in a study of 57 gay and bisexual men who received 10 sessions of treatment-as-usual in two LGBTQ community organizations as part of a larger trial.Results Independent raters reliably agreed on the presence of LGBTQ affirmation and discussion in sessions when using the LADI. Even when controlling for the therapeutic alliance, clients exhibited greater change in observer-rated depressive symptoms, self-reported substance use consequences, and internalized heterosexism when they had a therapist who displayed more LGBTQ affirmation on the LADI, although results for internalized heterosexism may have been sensitive to an outlier. The LADI did not predict changes in HIV-risk-transmission behavior, alcohol use, anxiety symptoms, suicidal ideation, rejection sensitivity, sexual orientation concealment, or identity affirmation.Conclusions The LADI can facilitate future research on LGBTQ-affirmative psychotherapy.