Table 2.

Qualitative Themes and Clinical Recommendations Derived from Content Experts, Sexual Minority Women Community Members, EQuIP Providers, and EQuIP Participants (N = 55)

Theme	Summary	Clinical Recommendations
Attend to SMW’s diverse gender identities and expressions	SMW present in gender-bending ways by adopting a range of gender signifiers Participants discussed unique gender-based stressors that SMW experience	Cognitive restructuring techniques could help SMW to locate the source of negative internalized thoughts within adverse environments rather than attributing these thoughts to personal failings Assertiveness training might help SMW to engage in shared decision making around idiographic treatment goals and to communicate their wants and needs in a values-driven manner Emotion regulation skills training could facilitate SMW clients’ tolerance of negative affect and reduce avoidance Consciousness-raising could offer SMW the opportunity to label stigmatizing events, avoid blaming themselves for their distress, and connect with other SMW Structural competency training could help providers work to change SMW’s social context by ameliorating oppressive forces through outreach, prevention, and advocacy Exposure therapy might help SMW to better tolerate the emotional sequelae of threatening encounters Motivational interviewing techniques could enhance SMW’s motivation to recognize potentially problematic drinking
Focus on nonbinary stressors across SMW’s sexual and gender identities	SMW’s sexual and gender identities resist hegemonic binary categorizations SMW and providers discussed challenges faced by SMW who inhabit borderlands
Formulate SMW’s gender-based stressors within a feminist framework	SMW and providers noted the need to promote SMW’s agency and resilience in response to sexism SMW and providers described patriarchal structures and systems representing important treatment targets
Apply an intersectionality framework when working with SMW who hold multiple marginalized identities	Experiences of heterosexism are inextricably tied to experiences of intersectional stressors SMW and providers discussed identity-related experiences among SMW with intersecting identities
Incorporate issues of diversity, multiculturalism, and social justice across individual, interpersonal, and structural levels	SMW and providers noted that therapists who reflect SMW’s diversity could reduce treatment barriers SMW discussed talking with their provider about cross-cultural therapy relationships
Address the role of trauma in SMW’s mental health	SMW and providers discussed the pervasiveness of gender-based violence facing SMW SMW’s trauma exposure can contribute to a generalized sense of fear and avoidance
Address the role of alcohol in SMW’s lives	Several SMW and providers described SMW’s unique risk factors for alcohol use, including permissive alcohol use norms in the LGBTQ community Providers noted that treatment efforts should address the function of SMW’s heavy drinking

Note. EQuIP = Empowering Queer Identities in Psychotherapy; SMW = sexual minority women.