Table 1.

Future directions in evidence-based practice for sexual and gender minorities

Research Questions	Possible Solutions
Do Existing Evidence-based Treatments Need to Be Adapted to Address SGM-specific Concerns?
Do SGM clients experience comparable benefit from existing evidence-based treatments as heterosexuals?	Routinely assess sexual orientation in naturalistic treatment settings
Do SGM-adapted evidence-based treatments work better than standard evidence-based treatments and SGM-affirmative non-evidence-based treatments?	Conduct randomized controlled trials comparing SGM-adapted evidence-based treatments to evidence-based and non-evidence-based treatment-as-usual
Are SGM clients optimally satisfied with non-SGM-specific treatments? Do they have a preference for SGM-specific treatments?	Survey consumers of mental health services, ideally in population-based surveys
How Do Existing Evidence-based Treatments Need to Be Adapted to Address SGM-specific Concerns?
Do SGM-specific treatments need to be created anew or are SGM adaptations of existing evidence-based treatments sufficient?	Determine whether theoretical frameworks of SGM mental health are compatible with theoretical frameworks of existing treatments
What strategies are currently effecting successful outcomes in community practice?	Conduct psychotherapy process research with practicing clinicians (e.g., qualitatively code effective treatment sessions to generate principles)
Why Do SGM-affirmative Treatments Work?
Do SGM-affirmative treatments reduce minority stress and universal psychological mechanisms?	Measure and track trajectory of minority stressors and universal psychological processes across treatment
Do SGM-affirmative treatments facilitate SGM-affirming narratives and worldviews?	Perform linguistic/textual analysis of session transcripts to monitor shifts in narrative themes and worldviews (e.g., shame/pride)
Under What Conditions Do SGM-affirmative Treatments Work Best?
Does the structural context (e.g., state policy environment) determine treatment outcome?	Examine structural stigma as a moderator of treatment outcomes in randomized controlled trials and naturalistic treatment settings
How can SGM-affirmative treatments be efficiently disseminated, especially in low-resource, high-stigma locales?	Examine the feasibility and efficacy of delivering SGM-specific treatments in low-resource, high-stigma locales (e.g., developing countries, the US South).
Can SGM-competence therapist training improve SGM treatment outcomes?	Conduct randomized controlled trials of therapist SGM-competence training linked to client outcomes
Does therapist-client match on SGM status affect treatment outcome?	Examine therapist-client match as a moderator of treatment outcomes in randomized controlled trials and naturalistic treatment settings
For Whom Do SGM-affirmative Treatments Work Best?
Do intersectional identities (e.g., racial minority status) influence SGM-specific treatment outcome?	Examine intersectional identities as moderators of treatment outcomes in randomized controlled trials and naturalistic treatment settings
Do SGM-affirmative treatments work best at certain ages or certain stages of SGM development?	Examine age and developmental stage as a moderator of treatment outcomes in randomized controlled trials and naturalistic treatment settings
Does baseline presence of SGM-specific stressors across individual, interpersonal, and structural levels influence treatment outcome?	Examine SGM-specific stressors as moderators of treatment outcomes in randomized controlled trials and naturalistic treatment settings