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Book Review: Contextual Behavior Therapy for Sexual and Gender Minority Clients

Citation: Skinta, M. D. (2020). Contextual Behavior Therapy for Sexual and Gender Minority Clients: A Practical Guide to Treatment. Routledge. 166pp.

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Allen, L. R. (2021, May 12). Book Review: Contextual Behavior Therapy for Sexual and Gender Minority Clients.

Reviewed by: Luke R. Allen, PhD

contextual-behavior-therapy-cover-wysiwyg For those with an interest in serving sexual and gender minority (SGM) clients, as well as those readers with an interest in Acceptance and Commitment Therapy (ACT), or more broadly contextual behavior therapy approaches, this book might be just what you were seeking. Contextual and Behavior Therapy for Sexual and Gender Minority Clients: A Practical Guide to Treatment provides a brief overview of key elements related to minority stress theory, intersectionality, and process-based therapies. The author, Matthew Skinta, incorporates his clear understanding of the scientific literature in each chapter and his clinical experience is evident through the clinical vignettes.

The language of the book is not overly technical nor obtuse, which functions to make it a perfect introductory book for graduate students, new clinicians, for those looking to improve their skills with sexual or gender minority (SGM) clients, and those who may be newer to contextual behavioral approaches. The clinical vignettes provided in the book are followed by easily digestible behavioral analyses to guide case conceptualizations. Most chapters include vignettes that illustrate how one might respond to a variety of presenting concerns (e.g., rejection sensitivity [i.e., a disposition to anxiously expect, easily perceive, and react strongly to rejection] and experiences of racism) through a contextual behavioral lens. Three chapters are devoted to ACT-related processes: “Mindfulness and Perspective Taking,” “Acceptance and Defusion,” and “Values and Committed Action.” Skinta also provides chapters devoted to specific considerations that might be present when doing work with SGM clients including topics of complex trauma & post-traumatic stress, health considerations, and special ethical considerations.

If brevity is a virtue, then this book is virtuous. Clinicians or graduate students would have little excuse for not being able to complete it. At the same time, the tradeoff is that it may lack a certain amount of depth and nuance. For those who are already within the SGM community or consider themselves a sexual orientation and gender diversity researcher, there might be little academic knowledge that is new here. Nonetheless, I found this book helpful and clinically thought provoking. The chapter on special ethical considerations was interesting and contained a practical discussion on how SGM clinicians may navigate certain ethical dilemmas (e.g., how to use dating applications when you and your client are both part of small communities). Moreover, the interventions described in the book (e.g., mindfulness exercises and relationship mapping activities) are largely transtheoretical and transdiagnostic and often relevant regardless of one’s theoretical orientation or a client’s specific diagnosis.

Ultimately, if you are a clinician who wants to broaden your repertoire of interventions while at the same time increasing knowledge of SGM clients and their experiences, this book is for you. Few books expertly weave evidence-based processes and an intersectional perspective in as clinically useful a way as Skinta has done.