Understanding the Minority Stress Model

One’s identities (race, gender, religion, and more) and their according privilege or lack thereof affect how they are treated in society. Those who belong to marginalized groups such the LGBTQ+ community and BIPOC communities, for example, are at risk for experiencing minority stress. The minority stress model is a theory that provides insight into the relationship between minoritized/marginalized and dominant groups that result in a contentious social environment for the minority group members. 

The first person to coin the term was Dr. Virginia Rae Brooks in her book, Minority Stress and Lesbian Women in 1981. Ilan Meyer’s 2003 study, Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations advanced Brooks’ research. Beyond this study, there are dozens of additional studies providing the existence of minority stress. The contentious social environment, especially prejudice and discrimination, has detrimental effects on the wellbeing of minority group members. The five types of minority stress are victimization, discrimination, heteronormative cultural norms, stereotyping and prejudice, and systematic bias. These ongoing stressors are what cause the detrimental effects of minority stress as a whole. It’s important to note that minority stress is distinct from general stress, which everyone can experience. Unlike general stress, minority stress is chronic and socially-based. The overarching social structures that create prejudice and discrimination in the first place are staples of society which means they are unending and inescapable.

Intersectional theory demands that we are, among other things, context specific. This means that people and, in the context of therapy, patients all have different needs, access, and privilege that all need to be taken into account when assessing one’s stress levels. There are a variety of theories about integrating treatment strategies to specifically target minority stress. 

One such theory is the ESTEEM model which aims to address mental, sexual, and behavioral health needs. It’s important to note that the study underlying the ESTEEM model was done on sexual minority men so while the information it generated is important, the research scope was limited. The ESTEEM model includes ten treatment modules to be conducted in one-on-one settings that range from tracking instances of minority stress in a patient’s life, discussing learned emotional responses and consequences of minority stress, and exploring the concept of emotion avoidance and emotion-driven behaviors. 

Minority stress is vital to understand for the general population and healthcare practitioners alike. The day to day effects of minority stress have significant effects on wellbeing and health which needs to be taken into account when assessing various health problems that may arise. While minority stress is unavoidable, there are self-care and professional treatment options to help work through its effects. If you’d like to speak with a professional therapist, contact the ESW team here.

LGBTQIA+ Affirming Health Care: Tips for Professionals and Patients

Doctors’ appointments aren’t necessarily something that most people actively look forward to but when the patient in question is LGBTQIA+, the prospect can be downright terrifying. Receiving healthcare is often a vulnerable position to be in and when the risk of discrimination is that much higher, many LGBTQIA+ folks hesitate to take the chance even if it means denying themselves critical care. 

According to a report by Lambda Legal, “almost 56% of lesbian, gay, or bisexual respondents had at least one of these [various negative types of interaction with healthcare professionals] experiences; 70% of transgender and gender nonconforming respondents had one or more of these experiences.” Those kinds of numbers make it abundantly clear that LGBTQIA+ individuals are consistently discriminated against in healthcare environments and this discourages them from seeking needed care; not to mention that in some U.S. states, healthcare professionals can legally turn away an individual for being LGBTQIA+. 

These systemic issues need to be addressed but at the same time, LGBTQIA+ people are suffering at the hands of healthcare discrimination which has potentially life threatening consequences. There is room both to critique the system and recognize that it needs to be overhauled, as well as to acknowledge that people need access to compassionate care now. Both healthcare providers and LGBTQIA+ patients can take measures to make healthcare a more accessible and affirming experience. There are strategies to mitigate discrimination and exposure to it despite the fact that it may not be entirely unavoidable. 

For Healthcare Professionals: Curating an LGBTQIA+ Welcoming Environment   

Change starts on an individual level and all healthcare professionals should strive to address the unique hurdles LGBTQIA+ people face when seeking care. Here are some ways to practice LGBTQIA+ affirming care:

• Ask patients’ pronouns and default to gender neutral language if their pronouns are unknown. Additionally, make space for patients to disclose both their legal name and the name they identify with as sometimes they are different, especially for transgender people. 

• Explicitly display support for LGBTQIA+ people and their health

  • Display brochures (multilingual when possible and appropriate) about LGBT health concerns, such as breast cancer, safe sex, hormone therapy, mental health, substance use, and sexually transmitted infections.

  • Hire LGBTQIA+ staff members

  • Attend and support local LGBTQIA+ events and businesses 

  • Publish a non-discrimination statement such as this example. 

• Allow for a wide variety of identities and boundaries on intake forms 

  • This may include replacing the strict male/female options with blank spaces for both “gender” and “sex” categories.

  • Add room for patients to specify what name they’d like to be called, in addition to their legal name 

  • Allow people to disclose boundaries for the doctor such as not wanting to be weighed or not wanting a genital exam (unless explicitly necessary to the health concern at hand) 

• Commit to continually learning and improving, especially in instances when you have made a mistake. 

  • Read our blog post with a round up of LGBTQIA+ education resources 

• Don’t assume anyone’s gender, anatomy, or sexuality

• Listen to how patients describe their own sexual orientation, partner(s), gender, and relationship(s), and use their language. Although many LGBT people may use words such as “queer,” “dyke,” and “fag” to describe themselves, these and other words have been derogatory terms used against LGBT individuals. They are not appropriate for use by health care providers unless and until explicit consent is given by the patient. If you are in doubt as to how to refer to a patient, ask what word or phrase they prefer.

• Ensure there is a gender neutral restroom option for patients

For LGBTQIA+ Individuals: How to Protect Yourself

• When searching for doctors, utilize resources such as a local LGBTQ+ clinics and centers for recommendations, or a directory like the one from the Gay and Lesbian Medical Association.

• Look up reviews of a potential doctor to learn more about their patients’ experiences.

• Explore the practice’s website to see if they explicitly display support for LGBTQIA+ people.

• If you have questions for the doctor before you feel comfortable going in for an appointment, try emailing or calling the office and ask them questions about their experience working with LGBTQIA+ patients. Listen to your gut feeling about them after your call.

• If possible, consider bringing a trusted friend, someone you feel safe and comfortable around, to your appointment. 

• Your doctor’s job is to take care of you; the best way you can help them do that is by being upfront about your boundaries and any pertinent information about yourself, including your identity. Any good doctor will appreciate the guidance and unless your requests go against medical necessity, they should respect it.   

• If you have a negative experience with a healthcare professional, make sure to practice self-care and process it with a trusted therapist if you have access to one. If not, talk with a consenting loved one about your experience.  

Hopefully these tips will assist both healthcare professionals and LGBTQIA+ patients to make LGBTQIA+ healthcare affirming, compassionate, and accessible. No one’s health should suffer because of ignorance. Healthcare is a human right for all, not just those who conform to arbitrary societal standards. LGBTQIA+ people deserve equitable access to proper healthcare.