Supporting sexual minority adolescents : A critical realist thematic analysis of psychological therapists' experiences

Young, Paris and Islam, Nargis and Lea, James and Daiches, Anna (2026) Supporting sexual minority adolescents : A critical realist thematic analysis of psychological therapists' experiences. Psychology and Psychotherapy: Theory, Research and Practice. ISSN 1476-0835

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Abstract

Objectives: Sexual minority adolescents experience elevated rates of psychological distress, influenced by societal stigma and heteronormativity. Psychological therapists can play a key role in supporting identity development and advocating for systemic change. This study explored therapists' lived experiences of working with sexual minority adolescents, attending to both reported experiences and deeper social mechanisms. Design: A qualitative study using a critical realist approach to thematic analysis that integrated inductive coding with abductive and retroductive theorising. Methods: Seven UK‐based psychological therapists participated in semi‐structured interviews conducted between January and March 2024. Analysis examined both dispositional and inferential themes, exploring both surface experiences and deeper social mechanisms shaping participants' experiences. Results: Three dispositional themes were generated: (1) therapists' experiences of socio‐environmental forces shaping adolescent sexuality; (2) the striving to offer attuned, responsive therapy; and (3) the influence of socio‐political tensions on navigating identity‐related work. The analysis suggests that the therapeutic process functions as a relational shield against conflicting structural forces. By centring this relational process to navigate developmental fluidity, effective practice relied on agential striving to protect the adolescent's narrative from external agendas. This involved fundamental clinical skills: creating a non‐judgemental space, using compassionate curiosity, and maintaining awareness of relational pulls and assumptions. Conclusions: Socio‐political structures are often enacted within the therapy room, presenting both challenges and opportunities for therapeutic work. The findings suggest that therapy functions as a mediating space, shielding adolescents' developing identities from polarisation and stigma. This highlights the ethical necessity of maintaining a protected process in a politicised climate.