J Homosex. 2026 Mar 18:1-25. doi: 10.1080/00918369.2026.2642717. Online ahead of print.
ABSTRACT
Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) clients often receive suboptimal mental health care. LGBTQ+ clinical competence self-report measures have been developed to assess therapists’ knowledge and attitudes and subjective self-perceived skills and performance. However, therapist self-perceived assessments of their skills and performance have been found to be biased. Observational measures of LGBTQ+ competence are needed to more objectively evaluate therapists’ skills and performance. The objective of this exploratory pilot study was to develop and assess the coding reliability of observational measures of therapists’ competence with LGBTQ+ clients. The observational measure developed and tested in this study consisted of 29 items that corresponded to 29 expected competencies applicable to LGBTQ+ competent and ethical therapy. On-line initial consultations between 43 therapists and a simulated client were video recorded. Two trained self-identifying LGBTQ+ coders observed the video-recordings and used the 29 items to rate the LGBTQ+ competencies of these 43 therapists. We generated item proportions and kappa statistics. This preliminary study suggests that 13 measures of LGBTQ+ clinical competence were operationally defined to be observable, measurable, and reliably coded. Future research is warranted to both confirm and expand on this conclusion to advance evidence-based approaches to improve the mental health care for LGBTQ+ clients.
PMID:41848553 | DOI:10.1080/00918369.2026.2642717
