Date Available

1-5-2025

Year of Publication

2024

Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation

College

Social Work

Department/School/Program

Social Work

First Advisor

Dr. Natalie D. Pope

Abstract

Queerness and disability have been shown to be intimately connected, with members of the LGBTQIA+ community significantly more likely to identify as disabled compared to the general population. Though there are roughly 3-5 million queer and disabled individuals living in the United States, this remains a multiply marginalized and understudied population. Owing partially to stigma, minority stress, and discrimination, these individuals face an increased risk of a variety of mental health problems including depression, anxiety, self-harm, PTSD, and suicidality. Additionally, several barriers to mental health treatment exist, including inaccessible services, lack of provider knowledge, and outright discrimination from providers. Though facilitators of therapeutic success with queer and disabled clients have been only minimally studied, research suggests that a strong therapeutic relationship can be instrumental to successful treatment.

In this study, a mixed methods approach was utilized to study the impact of two components of the therapeutic relationship, the real relationship and the working alliance, on the satisfaction of queer and disabled therapy recipients with the services they received. The impact of several client and therapist factors on the strength of the therapeutic relationship and client satisfaction with therapy were tested utilizing univariate, bivariate, and multivariate statistical analyses. Additionally, qualitative interviews were used to determine how queer and disabled therapy recipients conceptualize the real relationship and working alliance and their roles and to gain additional insight on client and therapist factors that impact the therapeutic relationship and satisfaction with therapy. A thematic analysis of qualitative data was conducted, resulting in several themes.

The role of the therapeutic relationship was conceptualized as three themes: facilitating therapeutic progress, building identity, and providing support. An additional analysis of factors impacting the real relationship resulted in three themes including conveying care, disclosing therapist’s self, and sharing identity. A final thematic analysis of factors impacting the working alliance revealed conveying knowledge, seeking understanding, and fostering partnership to be important themes. Scores on inventories measuring the real relationship and working alliance indicated that the average participant shared a moderate to moderately strong real relationship and working alliance with their provider. Additionally, overall satisfaction with the therapeutic experience was high. Higher scores on these inventories were found based on age match, gender match, and sexual orientation match. Therapist understanding of client gender, sexual orientation, and disability also impacted the therapeutic relationship and satisfaction with therapy. A variety of factors including type of disability, age, race, gender, and reason for receiving therapy were found to be predictors of components of the therapeutic relationship and satisfaction with therapy. Relevance to social work as well as implications for education, practice, and future research are also discussed.

Digital Object Identifier (DOI)

https://doi.org/10.13023/etd.2024.14

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Available for download on Sunday, January 05, 2025

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