The systemic oppression of lesbian, gay, bisexual, transgender, queer/questioning plus (LGBTQ +) communities significantly contributes to higher rates of both physical and mental health concerns. Moreover, this systemic oppression negatively impacts LGBTQ + romantic relationships, resulting in increased rates of intimate partner violence, lower levels of trust, and relationship instability. Research indicates that LGBTQ + individuals are more likely to seek therapy compared to their heterosexual, cisgender peers despite a reported lack of comfort and competency reported by therapists working with this population. Additionally, very few evidence-based few models of romantic relationship therapy have been applied to and/or developed with/for LGBTQ + relationships. The dearth of therapeutic approaches, such as Emotionally Focused Therapy (EFT), specifically tailored and adapted to meet the unique therapeutic preferences, needs, and lived experiences of LGBTQ + relationships as well as the lack of integration of client voices and identities into therapeutic interventions jeopardizes the quality, rigor, and the ability of relationship therapy to adequately address the concerns brought forth by LGBTQ + communities. Therefore, this study offers important empirical insight into how an evidence-based model of therapy, namely EFT, can be modified to account for LGBTQ + client therapeutic preferences, needs, identities, and lived experiences. The purpose of this qualitative, phenomenological study was to explore the recommendations made by LGBTQ + EFT clients for adapting EFT to account for their unique therapeutic preferences, needs, identities, and lived experiences. The sample included 35 EFT clients who identified as members of LGBTQ + communities and who had attended at least six sessions of EFT. Data were collected across eight focus groups using theater testing. A rigorous thematic analysis approach was used to label, analyze, and consolidate patterns of meaning following the tenants of Braun and Clarke (2006; 2019). Data analysis resulted in seven primary themes: (1) the universality of emotion, EFT, and the withdraw/pursue cycle, (2) client enthusiasm for EFT, (3) the impact of marginalization, (4) the importance of finding an LGBTQ + affirming therapist, (5) the integration of discrimination in relationship therapy, (6) the discussion of identity as othering, (7) client recommendations for EFT, and (8) working with therapists holding marginalized identities. Results illustrated the effectiveness of EFT, as well as how the lived experiences of the LGBTQ + communities impact the content and process of EFT. Although the aim of the study was to obtain recommendations for adapting EFT, participants also broadly discussed their experience of EFT overall, the impacts of marginalization, and the importance of working with relational therapists who understood the unique lived experiences of LGBTQ + clients. Several implications for both future research and clinical practice were identified. The qualitative findings from this study can inform how EFT is applied when working with members of the LGBTQ + communities as well as further research examining the effectiveness of an adapted EFT. The results are applicable not only for EFT therapists, but also any therapists using an evidence-based relational therapy model with people who identify as a member of the LGBTQ + communities.
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