As the field of clinical psychology has developed an understanding of mental illness from a largely white, heteronormative, and middle-class perspective, therapeutic tools and practices have been guided by this limited scope. A line of literature has identified disparities in access and quality of mental healthcare that is available and provided to individuals with marginalized backgrounds, related to sexual orientation, gender, race and ethnicity. Telehealth has been posited as an efficacious method to reach underserved populations with quality mental health services. However, less is known about the nuanced experiences of individuals with marginalized identities within the larger therapeutic context. The goal of this study is to qualitatively explore the experiences of individuals with marginalized identities to identify what clients perceive as benefits and challenges to telehealth therapy and what kinds of therapist behaviors and approaches are the most helpful, particularly in a virtual format. 8 individuals with marginalized racial, ethnic, sexual orientation, or gender identities completed semi-structured interviews exploring the experiences of individuals with marginalized identities in receiving mental health care and their perspectives on receiving care in person vs. via telehealth. Thematic analysis identified 26 themes organized into 6 domains: Process of seeking help, telehealth compared to in-person therapy, relevance of identity topics in therapy, experiences in therapy, beliefs about therapy, and recommendations for improving therapy. Findings contribute to the understanding of helpful and unhelpful therapist behaviors, especially when working with individuals with marginalized identities, the ability for telehealth therapy to reach underserved populations, and the relevance of identities in the experiences of mental illness, especially within the therapeutic context.
Author: Andrew Martinez, Psychology
Advisor: Vaishali Raval, Psychology
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