In order to recognize Pride Month in June, we asked EMDRIA members for video or written responses to the following question:
*** Liliana Baylon, LMFT-S, Colorado, USA. EMDRIA Certified Therapist™ and Approved Consultant™ – “Culturally responsive EMDR with LGBTQIA+ clients begins with humility, curiosity, and context attunement. Assess trauma; do not make anguish an identity. Think about how the nervous system and negative thinking are impacted by attachment injury, familial rejection, religious hurt, migration, racism, language, gender policing, systemic discrimination, and medical or legal vulnerability. Mapping resilience, chosen family, community, cultural pride, spiritual meaning, and embodied safety should also be part of conceptualization. Targets should include both individual traumatic experiences and cumulative relational or systemic traumas, such as microaggressions, concealment, bullying, and invalidation. Clinicians must interrogate assumptions, authority, and cultural location as a constant. By responsiveness, I mean questioning, “What has this client had to protect, hide, grieve, or reclaim to survive?” It involves pacing work such that identity, safety, and belonging stay fundamental, not peripheral, to recovery.”
*** Meagan Dye, Virginia, USA – “I just finished my EMDR training, so I have limited experience with case conceptualization. But I wanted to reach out because in my training the trainer offered that there is evidence that an ecological sound SUD for a person of color could be higher because of chronic and historic racism. The trainer shared that may be true for queer people too but there aren’t studies yet to know for sure. As a queer person myself, that really clicked for me that some part of how my nervous system responds is directly related to that identity. But I think that is likely different for each queer person depending on when they were born, what age they were when they realized they were queer, how long they kept it to themselves if they did and what that experience was like, what their family environment was like growing up or at the time of them realizing they were queer or different, family attitudes towards queerness, POC, people with disabilities, etc, (even if family didnt say we are anti queer messaging about other marginalized groups may have been internalized and taken to heart), religious and spiritual influences, what was going on in the political and media spheres related to queerness when the person was becoming aware of their identity, what other identities the person might hold that also influence how they experience of queerness (like if the person is disabled and queer or black and queer). It seems like having questions directly related to those things on an intake could be helpful for starting to identify potential targets that might be helpful to the person even if they do not immediately identify them as targets. It could also be helpful for the person receiving EMDR to begin to help them have more awareness about how identities may impact nervous systems and trauma and they may come up with targets on their own from thinking about it. Again, I am totally new to this but I wanted to share. I have also received EMDR before I did the training, which was incredibly helpful, but didn’t directly address those questions above because that wasn’t my presenting concern. It might be helpful to have this information to also understand why someone’s current symptoms or presenting concern might be presenting as it is in the room and how comfortable they are in their identity.”
*** Melissa Galiotto, LPC, Pennsylvania, USA, EMDRIA Certified Therapist™ – “A few thoughts: 1. The therapist being affirming, meaning that the client experiences the therapist as safe, non judgemental, non assuming and providing a validating, safe, knowledgeable space. 2. Assessing for safety, meaning that disclosure could pose a risk for their employment, housing, finances or supportive group. Discussing plans to maintain physical, intellectual, and emotional safety. Stabilization and Resourcing are important for clients that may have experienced relational trauma or feel stress in their lives. Also, highlight the strengths and resources – showing where they can build on those strengths. 3. The case conceptualization with the client means that the provider needs to assess for concerns such as gender dysphoria, break up trauma, identity concealment, medical trauma, and bullying just to list a few areas. 4. Finally, the therapist pursues consultation, continuing ed so that they have awareness of where they are lacking or biases.
*** Dr. Steven Halady, LCSW, New York, USA, EMDRIA Certified Therapist™ and Approved Consultant™ – “LGBTQIA+ identities intersect with countless combinations of other social categories, including racial, ethnic, national, class, sexual, gender, disability, neurotype identities. These complex identities are further shaped by environmental factors that can be specific to time and place. They are also impacted by multiple forms of systemic oppression that contribute both to the kinds of trauma experienced and how that trauma is expressed. No EMDR case conceptualization can do what we need it to do – support and guide healing – unless it includes an understanding of these intersections, the impacts of multiple forms of system oppression, and the need to radically dismantle those systems. “
*** Alexandr Yanikin, Clinical Psychologist, Budapest, Hungary, EMDRIA Certified Therapist™ – “As an EMDR therapist and a member of the LGBTQIA+ community, I believe culturally responsive case conceptualization begins with understanding that many LGBTQIA+ clients carry not only single-event trauma, but also chronic minority stress, shame, rejection, concealment, and attachment-related wounds. These experiences may shape core negative cognitions such as “I am not safe,” “I do not belong,” or “I must hide to survive.” Responsive EMDR conceptualization requires looking beyond the obvious target and considering family systems, internalized stigma, discrimination, identity-related trauma, community belonging, and resilience factors. It is equally important not to pathologize identity itself, but to recognize how trauma often develops around identity in unsafe environments. EMDR can be especially powerful when LGBTQIA+ clients feel not only clinically understood, but deeply seen, safe, and respected as whole people.”
“What factors help ensure a culturally responsive EMDR case conceptualization for clients who identify as LGBTQIA+?”
*** Liliana Baylon, LMFT-S, Colorado, USA. EMDRIA Certified Therapist™ and Approved Consultant™ – “Culturally responsive EMDR with LGBTQIA+ clients begins with humility, curiosity, and context attunement. Assess trauma; do not make anguish an identity. Think about how the nervous system and negative thinking are impacted by attachment injury, familial rejection, religious hurt, migration, racism, language, gender policing, systemic discrimination, and medical or legal vulnerability. Mapping resilience, chosen family, community, cultural pride, spiritual meaning, and embodied safety should also be part of conceptualization. Targets should include both individual traumatic experiences and cumulative relational or systemic traumas, such as microaggressions, concealment, bullying, and invalidation. Clinicians must interrogate assumptions, authority, and cultural location as a constant. By responsiveness, I mean questioning, “What has this client had to protect, hide, grieve, or reclaim to survive?” It involves pacing work such that identity, safety, and belonging stay fundamental, not peripheral, to recovery.”
*** Meagan Dye, Virginia, USA – “I just finished my EMDR training, so I have limited experience with case conceptualization. But I wanted to reach out because in my training the trainer offered that there is evidence that an ecological sound SUD for a person of color could be higher because of chronic and historic racism. The trainer shared that may be true for queer people too but there aren’t studies yet to know for sure. As a queer person myself, that really clicked for me that some part of how my nervous system responds is directly related to that identity. But I think that is likely different for each queer person depending on when they were born, what age they were when they realized they were queer, how long they kept it to themselves if they did and what that experience was like, what their family environment was like growing up or at the time of them realizing they were queer or different, family attitudes towards queerness, POC, people with disabilities, etc, (even if family didnt say we are anti queer messaging about other marginalized groups may have been internalized and taken to heart), religious and spiritual influences, what was going on in the political and media spheres related to queerness when the person was becoming aware of their identity, what other identities the person might hold that also influence how they experience of queerness (like if the person is disabled and queer or black and queer). It seems like having questions directly related to those things on an intake could be helpful for starting to identify potential targets that might be helpful to the person even if they do not immediately identify them as targets. It could also be helpful for the person receiving EMDR to begin to help them have more awareness about how identities may impact nervous systems and trauma and they may come up with targets on their own from thinking about it. Again, I am totally new to this but I wanted to share. I have also received EMDR before I did the training, which was incredibly helpful, but didn’t directly address those questions above because that wasn’t my presenting concern. It might be helpful to have this information to also understand why someone’s current symptoms or presenting concern might be presenting as it is in the room and how comfortable they are in their identity.”
*** Melissa Galiotto, LPC, Pennsylvania, USA, EMDRIA Certified Therapist™ – “A few thoughts: 1. The therapist being affirming, meaning that the client experiences the therapist as safe, non judgemental, non assuming and providing a validating, safe, knowledgeable space. 2. Assessing for safety, meaning that disclosure could pose a risk for their employment, housing, finances or supportive group. Discussing plans to maintain physical, intellectual, and emotional safety. Stabilization and Resourcing are important for clients that may have experienced relational trauma or feel stress in their lives. Also, highlight the strengths and resources – showing where they can build on those strengths. 3. The case conceptualization with the client means that the provider needs to assess for concerns such as gender dysphoria, break up trauma, identity concealment, medical trauma, and bullying just to list a few areas. 4. Finally, the therapist pursues consultation, continuing ed so that they have awareness of where they are lacking or biases.
*** Dr. Steven Halady, LCSW, New York, USA, EMDRIA Certified Therapist™ and Approved Consultant™ – “LGBTQIA+ identities intersect with countless combinations of other social categories, including racial, ethnic, national, class, sexual, gender, disability, neurotype identities. These complex identities are further shaped by environmental factors that can be specific to time and place. They are also impacted by multiple forms of systemic oppression that contribute both to the kinds of trauma experienced and how that trauma is expressed. No EMDR case conceptualization can do what we need it to do – support and guide healing – unless it includes an understanding of these intersections, the impacts of multiple forms of system oppression, and the need to radically dismantle those systems. “
*** Elizabeth Hinkle, LMFT, Virginia, USA, EMDRIA Certified Therapist™ and Approved Consultant in Training™ -“Safety hasn’t been an option for many of the clients who have struggled with coming out, being themselves, and being loved and supported in safe places, emotionally, physically, and otherwise. Calm Place: As I teach this resource, I’m not going to call it a “safe” place. During the discussion and practice of calm place, I’m going to encourage the client to imagine places they find calming, and although it’s an imagined place that could be safe for them, it may not be. I’ll always follow the client’s lead. Positive cognition: If the client identifies some version of “I feel safe”, I’m going to explore this further, as this may not be an option for a client to truly believe at a Validity of Cognition (VoC) of 7. In our EMDR therapy sessions, open discussions around safety in the context of being a person in the LGBTQIA+ community are essential.”
*** Sandi James PGPsy, Victoria, Australia – “Culturally responsive EMDR case conceptualization for LGBTQIA+ individuals includes integrating minority stress theory into the Adaptive Information Processing (AIP) model. Key factors include a comprehensive assessment of identity-based trauma. This can include rejection, conversion experiences, medical pathologization, and cumulative microaggressions and macroaggressions. These often present as complex, multi-layered networks rather than distinct memories. Essentially, exploring intersectionality across gender identity, sexual orientation, race, and disability recognizes that these identities compound both stressors and resilience pathways. The therapeutic relationship itself is a critical factor; as a lived experience clinician, this shared positionality can help reduce shame and facilitate disclosure of targets often hidden from non-LGBTQIA+ practitioners. Resource installation phases explicitly affirming queer identity as a source of strength, beside the trauma context can be extremely helpful in healing. Community belonging, chosen family, and pride represent genuine positive cognitions. Importantly, conceptualization must distinguish internalized homophobia/transphobia from ego-dystonic distress to avoid inadvertently reinforcing shame-based schemas.”
*** Kate Kincaid, LPC, Arizona, USA, EMDRIA Certified Therapist™ and Approved Consultant™ – “The most important factor in culturally responsive EMDR case conceptualization for LGBTQIA+ clients is one that precedes any protocol: safety in the therapeutic relationship itself.
For clients whose trauma is fundamentally relational — rooted in rejection by family, community, and institutions — the clinician’s genuine affirmation is not just supportive, it’s corrective. As a queer clinician, I know firsthand that there is a particular exhale that happens when a client realizes they don’t have to translate themselves to be understood. Case conceptualization should explicitly account for attachment injuries related to identity, and preparation phases may need to be longer and more intentional as a result. Beyond the relationship, clinicians should assess for the full spectrum of minority stressors: religious trauma, medical trauma (particularly for trans clients), family rejection, and the cumulative weight of chronic hypervigilance. Intersectionality matters too — a queer client who is also a person of color, disabled, or undocumented carries compounding layers that must be mapped, not assumed. Finally, negative cognitions should be evaluated for their cultural accuracy before being targeted. Some beliefs aren’t distortions. They’re survival knowledge that deserves respect even as we work to free clients from its grip.”
*** Dr. Rebecca Klinger, Colorado, USA. EMDRIA Certified Therapist™ and Approved Consultant™ – “It may seem obvious, but it bears saying: LGBTQIA+ identified clients are human beings who want and deserve to be heard, valued for who they are authentically, and able to live their lives. Viewing clients in this way and treating them as such is essential. There are certainly specific factors that go into this: asking for pronouns and using the appropriate pronouns and name; being familiar with terms used in the community; understanding the fluidity and diversity of gender identity, sexual identity, and other identities; understanding the distinctions of sex assigned at birth, gender identity, gender expression, etc.; and being aware of your own implicit biases and working to unlearn them. To name a few. And yet, at the heart, maintaining the perspective that LGBTQIA+ identified clients deserve to be heard, valued, and able to live their lives will serve you well and guide you through any case conceptualization.”
*** Cub Larkin, LMHC, USA, EMDRIA Certified Therapist™ – “As a queer clinician and member of the LGBTQIA+ community myself, culturally responsive EMDR case conceptualization starts long before we identify a target memory. It begins with understanding that for many LGBTQIA+ clients, trauma isn’t a single incident. It’s woven into the fabric of daily life through chronic minority stress, internalized shame, family rejection, and a world that has repeatedly sent the message that who you are is wrong. That cumulative experience must be honored when we build the trauma narrative. From there, a culturally responsive conceptualization considers the role of identity-based negative cognitions (“I am defective,” “I am unlovable”), the impact of religious or family of origin wounding, chosen family as a resourcing tool, and the client’s own relationship with their identity as a source of profound resilience. Affirmation isn’t an add-on. It’s the foundation.”
*** Cub Larkin, LMHC, USA, EMDRIA Certified Therapist™ – “As a queer clinician and member of the LGBTQIA+ community myself, culturally responsive EMDR case conceptualization starts long before we identify a target memory. It begins with understanding that for many LGBTQIA+ clients, trauma isn’t a single incident. It’s woven into the fabric of daily life through chronic minority stress, internalized shame, family rejection, and a world that has repeatedly sent the message that who you are is wrong. That cumulative experience must be honored when we build the trauma narrative. From there, a culturally responsive conceptualization considers the role of identity-based negative cognitions (“I am defective,” “I am unlovable”), the impact of religious or family of origin wounding, chosen family as a resourcing tool, and the client’s own relationship with their identity as a source of profound resilience. Affirmation isn’t an add-on. It’s the foundation.”
*** Tom Lorio, LCSW, New York, USA – “A few points to consider when preparing LGBTQIA+ clients for EMDR:
- Coming out is not a one-time event. It is shaped by context, relationships, safety, and life stage. A person may be out in some areas of life and not others. Ask clients when they first came out to themselves and to others, and what the response was. Be curious about the template it set for safe attachment, self-care, self-worth, and trust.
- Bullying is abuse.
- Thankfully, HIV/AIDS rates have decreased because of medicines like PrEP and effective HIV treatment. That does not mean the fear, grief, trauma, and loss associated with the epidemic, or with surviving it, have been processed or acknowledged. For many, especially older generations, sex became associated with danger, illness, and death. These long-lasting effects on attachment, intimacy, sexual health, identity formation, and relationship development may inform your clients’ experiences, both consciously and unconsciously.”
*** Mor Regev, LCSW-S, Texas, USA, EMDRIA Certified Therapist™ and Approved Consultant in Training™ – “The first consideration is the client’s comfort with this aspect of their identity. Are they open to exploring it, questioning it, or experiencing shame? It’s important to meet them where they are and avoid rushing the process. When taking history with LGBTQIA+ clients, I ask more specific questions about coming out, messages they received growing up about sexuality and gender, and how recently they came out. I also explore when they first recognized their identity, whether they felt pressure to hide or repress it in childhood, and how societal messaging may have shaped early sexual experiences, emotions, or internal conflict.”
*** Patrick Sobol, LCSW, Illinois, USA, EMDRIA Certified Therapist™ – “Culturally responsive EMDR with LGBTQIA+ clients requires understanding trauma not only as isolated events, but as cumulative experiences of shame, rejection, concealment, hypervigilance, and relational injury shaped by family, religion, healthcare, and societal systems. Effective case conceptualization must account for minority stress, attachment wounds, identity development, and the impact of chronic invalidation. It also requires awareness of intersecting communities and subcultures, such as consensual nonmonogamy, kink/BDSM, sex work, or sexualized spaces, without pathologizing consensual identity or expression. Safety, collaboration, pacing, and consent are central to the therapeutic relationship. Appropriate, intentional therapist self-disclosure can sometimes strengthen safety, reduce power differentials, and deepen therapeutic attunement when used in service of the client. LGBTQIA+ competence is not just affirming language—it is understanding systemic oppression, religious trauma, identitybased harm, and the resilience clients develop while surviving those experiences.”
*** Alexandr Yanikin, Clinical Psychologist, Budapest, Hungary, EMDRIA Certified Therapist™ – “As an EMDR therapist and a member of the LGBTQIA+ community, I believe culturally responsive case conceptualization begins with understanding that many LGBTQIA+ clients carry not only single-event trauma, but also chronic minority stress, shame, rejection, concealment, and attachment-related wounds. These experiences may shape core negative cognitions such as “I am not safe,” “I do not belong,” or “I must hide to survive.” Responsive EMDR conceptualization requires looking beyond the obvious target and considering family systems, internalized stigma, discrimination, identity-related trauma, community belonging, and resilience factors. It is equally important not to pathologize identity itself, but to recognize how trauma often develops around identity in unsafe environments. EMDR can be especially powerful when LGBTQIA+ clients feel not only clinically understood, but deeply seen, safe, and respected as whole people.”
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Date
June 19, 2026
Topics
Racial Trauma
Client Population
LGBTQIA+
Practice & Methods
Case Conceptualization, Your EMDR Practice
