Reflective functioning and mentalised affectivity among therapists working with LGBTQ+ patients: Associations with the therapeutic alliance

Psychotherapists’ personal characteristics, including affirming attitudes and clinical skills when working with LGBTQ+ patients, may contribute to the development of a strong therapeutic alliance. Although therapists’ mentalisation abilities have been associated with better alliance in general clinical settings, this association has not been specifically examined in work with LGBTQ+ patients. The present cross-sectional study investigated whether therapists’ reflective functioning and mentalised affectivity were associated with therapist-rated working alliance with LGBTQ+ patients. Associations with sociodemographic and professional variables (i.e. age, sex assigned at birth, LGBTQ+ identity, and attendance at LGBTQ+ training) were also explored. The sample included 45 Italian psychologists and psychotherapists (Mage = 40.87, SD = 10.18) who reported clinical experience with LGBTQ+ patients. Results indicated that stronger working alliance was positively associated with therapists’ certainty about mental states and greater ability to express emotions. No significant associations emerged for sociodemographic or professional variables. Moreover, expressing emotions mediated the association between certainty about mental states and working alliance.These findings suggest that therapists’ capacity to understand mental states and express emotions may support the quality of the therapeutic relationship with LGBTQ+ patients. Training and supervision programmes may benefit from addressing these intrapersonal processes alongside culturally affirmative knowledge and skills.