A good place to start for Queer mental health issues

A guide to mental health specifically for the Queer community? My first thoughts – finally! I had been looking forward to reading this since Dr Brendan Dunlop announced it on Twitter. With significantly higher rates of mental health difficulties in Queer communities compared with the general population - yet worrying reports of Queer people having unhelpful and even traumatising encounters with healthcare professionals - The Queer Mental Health Workbook feels long overdue.

The book starts with 'Being Queer': a guided exploration of Queer identity, with emphasis on self-acceptance and self-compassion, as well as consideration of the impact of systemic factors and intersectionality. The Workbook covers issues of discrimination, power and privilege sensitively and thoughtfully, with diverse examples and guided activities for self-reflection and exploration.

The second section focuses on 'Specific Mental Health Difficulties', with chapters dedicated to anxiety, low mood, shame, trauma, sleep and eating difficulties, self-harm and suicide. It is informative and thoughtful, carrying through the emphasis on validation, with particular consideration for why many of these issues disproportionately affect Queer people, as well as including a variety of suggested practical activities and strategies. Throughout, Dunlop makes it clear that not every suggestion will work for each person. The advice to take what works and leave what doesn't, feels important; encouraging personal reflection and acknowledgement that each person will know themselves best.

I do, however, have a few criticisms. Considering the in-depth discussion of the choice of the word 'Queer', I was disappointed to see 'transwoman' written as one word. This is considered offensive by many people, as it implies an unhelpful distinction between trans women and cisgender women, and that being trans is an inseparable, defining part of the person's womanhood. While this may be true for some people, we cannot assume or suggest it is true for all. 'Trans', or 'transgender' is an adjective, and should be used as such – using it in the way the book does is akin to writing 'tallwoman' or 'whitewoman', as though being tall or white is inseparable from the person's identity as a woman.

"This book is a reminder that we have a long way to go before we reach a truly inclusive, equitable health service."

I also felt that at times there was a conflict between the book's emphasis on the impact of systemic factors and its repeated return to CBT techniques that place responsibility for the problem with the individual. I don't dispute CBT's extensive evidence base, nor its helpfulness for many people. However, this is a book specifically for Queer people. To go from reading about systemic oppression, considering the impact this has had for me personally and the Queer community generally, to being faced with a thoughts-feelings-behaviour chart and being encouraged to challenge my thoughts, felt jarring and somewhat invalidating.

That said, the integration of different therapeutic modalities, such as Compassion Focused Therapy's emphasis on a de-shaming approach, and Narrative Therapy's ideas around social stories, felt much more congruent with the book's core message of 'embracing your Queer identity'.

I feel it's important to acknowledge that I expected a lot from this book – perhaps too much! As the book notes, many Queer people do not feel safe seeking mental health support from professionals, due to experiences and/or fears of discrimination. One book cannot possibly be expected to fill the gaping void of support needed for the Queer community, although it makes a valiant effort in providing a valuable resource!

This book is a reminder that we have a long way to go before we reach a truly inclusive, equitable health service (and society), and that there is a pressing need for better training and accountability for professionals. For clinicians, to be part of the much-needed change, this book is a good place to start. For my fellow Queers, I hope it offers validation and support, space to learn, grow and get to know yourself better. I also hope it offers recognition that the responsibility doesn't lie with you: you are enough. In fact - you are fabulous - exactly as you are.

Reviewed by Kirsty Conway (they/them), Trainee Clinical Psychologist, University of Liverpool.

The Queer Mental Health Workbook: A Creative Self-Help Guide using CBT, CFT and DBT was written by Dr Brendan J Dunlop and published by Jessica Kingsley Publishers.