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In the hybrid case of "Adam," Mandel (2014) has provided an example of a comprehensive cognitive-behavioral treatment for a depressed, gay, man who is in the process of coming out and disclosing his sexual identity.  Affirmative therapies, however, are practiced within a broader context of a culture that presumes that heterosexuality is the norm by which sexual minorities are compared.  This commentary suggests an alternative approach to the comprehensive CBT approach, with a briefer behavioral activation treatment possibility.  Also, areas wherein a well-meaning, knowledgeable and skilled therapist still made possible missteps because of the influence of the overall heteronormative culture are discussed.

The Hybrid Case Study of "Adam": Perspectives from Behavioral Activation and the Influence of Heteronormativity on LGB-Affirmative Therapy