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Depuis la dépathologisation de l’homosexualité par les sociétés savantes en santémentale, la formation des psychothérapeutes sur les minorités sexuelles comporte deslacunes. On préconise souvent de traiter les patients issus de ces minorités comme tous lesautres. Or, le développement identitaire de ces personnes comporte des particularités qu’ilest nécessaire de connaître pour adapter les évaluations et les interventionspsychothérapeutiques comme il se doit. Le présent article propose un cadre théorique, desoutils d’évaluation et des pistes thérapeutiques pour accompagner une personne issue d’uneminorité sexuelle qui consulte un professionnel en santé mentale.Les concepts de non-binarité de genre, de construction sociale des rôles de genre,les dimensions distinctes de l’orientation sexuelle (attirance émotive, attirance physique,comportement et identité sexuelle), l’indépendance des attirances envers un sexe et enversl’autre, l’impact et les manifestations de l’homophobie ainsi que le processus identitairesont décrits dans le présent article. Une attitude d’ouverture quant à la diaspora sexuelleest prônée afin d’accueillir le patient et de lui permettre une exploration ouverte dans uncadre thérapeutique sécurisant et sans danger.Les différentes facettes à explorer lors de l’évaluation de la sexualité sonténumérées. Des pistes de traitement psychoéducatif, cognitif et psychodynamique sontproposées, entre autres : déconstruire les mythes pour réduire l’homophobie ou latransphobie, panser les blessures narcissiques et relationnelles dues à l’homophobie,analyser le pour et le contre d’un mode de vie authentique, avec ou sans « sortie duplacard » ou coming out. L’apport des interventions familiales et des thérapies degroupe est aussi exposé.Objective To propose a theoretical model and clinical approach tosexual minority patients who consult mental health professionalsMethods Clinicians at the McGill University Sexual Identity Center(MUSIC) who have been treating patients from various sexual minorities for more than 15years present useful theoretical constructs of gender and sexuality as well as guidelinesfor the evaluation and treatment of patients consulting for discomfort or confusionsurrounding their sexual orientation, their gender identity or both, based on both thecurrent literature and their clinical experience.Results The notions of non-binary construction of gender, ofsocial determinism of gender roles and expression, and of gender creativity are presented.Sexual orientation is divided into four most commonly used dimensions (emotional attraction,physical attraction, behaviour and identity); the fluidity of these and their potentialnon-concordance are described. The fact that attraction to one gender is independent ofattraction to another gender is highlighted. An attitude of openness to all forms of genderexpression and sexual orientation constellations is encouraged to allow the patient freeexploration of the several facets of their sexuality.Various domains to explore in evaluating sexual orientation and gender as well astherapeutic avenues are proposed. Areas to enquire about include: mental, physical andsocial experiences of gender, eroticism and sexual fantasies towards all genders, emotionalattraction towards them, sexual and romantic experiences, comfort and certainty about one’sidentity and about disclosing it.Psychoeducation can be used to teach about sexual diversity and to assess the risksand benefits of coming out to self, family, friends, co-workers or strangers. Cognitivestrategies can be undertaken to debunk homophobic and transphobic myths which may fuel poorself-esteem. Psychodynamic approaches can be used to heal the narcissistic wounds ofhomophobia that may lead one to be mistrustful of authority figures or to suppress sexualfeelings when emotional attachment becomes important. Some of these dynamic patterns arerooted in past reactions to parental homophobia and the compromises sexual minorities madeas children in order to preserve their relationships with their parents. For youth comingout in present times, family support is crucial to well-being and can be enhanced throughfamily therapy. In mixed orientation couples, couple therapy can help both spouses adapt tothe coming out of one of the partners and find a new partnership. Group therapy is usefulfor many of the above issues particularly as it provides a sense of community which is oftenlacking in minority groups, especially when individuals and their families do not share thesame minority status.Conclusion With the proposed framework and an attitude of opennessto sexual diversity, clinicians should feel competent to treat sexual minoritypatients

Les minorités sexuelles : concepts, prémisses et structure d’une approche clinique adaptée