This presentation aims to review the term internalized heterosexism—and its predecessor internalized homophobia—, the theoretical background behind it from a cognitive and social psychology perspective, and its relevance to psychotherapy from a cognitiveintegrative perspective. Research and practice have shown a growing interest in this concept in recent years, with an increasing number of studies focusing on it and specific training for therapists to address gender diversity and sexual orientation issues. The central content of this presentation comes from practical observations made in the therapy room when working with gay men. Its primary aim is to review the literature that determines the ways in which internalized heterosexism has damaging consequences for wellbeing and mental
health, illustrating these phenomena with practical examples and proposing a set of recommendations for therapy. A qualitative content analysis has been applied to extracts from therapy sessions or qualitative interviews with six gay men, focusing on clinical issues that illustrate the theoretical background, the link between traumatic experiences and internalized heterosexism, and the relevant implications for psychotherapy: specifically, the coming-out process, family reactions, school bullying, structural discrimination, unaddressed symptoms of anxiety, depression and suicidal ideation, schemas and coping mechanisms, attachment issues, and resilience. The history of depathologization of sexual orientation is reviewed, along with the literature on prejudice, cognitive categorization, and minority stress. Due to its pervasiveness and resistance to change, evidence-based cognitive-integrative programs that specifically target internalized heterosexism are the primary choices for addressing this issue in gay men.