**4.5. Specificities in CBCT for diverse populations**

As of now, there are clinical and research drawbacks regarding how CBCT can be effectively offered to couples who present specificities that can affect how they experience intimate relationships, such as same-sex or intercultural couples [18, 83]. For instance, in the past decade, the number of intercultural couples has increased in North America [84, 85] but these couples remain understudied [85]. In addition, even if couples from different cultural backgrounds usually experience the same kind of issues than other couples [86, 87], they may also face unique challenges that require specific attention in CBCT. Indeed, studies have reported that intercultural couples will experience greater difficulties with communication, marital satisfaction and divorce [88, 89]. As such, intercultural couples might need more negotiation skills than others to deal with couple issues (e.g., discussing the language(s) spoken at home, religion and rituals that will be practiced by the children, etc.). Furthermore, parenting and disciplinary styles often involve debates in intercultural couples [85]. Exploring and negotiating the couples' cultural differences could thus potentially foster intimacy between partners and promote a sense of mutual understanding [90].

Due to widespread heterosexist standards, many lesbian, gay and bisexual couples experience prejudice, rejection, discrimination and lack of social support, which can significantly impede couple satisfaction and functioning [83, 91]. However, research has shown that, in general, same-sex and bisexual couples show more similarities than dissimilarities when compared to heterosexual couples [92] and tend to seek couple therapy for similar reasons [93, 94]. Indeed, most CBCT interventions, such as cognitive restructuring, role playing, assertiveness training, psychoeducation, decision making and negotiation, are used similarly with same-sex, bisexual or heterosexual couples [23]. Communication and problem-solving training can also be of significant importance for certain same-sex or bisexual couples who struggle with internalized homophobia (i.e., refers to negative stereotypes, hate, stigma and prejudice about homosexuality or bisexuality that a person with same-sex attraction turns inward on him/herself), issues regarding disclosure of sexual orientation, conflicts related to relationships or the division of household work and parenting difficulties (for a review, see [83]). Yet, many therapists report difficulties comprehending the unique situations in which same-sex or bisexual partners live [95] or report a lack of confidence about how to intervene with same-sex and bisexual couples. In addition, many therapists have few opportunities to develop their psychotherapeutic expertise with patients from sexual minorities given that the majority of their clients are heterosexual [96]. Therapists must therefore possess a good understanding of the challenges faced by these couples as well as the ability to have a non-discriminatory attitude in order to help their patients overcome prejudice in and out of their relationship [23]. To do so, couple therapists who decide to work with same-sex and bisexual couples should aim at receiving specific training or supervision to further understand and help these populations.
