Sexual minorities, including those who identify with the LGBTQ+ acronym, are at significantly greater risk of experiencing common mental health problems compared to cisgender heterosexual individuals. LGBTQ+ couples are likely to struggle with lots of the same issues as their heterosexual counterparts. However, they are also exposed to a range of minority stressors which make their lives more difficult and impose additional stress on their relationships. This chapter attempts to give a sense of what it might be like to work with sexual minority couples using cognitive behavioural couple therapy (CBCT). It gives an overview of relevant existing theory and research documenting the specific characteristics and needs of LGBTQ+ relationships. This is followed by a case study involving ‘Amy’ and ‘Zarah’ – a same-sex lesbian couple who presented for therapy. Differences and similarities between LGBTQ+ and heteronormative relationships are discussed. Therapist tips are suggested, giving ideas about how to engage sexual minority couples in therapy and address some of the LGBTQ+ specific factors that might be maintaining their relationship distress.