Clinical Issues in Working With Lesbian, Gay, and Bisexual Clients.

Abstract

This article discusses some of the key clinical issues for therapists to consider when working with lesbian, gay, and bisexual (LGB) clients. After a discussion of the biases that can influence psychotherapy, guidelines are given for conducting LGB-affirmative therapy that avoids these biases. Issues that therapists need to be familiar with in working with LGB clients include LGB identity development; couple relationships and parenting; LGB individuals as members of families; the unique stressors faced by individuals who are underrepresented in the LGB research literature (e.g., older LGB individuals, ethnic minorities, religious LGB individuals, bisexual individuals); and legal and workplace issues. An examination of the published literature is offered with particular emphasis given to the available empirical research. Lesbian, gay, and bisexual (LGB) women and men utilize therapy at rates higher than the general population (Bell & Weinberg, 1978; Liddle, 1996; Morgan, 1992; National Lesbian and Gay Health Foundation, 1988), and nearly all therapists report seeing at least one LGB client in their practices (Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991). Yet, the mental health professions have historically demonstrated heterocentric and homophobic beliefs, prejudices, and practices against LGB individuals, placing the burden of distress on the client and his or her possession of an illness (Goldfried, 2001). Indeed, some professionals continue to promote cures for homosexuality (Nicolosi & Nicolosi, 2002). Even when homosexuality is not viewed as pathological, mental health professionals need to consider the distress that antihomosexual bias can cause LGB individuals. Disregarding such factors may lead to erroneous and unfortunate attributions of the sources of distress in an LGB person who is seeking therapy. There is a dearth of systematic research on the unique therapy experiences of LGB individuals. Although theoretical work on the nature, etiology, and consequences of LGB identities abounds, little exists in the way of empirical studies on these issues. Thus, it comes as no surprise that when working with LGB clients, we as therapists are often inadequately equipped in our training to handle issues that are unique to LGB individuals (Phillips & Fischer, 1998). As a consequence, LGB clients have a right not only to be skeptical of our competence in handling their LGB-related issues but also to expect that we gain proficiency in handling any such issues that may arise in the therapeutic context. Although guidelines for conducting psychotherapy with LGB clients exist (American Psychological Association, 2000), there is a need for work that explicates these guidelines with the intent of making them more useful for clinicians. Important issues in the lives of LGB clients include LGB identity development, romantic relationships, family relationships, and parenting. There are a number of additional issues and considerations that are important to consider when working with certain members of this population (e.g., specific issues of concern to bisexual, ethnic minority, and older LGB individuals). The primary purpose of this article is to provide an overview of many of the issues we need to know about as therapists when working with LGB clients. As will be seen, some of these issues are based on clinical impressions and some on research findings. We first consider the ways that heterocentrism and homophobia affect LGB individuals and some of the potential therapeutic biases that may arise when working with LGB clients. Toward the goal of encouraging an LGB-affirmative approach to therapy, several of the specific issues confronting our LGB clients are then discussed.