Bisexual Clients Research Articles

Counselor Lesbian, Gay, and Bisexual Competency: Christian and Non-Religious Addiction Counseling Programs

This study compared levels of professional competency working with self-identified lesbian, gay, and bisexual (LGB) clients among graduates and field experience students of Christian and nonreligious-affiliated CACREP-accredited addiction counseling programs. Applicants completed an instrument to measure the dependent variables of awareness, knowledge, and skills to work with LGB clients. The sample consisted of 84 master’s students in field experience and unlicensed counselors within 2 years of graduation. Multivariate analysis of variance was used to test the hypotheses. Participants from nonreligious-affiliated addiction counseling programs scored higher on the awareness (<em>M</em> = 68.82, <em>M</em> = 63.03), knowledge (<em>M</em> = 50.22, <em>M</em> = 35.88), and skills (<em>M</em> = 43.20, <em>M</em> = 37.91) subscales than participants from Christian-affiliated programs. These differences were found to be statistically significant at <em>p</em> < .000.

Therapist Multicultural Orientation: Client Perceptions of Cultural Humility, LGB Identity, and the Working Alliance

ABSTRACT Little attention has been given to how therapist cultural humility may benefit lesbian, gay, and bisexual (LGB) clients. Thus, the current study examined whether therapist cultural humility predicted stronger client-therapist working alliances in a sample of 333 LGB individuals. LGB identity centrality (IC; the extent to which a person’s LGB identity is central to their overall identity) and LGB identity affirmation (IA; the extent to which an LGB person associates their sexual orientation with positive thoughts or feelings) were considered as moderators. Therapist cultural humility predicted stronger working alliances between LGB clients and their therapist; however, this association was not moderated by IC or IA. The present results suggest that LGB clients who rated their therapists as culturally humble toward their sexual orientation also reported stronger working alliances with their therapist, regardless of IC or IA. Lastly, exploratory analyses revealed that lower therapist cultural humility ratings were associated with greater sexual orientation acceptance concerns, internalized homonegativity, difficulties coming out, and sexual orientation concealment. The clinical implications of these findings are discussed. Future research should consider the benefits of therapist cultural humility for other gender and sexually diverse persons.

The APA Guidelines for Psychological Practice With Sexual Minority Persons: An executive summary of the 2021 revision.

This article provides an executive summary of the American Psychological Association (APA)-approved Guidelines for Psychological Practice With Sexual Minority Persons (American Psychological Association, APA Task Force on Psychological Practice with Sexual Minority Persons, 2021). These Guidelines were produced at the request of the APA Society for the Psychology of Sexual Orientation and Gender Diversity (Division 44) and the APA Committee on Sexual Orientation and Gender Diversity (CSOGD) who, in 2018, jointly established a new task force to revise the 2010 Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients. This article provides a summary of the conceptual foundations that influenced these Guidelines, as well as an overview of the complete Guidelines. We highlight major changes in structure and new content areas. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Risk factors associated with alcohol and drug use among bisexual women: A literature review.

Bisexual women report elevated alcohol and drug use compared to other sexual minority women. This review summarized extant research on mechanisms (i.e., coping processes with minority stress and victimization, disclosure of sexual identity, connectedness to lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ +) community, religiosity, and normative perceptions) that may influence alcohol and other drug use among bisexual women. Specifically, bisexual women experience unique sexual discrimination (i.e., binegativity) and are at heightened risk for other forms of victimization and other stressful life events. Given this heightened experience with stress, bisexual women may use alcohol as a maladaptive coping mechanism. Further, disclosure of one's sexual identity may produce opportunities for connecting with the LGBTQ + community, but such openness may increase exposure to discrimination and stigmatization among bisexual women. Findings on religiosity have been mixed, but there is some support that bisexual women may use substances in response to internal conflict between their religious beliefs and sexual identity. Lastly, we found that normative perceptions of other bisexual women's drinking behaviors are strongly tied to their own levels of alcohol use. From a therapeutic perspective, we suggest that practitioners recognize the unique experience of minority stress and teach strategies that lessen internalized stigma and promote healthy psychosocial adjustment among their bisexual clients. Clinicians may also help their clients find sources of support, which may protect them against the use of alcohol and drugs to manage minority-induced stress. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Working With Lesbian, Gay, Bisexual, and Transgender Clients: Occupational Therapy Practitioners' Knowledge, Skills, and Attitudes.

A lack of health care provider knowledge and training has been identified as one factor that contributes to health disparities for sexual and gender minority (SGM) populations. To explore occupational therapy practitioners' self-reported knowledge about, clinical preparedness for, and attitudes toward working with lesbian, gay, bisexual, and transgender (LGBT) clients. Online survey of occupational therapy practitioners. Respondents were recruited by means of snowball sampling through social media groups, state occupational therapy association websites, and emails. Surveys were posted to electronic occupational therapy social media sites. Knowledge, clinical preparedness, and attitudes were measured using the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS). Information about demographic characteristics, education, and workplace was also collected. Five hundred eighty-nine occupational therapy practitioners responded to the survey. Degree level (master's vs. bachelor's or less), continuing education (minimum 1-2 hr of LGBT-specific training), practice setting (mental health), minority sexual orientation, and having a close friend or family member who identifies as SGM were associated with higher mean scores on the LGBT-DOCSS. Higher religiosity and frequency of religious practice were associated with lower scores on knowledge and attitudinal awareness. Occupational therapy practitioners often care for clients from backgrounds and cultures that differ from their own. Identifying gaps in education and opportunities for fostering LGBT-positive attitudes can facilitate the development of programs to improve practice with LGBT clients and help measure the effectiveness of such programs. What This Article Adds: This study provides evidence that a basic level of continuing education can improve occupational therapy practitioners' knowledge of and skills for working with LGBT populations and highlights the need to examine and change structural biases.

Is It Worth It? A Grounded Theory Analysis of Navigating the Decision to Come Out as Bisexual

Although bisexual individuals are estimated to make up the largest percentage of sexual minority individuals, they tend to be the least visible and accepted members of LGBTQ + communities. Negative attitudes and stereotypes about bisexual people can contribute to identity uncertainty and experiences of stigma and discrimination, which impact the disclosure of bisexual identity. This qualitative study sought to explore the factors that influence the decision to come out for bisexual individuals. Six participants (three cisgender women and three cisgender men) were interviewed. A grounded theory analysis was conducted. Themes culminated with a core category, revealing that the decision to come out as bisexual is based on the experiences of navigating contextual and psychological factors and weighing a desire to be authentic against perceived consequences of disclosure. Implications for those who identify as bisexual, for mental health clinicians working with bisexual clients, and for the general public are discussed. Supplemental data for this article is available online at https://doi.org/10.1080/15299716.2021.2004482.

OT Practitioners' Knowledge, Clinical Preparedness, and Attitudes for Working With Lesbian, Gay, Bisexual, and Transgender Clients

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Practitioners were surveyed about knowledge, preparedness, and attitudes toward treating LGBT clients. Multivariate analysis was used to compare LGBT–Development of Clinical Skills Scale scores and characteristics of respondents (N = 558). Type of degree, setting, experience, religiosity, and hours of education contributed to significant differences in knowledge and preparedness, but not attitudes. Findings suggest even minimal practitioner education has potential for improving equity and inclusion for LGBT population. Primary Author and Speaker: Deborah J. Bolding Additional Authors and Speakers: Angela Acosta, Brigitte Butler, April Chau, Brenna Craig, and Fiona Dunbar

Examining how lesbian, gay, and bisexual Christian clients' perceptions of therapists' cultural humility contribute to psychotherapy outcomes.

Understanding the intersection between sexual and religious identity has important implications for mental health. The lesbian, gay, and bisexual (LGB) community is at high risk for a wide range of psychopathologies, and religious culture can further these risks when it creates homophobic environments (Sherry et al., 2010). The present study examined lesbian, gay, and bisexual (LGB) Christian clients' religious commitment and perceptions of their therapists' cultural humility in relation to the working alliance and therapeutic outcomes. A sample of 158 LGB Christians who were currently or had been in psychotherapy within the last year participated in the study. Perceptions of their therapists' cultural humility positively predicted therapeutic outcomes, and the working alliance partially mediated the relation between cultural humility and therapeutic outcomes. Contrary to predictions, religious commitment did not moderate the relation between cultural humility and working alliance. Implications are discussed, namely, that the results of this study join existing literature to potentially suggest a systemic shift in psychotherapy training that includes cultural humility. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Impact of Provider Biphobia and Microaffirmations on Bisexual Individuals’ Treatment-Seeking Intentions

Bisexual individuals experience mental illness at higher rates than monosexual individuals. In addition, previous research has found that bisexual persons face documented discrimination from mental health providers. However, research is lacking in examining how negative experiences with providers impact attitudes toward mental health care utilization among bisexual clients. This study explores the associations between bisexual individuals’ level of outness with providers, experiences of provider biphobia, experiences of microaffirmations from providers, and help-seeking attitudes. We hypothesized that: (a) Anti-bisexual experiences from a mental health provider would mediate the relationship between outness and help-seeking intentions, and (b) Microaffirmations from a provider would mediate the relationship between outness and help-seeking intentions. Results indicated that greater outness with mental health providers predicted greater microaffirmation experiences from mental health providers. As expected, anti-bisexual experiences significantly and negatively impacted intent to seek mental health treatment. There was not evidence of mediation.

Counselor Empathy; Religiosity; and Lesbian, Gay, and Bisexual Perspectives

Values‐based conflicts, such as between counselor religiosity and ability to work with lesbian, gay, and bisexual (LGB) clients, can present a challenge for counselors and trainees who seek to provide ethical and competent care. Because empathy can facilitate understanding a client's frame of reference, the authors examined the relationships between counselor religiosity, empathy, and LGB perspectives, as well as the potential mediating effects of empathy on values conflicts. The authors discuss implications for counselor education and practice.

The Psychometric Properties of the Competency Assessment Tool for Lesbian, Gay, Bisexual, and Transgender Clients

ABSTRACT This study introduces a new instrument designed to assess affirmative clinical practices with sexual and gender minority (SGM) clients, the Lesbian, Gay, Bisexual, and Transgender Competency Assessment Tool (LGBT-CAT). The LGBT-CAT has two unique qualities: Its design enables adaptation to measure practice competencies with gay, lesbian, bisexual and/or transgender clients, the latter of which has no existing measures regarding practice competencies, and it uses a qualitative collection method. Participants respond to 12 open-ended prompts; responses are then quantified by one or more raters based on a scoring rubric. In this cross-sectional study, practicing social workers (N = 357) were surveyed using the LGBT-CAT as well as measures of affirmative practices with SGM clients, knowledge, beliefs, self-efficacy skills, attitudes, and behaviors. The LGBT-CAT demonstrated good reliability, poor criterion validity, and adequate construct validity. These results support the potential integration of the LGBT-CAT into research on practice with SGM clients.

Christian Pastors’ Perspectives and Insights on the Practice of Family Therapists Referring LGB Clients: Exploring the Role of Religion

This qualitative study explored Christian pastors’ perceptions and insights for family therapists who refuse to work with lesbian, gay, and bisexual (LGB) clients by consistently referring them. Twenty-one pastors from diverse Christian traditions were interviewed. Thematic analysis identified the following themes related to the pastors’ perceptions of the practice of referring LGB clients: (1) Best Interest of the Client and Therapist, (2) Discriminatory Practice, and (3) No Referrals will be Provided. The following themes represent pastors’ advice for family therapists: (1) Develop a Well-Thought-Out Referral Plan; (2) Be Accountable for Your Own Beliefs; and (3) Engage in Conversations.

Partners and Prejudice: Bisexual Partner Gender and Experiences of Binegativity From Heterosexual, Lesbian, and Gay People.

Bisexual individuals may experience pervasive binegativity originating from both heterosexual and lesbian/gay (L/G) individuals as a result of various psychosocial and relational factors. The present study aimed to explore how partner gender is particularly associated with experiences of binegativity from heterosexual and L/G persons and to examine how such experiences are related to internalized binegativity. A total of 350 self-identified cisgender bisexual men and women from across the United States were recruited online for this study. Participants completed an online survey battery assessing levels of both experienced and internalized binegativity. Regression analysis results indicated that binegativity from L/G persons, but not heterosexual persons, was significantly and positively associated with internalized binegativity. A significant interaction between binegativity from L/G persons and partner gender revealed a stronger association among those in same-gender relationships, such that those with same-gender partners who reported binegativity from L/G persons experienced more internalized binegativity than those with other-gender partners. When further examined by gender, these findings appeared to be driven by the relation among women, but not men, as women in same-gender relationships who reported binegativity from L/G persons reported the highest levels of internalized binegativity. Among men, binegativity from heterosexual, but not L/G, persons was significantly related to internalized binegativity independent of partner gender. The present study highlights key gender differences in interpersonal factors related to binegativity and have important implications for clinical practice with bisexual clients facing stigma and advocacy work addressing bisexual discrimination.

How to address clinical work with older bisexual clients and their partners?

Summary To grow old well is not simple in our society. To grow old successfully and be bisexual it is a kind of challenge. Negative attitudes toward bisexuals have been documented among heterosexuals as well as homosexuals. Older bisexual adults may then experience various forms of discrimination which will lead to marginalization and invisibility. Forming and maintaining a bisexual identity in a sexually dichotomous culture is a complex and difficult task that calls for resilience to counter the isolation. Older bisexuals have many different types of relationships. Moreover, their families have very different arrangements. Good communication about bisexuality and other marital issues were found to be the key of the couple satisfaction. Mixed-orientation couples face problems stemming from the dichotomizing of sexuality, negative myths and stereotypes, and lack of awareness of models and resources. It can be particularly problematic when a partner's bisexuality is first addressed within a committed relationship, especially if sexological problems arise. In this narrative review the authors will present some of the key aspects of aging bisexuals in the relationships relevant for the sexual health professionals, focusing on the most important issues highlighted in the literature and proposing recommendations for clinicians. Various therapeutic strategies are now available, all of them should be applied in the framework of an integrative approach. Therapeutic tasks in these couples include addressing sexuality and relationships in the aging in the context of stigma, assessing sexual history and the relationship, clarifying personal meanings of bisexuality, providing education and resources. If there is the need, it is important to facilitate negotiations regarding safer sex and polyamory. Therapy provides affirmation of bisexuality and validation of the different types of relationships. The therapist plays an important role in providing acceptance for bisexuality, serving to counteract bisexual invisibility, facilitating an exploration of both partner's feelings and needs.

Affirmative Competence and Practices of Mental Health Professionals with LGB clients: An Ibero-American Study.

There are not many studies about affirmative competence and practices among mental health professionals working with Lesbian, Gay, and/or Bisexual (LGB) clients. Thus, the objectives of this research are to assess the levels of affirmative competence and practices of professionals in Ibero-American countries. The sample consists of 630 mental health professionals from various countries whose ages range from 22 to 75years old, with a mean age of 41.46years. The study utilizes the following measures: a socio-demographic questionnaire, the Sexual Orientation Counselor Competency Scale, and the Affirmative Practice Questionnaire. Results show that mental health professionals who present higher levels of Affirmative Competence are those who have higher levels of education and training on LGBT topics, show left-wing political affiliations, self-identify as LGB, and have no religious affiliations. Regarding Affirmative Practices, it was found that single participants show lower practices, and more studies are needed to better understand this result. Regression models demonstrate that Affirmative Practices and Competences are predicted by the hypothesized variables, namely, religious and political beliefs, and training/education. Hence, this study indicates that mental health professionals could undergo some type of academic or professional training and/or possess experience in regard to working with LGB clients, in order to enhance their approach when working with this population.

“Stepping up the ladder in safety”: An interpretative phenomenological analysis of how LGB clients experience their therapists’ sexual orientation

Relevant literature has explored the issue of disclosure of Lesbian, Gay and Bisexual (LGB) therapists to heterosexual or LGB clients. But how do homosexual or bisexual clients understand and experience their therapist’s heterosexual orientation, known or assumed, in relation to the therapeutic alliance and the therapeutic process? In this qualitative study, we used the Interpretative Phenomenological Analysis to examine eight semi-structured interviews with LGB clients in a family-oriented therapy in Greece. Analysis revealed two themes of higher order, each having three subordinate themes depicting the client’s experience of the therapist’s sexual orientation: 1. Focus on the therapist’s sexual orientation: (a) as a hypothesis (b) as a factor of acceptance (c) as a factor of professional capability and 2. Focus on other therapist features: (a) gender (b) personality traits (c) practice of professional role. The therapist’s sexual orientation or the one perceived by the client was not a neutral issue in therapy and the cultivation of the therapeutic relationship but was only one part of the process. The way all these issues were processed and approached by clients was related to their personal history and phase of therapy. Suggestions for future research include conducting a research on clients from different therapeutic perspectives since it was carried out only on participants in long-term systemic family therapy.

Addressing Attachment Injuries with Bisexual Clients and their Monosexual Partners during the Coming out Process

Individuals who identify as bisexual, a marginalized sexual minority group different from lesbian women or gay men (LG), face complex challenges from the heterocentric society and members of the LG community. One of the challenges that leads to discrimination and mental health issues for bisexual people occurs during the coming-out process. This article examines attachment injuries that may occur during the bisexual coming-out process, when their partner identified as monosexual, and how the attachment injury resolution model (AIRM), which stems from emotionally focused couple therapy (EFT) may be used to address the early stages of these injuries through couple’s counseling.

LGBQ+ adults’ experiences of Improving Access to Psychological Therapies and primary care counselling services: informing clinical practice and service delivery

AbstractLesbian, gay, bisexual, queer and other sexual minority (LGBQ+) people experience higher levels of psychological difficulties than heterosexual people. Evidence suggests that LGBQ+ treatment outcomes within England’s Improving Access to Psychological Therapies (IAPT) services are worse than the outcomes for heterosexuals, especially for bisexual people and sexual minority women. IAPT services provide evidence-based treatments like cognitive behavioural therapy (CBT), typically for anxiety or depression. This study explored LGBQ+ adults’ experiences with IAPT services and/or primary care counselling. LGBQ+ adults (n = 136) answered an online questionnaire (fixed-response and optional open-ended questions) about their access and treatment experiences. Descriptive statistics summarized multiple-choice responses. Qualitative data were analysed through thematic analysis. Before access, 41.9% of participants were concerned about experiencing LGBQ+ stigma/discrimination within psychological services. Only 13.2% of participants thought their sexuality negatively impacted their treatment, although prejudice/discrimination may be underestimated as 33.6% participants did not disclose their sexuality to practitioners and sexuality was not discussed in treatment for 44.0% of participants. Bisexual clients were significantly less likely to disclose their sexuality. The barriers LGBQ+ people described within IAPT or primary care services included: feared or experienced stigma in the services; reluctance to disclose sexuality; inconsistent discussion of sexuality in treatment; a lack of awareness and understanding towards LGBQ+ identities and community-specific challenges; and distrust, disillusionment and exclusion resultantly. Overall, 52.2% thought services could be improved for LGBQ+ individuals. This study identified multiple issues to be addressed in therapist training and service development.Key learning aims (1)The unique needs/experiences that LGBQ+ people bring to therapy, such as the need to disclose their sexuality and past experiences of stigma/discrimination, including how this differs within the community (e.g. bisexual people or LGBQ+ Black and minority ethnic people).(2)How these needs/experiences can result in barriers that make their treatment experience distinct from heterosexuals and influence their treatment outcomes.(3)What steps should be taken in future research and clinical practice to ensure improvements in the psychological treatment experiences of LGBQ+ people, including in relation to therapist understanding and training in LGBQ+-related issues.

Supplemental Material for The Therapeutic Relationship Mediates the Association Between Affirmative Practice and Psychological Well-Being Among Lesbian, Gay, Bisexual, and Queer Clients

Supplemental Material for The Therapeutic Relationship Mediates the Association Between Affirmative Practice and Psychological Well-Being Among Lesbian, Gay, Bisexual, and Queer Clients

Should a Dramatherapist Disclose their Sexual Orientation to their Clients? Perhaps they should be Prepared To

This article discusses the proposition that a therapist should be prepared to ‘come out’ and disclose their sexual orientation to a client, irrespective of how they identify. This enquiry has been shaped by the author's experience as a newly qualified dramatherapist, as a lesbian and as a new author. In the absence of existing dramatherapy literature on the topic of Therapist Self-Disclosure (TSD) and Therapist Self-Disclosure of Sexual Orientation (TSDSO), research has been drawn from publications across psychological literature. The article particularly focuses on the use of verbal and, to a lesser extent, non-verbal TSDSO with lesbian, gay or bisexual (LGB) therapists and/or clients. ‘Analytical snapshots’ from the author's clinical experience, as a final-year dramatherapy trainee, and from the author's personal experience will be presented and considered to further the discussion around preparedness for self-disclosure. The article supports the view that a dramatherapist should be prepared to disclose their sexual orientation to a client if required; and that becoming prepared would require the use of personal therapy, training, clinical supervision and awareness of the therapeutic relationship, as well as awareness of supporting literature.