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

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists' Clinical Evaluations and Attitudes: An Examination of the Influence of Gender and Sexual Orientation.

Becoming aware of factors that may affect differential treatment of clients is necessary for psychologists to practice competently. Scholarly writing and empirical studies have suggested that therapist gender, client gender, and client sexual orientation are 3 such factors. This study examined therapist gender, client gender, and client sexual orientation in relation to psychologists' attitudes and clinical evaluations for clients. Results indicated that female psychologists held more positive attitudes and treatment expectations for clients than did male psychologists and that some psychologists hold inconsistent attitudes toward female clients generally and lesbian, gay, and bisexual clients in particular. Continuing education and consultation are recommended to increase psychologists' awareness of gender and sexual orientation issues and potential influences in treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-acceptance and self-disclosure of sexual orientation in lesbian, gay, and bisexual adults: An attachment perspective.

A model linking attachment variables with self-acceptance and self-disclosure of sexual orientation was tested using data from 489 lesbian, gay, and bisexual (LGB) adults. The model included the following 4 domains of variables: (a) representations of childhood attachment experiences with parents, (b) perceptions of parental support for sexual orientation, (c) general working model of attachment, and (d) LGB variables. Results generally supported the proposed model. For example, attachment avoidance and anxiety were associated with self-acceptance difficulties, and avoidance was associated with low levels of outness in everyday life. Parental attachment had an indirect effect on identity and outness through its associations with parental LGB support and general attachment. Some results varied depending on participants' gender and parental religious affiliation. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Victimization Over the Life Span: A Comparison of Lesbian, Gay, Bisexual, and Heterosexual Siblings.

Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lesbian, gay, and bisexual victimization in the military: An unintended consequence of “Don't Ask, Don't Tell”?

The integration of lesbian, gay, and bisexual (LGB) individuals into the U.S. military is a long-standing and politically and socially divisive issue. Exclusionary and pseudo-inclusionary policies that restrict openly LGB individuals from military service are also of long duration. Yet LGB servicemembers have continued to serve covertly in the military for many decades. Moreover, political issues and social conventions associated with “Don't Ask, Don't Tell” (DADT) have diverted focus from imperative research issues, such as LGB servicemembers and incidents of victimization in the military. Research is reviewed to evaluate such victimization, which is conceptualized as resulting from a convergence of sexual stigma, conservative gender role beliefs, and sexual prejudice. DADT, in combination with overarching difficulties intrinsic to sexual orientation research, serves to augment LGB victimization and reduce victim reports and help seeking. Consequently, there is a deficient evidence base for assisting LGB servicemembers and for advancing research, prevention efforts, and policy changes. Implications of repealing DADT are discussed, as are future directions for LGB military research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Out on campus: sexual orientation and academic climate in a university context

Although lesbian, gay, and bisexual (LGB) students often "come out" in university settings, empirical studies have demonstrated that these environments are often hostile toward them. The current paper posits that such hostile contexts adversely affect their educational experiences. Results from a survey of a stratified random sample of 1,927 undergraduate and graduate students on a scale measuring perceptions of academic climate (General Campus Climate) supported this claim: LGB students had more negative perceptions of a variety of campus factors. In addition, a scale measuring perceptions of Lesbian, Gay, and Bisexual Campus Climate found that LGB students were more likely than heterosexuals to perceive the campus as inhospitable to LGB people. Women and racial and ethnic minorities were also more likely to rate the LGB climate as hostile. Finally, data from two scales measuring attitudes believed to influence these perceptions yielded gender, racial/ethnic, religious, and sexual orientation differences in theoretically meaningful directions. Results indicate that LGB students often experience the university in more negative ways than heterosexual students, and that certain campus communities--particularly women and racial/ethnic minorities--are more aware of this negativity and contribute to it less because of their relatively more progay attitudes. Implications for how to improve LGB students' experiences are discussed.     

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internalized homophobia and adult attachment: Implications for clinical practice.

Two hundred eighty-six men and women who identified as lesbian, gay, or bisexual (LGB) were surveyed using measures of attachment, internalized homophobia, shame, and guilt. Results indicated that secure attachment was negatively correlated with internalized homophobia, shame, and guilt. Fearful and preoccupied attachments were positively correlated with these constructs, accounting for 36.9% of the variance in scores. Results are discussed in terms of the therapeutic relationship, with the therapist serving as a secure base for LGB clients working through issues of internalized homophobia and social isolation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affirming Faith Experiences and Psychological Health for Caucasian Lesbian, Gay, and Bisexual Individuals.

Religious faith plays a central role in the lives of many people. Although studies and anecdotal literature have explored the conflict between sexual and religious identities, no research has investigated the role of faith group affirmation of a lesbian, gay, or bisexual (LGB) identity on the mental health of LGB members. This study compared 2 models of the relations between psychological health and current faith affirmation experiences, internalized homonegativity, and spirituality. Participants were 583 LGB individuals who identified themselves as currently affiliated with a faith group. Results indicated that the fully mediated model was a good fit and offered a more parsimonious explanation than the partially mediated model. Affirming faith experiences were related to psychological health through internalized homonegativity and spirituality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' sexual values for self and clients: Implications for practice and training.

Therapists may be confronted with clients whose sexual values and behaviors are different from their own. To understand more about therapists' sexual values and how these values may affect therapy, the current study assessed therapists' sexual values for both themselves and their clients in the areas of premarital, casual, and extramarital sex, open marriages, sexual orientation, and sex in adolescence and late adulthood. Therapists differed selectively in their sexual values depending on their gender, religious involvement, and political affiliation. Therapists appeared comfortable working with a variety of sexual issues in therapy, and it appears that training in sexual issues is helpful in clinical work. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of clinical psychologists on treating lesbian, gay, and bisexual clients.

Should the average psychologist receive specific training on lesbian, gay, and bisexual (LGB) concerns? On the basis of a random sample of practicing psychologists, LGB clients are present in most caseloads. Respondents rated the most important therapeutic issues with LGB clients and identified training that would improve their work with LGB clients (including the topics of coming out, estrangement from family, support system development, and internalized homophobia). In addition, participants reported on the types of training that they are getting (most frequently reading articles, supervision, and continuing education). The implications for training programs and private practitioners are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

When psychologists work with religious clients: Applications of the general principles of ethical conduct.

Psychologists become more effective and relevant when they appreciate that many clients hold religious values and commitments. Greater awareness of religion and religious values in the lives of clients may aid clinicians' efforts to provide more accurate assessments and effective treatment plans. The authors use the American Psychological Association's (1992) "Ethical Principles of Psychologists and Code of Conduct" as a framework to examine many of the ethical issues relevant when psychologists work with religious clients. This article also provides suggestions for ways in which clinicians may obtain the skills needed to offer competent assessments and interventions with religiously committed clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sacred adolescence: Practical suggestions for psychologists working with adolescents' religious and spiritual identity.

This article explores the relevance of adolescents' spiritual, religious, atheist, and agnostic identity development in the therapy process and the potential difficulties that psychologists face in effectively working with adolescents around spiritual/religious issues. Psychologists' limited personal and professional opportunities for increasing their self-awareness around their spirituality and religion may impact their ability to adequately address issues related to the spiritual/religious identity development of their adolescent clients. Psychologists' limited knowledge, awareness, and skills in reference to the process of adolescents' spiritual/religious/nonreligious identity may result in their neglect of spiritual/religious issues in psychotherapy. In such cases, adolescent clients may feel unsure if therapy is a safe place to discuss spiritual, religious, atheist, agnostic questions or issues that arise for them. The article concludes with practical suggestions that are framed around six critical concerns that are relevant for adolescents: (a) the relationship between spirituality/religion and health and coping, (b) negotiating multiple social identities, (c) religious cults, (d) religious conversion experiences, (e) anti-religious sentiment or religious discrimination, and (f) ethical considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Continuing to depolarize the debate on sexual orientation and religion: Identity and the therapeutic process.

Potential identity conflicts arising at the intersection of sexual and religious orientations are examined. Using case examples, a therapeutic process that explores clients' intersecting identities, belief structures, and life experiences is described. This therapeutic approach is aimed at giving personal meaning to the conflict between sexual orientation and religion, allowing clients to seek identity resolutions that are flexible and do not compromise well-being. Multicultural counseling, psychology of religion, symbolic interactionism, and identity development theories provide frameworks for an analysis of the nature of the conflict and its potential resolutions. Countertransference issues arising from ethical and social justice considerations are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions.

Research on whether disclosure of sexual orientation promotes lower substance use among lesbian, gay, and bisexual (LGB) individuals has been inconsistent. One reason for this may be that disclosure results in accepting and rejecting reactions. The current report longitudinally examines whether the types of reactions to disclosure are associated with substance use and abuse among 156 LGB youths (ages 14–21). Neither the number of disclosures nor the numbers of accepting or neutral disclosure reactions were associated with substance use or abuse. However, the number of rejecting reactions to disclosure was associated with current and subsequent alcohol, cigarette, and marijuana use, even after controlling for demographic factors, social desirability, and emotional distress. Further, accepting reactions were found to moderate or protect youths from the negative role of rejecting reactions on alcohol use, but not other substances. This research indicates that, rather than disclosure per se, it is the number of accepting and rejecting reactions in response to disclosure that are critical to understanding substance use among LGB youths. Further, the results suggest that to be maximally effective, substance use prevention and treatment efforts should address rejecting reactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and sexual identity-based predictors of lesbian, gay, and bisexual affirmative counseling self-efficacy.

This exploratory study applies the tenets of social cognitive theory to investigate the influence of gender self-confidence and of sexual identity exploration and commitment on lesbian, gay, and bisexual (LGB) affirmative counselor self-efficacy. Data were gathered from a convenience sample of 178 mental health clinicians. Controlling for participants' age, professional experience, level of income, race and ethnicity, and sexual orientation, findings revealed that higher levels of LGB-affirmative counseling self-efficacy were positively associated with gender self-definition and with sexual identity commitment. Post hoc analyses conducted with the 5 subscales of the LGB-affirmative counseling self-efficacy measure indicated that findings varied across specific self-efficacy domains. Implications of these results for continuing education, training, and research promoting LGB-affirmative psychotherapy are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing the resolution on appropriate therapeutic responses to sexual orientation: A guide for the perplexed.

This article provides background information and concrete examples to assist practitioners in the implementation of the American Psychological Association's Resolution on Appropriate Therapeutic Responses to Sexual Orientation. It provides some general information about psychosocial aspects of lesbian, gay, or bisexual identities. It examines the issues surrounding the assertion that sexual orientation can be changed and the implications for practice. Vignettes, based on actual case studies, are used to illustrate how practitioners might respond appropriately to clients who are struggling with issues surrounding their sexual orientation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual attraction to clients: The human therapist and the (sometimes) inhuman training system.

585 Division 42 (Psychologists in Private Practice) members responded to a 17-item questionnaire designed to gather initial information about the attraction therapists feel for their clients. 286 Ss were aged 45 yrs and under, while 299 Ss were aged 46 yrs and over. Results show that 508 Ss were attracted to clients; significantly more males than females reported such an attraction. Younger Ss were significantly more attracted to clients than were the older Ss. 104 Ss (primarily male) had considered sexual involvement, 91 more than once. Approximately 37 Ss had acted out sexually with clients. 488 Ss indicated feeling uncomfortable, guilty, or anxious about their attraction to clients. 55% of Ss indicated that they had received no education or training about sexual attraction to clients. (65 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing evangelical Protestant psychologists trained at secular versus religiously affiliated programs.

Four hundred evangelical Protestant psychologists trained at secular or religiously affiliated clinical psychology doctoral programs were compared for their views on ethical issues and their use of religious interventions in clinical practice. Religious psychologists trained at secular programs were comparatively more conservative and more likely to use and value religious techniques in psychotherapy with religious or nonreligious clients than were religious psychologists trained at religiously affiliated programs (p     

Clinical intervention with bisexuals: A contextualized understanding.

Many clinicians, situated in a culture that privileges a dichotomous understanding of sexual orientation, are often challenged by the complex issues presented by bisexual clients. The aim of this article is to provide an expanded and contextualized understanding of bisexuality that will inform effective intervention with the clinical concerns presented by this frequently marginalized population. An overview of evolving perspectives on sexual orientation and bisexuality is followed by a discussion of treatment concerns relevant to bisexuals. A review of treatment approaches offers clinicians a fundamental framework to begin to effectively address the unique clinical concerns of bisexual clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)