Working with gay and lesbian clients

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There is now a sizeable literature on working with gay and lesbian people in psychological therapy. In many ways, therapy for LGBT+ people is the same as therapy for cisgender and heterosexual people. However, understanding common stressors that gay people face can help.

Gay people (a label that includes lesbians) are diverse in their personalities, lifestyles, strengths, and problems.

Some LGBT+ therapists may choose to come out to their gay clients. This is a personal decision and therapists should weigh the risks and benefits on their own.

Common problems

Being gay is not a problem, but stigma can create problems for gay people. Many gay people experience significant minority stress.

This section lists some problems that are common among gay people. However, gay people can have any of the same problems that straight people have, from attachment issues to fear of failure. It is important to get to know the individual and their history.

Internal stressors

Internalized homophobia may lead to feelings of shame. This may be learned from childhood and later experiences. Bullying, religious trauma, and exposure to homophobic comments can impact mental health. Some gay people need to work on self-acceptance, which may take time.

Religious trauma can contribute to these issues. Some gay people were raised in homophobic religious environments that may compound feelings of shame or anxiety about their identity and feelings. While some people leave these religions in favor of atheism or a more accepting religion, others continue to follow the teachings of homophobic religious sects.

Childhood trauma from bullying and other issues may exist.

Minority stress can lead to mental disorders. Some develop anxiety, depression, substance use disorders, self-harm, and suicidal ideation.

Interpersonal and community stressors

Homophobia may impact interpersonal relationships and lead to discrimination.

Family life may be an issue if family members are homophobic. Some gay people face ostracism, bullying, or abuse at the hands of homophobic family members. In severe cases, this can lead to homelessness.

The dating world can be stressful for gay people, just like it is for others. Since many people are straight, gay people may have fewer romantic options. Gay men may face extra pressure to live up to certain standards for physical appearance. In the United States, some gay people may worry about gun-related terrorist attacks at gay bars and other gathering places.

Legislation and political landscape can also affect mental health. In the United States, LGBT+ people who live in states with more protections for LGBT+ people tend to have better mental health. Meanwhile, anti-LGBT+ legislation can jeopardize their sense of community safety.

Coming out

Some gay people choose not to come out. Those who are still "in the closet" are more likely to have mental health problems. Weighing mental health risks with problems like safety issues and avoiding victimization is important.

Coming out to various people can sometimes be stressful. Gay people may worry about whether different people would accept and support them. They may need support handling these fears and weighing the risks and benefits of coming out.

Some gay people are "outed," meaning that their identity is revealed without their consent. This violation can have serious psychological consequences, especially if the person has not accepted themselves as gay and/or the environment is homophobic.

Healthy lifestyle

Gay and bisexual people who spend time with other LGBT+ people tend to have better mental health. Your client may feel better if they can spend time at pride events, gay bars and other gatherings, and/or LGBT+ support groups.

Some gay people enjoy time with "found families," or fictive kin that are supportive. These relationships can be a substitute for a traditional family if the traditional family is unsupportive.

Gay people who are able to come out generally have better mental health. A client who is unable to come out in some circumstances may still be able to access supportive environments in other areas, including online communities.

Things to avoid

Making homophobic comments, even unintentionally, can harm rapport and damage client self-esteem. Thus, education on homophobia is important.

Psychologists recommend against asking gay people why there are gay. There isn't a clear answer to this, and nobody asks straight people why they are straight. This question implies that heterosexuality is the norm and that being gay is somehow less natural.

See also

• LGBT
• Minority stress
• Homophobia

Key texts

Books

• Bieber, I., Dain, H.J., Dince, P.R., Drellich, M.G.,Grand, H.G., Gundlach, R.H., Kremer, M.W.,

Rifkin, A.H., Wilbur, C.B. & Bieber, T.B. (1962). Homosexuality: A Psychoanalytic Study. New York: Basic Books.

• Davies, D. & Neal, C. (Eds) (1996). Pink Therapy: A Guide for Counsellors and Therapists Working with

Lesbian, Gay and Bisexual Clients. Buckingham: Open University Press.

• Dworkin, S. & Gutierrez, F. (Eds) (1992). Counseling Gay Men and Lesbians: Journey to the End of the Rainbow. Alexandria, VA: American Association for Counseling and Development.
• Falco, K.L. (1991). Psychotherapy with Lesbian Clients: Theory into Practice. New York: Brunner/Mazel.
• Gonsiorek, J. (Ed.) (1982). Homosexuality and

Psychotherapy: A Practitioner’s Handbook of Affirmative Models. New York: Haworth.

• Kitzinger, C. (1987). The Social Construction of

Lesbianism. London: Sage.

• Kitzinger, C. (1991). Lesbians and gay men in the

workplace: Psychosocial issues. In M.J. Davidson & J. Earnshaw (Eds), Vulnerable Workers: Psychosocial and Legal Issues. London: Wiley.

• O’Connor, N. & Ryan, J. (1993). Wild Desires and

Mistaken Identities: Lesbianism and Psychoanalysis. London: Virago.

• Socarides, C.W. (1978). Homosexuality. New York:

Jason Aronson.

• Stein, T. & Cohen, C. (Eds) (1986). Contemporary

Perspectives on Psychotherapy with Lesbians and Gay Men. New York: Plenum.

Papers

• Annesley, P. & Coyle, A. (1995). Clinical psychologists’ attitudes to lesbians. Journal of Community & Applied Social Psychology, 5, 327-331.
• Brown, L. (1988). Gay men and their families:

Common clinical issues. Journal of Gay and Lesbian Psychotherapy, 1, 65-77.

• Coyle, A. (1993). A study of psychological well-being among gay men using the GHQ-30. British Journal of Clinical Psychology, 32, 218-220.
• Garnets, L., Hancock, K.A., Cochran, S.D.,

Goodchilds, J. & Peplau, L.A. (1991). Issues in psychotherapy with lesbians and gay men: A survey of psychologists. American Psychologist, 46, 964-972.

• Hancock, K. (1995). Psychotherapy with lesbians

and gay men. In A.R. D’Augelli & C.J. Patterson (Eds), Lesbian, Gay and Bisexual Identities Across the Lifespan: Psychological Perspectives. New York: Oxford University Press.

• Hitchings, P. (1994). Psychotherapy and sexual orientation. In P. Clarkson & M. Pokorny (Eds), The

Handbook of Psychotherapy. London: Routledge

• Kitzinger, C. & Coyle, A. (1995). Lesbian and gay

couples: Speaking of difference. The Psychologist: Bulletin of The British Psychological Society, 8, 64-69.

• Kitzinger, C. & Wilkinson, S. (1995). Transitions

from heterosexuality to lesbianism: The discursive construction of lesbian identities. [[Developmental Psychology]], 31, 95-104.

• Milton, M. (1996). Coming out in therapy.

Counselling Psychology Review, 11, 26-32.

• Milton, M. and Coyle, A. (1998). Psychotherapy with

lesbian and gay clients.The psychologist:Bulletin of The British Psychological Society, 11, 73-76 UK perspective Full text

• Ratigan, B. (1995). Inner world, outer world:

Exploring the tensions of race, sexual orientation and class and the internal world. [[Psychodynamic Counselling]], 1, 173-186.

• Rivers, I. (1995a). Mental health issues among lesbians and gay men bullied in school. [[Health and Social Care in the Community]], 3, 380-383.
• Rivers, I. (1995b). The victimisation of gay teenagers in school: Homophobia in education. Pastoral Care in Education, 13, 39-45.

Additional material

Papers

• Google Scholar