Practice Opportunities in the Lesbian, Gay and Bisexual Community

by Armand R. Cerbone, PhD

January 20, 2006 — Awareness and understanding of the lives of lesbian, gay and bisexual (LGB) people are increasing. However, social bias and discrimination remain potent forces in the lives of LGB individuals. When these individuals seek psychotherapy, their experiences with discrimination are often intertwined with their reasons for seeking therapy, although they may not report this explicitly.

LGB individuals who seek psychological services require psychotherapists who recognize and understand the distinct character of their needs, respect the diversity of their lives, and provide effective and appropriate assessment and treatment. This article focuses on practice opportunities in the LGB community.

The profession of psychology has been a leader among mental health professions in promoting practices and policies that are based on accurate understanding of LGB individuals and their lives. Psychology has conducted extensive research on LGB issues and opposed discrimination and stigma on the basis of sexual orientation at local and national levels.

The following issues may prompt an LGB individual to seek psychological services or may arise in the course of receiving psychological services. They are representative and suggestive only. Many are issues that heterosexual individuals may present. What distinguishes these issues as lesbian-, gay-, or bisexual-specific are the effects of stigma and sexual prejudice and the lifelong task of coming out — that is, adapting to one’s variant sexuality throughout life (Cerbone, 1990).

Therapists may employ a variety of therapy modalities, e.g., individual psychotherapy for couples counseling and group psychotherapy for coming-out issues, dating and intimacy issues, or adjusting to HIV-positive status.

• The effects of stigma take many forms, from internalized negative attitudes toward one’s homosexuality to depression, generalized anxiety, or PTSD II symptoms. They may also manifest as difficulties in long-term relationships (such as sexual dysfunction and loss of attraction) or employment problems (such as erratic work histories).

• LGB persons with multiple minority status face particular challenges in conflicting cultural norms. Often these individuals encounter racial prejudice within the LGB community as well.

• Coming-out issues affect an LGB person throughout life. Disclosure of one’s variant sexual orientation can result in harassment in schools or even homelessness, loss of employment as an adult, and lack of appropriate medical care and housing as a senior. This is particularly true in jurisdictions where such discrimination is legal or there are no laws to protect LGB persons.

• Often the families of LGB persons need assistance in dealing with negative attitudes toward homosexuality and bisexuality that affect their relationships with their LGB members (e.g., siblings, children or parent). There is increasing awareness of the needs of married men and women who come out later in life.

• Many LGB persons are forming families that include children and may need help with parenting issues.

• LGB persons who are members of a church that proscribes homosexuality may experience psychological stress resulting from spiritual conflicts that challenge integration of their homosexual or bisexual feelings and identity.

Psychology has substantial credibility among many LGB individuals. APA has been a leader in adopting policies intended to de-stigmatize homosexuality, combat the view of homosexuality as a mental disorder, and advance the rights of LGB people. As a result, psychologists may have an advantage in seeking LGB clients, if they are proactive in building personal visibility and professional credibility with the LGB community.

Psychologists can increase their visibility first by joining LGB-identified mental health associations, especially LGB sections of state psychological associations. If none exists in your state association, petitioning for the establishment of such a section can increase awareness of the mental health needs of LGB persons and identify for the association your interest and expertise in LGB issues.

Further, there are important ways to network within the LGB community. Advertising in the LGB press and program booklets for LGB events informs LGB persons of a psychologist’s availability. (See "Have You Considered Advertising Your Services?" for information about advertising for psychologists.) Joining LGB-identified organizations such as local chapters of Parents and Friends of Lesbians and Gays, political action committees, health service agencies, and educational organizations such as the Gay, Lesbian, and Straight Educational Network can introduce a psychologist to important community gatekeepers.

Psychologists can increase their professional credibility by:

• Joining national, regional, and state psychological associations, especially sections in organizations that focus on LGB issues.

• Offering workshops through LGB health and mental health agencies on topics of interest and importance to LGB individuals, couples and families.

• Volunteering to serve on boards and committees of LGB health, mental health and professional organizations and social, political and recreational groups.

• Teaching and lecturing on LGB mental health issues, policies and practice to primary and secondary school faculties and counselors or as adjunct faculty in graduate training programs.

APA offers a number of resources and policies that assist psychologists in providing psychological services to LGB individuals:

• Guidelines for Psychotherapy with Lesbian, Gay and Bisexual clients, adopted in February 2000. This policy identifies psychological issues unique to LGB individuals and makes recommendations for appropriate and effective assessment and treatment.

• APA Policy Statement on Appropriate Therapeutic Responses to Sexual Orientation, adopted in 1997. This resolution identifies important issues to be considered when therapists are asked to participate in sexual orientation change, often referred to as reparative therapy.

• APA Policy Statement on Sexual Orientation, Parents and Children, adopted in 2004. This policy affirms the dignity and integrity of LGB families and provides accurate information on LGB parenting and the development of children in these families.

Other APA resolutions and policies (Conger, 1975, 1977; Abeles, 1981; Fox, 1988, 1989a, 1989b, 1992; DeLeon, 1993; APA, 1998; APA, 2000; APA, 2004a; APA, 2004b, APA, 2004c) affirm that homosexuality and bisexuality are not mental disorders and encourage the removal of the stigma long associated with these sexual orientations.

Armand R. Cerbone, PhD, ABPP, coauthored the Guidelines for psychotherapy with lesbian, gay and bisexual Clients. He chaired the task force that drafted the APA's Resolution on Sexual Orientation and Marriage and the Resolution on Sexual Orientation, Parents, and Children. He maintains a private practice in Chicago and is the 2006 co-chair of the Board for the Advancement of Psychology in the Public Interest.

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American Psychological Association. (2004a). Sexual orientation and marriage in the proceedings of the American Psychological Association. Incorporated for the legislative year 2004. (In press.)

American Psychological Association. (2004b). Sexual orientation, parents, and children in the proceedings of the American Psychological Association. Incorporated for the legislative year 2004. (In press.)

American Psychological Association. (2004c). Sexual orientation and military service in the proceedings of the American Psychological Association. Incorporated for the legislative year 2004. (In press.)

Cerbone, A. (1990). Coming out as a lifelong developmental task: Erik Erikson rethought. American Psychological Association Annual Convention, San Francisco, CA., 1990.

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