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Perceptions of Sexual Orientation
and Therapist Effectiveness
With estimates of 4% to 17% (Gonsiorek & Weinrich, 1991) of the population
identifying themselves as lesbian or gay, the issue of providing competent and
ethical treatment to gay and lesbian clients is an important one. This concern
has not gone unnoticed by the mental health field. The proposed revision of the
ethical standards for the American Counseling Association (ACA) offers that "counselors
do not condone or engage in discrimination based on age, color, culture, disability,
ethnic group, gender, race, religion, sexual orientation, or socioeconomic status"
(ACA, 1994, p. 20).
The stance the American Psychological Association (APA,
1992) takes is similar, given as follows:
of age, gender, race, ethnicity, national origin, religion, sexual orientation,
disability, language, or socioeconomic status significantly affect psychologists'
work concerning particular individuals or groups, psychologists obtain the training,
experience, consultation, or supervision necessary to ensure the competence of
their services, or they make appropriate referrals. (p. 1602)
is clear that the responsibility to provide ethical and unbiased services
to gay and lesbian clients falls on the shoulders of mental health practitioners.
Key to the provision of such treatment is the necessary distinction between gay
and lesbian clients and the similar and divergent issues that each gender presents.
The question is this: How do mental health professionals become
prepared to offer educated and unbiased treatment? Several studies suggest that
without proper training it is unlikely that mental health professionals could
provide unprejudiced treatment to gay and lesbian clients. The Committee on Lesbian
and Gay Concerns (1991) addressed this concern in a national survey, the results
of which indicate a broad range of biased, inadequate, and inappropriate practice
being provided to gay and lesbian clients. In another study, Graham, Rawlings,
Halpern, and Hermes (1984) reported that the practitioners they surveyed had great
concern about their own biases and prejudices and expressed difficulty in identifying
the strengths, weaknesses, problems, and coping mechanisms of their gay and lesbian
clients. Additional reports reveal the biases that mental health providers have
toward gay and lesbian clients (Fassinger, 1991; Glenn & Russell, 1986, Rudolph,
The answer, then, may begin at the graduate level of
training. This article addresses the status of training for graduate students
in counseling gay and lesbian clients. The importance of including gender issues
relevant to counseling gay and lesbians clients is also discussed. A course designed
to meet the ethical challenges of preparing counselors to treat gay and lesbian
clients is described. Suggestions for including segments of this course in any
graduate course is presented.
STATUS OF TRAINING
literature shows a lack of emphasis on gay and lesbian issues in graduate training
programs. In a study of female counseling psychology doctoral students, Buhrke
(1989) discovered that for approximately 29% of the participants, gay and lesbian
issues were not addressed in any of their courses. Almost 50% of the respondents
reported providing no direct therapeutic service to gay and lesbian clients during
their training experience. Similarly, Glenn and Russell's (1986) study to assess
biases among students in counseling psychology, guidance, and counseling programs
found that of 36 female master's-level counseling student participants, only 2
had received any kind of training on counseling gay and lesbian clients. Murphy's
(1991) examination of the status of specific training in gay and lesbian issues
for mental health professionals concluded that "despite official statements
about the importance of sensitivity to sexual orientation, gay and lesbian topics
are rarely discussed either in graduate education programs or in the field"
Additional confirmation of the absence of training
is provided by assessing the practice of clinicians. The national survey conducted
by the Committee on Lesbian and Gay Concerns (1991) found practitioners reporting
inaccurate information about and lack of sensitivity toward particular concerns
and issues regarding gay and lesbian lifestyles and identity development. In addition,
practitioners reported receiving inaccurate and prejudiced supervision and teaching
during clinical training. In the survey by Graham et al. (1984) of practicing
psychologists, it was revealed that they had received little or no information
on lesbian and gay Issues during their doctoral training. Graham et al. concluded
that given the results of their survey, graduate programs should include training
about working with gay and lesbian clients and that "training should reflect
the fact that lesbian and gay client populations constitute two separate subcultures
and therefore require different knowledge bases and skills" (p. 493).
Gender differences are often not made salient when discussing "homosexual"
clients. Eldridge (1987) noted that "in working with lesbian or gay male
clients . . . concepts of gender and the corresponding socialization may be far
more salient than sexual orientation" (p. 569). This implies that the shared
experience of same-sex sexual orientation does not result in gay men and lesbians
being more like each other than their heterosexual counterparts. Moses and Hawkins
(1982) reminded us that "gay men and women have both been raised and socialized
as members of their respective genders [and that] because of this, gay men are
typically like nongay men and gay women are like nongay women in most facets of
their lives" (p. 59).
There are many aspects of both gay and lesbian
identity development and lifestyles that indicate differences based on gender.
In particular, the developmental process of acquiring a gay or a lesbian identity,
or coming out, and the issue of entering into and maintaining a gay or a lesbian
relationship are areas in which the literature has uncovered disparate gender-based
experiences (Browning, 1988; DeMonteflores & Schultz, 1978; Isay, 1989).
The process of coming out unfolds through a series of stages, beginning
with the recognition of oneself as gay or lesbian (Cass, 1979; Coleman, 1982).
Gender role factors affect the coming out process for men and women. Gender role
violation may make coming out more difficult for men than for women. Isay (1989)
reported that because the male role is valued over the female role in this society,
homosexuality is more threatening for men than for women, making the stigma attached
to being gay more painful for them. DeMonteflores and Schultz (1978) suggested
that because of gender role expectancies, sexual activity plays out differently
for gay men and lesbians in the coming out process (see Browning, 1988; Browning,
Reynolds, & Dworkin, 1991; Fassinger, 1991; Isay, 1989). It seems that gay
men become aware of and act on their homosexual feelings earlier than do lesbians
(Browning, 1988; Isay, 1989), whereas lesbians often come out later, and they
do so in the context of a relationship with another woman. These differences parallel
the sexual socialization process in which sexual activity is fused with masculine
competence for men and sexuality is meshed with emotionality for women (Troiden,
In a literature review of
gender issues with same-sex couples, Eldridge (1987) discussed the differences
found between gay and lesbian couples. She reported that the chief factor affecting
differences in relationship values was gender, not sexual orientation. The dynamics
within the relationships varied as a result of the patterns of interaction associated
with men and women. Differences tended to cluster around the value placed on emotional
expressiveness and sexual exclusivity. Sexual exclusivity was more highly valued
by women than by men, with gay men tending to be more sexually exclusive during
the beginning stage of a relationship than later on. Because lesbian couples tend
to value emotional attachment and intimacy over autonomy, enmeshment is a frequent
result (Krestan & Bepko, 1980; Pearlman, 1989), whereas the tendency of gay
male couples to value independence and competition may result in intimacy difficulties
(Hawkins, 1992; Isay, 1989).
A different course in the development
of a gay or a lesbian relationship may also be noted. As a result of differential
socialization patterns of men and women, gay male couples tend to develop an affectional
relationship from a sexual one and to have a briefer courting period, whereas
lesbian couples often develop a sexual relationship from an affectional one after
a more lengthy courtship (Eldridge, 1987).
Because of the
scope and complexity of issues facing counselors and mental health professionals
working with gay and lesbian clients, it is clear that graduate programs need
to provide training that addresses these issues. It is also apparent that an emphasis
on gender-related issues needs to be embedded within the curricula.
Joy, Providing Training about Sexual Orientation in Counselor Education, Counselor
Education & Supervision, December 1995, Vol. 35, Issue 2.
Reflection Exercise #3
The preceding section contained information
about providing training about sexual orientation in counselor education. Write
three case study examples regarding how you might use the content of this section
in your practice.
Peer-Reviewed Journal Article References:
Drinane, J. M., Roberts, T., Winderman, K., Freeman, V. F., & Wang, Y.-W. (2021). The myth of the safe space: Sexual orientation disparities in therapist effectiveness. Journal of Counseling Psychology.
Pachankis, J. E., Mahon, C. P., Jackson, S. D., Fetzner, B. K., & Bränström, R. (2020). Sexual orientation concealment and mental health: A conceptual and meta-analytic review. Psychological Bulletin, 146(10), 831–871.
Thompson, M. N., Chin, M. Y., & Kring, M. (2019). Examining mental health practitioners’ perceptions of clients based on social class and sexual orientation. Psychotherapy, 56(2), 217–228.
Why do gay male couples tend to develop an affectional relationship
from a sexual one and to have a briefer courting period, whereas lesbian couples
often develop a sexual relationship from an affectional one after a more lengthy
courtship? To select and enter your answer go to .