Tailoring treatment for lesbian, gay, bisexual clients

Psychologists with an expertise in working with lesbian, gay and bisexual clients offer the following advice for those venturing into the field.

• Obtain a copy of the Guidelines for Psychotherapy with Lesbian, Gay and Bisexual Clients, which originally appeared in the December 2000 American Psychologist (Vol. 55, No. 12). These comprehensive, clearly written suggestions cover attitudes toward homosexuality and bisexuality; relationship and family issues of importance for LGB clients; diversity issues; and ways to increase one's training in LGB issues.

"The guidelines provide you with basic information so that LGB clients don't have to educate you about their normative experiences," says Doug Haldeman, PhD, a clinical faculty member at the University of Washington. They also include a comprehensive reading list of the latest research on LGB clients and mental health.

"In a very gentle, aspirational way, the guidelines provide a lot of good direction for therapists," he says.

The guidelines are easy to obtain, too: access them on the Web, or request copies from APA's Public Interest Directorate by emailing them; or calling APA's Lesbian, Gay and Bisexual Concerns Office at (202) 336-6041.

• Put yourself in the shoes of an LGB person. "Think about what it might be like to live and work in your community as a gay person," Haldeman advises. What is it like to still be seen as "different" in some communities, to be discriminated against in a variety of legal, practical and more subtle ways? This empathic exercise can give you an important inroad into the reality of LGB clients' lives, suggests Haldeman.

• Don't be afraid to ask questions. "Many LGB people may not be ready to volunteer everything to a heterosexual person," Haldeman notes. So, "it's OK to gently but directly ask questions, like 'Tell me about your social life,' or 'Let's talk about your sexuality.'"

• If you're homophobic, refer the LGB person to someone who's not. "For a straight therapist who feels homophobic, don't see a gay person!" Haldeman says. "It will inevitably end up doing more harm than good."

If psychologists do decide to expand their practices by serving more LGB clients, they're in a good position to do so, emphasizes Armand Cerbone, PhD, who along with Kristin Hancock, PhD, co-chaired the task force that drew up the practice guidelines.

"Psychology has substantial credibility within the LGB community," notes Cerbone. The field has a long history of research on LGB issues, of resolutions and policies against discrimination on the basis of sexual orientation, and of leadership among the mental health professions in fostering mental health practices and policies that are based on accurate knowledge and understanding of LGB individuals and their lives, he says.

--T. DeANGELIS