Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients

American Psychological Association

The “Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual Clients” provide psychologists with (a) a frame of reference for the treatment of lesbian, gay, and bisexual clients1 and (b) basic information and further references in the areas of assessment, intervention, identity, relationships, diversity, education, training, and research. These practice guidelines are built upon the “Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients” (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns Joint Task Force on Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients, 2000) and are consistent with the American Psychological Association (APA) “Criteria for Practice Guideline Development and Evaluation” (APA, 2002a). They assist psychologists in the conduct of lesbian, gay, and bisexual affirmative practice, education, and research. The term guidelines refers to pronouncements, statements, or declarations that suggest or recommend specific professional behavior, endeavors, or conduct for psychologists. Guidelines differ from standards in that standards are mandatory and may be accompanied by an enforcement mechanism. Thus, these guidelines are aspirational in intent. They are intended to facilitate the continued systematic development of the profession and to help ensure a high level of professional practice by psychologists. These guidelines are not intended to be mandatory or exhaustive and may not be applicable to every clinical situation. They should not be construed as definitive and are not intended to take precedence over the judgment of psychologists. Practice guidelines essentially involve recommendations to professionals regarding their conduct and the issues to be considered in particular areas of psychological practice. Practice guidelines are consistent with current APA policy. It is also important to note that practice guidelines are superseded by federal and state law and must be consistent with the current APA “Ethical Principles of Psychologists and Code of Conduct” (APA, 2002b).2

promoting the mental health and well-being of lesbian, gay, and bisexual people and in providing psychologists with affirmative tools for practice, education, and research with these populations. In 2009, the association affirmed that “same-sex sexual and romantic attractions, feelings, and behaviors are normal and positive variations of human sexuality regardless of sexual orientation identity” (APA, 2009a, p. 121).
This article was published Online First August 29, 2011. These guidelines were adopted by the APA Council of Representatives, February 18 –20, 2011, and replace the original “Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients,” which were adopted February 26, 2000, and expired at the end of 2010. These revised and updated guidelines were developed by the Division 44/Committee on Lesbian, Gay, Bisexual, and Transgender Concerns Guidelines Revision Task Force. The task force included Kristin Hancock (chair) and members Laura Alie, Armand Cerbone, Sari Dworkin, Terry Gock, Douglas Haldeman, Susan Kashubeck-West, and Glenda Russell. The task force thanks Glenn Ally, Laura Brown, Linda Campbell, Jean Carter, James Croteau, Steven David, Randall Ehbar, Ruth Fassinger, Beth Firestein, Ronald Fox, John Gonsiorek, Beverly Greene, Lisa Grossman, Christine Hall, Tania Israel, Corey Johnson, Jennifer Kelly, Christopher Martell, Jonathan Mohr, David Pantalone, Mark Pope, and Melba Vasquez for their thoughtful contributions. The task force also acknowledges the long-standing support of Clinton Anderson, director of APA’s Lesbian, Gay, Bisexual, and Transgender Concerns Office, and APA staff liaisons Sue Houston (Board for the Advancement of Psychology in the Public Interest) and Mary Hardiman (Board of Professional Affairs) for their assistance. Each of the 21 new guidelines provides an update of the psychological literature supporting it, includes sections on rationale and application, and expands upon the original guidelines to provide assistance to psychologists in areas such as religion and spirituality, the differentiation of gender identity and sexual orientation, socioeconomic and workplace issues, and the use and dissemination of research on lesbian, gay, and bisexual issues. The guidelines are intended to inform the practice of psychologists and to provide information for the education and training of psychologists regarding lesbian, gay, and bisexual issues. The revision was funded by Division 44 (Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues) of the American Psychological Association (APA) and the APA Board of Directors. This document is scheduled to expire as APA policy in 10 years (2020). After this date, users are encouraged to contact the APA Public Interest Directorate to confirm that this document remains in effect or is under revision. Correspondence concerning this article should be addressed to the Public Interest Directorate, American Psychological Association, 750 First Street, NE, Washington, DC 20002-4242.
1 Throughout this document, the term clients refers to individuals across the life span, including youth, adult, and older adult lesbian, gay, and bisexual clients. There may be issues that are specific to a given age range, and, when appropriate, the document identifies these groups. 2 Hereinafter, this document is referred to as the APA Ethics Code.

In 1975, the APA adopted a resolution stating that “homosexuality per se implies no impairment in judgment, stability, reliability, or general social or vocational capabilities” and urging “all mental health professionals to take the lead in removing the stigma of mental illness that has long been associated with homosexual orientations” (Conger, 1975, p. 633). In the years following the adoption of this important policy, the APA indeed has taken the lead in 10

January 2012 ● American Psychologist
© 2011 American Psychological Association 0003-066X/11/$12.00 Vol. 67, No. 1, 10 – 42 DOI: 10.1037/a0024659

Sixteen years following APA’s 1975 resolution, a gap in APA policy and the practice of psychologists was identified in a study by Garnets, Hancock, Cochran, Goodchilds, and Peplau (1991) that documented a wide variation in the quality of psychotherapeutic care to lesbian and gay clients. These authors and others (e.g., Fox, 1996; Greene, 1994b; Nystrom, 1997; Pilkington & Cantor, 1996) suggested that there was a need for better education and training in working with lesbian, gay, and bisexual clients. For this reason, the “Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients” (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns Joint Task Force on Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients, 2000) were developed.

Development Process
These guidelines were developed collaboratively by Division 44/Committee on Lesbian, Gay, Bisexual, and Transgender Concerns. The guidelines revision process was funded by Division 44 and by the APA Board of Directors. Supporting literature for these guidelines is consistent with the APA Ethics Code (APA, 2002b) and other APA policy. In addition, the Application sections of the text were enhanced to provide psychologists with more information and assistance.

Definition of Terms
Sex refers to a person’s biological status and is typically categorized as male, female, or intersex (i.e., atypical combinations of features that usually distinguish male from female). There are a number of indicators of biological sex, including sex chromosomes, gonads, internal reproductive organs, and external genitalia. Gender refers to the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex. Behavior that is compatible with cultural expectations is referred to as gender normative; behaviors that are viewed as incompatible with these expectations constitute gender nonconformity. Gender identity refers to “one’s sense of oneself as male, female, or transgender” (APA, 2006). When one’s gender identity and biological sex are not congruent, the individual may identify as transsexual or as another transgender category (cf. Gainor, 2000). Gender expression refers to the “way in which a person acts to communicate gender within a given culture; for example, in terms of clothing, communication patterns, and interests. A person’s gender expression may or may not be consistent with socially prescribed gender roles, and may or may not reflect his or her gender identity” (APA, 2008, p. 28). Sexual orientation refers to the sex of those to whom one is sexually and romantically attracted. Categories of sexual orientation typically have included attraction to members of one’s own sex (gay men or lesbians), attraction to members of the other sex (heterosexuals), and attraction to members of both sexes (bisexuals). Although these categories continue to be widely used, research has suggested that sexual orientation does not always appear in such definable categories and instead occurs on a continuum (e.g., Kinsey, Pomeroy, Martin, & Gebhard, 1953; Klein, 1993; Klein, Sepekoff, & Wolff, 1985; Shively & De Cecco, 1977). In addition, some research indicates that sexual orientation is fluid for some people; this may be especially true for women (e.g., Diamond, 2007; Golden, 1987; Peplau & Garnets, 2000). Coming out refers to the process in which one acknowledges and accepts one’s own sexual orientation. It also encompasses the process in which one discloses one’s sexual orientation to others. The term closeted refers to a state of secrecy or cautious privacy regarding one’s sexual orientation. 11

A revision of the guidelines is warranted at this point in time because there have been many changes in the field of lesbian, gay, and bisexual psychology. Existing topics have evolved, and the literature also has expanded into new areas of interest for those working with lesbian, gay, and bisexual clients. In addition, the quality of the data sets of studies has improved significantly with the advent of population-based research. Furthermore, the past decade has seen a revival of interest and activities on the part of political advocacy groups in attempting to repathologize homosexuality (Haldeman, 2002, 2004). Guidelines grounded in methodologically sound research, the APA Ethics Code, and existing APA policy are vital to informing professional practice with lesbian, gay, and bisexual clients. These guidelines have been used nationally and internationally in practice and training and in informing public policy. They will expire or be revised in 10 years from the date they are adopted by APA.

These guidelines build upon APA’s Ethics Code (APA, 2002b) and are consistent with preexisting APA policy pertaining to lesbian, gay, and bisexual issues. These policies include but are not limited to the resolution titled “Discrimination Against Homosexuals” (Conger, 1975); the “Resolution on Sexual Orientation, Parents, and Children” (Paige, 2005); the “Resolution on Sexual Orientation and Marriage” (Paige, 2005); the “Resolution on Hate Crimes” (Paige, 2005); the “Resolution Opposing Discriminatory Legislation and Initiatives Aimed at Lesbian, Gay, and Bisexual Persons” (Paige, 2007); and the “Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts” (APA, 2009b). The guidelines are also compatible with policies of other major mental health organizations (cf. American Association for Marriage and Family Therapy, 1991; American Counseling Association, 1996; American Psychiatric Association, 1974; Canadian Psychological Association, 1995; National Association of Social Workers, 1996) which state that homosexuality and bisexuality are not mental illnesses. January 2012 ● American Psychologist

Attitudes Toward Homosexuality and Bisexuality
Guideline 1. Psychologists strive to understand the effects of stigma (i.e., prejudice, discrimination, and violence) and its various contextual manifestations in the lives of lesbian, gay, and bisexual people. Rationale. Living in a heterosexist society inevitably poses challenges to people with nonheterosexual orientations. Many lesbian, gay, and bisexual people face social stigma, heterosexism, violence, and discrimination (Herek, 1991b, 2009; Mays & Cochran, 2001; I. H. Meyer, 2003). Stigma is defined as a negative social attitude or social disapproval directed toward a characteristic of a person that can lead to prejudice and discrimination against the individual (VandenBos, 2007). Herek (1995) defined heterosexism as “the ideological system that denies, denigrates, and stigmatizes any nonheterosexual form of behavior, identity, relationship, or community” (p. 321). These challenges may precipitate a significant degree of minority stress for lesbian, gay, and bisexual people, many of whom may be tolerated only when they are “closeted” (DiPlacido, 1998). Minority stress can be experienced in the form of ongoing daily hassles (e.g., hearing antigay jokes) and more serious negative events (e.g., loss of employment, housing, custody of children, physical and sexual assault; DiPlacido, 1998). According to a probability sample study by Herek (2009), antigay victimization has been experienced by approximately 1 in 8 lesbian and bisexual individuals and by about 4 in 10 gay men in the United States. Enacted stigma, violence, and discrimination can lead to “felt stigma,” an ongoing subjective sense of personal threat to one’s safety and well-being (Herek, 2009). Antigay victimization and discrimination have been associated with mental health problems and psychological distress (Cochran, Sullivan, & Mays, 2003; Gilman et al., 2001; Herek, Gillis, & Cogan, 1999; Mays & Cochran, 2001; I. H. Meyer, 1995; Ross, 1990; Rostosky, Riggle, Horne, & Miller, 2009). Equally important, as individuals form lesbian, gay, and bisexual identities in the context of extreme stigma, most lesbian, gay, and bisexual people have some level of internalized negative attitudes toward nonheterosexuality (Szymanski, Kashubeck-West, & Meyer, 2008a). Szymanski, Kashubeck-West, and Meyer (2008b) reviewed the empirical literature on internalized heterosexism in lesbian, gay, and bisexual individuals and found that greater internalized heterosexism was related to difficulties with selfesteem, depression, psychosocial and psychological distress, physical health, intimacy, social support, relationship quality, and career development. There are significant differences in the nature of the stigma faced by lesbians, gay men, and bisexual individuals. Lesbians and bisexual women, in addition to facing sexual prejudice, must contend with the prejudice and discrimination posed by living in a world where sexism continues to exert pervasive influences (APA, 2007). Similarly, gay and bisexual men are confronted not only with 12

sexual prejudice but also with the pressures associated with expectations for conformity to norms of masculinity in the broader society as well as in particular subcultures they may inhabit (Herek, 1986; Stein, 1996). Bisexual women and men can experience negativity and stigmatization from lesbian and gay individuals as well as from heterosexual individuals (Herek, 1999, 2002; Mohr & Rochlen, 1999). Greene (1994b) noted that the cumulative effects of heterosexism, sexism, and racism may put lesbian, gay, and bisexual racial/ethnic minorities at special risk for stress. Social stressors affecting lesbian, gay, and bisexual youths, such as verbal and physical abuse, have been associated with academic problems, running away, prostitution, substance abuse, and suicide (D’Augelli, Pilkington, & Hershberger, 2002; Espelage, Aragon, Birkett, & Koenig, 2008; Savin-Williams, 1994, 1998). Less visibility and fewer lesbian, gay, and bisexual support organizations may intensify feelings of social isolation for lesbian, gay, and bisexual people who live in rural communities (D’Augelli & Garnets, 1995). Research has identified a number of contextual factors that influence the lives of lesbian, gay, and bisexual clients and, therefore, their experience of stigma (Bieschke, Perez, & DeBord, 2007). Among these factors are race and ethnicity (e.g., L. B. Brown, 1997; Chan, 1997; Espin, 1993; Fygetakis, 1997; Greene, 2007; Szymanski & Gupta, 2009; Walters, 1997); immigrant status (e.g., Espin, 1999); religion (e.g., Davidson, 2000; Dworkin, 1997; Fischer & DeBord, 2007; Ritter & Terndrup, 2002); geographical location–regional dimensions, such as rural versus urban or country of origin (e.g., Browning, 1996; D’Augelli, Collins, & Hart, 1987; Kimmel, 2003; Oswald & Culton, 2003; Walters, 1997); socioeconomic status, both historical and current (Albelda, Badgett, Schneebaum, & Gates, 2009; Badgett, 2003; Dıaz, Bein, & Ayala, 2006; Martell, 2007; ´ G. M. Russell, 1996); age and historical cohort (G. M. Russell & Bohan, 2005); disability (Abbott & Burns, 2007; Shuttleworth, 2007; Swartz, 1995; Thompson, 1994); HIV status (O’Connor, 1997; Paul, Hays, & Coates, 1995); and gender identity and presentation (APA, 2008; Lev, 2007). Application. Psychologists are urged to understand that societal stigmatization, prejudice, and discrimination can be sources of stress and create concerns about personal security for lesbian, gay, and bisexual clients (Mays & Cochran, 2001; Rothblum & Bond, 1996). Therefore, creating a sense of safety in the therapeutic environment is of primary importance (see Guideline 4). Central to this is the psychologist’s understanding of the impact of stigma and his or her ability to demonstrate that understanding to the client through awareness and validation. Psychologists working with lesbian, gay, and bisexual people are encouraged to assess the client’s history of victimization as a result of harassment, discrimination, and violence. In addition, overt and covert manifestations of internalized heterosexism should be assessed (Sanchez, ´ Westefeld, Liu, & Vilain, 2010; Szymanski & Carr, 2008). Different combinations of contextual factors related to gender, race, ethnicity, cultural background, social class, religious background, disability, geographic region, and other January 2012 ● American Psychologist

2009b. online resources may prove helpful. American Psychiatric Association. 2003. discrepant sampling procedures. & Williams. Psychologists are encouraged to avoid attributing a client’s nonheterosexual orientation to arrested psychosocial development or psychopathology. Hooker’s (1957) study was the first to challenge this historical assumption by finding no difference on projective test responses between nonclinical samples of heterosexual men and gay men. & Rosario. & Epting. In her analysis of recent population-based studies. for clients who are more comfortable with their lesbian. Pillard. Therefore. 1990b. Psychologists understand that lesbian. 1996) have affirmed that homosexuality and bisexuality are not mental illnesses. 1994). Guideline 2. inaccurate classification of participants. and pathologizing views of homosexuality and bisexuality can subtly manifest as the inappropriate attribution of a client’s problems to his or her nonheterosexual orientation (Garnets et al. 1988. an ignorance of confounding social factors. these differences have been attributed to the effects of stress related to stigmatization on the basis of sexual orientation. efforts to repathologize nonheterosexual orientations persist on the part of advocates for conversion or reparative therapy (APA. Haldeman. Beckstead and Israel (2007) suggested a collaborative approach in establishing therapeutic goals and examining the negative effects of prejudicial beliefs. American Counseling Association. and bisexual people. given the client’s psychological readiness. its effects may not even be evident to a lesbian. No scientific basis for inferring a predisposition to psychopathology or other maladjustment as intrinsic to homosexuality or bisexuality has been established. Fox (1996) found no evidence of psychopathology in nonclinical studies of bisexual men and bisexual women. In these cases. Psychologists are urged to weigh the risks and benefits for each client in context. Among the interventions psychologists are urged to consider are (a) increasing the client’s sense of safety and reducing stress. Cochran. Psychologists strive to consider the relative levels of safety and social support that the client experiences in his or her environment and to plan interventions accordingly. 2002). and the use of questionable outcome measures. gay. gay. or bisexual person. Michelson. Gilman et al. homosexual. 2009). Shidlo and Schroeder (2002) found that nearly two thirds of a sample of psychotherapy clients reported that their therapists told them that. 1975]. Such statements stem from a fundamental view that homosexuality and bisexuality indicate or are automatically associated with mental disturbance or dysfunction. APA (2009b) “supports the dissemination of accurate scientific and professional information about sexual orientation in order to counteract bias” (p. Pachankis & Goldfried. (c) resolving residual trauma. 1991. Canadian Psychological Association. Ross. 1998). 1994). it may be helpful for the psychologist to consider referrals to local support groups or other community organizations. Kessler. & Roeder. Herek. an extensive body of literature has emerged that identifies few significant differences between heteroJanuary 2012 ● American Psychologist sexual.. Savin-Williams. Rothblum. Although these studies concluded that homosexuality is a mental illness. outmoded. These findings are consistent with an extant body of research that associates exposure to discriminatory behavior with psychological distress (e. DiPlacido. Ivey & Ivey. 1991. 1990. Psychologists are thus urged to understand these contextual factors in their assessment of which interventions are likely to be acceptable and effective and how clients evaluate the outcome of their therapy (Fontes. productive lives or participate in stable primary relationships. or bisexual identity. 2008. Subsequent studies have continued to show no differences between heterosexual groups and homosexual groups on measures of cognitive abilities (Tuttle & Pillard. 2001. 2007). gay. and bisexual people on a wide range of variables associated with overall psychological functioning (Gonsiorek. van den Berg. Moreover. National Association of Social Workers. When studies have noted differences between homosexual and heterosexual individuals with regard to psychological functioning (e. and (d) empowering the client to confront social stigma and discrimination. At the present time.g. 1999. 2004). as gay men and lesbians. major mental health organizations (cf. 2004. Because stigma is so culturally pervasive. Practice that is informed by inaccurate. 1991) and psychological well-being and selfesteem (Coyle. 1994.g. Mays. 122) and “opposes the 13 . Pachankis & Goldfried. there is no valid empirical support for beliefs that lead to such inaccurate representations of lesbian.. 1993. Furthermore. American Association for Marriage and Family Therapy. Rationale. These effects can be addressed directly or indirectly (Bieschke. they could not expect to lead fulfilling. For clients who are less comfortable with their nonheterosexual orientation. Application. 1996. Rotheram-Borus. gay. For example. Savin-Williams.sources of identity can result in dramatically different stigmatizing pressures and coping styles. Gonsiorek (1991) reviewed this literature and found such serious methodological flaws as unclear definitions of terms. 1991. 1995. (b) developing personal and social resources. inappropriate comparisons of groups. Clients who have been exposed to notions of homosexuality and bisexuality as mental illnesses may present with internalized prejudicial attitudes (Beckstead & Morrow.. it may be helpful for psychologists to consider the ways in which stigma may be manifest in the lives of their clients even if it is not raised as a presenting complaint. when appropriate. the literature that classified homosexuality and bisexuality as mental illnesses has been found to be methodologically unsound. and bisexual orientations are not mental illnesses. 2008) as appropriate. APA [Conger.. it is important to consider the effects of internalized stigma. Hunter. Cochran (2001) concluded that increased risk for psychiatric distress and substance abuse among lesbians and gay men is attributable to the negative effects of stigma. Nevertheless. 1998. 1990). Markowitz. 1974. 2004). Such contextual differences also may result in different clinical presentations and clinical needs (Moradi.

and alternative treatment approaches. feelings. 2001. 122). Drescher. adults. The policy cited above calls upon psychologists to discuss the treatment approach. and violence may contribute to an individual’s fear of self-identification as lesbian. assessments based solely upon self-reports. Yarhouse & Burkett. its theoretical basis.. reasonable outcomes.g. APA. Psychologists are encouraged to identify and address bias and internalized prejudice about sexual orientation that may have a negative influence on the client’s self-perception. Therapeutic efforts to change sexual orientation have increased and become more visible in recent years (Beckstead & Morrow. inaccurate classification of subjects. These reviews highlight a host of methodological problems with research in this area. 1994. 2004). Most contexts in which SOCE occur derive from the religionbased ex-gay movement (Haldeman. Haldeman. career. The ultimate goal that may make sense for many January 2012 ● American Psychologist . Therapeutic interventions intended to change. and behavior are normal variants of human sexuality and that efforts to change sexual orientation have not been shown to be effective or safe. The potential for SOCE to cause harm to many clients also has been demonstrated. 2004). 2009b). Further. For example. These sections include prohibitions against discriminatory practices (e. 1998. particularly with youths. it is important for the psychologist faced with such a request to proceed with deliberation and thoughtfulness. psychologists may help neutralize the effects of stigma and inoculate the client against further harm. 1998). basing treatment upon pathology-based views of homosexuality or bisexuality). 2009b). In addition. Psychologists are encouraged to carefully assess the motives of clients seeking to change their sexual orientation. 1992).. The majority of clients who seek to change their sexual orientation do so through so-called ex-gay programs or ministries (Haldeman. 1992). “the benefits reported by participants in sexual orientation change efforts can be gained through approaches that do not attempt to change sexual orientation” (p. Tozer & Hayes. some clients report that nonheterosexual orientation is inconsistent with their religious beliefs or values (APA. it discourages coercive treatments. 1998). Informed consent would include a discussion of the lack of empirical evidence that SOCE are effective and their potential risks to the client (APA. spiritual community) as well as vulnerability to harassment. modify. Rationale. 2009b. Fear of potential losses (e. APA’s (1998) “Resolution on Appropriate Therapeutic Responses to Sexual Orientation” offers a framework for psychologists working with clients who are concerned about the implications of their sexual orientation. 2004). friends. Beckstead. 2004. Clients who are conflicted with respect to sexual orientation and religious identification and expression have long posed challenges for psychologists (Beckstead & Morrow. 2009b) and the provision of accurate information about sexual orientation to clients who are misinformed or confused. sexual dysfunction. Psychologists understand that same-sex attractions. or bisexual. and suicidality. and bisexual older adults. the misrepresentation of scientific or clinical data (e. spanning several decades. gay. 2002). Shidlo and Schroeder (2002) found that a majority of subjects reported that they were misled by their therapists about the nature of sexual orientation as well as the normative life experiences of lesbian. have consistently found that efforts to change sexual orientation were ineffective (APA. F.g. and a clear mandate for informed consent (APA.. depression. family. gay. the unsubstantiated claim that sexual orientation can be changed). Therefore. Additionally. according to the APA “Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts” (APA. 2009b. 1994) and are implicated in many client requests to change sexual orientation. or manage unwanted nonheterosexual orientations are referred to as “sexual orientation change efforts” (SOCE. and bisexual individuals. 121). Application. Given the influence of internalized homonegativity and antigay religious beliefs on client requests to change sexual orientation (Tozer & Hayes. In providing the client with accurate information about the social stressors that may lead to discomfort with sexual orientation.distortion and selective use of scientific data about homosexuality by individuals and organizations seeking to influence public policy and public opinion” (p. although several psychotherapeutic approaches also exist. 1994). 2001). and youths. Reviews of the literature. Murphy. 2004. gay. 2009b.g. Nicolosi (1991) described a model in which male homosexuality is treated through the therapeutic resolution of a developmental same-sex attachment deficit. Haldeman. Tozer and Hayes (2004) found that the internalization of negative attitudes and beliefs about homosexuality and bisexuality was a primary factor in motivating individuals who sought to change their sexual orientation. 2003) and that less than a third of subjects in such studies claim successful treatment (Haldeman. in the current climate of evidence-based practice. The resolution highlights those sections of the APA Ethics Code that apply to all psychologists working with lesbian. Haldeman. the psychologist is ethically obliged to provide accurate information about sexual orientation to clients who are misinformed or confused (APA. Guideline 3. Furthermore. 14 Bias and misinformation about homosexuality and bisexuality continue to be widespread in society (APA. SOCE cannot be recommended as effective treatment. Moreover. they noted that most subjects were not provided with adequate informed consent regarding their conversion therapy procedures as delineated in APA’s “Resolution on Appropriate Therapeutic Responses to Sexual Orientation” (APA. discrimination. Haldeman (2002) described a spectrum of negative client outcomes from failed attempts at conversion therapy. Even the most optimistic advocates of SOCE have concluded that sexual orientation is nearly impossible to change (Spitzer. 2004). and poor or nonexistent outcome measures. T. including biased sampling techniques. 2004. These include intimacy avoidance.

Gawronski. 2007). Beckstead. and Haldeman (2004). and undesirable. even when it has not been presented as a problem (Garnets et al. To do so.. Nystrom. & Rothblum. gay. & Callanan. sexual orientation . Brown.. consultation. Psychologists are encouraged to recognize how their attitudes and knowledge about lesbian. a client’s same-sex sexual orientation is apt to be viewed as a major source of the client’s psychological difficulties. a socalled blind perspective would likely perpetuate heterosexism in a manner that is unhelpful to clients (Garnets et al. The psychological assessment and treatment of lesbian. and bisexual clients). and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated. individual. The potential for SOCE to cause harm to many clients has been noted (APA. 2001. behavior. Psychologists working with men who have undergone some form of SOCE are encouraged to recognize that a sense of “demasculinization” is common (Haldeman. and role differences. 2002b). 1989. conscious efforts to recognize and counteract such heterosexism are imperative in order for optimal assessment and treatment to take place. Guideline 4. theories. 1994). psychologists are encouraged to be aware of both the explicit and implicit biases they may have. Winegarten. Hancock. bias-free therapeutic environment may help the client cope with internalized stigma and create an integrated life of his or her own construction based upon positive self-regard. Markowski. and limitations. such a transition may not be possible. Cassie. Psychologists are encouraged to assess the emotional and social distress associated with clients’ unsuccessful attempts at SOCE. 1996. gay.. especially when offering assessment and treatment services to people who share characteristics that are different from their own (e. that this is not the same as changing or even managing sexual orientation but is a treatment goal established in the service of personal integration. 2004. 1996. Since safety in the psychotherapeutic relationship has been viewed as central to the development of positive change (Levitt & Williams. Kozlowski. gay. gay. 1063). 2002). but they may nonetheless have a significant negative impact on the psychotherapeutic process. Anderson.g. including those due to . the effectiveness of psychotherapy can be compromised by their heterosexist bias. feelings. 2001). such a perspective ignores or denies the culturally unique life experiences of the lesbian. Given that acceptance of one’s sexual orientation is positively correlated with self-report measures of life satisfaction (Herek. These emotional concerns may include avoidance of intimate relationships. . 2002b. psychologists strive to evaluate their competencies and the limitations of their expertise. Schneider-Corey. and bisexual clients can be adversely affected by their therapists’ explicit or implicit negative attitudes. . 2004. In these instances. Since heterosexism pervades the language. Explicit biases are more obvious both to the psychologists who hold them and to their clients and have been described as direct and conscious forms of prejudice (Conrey. or bisexual clients. . An alternative but similarly ineffective approach is to adopt a “sexual orientation blind” perspective when offering assessment and treatment. p. when homosexuality and bisexuality are regarded as evidence of mental illness or psychopathology. and behaviors may be misinterpreted as abnormal. gay. Like similar “color-blind” models. It should be noted.g. In 15 . 1995). deviant. For example. and bisexual community. Principle E). however. . psychologists are encouraged to use appropriate methods of self-exploration and self-education (e. it is important to note that SOCE participants confronting coming out as gay frequently experience problems of social adjustment due to unfamiliarity with the lesbian. 2009b. needs. 2001). their thoughts. Without a high level of awareness about their own January 2012 ● American Psychologist beliefs. particularly those who experience religious orientation as a more salient aspect of identity than that of sexual orientation. In contrast. L.g. However. study. for some clients. Moreover. 2010). gay. Beckstead and Morrow (2004). gay. see APA (2009b). S. as with the client who accepts that he or she is gay and moves from a conservative to an open and affirming religious denomination. Hugenberg. and bisexual clients. Haldeman. implicit biases are outside the awareness of those holding them (Greenwald & Banaji. 2002b. when psychologists are unaware of their own negative attitudes. and formal continuing education) to identify and ameliorate implicit and explicit biases about homosexuality and bisexuality. lesbian. As noted in the APA Ethics Code (APA.. Waldo. psychologists may impede the progress of a client in psychotherapy (Corey. The APA Ethics Code urges psychologists to eliminate the effect of biases on their work (APA. 2001. psychologists are called to be “aware of and respect cultural. and relationships are applied to lesbian. & Groom. They also may need support for potential losses (e. To do so. 2006). Instead of eliminating heterosexist bias. family relationships. and try to eliminate the effect on their work of biases based on [such] factors” (APA. & Yoder. Application. Sherman.Haldeman. For a more detailed discussion of planning treatment with clients who are conflicted about sexual orientation and religious identification. because men in such programs are often instructed that “real” men cannot be gay. Morris. and a sense of being doubly stigmatized for being gay and unable to change. 1993). Rationale. Shidlo & Schroeder. Additionally. Liddle. Throckmorton. connections with communities of faith).such conflicted clients is an integration of sexual orientation with religious identification.. This is the case because when heterosexual norms for identity. a supportive. 1991. 1991. suicidal feelings. values. This is particularly relevant when providing assessment and treatment services to lesbian. & Cerbone. 2003. problems with sexual functioning. Gingold. and psychotherapeutic interventions of psychology (S. 2005). 1997). Beckstead (2001). depression and anxiety. and bisexual populations. the client may choose to prioritize his or her religious affiliation over sexual orientation and may seek accommodation compatible with such a choice (APA. 2009b.

marital status. 2007.. Visibility of sexual identity may be particularly challenging for bisexual persons. developmentally arrested. January 2012 ● American Psychologist . (c) the coming-out process and how such variables as age. ethnicity. 2000a). Green & Brinkin. 2007). Application. Bisexual individuals also may be viewed as promiscuous. regardless of sexual orientation (J. (d) same-sex relationship dynamics. sexual orientation. H. 1990). 1996b. Guideline 5. 2003. Martin. 2007). Lombardi. Although few researchers have investigated the mental health of bisexual individuals specifically. these mental health risks have been attributed to discrimination and social isolation (Dodge & Sandfort. Mulick & Wright. 2000b). 2006). anxiety. 2008. Herek. G. Bisexual persons are affected by negative individual and societal attitudes toward bisexuality that are expressed by both heterosexual and gay/lesbian people (Bradford. and some consistently embrace a bisexual identity (Fox. Psychologists also are encouraged to examine their attitudes toward relationships and strive to examine biases toward the nontraditional relationships that some bisexual people may have (Buxton. 2006. Dworkin. or supervision when necessary to ensure competent practice with these populations. Kite. T. Identity development trajectories vary for people who are attracted both to women and to men. gender. gay. People may embrace a bisexual identity because they are attracted both to women and to men. Meyer. some later adopt a lesbian or gay identity. Bisexuals are not a homogeneous group. Bisexual individuals may be more likely than lesbian or gay persons to be in a nonmonogamous relationship and to view polyamory as an ideal. independent of that person’s actual sexual orientation. & Cohen. Psychotherapy with bisexual clients involves respect for the diversity and complexity of their experiences (Bradford. and (h) the coping strategies for successful functioning. 2007. such as gender. Rust. 2007). 2004. bisexual men and women sometimes come out after being in a mixed-sex or same-sex relationship (including marriage) and want to acknowledge or act on their attractions to the other sex (Keppel & Firestein. 2001. or psychologically impaired (Fox. Kite & Deaux. & Laflin. experience. Rationale. Mohr. Keppel & Firestein. including cultural differences relative to bisexuality (Collins. 2007. or because they find traditional notions of sexual orientation limiting (Ross & Paul. 2001. Goetstouwers. (b) the impact of social stigma on sexual orientation and identity development. suicidality. psychologists strive to familiarize themselves with the development of a bisexual identity. Rust. Because gender nonconformity is likely to be stigmatized. culture. and substance abuse than do lesbian. Treatment may thus need to help them negotiate a new relationship with their married spouse that may include a divorce (Buxton. some studies have suggested that bisexuals may have higher rates of depression. 2007). Some such individuals initially adopt a lesbian or gay identity. 2004a. religion. Guideline 6. 2007. Herek. For example. 2002. 2001) but instead be viewed as a transitional state between heterosexual and homosexual orientations (Eliason. 2007) and gender differences (Eliason. psychologists are strongly encouraged to seek training. Page. even in the presence of apparent markers of heterosexuality (e. 2004b). Russell & Richards. because gender is not a key criterion for choosing an intimate partner. Because many psychologists have not received sufficient current information regarding lesbian. heterosexism. and socioeconomic status may influence this process. Similarly. Rationale. Goetstouwers.doing so. Psychologists strive to distinguish issues of sexual orientation from those of gender identity when working with lesbian. gender nonconformity may result in an individual being perceived as lesbian or gay. lesbian. 2007. Evans. parenthood). Israel. Sexual orientation and gender identity are distinct characteristics of an individual (APA. 2001. race. & Sedlacek. 2003.g. 1996). Eliason. Ferrer & Gomez. Rust. ´ Scott. (e) family-oforigin relationships. Weitzman. Helgeson. disability. and religious ideology. 2006. 2001. Oxley & Lucius. and bisexual clients. Weis. 2007. 1996. although 16 there are many bisexual people who desire and sustain monogamous relationships (Rust. 1987. (f) the struggles with spirituality and religious group membership. In addition. 1992). gay. 2000). 2006). 1994. 1994. 2003). 2007. Weitzman. Dodge & Sandfort. 2002). Gorcheva. Carlsson. bisexuality may not be regarded as a valid sexual orientation (Dworkin. 2003). may influence their assessment and treatment of gay. consultation. 2001. identity development. 2007). and bisexual clients (Pilkington & Cantor. Evans. 2004a. Sulzner. 2007). Walther. In addition. relationships. Psychologists strive to recognize the unique experiences of bisexual individuals. Israel. Fox. M. 1996). psychologists strive to be aware of how their own background and personal factors. psychologists strive to avoid making assumptions that a client is heterosexual.g. The diversity among bisexual individuals is reflected in variations in gender. 1994. 1996. (g) career issues and workplace discrimination. Psychologists are encouraged to keep in mind that affirmative psychotherapy with bisexual clients may differ from that with gay and lesbian clients (Bradford.. and bisexual clients (T. 2000). 2002. 2003. Firestein. 2007). As with minority stress models for lesbian and gay individuals (I. as others may assume they are lesbian or gay if in a same-sex relationship or heterosexual if they are in a mixed-sex relationship (Bradford. 2007). A common error is to see gay men and lesbians as particularly likely to manifest gender-nonconforming behavior and/or to be transgender (Fassinger & Arseneau. gender nonconformity itself can result in prejudice and discrimination. 2004. Key areas for psychologists to be familiar with include but are not limited to an understanding of (a) human sexuality across the life span. 2006. Israel & Mohr. In addition. and meaning of bisexuality (Fox. and heterosexual populations (e. Morrow. 2006. gay. Psychologists therefore are encouraged to develop a comprehensive understanding of sexual orientation in their approach to treatment (Horowitz.

Psychologists also are encouraged to be aware of the potential that gender nonconformity in lesbian.transequality. Brill & Pepper. Ubaldo & Drescher. gay.wpath. APA. the Gender Public Advocacy Coalition (http://www. Application. Lev. Peplau & Cochran. and develop adequate social supports (R. Green & Mitchell. and bisexual clients may exacerbate stigmatization. The differences are derived from several factors.gpac. G. many lesbians and gay men come out years after they have been heterosexually married (Buxton. gay. 2007. 1988. or bisexual orientation alone (e. 2000) and the prohibition of legal and medical protections for same-sex families as in Virginia and Florida (Herek. & 2004). gay. They form relationships for similar reasons (Herek. A variety of resources now exists for psychologists working clinically with clients who identify somewhere along the spectrum of gender nonconformity (e. relationship patterns and choices among lesbian. 1997. gay.srlp. 1994. lesbian. Changes in physical health may present unique stressors. Psychologists strive to be knowledgeable about and respect the importance of lesbian. Some gay. communication difficulties. For example. Horn. 1991b. Benjamin. 2007). express similar satisfactions with their relationships (Kurdek. McJanuary 2012 ● American Psychologist Whirter & Mattison.transgenderlawcenter . M. J. 2007). gay. 2002. and bisexual clients may have become so inured to the effects of stigma and discrimination in their relationships that they may not recognize the contribution of stigma to the conflicts they face. Nonetheless. Useful websites include those of the American Psychological Association (http://www. or bisexual clients may present in gender-conforming or gender-nonconforming ways.. and bisexual couples. 1996). commitment decisions) or for dissimilar reasons (e. Lesbian. Brown and Rounsley’s (1996) work offers information for helping professionals on transsexualism. the Sylvia Rivera Law Project (http://www. 2000. 1984. 2003). gay.. 2010. gay. For example. A couple may not recognize the contribution of stigma and marginalization to the common relationship problems that all couples may encounter (R. lesbian.2001). or bisexual can utilize the emerging professional literature as well as online resources to keep abreast of the changing context for this population. and bisexual couples may need to resolve ambiguity in areas of commitment and boundaries. Israel & Tarver. 1990). To work effectively with issues related to gender nonconformity. and the Transgender Law Center (http://www. Furthermore. Psychologists may see clients who are struggling with coming-out issues and who also express confusion concerning whether their gender conformity or nonconformity is related to their sexual orientation. issues derived from the effects of gender socialization). Kurdek. Psychologists who work with transgender people who also identify as lesbian. 2000). 1991a. Hancock. disclosure of sexual orientation.. Relationships and Families Guideline 7. 2004. These include the psychological effects of political campaigns against samesex marriage (Rostosky et al. M. Gainor (2000) provided a comprehensive introduction to transgender issues in lesbian. 2008.g. and sexual orientation when these issues are in conflict. Familiarity with nontraditional relationship structures may be helpful to the psychologist working with same-sex couples (Martell & Prince. and bisexual couples may seek therapy for reasons similar to those of heterosexual couples (e. 2008. Ossana.. Veniegas. gay. 1967. cope with gay. the World Professional Association of Transgender Health (http://www. 2006). differences between partners in the disclosure process. gay. some research in schools indicates that gender nonconformity (regardless of sexual orientation) evokes at least as much antipathy among high school students as does a lesbian. J. The relationship structures of lesbian. 2000. possible loss of contact for partners in nursing homes or other inpatient settings. gender-related behavior. 2002). McWhirter & Mattison. Application. 2005). 2006).g. Russell. facing homophobia in caretakers or fellow residents in nursing homes and assisted living situations). 1984). Rationale. the pair may encounter conflicts around where to spend the holidays or whether to “de-gay” the house when visitors are and bisexual couples are both similar to and different from heterosexual couples ( Gainor. E. and bisexual individuals may be affected by early-life stigma and marginalization (Mohr & Fassinger. 2002. Raj. including different patterns of sexual behavior. Peplau. Greenan & Tunnell. gay. psychologists strive to be aware of their own values and biases regarding sex.g. Psychologists are encouraged to consider the negative effects of societal prejudice and discrimination on lesbian. gay. Carroll. 2000). and bisexual couples (e. 17 . and bisexual relationships. gay. gender role socialization (Hancock. possible separation from partners. Korell & Lorah. especially to older lesbian. and bisexual psychology. and bisexual couples vary and may present unique concerns. 1993). Green & Mitchell. and bisexual relationships. the National Center for Transgender Equality (http://www.g. 1991). sexual problems. gender. Lesbian. 2008.apa. and the stigmatization of their relationships (Garnets & Kimmel. dual career issues.. Nonmonogamous or polyamorous relationships may be more common and more acceptable among gay men and bisexual individuals than is typical for lesbians or heterosexuals (Herek. Psychologists are encouraged to help clients understand the differences between gender identity. Same-sex couples must sometimes adapt to conditions that are hostile to or devalue their relationships. 2002.. 2009. when one partner has disclosed his sexual orientation to his family of origin and the other has not. Psychologists are therefore encouraged to consider familial and other social and cultural factors in conducting therapy with lesbian. and follow developmental patterns similar to heterosexual couples (Clunis & Green. Carroll & Gilroy. Herek. G. 1995.g. and sexual orientation (APA. Lesbian. 2003. In addition.

and bisexual people may include people who are not legally or biologically related. various forms of sexual dysfunction. gay. 2004. Other unique concerns for lesbian. concerns related to intimacy and desire).. Psychologists are encouraged to examine the various facets of identity (e. research has focused on the children of lesbian. Fulcher. legal barriers to foster parenting and same-sex and second-parent adoption. gay. In the absence of socially sanctioned supports for their relationships. Bos. Flaks. and bisexual households (Perrin & the Committee on Psychosocial Aspects of Child and Family Health.g. gay. the spouses and families of these individuals may require therapeutic support. foster care. Research has indicated that lesbian. and institutions and to provide accurate information based upon scientifically and professionally derived knowledge. gay. and bisexual couples to be sensitized to and knowledgeable about common sexual practices and concerns shared by lesbian. These include (a) the gender identification. 1999). disability. Guideline 8. ACLU Lesbian and Gay Rights Project. gay. Psychologists are encouraged to recognize that internalized heterosexism can complicate the development of healthy sexual relationships. and bisexual parents. 2000. 2005). 2006). Increasingly. Psychologists recognize that the families of lesbian. In becoming parents. 2002.. and school personnel. Erich. Rationale. Families of the nonbiological lesbian mother may be resistant to seeing nonbiological children as 18 true grandchildren. and were more effective in child rearing than were fathers in heterosexual marriages. and psychiatric health. Psychologists strive to recognize the challenges faced by lesbian. given the context of discrimination that lesbian.g. and bisexual couples. gay. van Balen. and bisexual parents and are encouraged to explore these issues with their clients. 2008). school adjustment. personality. Such findings are important to note. gay. 2007) reported that lesbian social mothers (nonbiological mothers) had higher quality parent– child interactions.. In addition. Masterpasqua. & Wainwright. and bisexual parents face (e. Psychologists strive to understand the experiences and challenges faced by lesbian. Leung. Patterson also reported that the data showed no major differences between children reared by lesbian parents and those raised by heterosexual mothers with regard to personal development in areas such as selfesteem. child custody and visitation. and bisexual people face challenges not required of heterosexual people. p. socioeconomic class. day-care providers. religious or spiritual traditions) that intersect in creating the experiences of lesbian. 2002). gay. 2002. Armesto. 2006. For example. Hertz. At the same time. and bisexual individuals are diverse. and bisexual individuals. psychologists are urged to recognize the unique strengths and resilience of lesbian. nieces. (b) the personal development of the children. 2005. Even when families are January 2012 ● American Psychologist . Three main concerns have been raised (primarily by those in the legal and social welfare systems) with regard to the well-being of children raised by lesbian. gay. culture. 2002). sexual frequency. lesbian. Appell. and van den Boom (2005. It is helpful for psychologists working with lesbian. 496). intelligence. gay. and bisexual couples. children. & Doskow. It is useful for psychologists to be aware of the diversity of these relationships and refrain from applying a heterosexist model when working with lesbian. and bisexual parents (Patterson. and reproductive health services” (Paige. lesbian. Psychologists are also encouraged to recognize the particular challenges that men and women in heterosexual marriages face in coming out and integrating their lesbian. 2007). Perrin.g. and bisexual parents. Although bias and misinformation continue to exist in the educational. gay. Her review of the empirical data (primarily based on children of lesbian mothers) indicated that none of these areas of concern have merit. gay. gay. the threat of loss of custody of children. the lack of legal rights of one of the parents. and bisexual parents are as capable as heterosexual parents (cf. gender role behavior. gay. gay. In fact. Monogamy is a normative expectation in many heterosexual relationships. Herek. Patterson (2005) conducted a comprehensive review of the literature in each of these areas. For a significant number of lesbian. Patterson. denial of access to marriage creates barriers for same-sex parents in accessing the same legal and economic benefits and social status as do married heterosexual couples (APA. and bisexual people create their own relationship models and support systems. whereas it is not always assumed among gay male couples. Tasker. were more committed as parents. such as stressors related to alternative insemination and surrogacy (Gifford. psychologists also are urged to correct this misinformation in their work with parents. 2002. Ficher. Rationale. and social welfare systems. gay. and bisexual couples (e. Guideline 9. This may be particularly salient with respect to the sexual lives of lesbian. In light of research findings supporting the positive outcomes for children of lesbian and gay parents. gay. and bisexual families. and bisexual parents. and Joseph (1995) found that lesbian couples had stronger parenting awareness skills than did heterosexual couples. locus of control. prohibitions against living with one’s same-sex partner. and sexual orientation of the children. Patterson. 2005. the American Academy of Pediatrics released a statement in 2002 supporting second-parent adoption in lesbian. 2010). 2004. or nephews (Ben-Ari & Livni. gay. community organizations. gay. The relationships of lesbian. race and ethnicity. behavior problems. nondisclosure of sexual orientation and/or lack of acknowledgement of their intimate relationships may result in emotional distancing from their family of origin (Patterson. & Kindle. legal.1988). gay. APA “encourages psychologists to act to eliminate all discrimination based on sexual orientation in matters of adoption. Application. Healthy sexual expression is generally taken to be an element of overall relationship satisfaction. and bisexual parents include lack of support from families and friends and homophobic reactions from pediatricians. or bisexual orientation into their lives. and (c) the social experiences of such children.

racial and ethnic minority families may fear losing the support of their community if they are open about having a lesbian. For many lesbian. J. 2007. Some young adult life transitions (e. a network of close friends may constitute an alternative family structure— one that may not be based on legal and/or biological relationships. Strommen. Meyer. Greene. 2007). gay. see Appendix A). or bisexual member (Oswald. or bisexual (Patterson. assistance. confronting the ways in which negative societal attitudes about homosexuality and bisexuality are manifested within the family. Issues of Diversity The following guidelines refer to aspects of the life experience that may overlap and/or contribute in varying de19 . For example. Psychologists are encouraged to explore with lesbian. Guideline 10. 2000). and other resources helpful in the development of a positive identity (I. or bisexual (Jennings & Shapiro. religious beliefs. employers. 2003. 2003. Wirth. 1998. Psychologists are urged to assist lesbian. Some families of origin may be unprepared to accept a lesbian. parental guilt and self-recrimination. psychologists are encouraged to recognize and value lesbian. gay. 1996). choosing careers. Savin-Williams. sexual and romantic relationships. however. and psychological well-being (Beals. there are families of origin in which acceptance of their lesbian. gay. gay. gay. Psychologists strive to understand the ways in which a person’s lesbian. Parents. and whether they consider members of this network to be “family. or negative stereotypes (Buxton. 2005). Finally. social support. Savin-Williams. and supporting family members in addressing difficulties related to societal stigmatization. or bisexual member. and bisexual clients. this acceptance often may be tolerance rather than true acceptance (R. gay. M. or bisexual child. or others do not recognize their alternative family structures. psychologists strive to be aware of the cultural variations in a family’s reaction and ways of adapting to a lesbian. 2004) and may be more significant than the individual’s family of origin (Kurdek. 2005). 2003). a sense of solidarity. 1996. 2002. as connection with the community may provide the individual with role models. Firestein. gay. 2007). and bisexual people.. this awareness may precipitate a family crisis that can result in profound distancing from or expulsion of the lesbian. gay.. These families of choice provide social connections and familial context for lesbian. Russell. Newer models of family therapy move beyond addressing difficulties and promote processes of creating constructive systemic change (Fish & Harvey. Given the importance of social support in relationship satisfaction.accepting. and Friends of Lesbians and Gays. gay. and bisexual members and to monitor the relationships among family members beyond the adjustment to discovering the identity of a lesbian. There are many responses a family can have upon learning that one of its members is lesbian. Children of Lesbians and Gays Everywhere. 2005. the quality of their relationships in that network. 2004). that even supportive families may experience an adjustment period upon learning that a family January 2012 ● American Psychologist member is lesbian. or conflicts within the parents’ relationship (Dickens & McKellen. or cultural norms. Savin-Williams & Dube. gay. 1988). For these families. gay. and bisexual family structures. ethnic. Green. Family. gay. or bisexual member is unconditional or without crisis (Patterson. 2001. J. Psychologists are encouraged to assist families in developing long-term support for their lesbian. 1992). and bisexual community. Application.g. or bisexual child or family member because of familial. G. Both the family of origin and the extended family may grapple with the recognition of same-sex partners and children raised by a same-sex couple. Chan. 2007. Psychologists strive to understand the culturally specific risks of coming out to one’s family of origin. gay. 1993). Such family structures can mitigate the effects of discrimination and the absence of legal or institutional recognition (Weston. Research does suggest. Local and national resources are available that can provide information. Pallotta-Chiarolli. 2003. When working with lesbian. H. Families may need support in developing new understandings of sexual orientation. stigma management. it can be helpful to ask them about their friendship network. and bisexuals who are in mixed-sex relationships may have difficulty maintaining their bisexual identity within their family of origin and extended family (Dworkin. deciding to parent) will be particularly complicated for the lesbian. Psychologists also are urged to consider the stress that clients may experience when their families of origin. gay. 2007. Griffin. 2003). gay. Green. gay. 1996. Savin-Williams. and parenting (Patterson. 2000. or bisexual family member. Application. It may be challenging to explain to family members how sexual orientation and experiences related to stigma may impact decisions related to work and career.g. rejection of the parents and siblings by that family member. On the other hand. Firestein. and support to family members (e. Psychologists can assist clients in facilitating discussions with their families about their identities as well as about cultural stigma. Matteson. Persons who identify as bisexual and become romantically involved with same-sex partners may receive pressure from their families of origin to choose a partner of the other gender. and bisexual clients in their efforts to present accurate information regarding sexual orientation to their families. and bisexual individuals (R. or bisexual orientation may have an impact on his or her family of origin and the relationship with that family of origin. 2002). gay. Bisexual individuals may experience some unique complications with their families of origin. Rationale.” A related issue would be the person’s level of involvement with the lesbian. 1995. & Wirth. gay. or bisexual family member. 2004). and bisexual clients any issues and concerns related to their family of origin and extended family.

The concept of intersectionality (Cole. gay. 1989) when the expectations of the lesbian. The following guidelines on diversity each reflect a substantive construct. Although some religious and spiritual belief systems are relatively neutral about diverse sexual orientations (e. Rust. 2008). a lesbian. psychologists are encouraged to consider as critical factors in treatment the ways in which clients may be affected by how their cultures of origin view and stigmatize homosexuality and bisexuality (Gock. is varied and diverse.. in addition to dealing with their minority sexual orientations. Psychologists strive to recognize and to help their clients recognize the effective coping strategies and other protective factors that their lesbian. or cultural group with which he or she also has a strong sense of belonging. Psychologists are also encouraged to understand and help their lesbian. 2007. 1994a. Ortega. gender. ethnic. Matthews. and unique effects of constructs such as race.grees to an individual’s sense of identity and relationship to his or her social and cultural environment. 2003).e. & Bridges. 2009) is used to characterize the variable. Intersectionality is defined by multiple categories of identity. and bisexual members of racial and ethnic minority groups. differential. Jones & Hill. however. Even within religious traditions that have been historically disapproving of nonheterosexual orientations. and pain that they have often experienced both as people from diverse racial. Furthermore. Meyer. ethnic. and similarities (i. ethnic. Rationale. Rust.. 1996a).g. social class. and bisexual persons. For example. 1994a. immigration status. difference. gay. especially with organized religion. These conflicts of allegiance may lead to a lesbian. 1996). 2009. and bisexual clients from racial. gay. Bein. and attitudes can be a significant source of psychological stress that affects the health and mental health of lesbians. gay. there has been an emerging and growing theological paradigm in the past 20 to 30 years that accepts and supports diverse sexual orientations (Borg. Cochran. According to Greene.. 2004). & Croteau. gender roles. Greene. gay. sexual orientation.. diversity within categories). Manalansan.. others historically have been more condemnatory (e. 1996. 2001. gay. Buddhism and Hinduism). values. Guideline 12. gay men. Recently. or cultural background experiencing the sense of never being part of any group completely (Greene. Cole. and bisexual individuals may have variable effects on their psychological functioning and well-being (Haldeman. It may be that the skills learned in negotiating one stigmatized aspect of identity may actually assist the individual in dealing with and protect the individual from other forms of stigmatization.e. and disadvantage. and beliefs regarding homosexuality and bisexuality of both mainstream and minority cultures (Chan. Rosario. Henne. and bisexual women and men (Dıaz.. Selvidge. values. sensitivity to the complex dynamics associated with other overlapping layers of social identities and statuses (e. and cultural backgrounds may have lower rates of mental health problems (e. Alegria. ethnic. there is evidence to suggest that lesbian. or bisexual person of color may experience “conflicts of allegiance” (Gock. and cultural backgrounds and as sexual minority people (Espin. Morales. ethnic. Garnets & Kimmel.g. and beliefs faced by lesbian.g. Greene. The understanding of how these categories depend upon one another for meaning is based on questions of inclusion (i. Christianity. Rust. the reader is encouraged to consider them through the lens of intersectionality.g. ethnicity. 1994b. ethnic. Harper & Schneider.. gay. as well as the effects of racism within the mainstream lesbian. 2008. Greene. gay. The influence of religion and spirituality in the lives of lesbian. and a source of ambivalence. 2001. and bisexual communities at large. gay. frustration. 1995. limited English-language proficiency. and cultural minority groups must negotiate the norms. values. 2001. & Marin. Lesbian. and bisexual clients address the anger. 2003. commonalities across categories typically viewed as deeply different. and cultural minority backgrounds may have developed through their multiple marginalization experiences (Greene. gay. January 2012 ● American Psychologist . and bisexual individuals who are members of racial. & Schwartz. 2007). Kertzner. The religious backgrounds of lesbian. gay. and bisexual communities (Gock. class. 2003. and cultural backgrounds. beliefs. Meyer. the integration of multiple identities could pose challenges for lesbian. H. Guideline 11. ethnic. relative placement in hierarchies of power and privilege). Schrimshaw. Nevertheless. gay. ´ Ayala. 2008).e. gay. and bisexual people from diverse racial. 1993. Judaism. Psychologists are encouraged to consider the influences of religion and spirituality in the lives of lesbian. inequality (i.g. geographic location. lesbian. Such is the case because their experience. gay. & Hunter. Dietrich. & Stirratt. ethnic. These challenges may be even greater for lesbian. Psychologists are urged to understand the different ways in which multiple minority statuses may complicate and exacerbate the difficulties their clients experience. Morales. Frost. 2001. culture. 2009). gay. Mays. I. age. 1994c). or cultural backgrounds who experience other forms of marginalization related to such factors as age. and bisexual community with which he or she identifies are at odds with those of the racial. 1996a). and bisexual person from a diverse racial. Meyer. religious beliefs) is critical to effective work with these populations (Chan. and bisexual individuals from diverse racial. 1995. 2004). and disability on the individual’s life. and Islam). Psychologists strive to recognize the challenges related to multiple and often conflicting norms. 1992. gay. Greene. Hardy. There is some evidence to suggest that cultural variation in these norms. H. and bisexual people of color 20 experience racism and discrimination within the lesbian. Application. 2003. For example. and bisexual people from diverse racial.. 1996. however. Rationale. and bisexual persons can be complex. & Takeuchi. I. and disability (e. Bieschke. social class. dynamic. acculturation status. 1996a) in assisting clients to negotiate these issues. Fassinger.

gay. and civil rights movements. gay. as older lesbian. 1995) may become significantly more challenging for older lesbian. Rationale. 1996. 2008) called upon psychologists to examine their own religious beliefs and prevent these beliefs from taking precedence over professional practice and standards in their clinical work with lesbian. 2008). 1995. gay. 1996). identity disclosure. there appear to be differences in perceived stigmatization by ethnicity and age among older lesbian. Cook. the women’s. such interactions may result in compromised health care (Fassinger & Arseneau. Slater. Finally. Furthermore. and bisexual individuals due to heterosexist discrimination. Shidlo & Schroeder. and bisexual psychologists in particular may be vulnerable to conscious or unconscious religious bias that could negatively affect their work with clients who espouse a strong religious identification (Haldeman. Moreover. For example. and property rights. and bisexual clients. As another example. and bisexual adults (David & Knight. they are urged to consider the rejecting and hurtful religious experiences that their lesbian. but others do not (Maynard. 2001. gay. Besides having diverse past experience with faith. gay. Similarly. and changes in conceptualizations of sexual and gender identity. Guideline 13. In particular.2004). Cohort effects and age effects interact. psychologists are encouraged to inquire about the social and cultural influences that may play a role in these requests. social class. health. related to gender.. gay. Cohort influences are broad historical forces that shape the context of development. Dzelme. 2004). 2005. gay. living arrangements. Buchanan. For example. and bisexual clients (Haldeman. gay. psychologists are encouraged to attend to the ways in which a particular age-related issue may be affected by cohort experience. gay. The integration of these sometimes disparate but salient aspects of identity is often an important treatment goal for psychologists working with lesbian. Psychologists are encouraged to consider such requests very carefully by reviewing the APA “Resolution on Appropriate Affirmative Responses to Sexual Orientation Distress and Change Efforts” (APA. psychologists are encouraged to be familiar with the resources (including but not limited to faith-related literature and groups) from different faith traditions in their communities that are affirming and welcoming of lesbian. & Hecker. many lesbian. 2008). changing religious and spiritual attitudes and practices. and bisexual clients may have had. Application. the influence and meaning of faith for lesbian. grieving related to the death of a partner (age-normative issue) may be exacerbated by heterosexism among older peers (cohort effect). and political involvement (Fassinger & Arseneau. and bisexual individuals. and bisexual persons may differ across the life span. and bisexual people. 2009b) and discussing the current research and possible risks associated with change efforts with their clients. Religion-Based and/or Religion-Derived Prejudice” (Anton.g. Application. and bisexual individuals may differ substantially based on the effects of cohort and age. 2007). Multiple minority status (e. and bisexual clients who are conflicted because of their religious identification (Benoit. the effects of HIV/AIDS on sexual minority communities. gay. and bisexual older adults experience ageism within lesbian. For example. Kimmel. Lesbian. 2007). gay. They are encouraged to understand both the historical and current role and impact of religion and spirituality in the lives of their lesbian. In addition. & David. 2008). gay. and bisexual individuals have more frequent interactions with medical providers (age effect) combined with the likely concealment of identity (cohort effect). 2009b. Psychologists strive to recognize cohort and age differences among lesbian. and bisexual older individuals (Kimmel. gay. gay. and bisexual individuals may differ in terms of the role that religion and spirituality play in their current lives. Berger. and bisexual communities (Kimmel et al. gay. 2006). 2001). Harris. finances. Harris. 21 . Lack of legal protections may raise problems in medical and financial decision making. parenting rights. Rose. In regard to the interaction of cohort and age. some view their faith traditions and spiritual beliefs as an important and integral part of identity. gay. a 15-year-old coming out today likely would have a different experience than a 45-year-old coming out today. In regard to age. Normative issues or changes related to aging for all older adults (e. for lesbian. the time period in which one has lived January 2012 ● American Psychologist and/or come out can profoundly shape such developmental tasks as claiming identity labels. APA’s “Resolution on Religious. lesbian. Lesbian. gay. access to appropriate health care. Tozer & Hayes. Psychologists are urged to consider the particular historical context of the cohort to which the client belongs. 2002. Psychologists strive to be aware and respectful of the diverse religious and spiritual practices espoused by lesbian. couple autonomy in health and end-of-life decisions. race and ethnicity) also will affect the experience of aging for lesbian. For instance. inheritances.. as for their heterosexual counterparts. & Kashubek-West. The majority of clients who seek SOCE hold religious beliefs that they experience as incompatible with their sexual orientation (APA. parenting.. retirement. gay. and bisexual people. health care and retirement benefits. psychologists recognize that older adults are a diverse group and that normative changes in aging may be positive as well as negative and are not necessarily related to pathology or to a client’s sexual orientation.g. gay. advancements in reproductive technologies and changes in ideologies about families. disability. resulting in a lack of support for the grieving partner. Cohort effects are distinct from age differences. including identity labels. and social support. a person who came out in the 1950s likely would have had a very different experience than someone who came out within the past decade. 2004). women in same-sex relationships may experience heightened financial difficulties due to the cumulative effects of depressed earnings over their lifetimes (Fassinger. 2006). and bisexual people. Examples of factors influencing generational differences include changing societal attitudes toward sexuality.

when appropriate. 2001). J. gay. such as social alienation (Sullivan & Wodarski. This study found that lower levels of familial rejection during adolescence and young adulthood were associated with lower level of depression. Application. Psychologists may find resources on positive adaptation to aging among lesbian. 1991). and bisexual individuals with disabilities may encounter a wide range of particJanuary 2012 ● American Psychologist .Psychologists recognize that federal. Psychologists are encouraged to recognize the particular challenges that lesbian. bisexual. gay. legal. T. and sexually transmitted diseases (Solorio. gay. Rationale. 2001). 2007. & Cloth. Psychologists therefore strive to create an open and affirming therapeutic context for discussions of sexuality and exploration of meaning that youths give to self-identifying terms... reduced substance use. and questioning youths who do not conform to gender norms may experience increased difficulties in peer relationships (D’Augelli et al. 1990. Espelage et al. gay. and bisexual teens at higher risk for unwanted pregnancy (Saewyc.. gay. such as school dropout. gay. 2006). 2006). and questioning youths (Ryan. Lee. Kimmel et al. Ryan. J. and bisexual youths often have problems in school that are related to their sexual orientation (Cooper-Nicols. Psychologists strive to understand the unique problems and risks that exist for lesbian. Ryan (2009) showed that even minor levels of parental acceptance are associated with increased psychological and physical well-being in lesbian. to hide their sexual orientation. D’Augelli. Lasser. poor academic performance. 2008). H. Psychologists are encouraged to consider the psychological impact of current social and political events and media portrayals of sexual minorities on lesbian. and bisexual individuals with physical. Youths may feel reluctant to claim an identity relative to sexual orientation. Green. 2006. such as homelessness (Urbina. gay. 2006). and bisexual youths is particularly important. gay. and questioning youths and their families to identify alternative resources for education. and age of consensual sex differ from state to state. Navigating the cognitive. 1994). Meyer. Schrimshaw. sensory. Meyer. Supportive families may be a protective factor against the negative effects of minority stress for lesbian. & Driscoll. and bisexual older adults helpful (Friend. However. and bisexual youths. Psychologists may help older lesbians. gay. less high-risk sexual behavior. psychologists are urged to assess the level of acceptance or rejection of their child’s sexual orientation. and bisexual youths of color. 2004). Furthermore. and bisexual clients to apply strategies they have learned from coping with heterosexism in managing the challenges associated with normative aging (Fassinger. & Hunter. A strong friendship network has been viewed as pivotal in sexual identity exploration and development (D’Augelli. 2006). and bisexual youths often experience negative parental reactions about their sexual orientation (Heatherington & Lavner. & Braun. Research shows that lesbian. 2007). Interventions might include employing psychoeducational strategies to provide accurate information about sexual orientation and building on familial strengths to increase support for their lesbian. and suicidal behavior. Meyer. bisexual. given that laws on confidentiality. Wilson & Wren. Guideline 15. 2005). such as posttraumatic stress (Rivers. and bisexual identities may create pressure on youths to conform to heterosexual dating behaviors. engaging in unsafe sex (Rosario. sexual identity may be experienced as fluid during adolescence (Diamond. 2002). Russell. gay. Rosario. 1987). Attempts to mask or deny their sexual identity may put lesbian. Psychologists are encouraged to work with teachers and school administrators to assist them in recognizing the long-term impact of such harassment. or questioning youths. 1997. 2009). Rationale. Franz. or to avoid social interactions (Safren & Pantalone. and suicide attempts (Savin-Williams. J. & Weiss. gay. for whom family and community may be a vital source of support for dealing with racism (see Guideline 11). 2003. and bisexual clients and are aware of relevant resources that may assist clients with medical. and questioning youths may be at increased risk for difficulties not experienced by their heterosexual counterparts (cf. 2006). gay. or bisexual identity can be challenging for youths (D’Augelli. gay. Decisions about coming out may pose even greater difficulties for lesbian. gay. Lesbian. and affirming Internet sites. gay. opportunities for support. 2002. 2002) and bullying (E. Psychologists can serve as resources to assist school personnel in reducing sexual orientation harassment in schools. and cognitive– emotional disabilities experience. well-intentioned heterosexual parents may not offer the degree of insight and socialization needed by lesbian. and bisexual youths (I. Milburn. and bisexual youths. 2006). and financial needs. bisexual. 2004). 2002. and lowered suicide risk. and bisexual youths are subjected to high levels of sexual orientation harassment in schools (E. gay. 2009). interpersonal violence (S. gay. and social developmental changes of adolescence while simultaneously integrating the emergence of a lesbian. These factors may increase the risk of substance abuse (Jordan. bisexual. 2009). gay men. prostitution (Savin-Williams. Close relationships with a network of supportive friends therefore are extremely important and can serve as a buffer against the pain of familial rejection and/or societal heterosexism. bisexual. Guideline 14. and bisexual youths to 22 protect them from both the experience of heterosexism and the internalization of heterosexist beliefs (R. gay. 2006). 2009). and local laws and regulations affect the rights of their older lesbian. Tharinger. gay. Lesbian. emotional. Lesbian. 2000) or have long-term consequences. gay. Lesbian. An awareness of ethical and legal issues when working with lesbian. Lesbian. health status disclosure. state. 2007). When working with parents of lesbian. gay. gay. Thomas & Larrabee. Psychologists also strive to help lesbian. and bisexual youths. Hunter. 2008. The social stigma associated with lesbian. Schrimshaw.

empirical studies on the mental health of people living with HIV/AIDS consistently have revealed high rates of mood and anxiety disorders (Bing et al. & Clay. Whetten. Older adults face particular challenges relative to HIV/AIDS. given the disenfranchisement and sense of invisibility experienced by many in this group (Shuttleworth. 2009). Additional factors that contribute to the prejudice and discrimination faced by people living with HIV/AIDS include misunderstanding of or misinformation about the virus (Ritieni. 1994). O’Toole & Bregante. 2004. Hunt et al. & Perez. Rath. In addition to coping with a stigmatized illness. health status. 2006). and cognitive– emotional disabilities. Parsons.. & Lammel. Berg. people living with HIV/AIDS have to face the myriad medical problems and medication side effects that are characteristic of the virus and its treatment (Johnson & Neilands. Mona. support. Because HIV/AIDS and sexual orientation have been conflated. 2008). 2007). may be specifically challenging. 1994). 2010). and medical and legal decision making. Hanjorgiris. which. and bisexual clients with disabilities. Some HIV-negative older adults may be at risk for seroconversion due to disinhibitory sexual behavior associated with decreased cognitive functioning. 2001). Many lesbian. and services that are available to those without disabilities (O’Toole. Lesbian. Furthermore. For example.g. Shapiro (1993) has pointed out that an individual’s self-concept may be negatively affected by these challenges. People living with the disease have reported higher rates of interpersonal violence than have their HIV-negative peers (Cohen et al. family members. family members. 2003. and bisexual individuals and communities. 2007). further compromises her or his sense of autonomy and personal agency. 2002). Psychologists working with lesbian. older adults who are surviving with HIV/AIDS may experience cognitive and physical changes associated with their treatment regimens (e. 1993). Psychologists strive to understand the impact of HIV/AIDS on the lives of lesbian.. Although an AIDS diagnosis was initially a death sentence. Anderson & Barret. For example. Olkin. gay. sexuality. & Widaman. or other emotional or existential factors (cf. 2001). 2007). cognitive– emotional. Rolland. & Karpiak..g. Eron. Milsom. Rationale. psychologists working with disabled lesbian. 2002). Comprehensive psychotherapeutic approaches to the intersection between disability and sexual orientation have been developed (cf. 1995. gay. gay. Lofgren-Martenson. gay men with intellectual and learning disabilities have been shown to be at significantly greater risk for engaging in unsafe sex (Yacoub & Hall. or bisexual person to come out to caregivers and health care professionals in order to receive responsive services (O’Toole & Bregante. They also may experience the sense of invisibility that is associated with the intersection of same-sex orientation and physical. partners. family support may not be available because of negative reactions to the person’s sexual orientation (McDaniel. gay. health care providers) and call for thoughtful assessment. 2006). Moreover. Matthews. support groups have been recommended as helpful adjuncts to psychotherapy (Williams. Many people with HIV/AIDS struggle with concerns about rejection following disclosure of their HIV-positive status to friends. & Tholandi. there may be additional stress associated with the pressure of a lesbian. Moreover. and bisexual people with disabilities have experienced coercive sexual encounters (Swartz. 1992). as well as provide information and facilitate problem solving in this often-overlooked area (Kaufman. 1995. Grov. There are a number of particular challenges faced by lesbian. and sex and romantic partners (Simoni & Pantalone. Greenwood et al. Moreover. 2007. 2006). age. & Theodore. R. it is important to note that HIV/AIDS issues occur 23 . 2005). gay. general homophobia and racism (Brooks. people living with the disease are stigmatized (Herek. Brennan. and bisexual people with disabilities may not have the same access to information. The potential additive effects of stigmatized aspects of identity may be exacerbated by issues in significant relationships (e. In addition. sexual orientation. including mobility. 2007. 2007). 2001. 2007). loneliness. Hinojos. 2007). Coping with this complex array of physical and mental health problems can be a significant challenge for individuals living with HIV. Michelson. & Odette.. 1992). Moskowitz. significant medical advances in the treatment of HIV/AIDS have resulted in its reconceptualization as a chronic disease (Pierret. and bisexual community and in the larger social context (Shapiro. Golub. and/or sensory disability (Abbott & Burns. and self-confidence. Psychologists are encouraged to inquire about January 2012 ● American Psychologist the sexual history and current sexual functioning of their lesbian. gay. sensory. 2000.. gay. 2009). gay. and socioeconomic status (Fraley. sexuality. Psychologists are urged to consider ways of empowering their lesbian. Application. & O’Neill. due to prevailing societal views of people with disabilities as nonsexual and alone. and bisexual individuals with disabilities are encouraged to pay particular attention to the covariance of issues of disability. and bisexual individuals are urged to consider the potential effects of social barriers in the lesbian. & Safren. Thompson. race. gay. 2007. Etzel. special issues related to life management. Williams. and bisexual individuals with physical. Guideline 16. as well for the psychologists who provide services to them (J. in turn. 1999). Where available. Henry. A sense of being “less masculine” also has been implicated in higher risk sexual behavior among disabled gay men (O’Neill & Hird. Capitanio. Oelklaus. ethnicity. gender.. and the fact that the virus is spread through behavior that some individuals or groups condemn as objectionable (Kopelman. In addition. Hunt. 2005). Miller. Within partner relationships. and bisexual clients with disabilities. as well as problems with drug and alcohol use and abuse (Pence. Sensitive exploration regarding the individual’s history of victimization is recommended. & Gaynes. depression. Silverberg. 2002).ular challenges related to the social stigma associated both with disability and with sexual orientation (Saad. caregivers. despite knowledge of safe sexual practices. 1997). gay.

Low-income individuals are more likely than those from upper socioeconomic brackets to suffer from a diagnosable mental disorder (Bourdon. 1994). 1998). Laryea & Gien. Rothblum. they continue to earn less money (Egan. For example.within the context of other physical health disparities (Krehely.g. and bisexual youths. lower socioeconomic status may constitute additional stress. Fassinger. 2005. Ayala. Badgett (2003) and Fassinger (2008) suggested that there is significant discrimination in the workplace against lesbians and gay men. Acquiring HIV may also be a catalyst for psychological or spiritual growth for some but a cause for mourning and grief for others (Moskowitz & Wrubel. Peterson. 1998). Research has also shown that gay men living in same-sex relationships earn less than men in heterosexual marriages (Allegretto & Arthur.. gay. 2003. by broaching this subject openly. Albelda et al. friends.g.g. HIV-positive men and women may experience shame or rejection from family members. 2007). and received unequal pay and benefits on the basis of their sexual orientation (Badgett. 2008). in an intimate partner relationship. Economic and Workplace Issues Guideline 17. Manderschild.. 2008. psychologists are encouraged to be cognizant of how different age cohorts may have had different experiences with HIV/AIDS. Rationale. For example. & Bakeman. Psychologists are encouraged to obtain the requisite information to be able to discuss HIV prevention strategies with their clients. Furthermore. 2005). safer/riskier sexual behavior).g. & Ho. Psychologists strive to understand and account for the impact of societal marginalization as a result of the unique multiple oppressed identities and other factors (e. and bisexual women and men may have undergone significant emotional trauma. Fassinger. In addition. There is increasing understanding of the relationship between poverty and mental health issues (e.. & Mickey. & Angold. Klawitter & Flatt. as there is in the retail market. Financial resources and education may mediate the negative effects of discrimination (e. and loss because of the many AIDS-related deaths of their friends and partners in the 1980s and early 1990s and may need continued support in the face of these losses. This is the case especially for individuals in sero-discordant relationships. & Regier. HIV seroconversion can seriously affect the social and intimate relationships of those living with the disease. psychologists are urged to avoid any assumptions pertaining to a client’s HIV serostatus based on sexual orientation or other demographic characteristics. Psychologists are encouraged to increase their awareness of the comprehensive impact of HIV/AIDS on the lives of people affected by and infected with the virus. Balsam. those lesbian. many older lesbians. Millett. Bieschke. Croteau. Among young gay men of color.g. Lesbian. and bisexual January 2012 ● American Psychologist . Van Leeuwen et al. as well as to provide support to those who are HIV positive (e. gay men. increased marginalization. Keeler.. 2001. low self-esteem and other factors (e. 2004). When conducting an initial assessment. HIV can serve as an additional stressor or barrier to intimacy. Moreover. & Sherrill. psychologists create an opportunity to offer accurate preventive educational information on HIV for all their clients (e. survival sex. gay. Narrow. Psychologists are encouraged to consider the impact of socioeconomic status on the psychological well-being of lesbian. Although gay men and lesbians tend to be more highly educated than their heterosexual counterparts (Carpenter. and bisexual youths are more likely to engage in high-risk behavior. Badgett found that gay men earned between 11% and 27% less than heterosexual males. and bisexual men and women who live in poverty have an added burden of further disenfranchisement and alienation. encouraging them to seek or continue medical care). and bisexual individuals have been fired. 2003. and lesbian couples in particular were also much more likely to be poor than heterosexual couples and their families. and drug use among lesbian. greater economic power and options. disability) of each of their clients living with HIV/AIDS..g. Data indicate that lesbian.. or coworkers (e. Rotheram-Borus. social networks) have been shown to contribute to high seroconversion rate (Brooks. given negative performance evaluations. low socioeconomic status.g. Therefore. gay. sexual minority. Ray (2006) noted that fear of persecution and lack of acceptance result in the homelessness of many lesbian. Costello. gay. In a 1995 study. denied promotion.g. (2009) found that lesbian and gay couple families are significantly more likely to be poor than are heterosexual married couple families. Bing.. Application. 2007). and bisexual men and women are often at economic disadvantage in contrast to their heterosexual counterparts. greater challenges in adjusting to a stigmatized sexual orientation. This interpersonal rejection may be particularly traumatic for those who previously have experienced similar difficulties as a result of the disclosure of other stigmatized aspects of their identity. 2007). There is no reliable way to know the HIV serostatus of any client without asking directly. Conversely. & Henry. Rae.. a person’s HIV-positive status may be a cause for discrimination in 24 employment or housing settings (e. gay. grief. Edelman. & Manning. improved self-esteem). 2008). Flores. gay. Psychologists are encouraged to discuss safe sexual behaviors with their at-risk clients. 2009). In addition. (2006) found a higher risk of suicide attempts. racial/ethnic minority. there can be significant changes in the identity and roles of those people living with HIV/AIDS as a result of their HIV infection (Baumgartner. Compton. Lau. Homeless lesbian. Moreover. 2007. and reduced opportunities to access appropriate social supports. Malcolm et al. Elmslie and Tebaldi (2007) found that gay men in managerial and blue-collar jobs can earn up to 23% less than their heterosexual counterparts.. 1993). because the partners must navigate the emotional and practical issues surrounding sex and intimacy. gay. Factor & Rothblum. and bisexual clients. Sears.

Education and Training Guideline 19. 2007).. gay. and compromised career assessment (M. 2007). lack of benefits (e. & Cogan. For example. Phillips & Fischer. and bisexual clients in identifying and addressing potential barriers to vocational development and success. and bisexual mentoring programs (Pope et al. including issues that arise in the process of searching for and obtaining a job (Lidderdale et al. Fassinger. and bisexual adults. heterosexism. Z. There are unique difficulties and risks faced by lesbian.youths than their heterosexual counterparts. Z. and bisexual issues in professional education and training. Psychologists also are encouraged to refrain from making assumptions about socioeconomic status based upon sexual orientation.g. 2005. gay.. hostile workplace climates (Ragins & Cornwell. psychologists are urged to consider the ways in which low socioeconomic status and economic discrimination based on sexual orientation may have compounding effects. 2007. 2008). Kirby. 2002). 2002). and bisexual clients in assessing their work environments and exploring appropriate strategies for sexual orientation disclosure in the workplace (M. Psychologists are urged to assist lesbian. and bisexual issues (Matthews. Social Security. Chung. and bisexual individuals include employment discrimination (Fassinger.. 2008. coping with feelings of dishonesty and invisibility. and lesbian. gay. Keeton. Pope et al. isolation from social and professional collegial networks and support. and other aspects of marginalized status (Bieschke et al. Psychologists strive to understand the unique workplace issues that exist for lesbian.g. Psychologists strive to include lesbian. 2007). pension plans. family medical leave. & Fisher. in their assessments. 2008). Anderson et al. 2003a. including constant vigilance about sharing information. Fassinger. and bisexual individuals. wage discrimination (Badgett.. Van Puymbroeck. 2004).. clergy) (Fassinger. Application. Selvidge. and bisexual individuals. gay. familial conflict. separation of personal and work lives. 2007). 2008. 2007).. Fassinger. gay. Psychologists strive to be aware of special considerations in the use of career assessment inventories with lesbian. Saucier. Same-sex couples experience legal barriers (e. exact a psychological price. Cahill & South. Herek & Garnets. These resources might include national lesbian and gay networks of professionals. TovarMurray. In addition. adjustment. The most salient issue for lesbian. and bisexual individuals (Chung. 2008. 2002). 2001. gay.. gay. 2007. Lidderdale.. Robinson. & Woodard. 2008. Matthews (2007) noted that “mental health 25 . Gillis. & Davis. occupational restrictions (e. preparing them to cope with the effects of racism. career shadowing opportunities with gay/lesbian professionals. 2004). Pope et al. 2003). Pope et al. 1996) and feel unprepared to work with these groups (Allison. gay. and bisexual workers in a context of sexual stigma is identity management (Croteau et al.. Nauta. Echemendia. and burnout from the stress of hiding identity (see Croteau et al.. it is helpful to consider the psychological sequelae of low socioeconomic status (e. and bisexual workers adopt identity management strategies to protect against actual or anticipated workplace discrimination (Croteau January 2012 ● American Psychologist et al. Croteau et al. Rationale. many lesbian. 2001. Despite the rising emphasis on diversity training during graduate education and internship. Cahill. 2005.. lack of access to legal marriage or health care benefits) that can result in socioeconomic disparities (APA. 2004). various challenges exist regarding traditional income-support mechanisms (e. race and ethnicity. & Knepp. gay. gay. It should be noted that the general assessment issues mentioned in Guideline 4 apply as well in the special case of career assessment. 1998). & DiStefano. 2008. 2001. however. and bisexual individuals in the workplace. same-sex partner benefits. Elmslie & Tebaldi. studies have shown that graduate students in psychology and early career psychologists report inadequate education and training in lesbian. the interactive effects of bias based upon gender. & Cornwell. and achievement (Croteau et al. gay. particularly the impact of sexual stigma (Herek. Anderson. & Ackerlind. Anderson. 401(k) plans. Tomlinson & Fassinger. 2009) on vocational decision making. and bisexual clients. job stereotyping (Chung. 2008.. G. ableism. gay. Psychologists are encouraged to assess the ways in which socioeconomic status affects lesbian. Psychologists are encouraged to address issues of multiple oppressions when providing counseling regarding work and career for lesbian. Psychologists can be helpful to lesbian.. Psychologists are encouraged to assist their lesbian. 1994.. anxiety) upon lesbian. gay. 2008). Rationale.g. 1996). Russell. Singh.g. and bisexual clients in overcoming internalized stereotypes about themselves and/or about the world of work that may affect their occupational choices and decision making (Adams. choice.. Herek. special programs by lesbian/gay professionals. sexism. Application. gay. Guideline 18. child care. 2003b. and bisexual clients in their vocational and workplace decision making by encouraging them to become aware of local and national career resources. shame. Ragins. gay. and other forms of marginalization (Bieschke et al. bereavement leave. M.. local gay/lesbian community resources. 2004). 2001. Pilkington & Cantor. 2008. depression. Croteau. Although research indicates that identity disclosure is linked to more positive mental health outcomes than is concealing identity (cf. and relationship problems. 2008). as these may linger throughout the life span even if one advances in socioeconomic status (Martell. Psychologists can aid lesbian. externships or cooperative education placements in gay/lesbian-owned or -operated businesses. Crawford. gay. 2002).. Croteau. disability.. military. Barriers to the vocational development and success of lesbian.g. ageism. In older lesbian. gay. 2001. 2008). 2009a). implementation. Identity concealment strategies. Croteau et al. and bisexual clients in areas such as low selfesteem. 2008). 2003.

gay. & Patton. gay. and Shulman (2003). 2002.. Students may describe their attitudes as more affirmative than these actually are if examined more deeply. and Blasko (2007) noted that some of these improved attitudes appear to be superficial and are not necessarily exhibited in the behavior of therapists. and bisexual clients. and/or supervision that psychologists receive regarding lesbian. 2000. Identification as lesbian. (f) unique career development and workplace issues experienced by lesbian. (d) the effects of stigmatization upon lesbian. Whilde. gay. gay. gay. and bisexual individuals. and bisexual clients (Biaggio et al. research support. and/or supervision in such areas as (a) human sexuality and multidimensional models of sexual orientation. attitudes.. 2007. 2003. 2000. Buhrke & Douce. (h) issues of religion and spirituality for lesbian. gay. Paul.. 2007). Faculty. experience. Perez.g. Reinhardt. advocacy). 2007. Ketz. and bisexual clients. 1995. and bisexual individuals. A. Guideline 20.. and bisexual issues is essential. APA. gender. Winegarten et al. gay. 1996. or bisexual does not necessarily confer expertise in practice with lesbian. 2000.. Application. & Mihara. 1064). practice experience. Prior to teaching about attitudes toward lesbian. 2003.g. and bisexual psychology may be used on a full-time or part-time basis to provide training and consultation to faculty. 1991. Resources are available to assist faculty in including lesbian. & Park. (b) mental health issues affecting lesbian. including ethnic and cultural factors affecting identity. 1995. Grzegorek. Bieschke. 2003). Psychologists who have expertise in lesbian. Pilkington & Cantor. training. Israel & Hackett. sexual orientation. Psychologists are encouraged to educate their students about the nature and effects of heterosexual privilege (T. and bisexual clients. (2003) suggested prioritizing the affirmation of diversity throughout the institution. overidentification with the client. Halpert. 1996. 1997. training.g. instructors (regardless of their sexual orientations) are strongly advised to explore their own attitudes (Biaggio et al. Psychologists are urged to consider additional education. Simoni. 2007. APA’s Ethics Code (APA. gay. & DeBord. 2002. Application. 2000). and bisexual issues often have been inadequate. and bisexual members of the institution (e. Recommendations for graduate education include both individual courses and the infusion of relevant information throughout the curriculum (Biaggio. Estrada.. and bisexual individuals. tenure. 2000). 205). training. T. 2005). disability). a broad range of knowledge. and families. Petrino. including sexual orientation in university equal employment opportunity statements and admission and recruitment. 2002b) urges psychologists to “undertake ongoing efforts to develop and maintain their competence” (p. J. & Toohey. Greene & Croom. Murphy.professionals live in the same heterosexist society as everybody else and are subject to the biases and prejudices that permeate that culture” (p. (g) nontraditional relationship forms. gay. Mintz & Bieschke. Tozer. and questioning clients. 1991. Psychologists are encouraged to increase their knowledge and understanding of homosexuality and bisexuality through continuing education. gay. Training has been shown to clarify negative attitudes about nonheterosexual orientations (Boysen & Vogel. supervisors. (c) lesbian. and bisexual identity development in a heteronormative society.g. bisexual. and bisexual training programs or modules have been shown to positively enhance the knowledge and skills of students (Rutter.. Unfortunately. gay. Lesbian. Greene (1997) outlined some of the issues unique to nonheterosexual practitioners (e. 1994). Orchard. and other personnel decisions. and bisexual clients. and bisexual issues to increase awareness of the unique needs of lesbian. Israel. Pope. gay. outdated. and consultation. & Diggs. gay.. Israel & Selvidge. and bisexual people. research guidance.. Ferguson. and providing 26 support systems for lesbian. Although the study of diverse populations has received more attention in recent years. gay. Nystrom. 2004. gay. 2000). Simoni. consultation. Ritter & Terndrup. 2009). Matthews. Rationale. 2003) and to challenge heterosexist bias (Biaggio et al. presented affirmative models of supervision that may be used with any theoretical orientation and that can help students become culturally competent practitioners with lesbian. Rawlings. and course and clinical supervision to students. 1996. Although the provision of current information regarding lesbian. Burke. class. Hancock. Phillips. gay. 1996) and in training and supervision (e. Israel & Hackett. 2008). 1996. 2003. the education. According to T. Issues regarding institutional climate and support also have been discussed in recent literature. concerns about boundaries. considering diversity in promotion. gay. and consultants are encouraged to integrate current information about lesbian. T. and bisexual clients. Studies historically have revealed psychotherapist prejudice and insensitivity in working with lesbian.. couples. resource centers. and (i) health and wellness January 2012 ● American Psychologist . Halpert et al. Croteau & Bieschke. and bisexual people (Garnets et al.g. Larson. gay. 2004). Personal exploration of attitudes and biases in the education and training of psychologists may ultimately assist students to evaluate themselves with greater honesty and accuracy and to provide more sensitive care to their lesbian. gay. or unavailable (Morrow. and bisexual clients reported by therapists (Bieschke. gay.. Biaggio et al. Bieschke. 2008. 2000). consultation. 1998. Phillips. Savin-Williams & Cohen. Hancock. and bisexual issues throughout graduate training for professional practice. Although more recent research has indicated more positive attitudes toward lesbian. (e) the intersections of multiple identities (e. a number of authors also strongly recommend personal exploration of attitudes and biases (e. Detrie. gay. McClanahan. Faculty and clinical supervisors are encouraged to seek continuing education course work in lesbian. gay. race and ethnicity. Cabaj & Stein.g. gay. Liddle. mentoring programs). many practicing psychologists may not have received basic information pertaining to working with lesbian. and bisexual content in program curricula (e. supervision. Sherry. 2000. 1995. and skills is called for in order to work effectively with lesbian. & Howe.

and electronic) in their work with lesbian. A listing of suggested mental health. gay. Sound research findings about any stigmatized group represent an important contribution to the discipline of psychology and to society in general. The nature of prejudice. Psychologists are further urged to seek continuing education courses that provide specific information on working with bisexual clients and materials that address their particular issues in treatment (e. 1996. 2001. and bisexual clients. Too high a price: The case against restricting gay parenting. Awareness of and access to community resources are important because research indicates that engagement in the lesbian.01). 1992. 792–796.2004. Psychologists strive to be aware of and to work proactively to prevent the dissemination of inaccurate information (APA. and bisexual community. Many psychologists might benefit from specific training pertaining to the particular issues of bisexual clients and affirmative psychotherapy with bisexual women and men. M. & Arthur. psychologists who cite others’ research are urged to present full and accurate descriptions of that research. and bisexual people or to a broader gay community and the resources it might afford. 2002b) requires psychologists to avoid false or deceptive statements (Standard 5. 2003) and to take their absence into account when applying or discussing research findings. (Original work published 1954) American Association for Marriage and Family Therapy. 2002b.. as the content of such courses is likely to be compatible with existing APA guidelines and policies. An empirical analysis of homosexual/heterosexual male earnings differentials: Unmarried and unequal? Industrial and Labor Relations Review. educational.issues. In the use and dissemination of research on sexual orientation and related issues. 1995. In much the same way that researchers strive to specify the limitations of their own findings. 1988. Gagnon. Fox. to offer to provide synopses of research studies or the actual research reports. (2007). 49. CA: Williams Institute. to ask for confirmation that journalists understand information provided. doi:10. M.1016/j. 1997). Poverty in the lesbian. (1979). M. gay. and bisexual people with intellectual disabilities in the United Kingdom and views of the staff who support them. AAMFT code of ethics. and bisexual populations and to take into account the complexities and the limitations of the research (Cochran. Robinson. Kimmel.792 Allport. MA: AddisonWesley.4. This situation. Journal of Vocational Behavior. Bargh & Chartrand.. Herek et al. American Psychologist. 19 –35.. & Michaels. Matteson.1525/srsp. Badgett. gay. Schneebaum. A. gay. What’s love got to do with it? Experiences of lesbian. gay lifestyles. D. 66. Journal of Homosexuality. Kurdek. Amaro. 1999). Human diversity and professional competence: Training in clinical and counseling psychology revisited. 2003). S. Members of the media are typically not well schooled in the intricacies of research methods or the appropriate interpretation of research findings. Psychologists are encouraged to exercise care when citing or quoting from the research findings published by third parties. G. (2002). Albelda. 2006. Echemendia. Los Angeles. Laumann. in combination with media emphasis on dramatic story lines (Conrad. 1998. Just as bias can influence the conduct of research. D.. A qualitative study of Latino lesbian and gay youths’ experiences with discrimination and the career development process. & Gates. W. A. (2005). New York. N. it also can influence the interpretations of research by others and the uses to which research results are put.. G. & Levy. gay. Research Guideline 21. psychologists strive to represent results fully and accurately and to be mindful of the potential misuse or misrepresentation of research findings. K.. 32(2).g. and bisexual people has been misused and misrepresented to the detriment of lesbian. Standard 5. B. Lemm. J. Psychologists strive to exercise caution in their use of research on lesbian. local. Herek.1037/0003-066X. Russell & Richards. Lesbian. Comparing the impact of homosexual and heterosexual parents on children: Meta-analysis of existing research. R. (1990)... Sexuality Research and Social Policy. 27 . DC: Author. & Burrell.2007. state.jvb. gay. Russell & Kelly. Journal of Homosexuality.9. J. It is also useful for psychologists January 2012 ● American Psychologist to maintain an awareness of subgroups within lesbian. Banaji. R. Psychologists are encouraged to make reasonable efforts to familiarize themselves with relevant resources (national. 1999..1. S. (2009). G.g. J. 27–39. can result in misleading or explicitly inaccurate expositions of research. and bisexual affirmative continuing education courses. However. gay. 1994. Firestein. & Melton. (1994).2307/2695994 Allen. 2001. 631– 646. and to emphasize to journalists the complexity and the limitations of research findings. & Burns. W.. L.49. Cahill. NY: American Civil Liberties Union. & Knepp. gay. gay.. 1998.. Rationale. 199 –218.11. Psychologists are encouraged to seek out lesbian. and bisexual communities who are not included in research samples (Greene. D’Augelli & Garnets. gay. 1991. M. 20(3– 4).002 Adelman. and community resources is provided in Appendix A. doi: 10. Michael. M. & Ackerlind. psychologists strive to be aware of the potential influence of overt and covert bias (Banaji & Hardin.. 1999). and adjustment to aging: A study of later-life gay men and lesbians. Crawford.27 ACLU Lesbian and Gay Rights Project. In addition. (2001). 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2007. J. 6(1–2). Lesbian and Straight Education Network (GLSEN) Strives to assure that each member of every school community is valued and respected regardless of sexual orientation or gender identity/expression. Markowski. http://thetaskforce. 10. Human Rights Campaign The largest national lesbian. Becoming visible: Counseling bisexuals across the lifespan ( Parents. 1996). Bisexual.1111/j. doi:10. Journal of Criminal Law & Criminology.00491. Defining sexual minority adolescents—GLB and same-sex attractions: Examining risks and outcomes. Y. their families. http://www. bisexual. Society for the Psychological Study of Lesbian. Counseling bisexuals in polyamorous relationships. 1995. and alumni have equity in every respect. educational.108 Wilson. and Transgender Concerns http://www. N. (2005).. San Francisco. and family support. J. Sexuality Research and Social Policy. & Wren. NY: Columbia University Press. social and recreational.. many national resources have information about regional resources. D. British Journal of Learning Disabilities. Weston.1300/ J159v06n01_08 Weitzman. transgender people. gay men. and so on. Cassie. and transgender persons. lesbian.apadivision44. faculty. G. (1992). Online resources exist at a number of levels. J. NY: Columbia University Press. doi:10. Gates and Ost (2004) have published an atlas of census-based information on the distribution of lesbian... gay.2008. Weitzman. Williams. and public policy work. K. Paper presented at the meeting of the American Psychological Association. B. and bisexual communities that can provide valuable guidance (e. To access resources in individual cities. and transgender civil rights organization. A.4. For National Gay and Lesbian Task Force (The Task Force) Works to build the grassroots power of the lesbian. bisexual. 307–315. 1363–1410.Wardenski.. 5–11. http://www. http://www. http://www. Professional Psychology: Research and Practice. B. Review of gay. Bisexual. G. 33. & Hall. real estate. (2007). one can search online using words such as gay paired with the city name. Paper presented at the meeting of the American Psychological Association. and Transgender Issues http://www. Gay. Gay. bisexual. Families and Friends of Lesbians and Gays (PFLAG) Promotes the health and well-being of gay.1525/srsp. (2006). New York. August). (2007).org/pi/lgbc/homepage. BiResource Committed to providing support to the bisexual community and raising public awareness about bisexuality and bisexual people. bisexual and transgender people with developmental disabilities and mental retardation: Stories of the Rainbow Support Group.g. education.x Yarhouse. 37.html APA Division 44. doi:10. Families we choose. and their friends. http://pflag. and transgender community. 312–335).lgbtcampus. 235– 241. Texas on LGBT Other Resources BiNet USA An umbrella organization and voice for bisexual people. (2009).235 Appendix A Internet Resources It is useful for psychologists to know how to acquire information about resources of various Children of Lesbians and Gays Everywhere (COLAGE) A national movement of children. I. (2002). 4. In addition. doi:10.hrc.1037/0735-7028. (2007. M.33. administrators. bisexuals. (2005). 95. Journal of Health Psychology. The interaction between young people with atypical gender identity organization and their peers. D’Augelli & Garnets.1. Several authors have provided overviews of lesbian.. Therapy with clients who are bisexual and polyamorous.apa. A minor exception? The impact of Lawrence v. and adults with one or more lesbian.. and bisexual households in towns or cities and states in the United States. In B. transgender. Firestein (Ed. & Chung. and/or queer parents.1468-3156. Yacoub. A. & Burkett. 108 –109. bisexual. B. bisexual. M. Whitney. National resources tend to be quite stable and can provide psychologists with a wide variety of general information. L. K. The sexual lives of men with mild learning disability: A qualitative study. & Yoder. August). religion and spirituality. including therapeutic. New York. Griffin.. C. gay. CA. Los Angeles. gay.biresource. Louis” yields many helpful links. January 2012 ● American Psychologist . gay. staff. a search on “gay Lambda Legal Committed to achieving full recognition of the civil rights of 40 Consortium of Higher Education LGBT Resource Professionals Works to critically transform higher education environments so that lesbian. American Psychological Association Resources APA Office of Lesbian. http://www. Mobley. 137–164. doi:10.binetusa.1177/ 1359105305051417 Winegarten. http://www. CA. http://www. and transgender students. Journal of Bisexuality.. Aversive heterosexism: Exploring unconscious bias toward lesbian psychotherapy clients. J. Kozlowski. social clubs. A. and those with HIV through impact litigation. An inclusive response to LGB and conservative religious persons: The case of same-sex attraction and behavior. gay. Esterberg.). (1994.3.lambdalegal. youths.. E. I. One can find many local resources related to health.

http://www. families. and every other kind of information. http://www. and gender January 2012 ● American Psychologist The Institute for Judaism and Sexual Orientation Its mission is to achieve the complete inclusion and welcoming of LGBT Jews in communities and congregations. http://www. http://www. families. families. and friends. and friends. families. Gay. Gay. and individuals established as a positive resource and support for Christian gays and Gay Buddhist Fellowship For LGBT Buddhists and their allies.galva108. and friends. http://www.welcomingresources. gender identity.apapracticecentral. ministries.affirmation. Bisexual. gay. and friends. Covenant Network of Presbyterians National group of clergy and lay leaders working for a fully inclusive church. it has the largest online resource on the intersection of http://www.huc. leadership training. www. and transgender Al-Fatiha For lesbian. and welcoming to LGBT Jews and their families. and friends.jewishmosaic.interweavecontinental. and friends. Integrity For LGBT Episcopalians and their allies. gay.lcna. families. and transgender (LGBT) Muslims and their allies. and Transgender Advocacy and Affinity Organizations Affirmation Provides a forum for gay Mormons to associate with their peers. DignityUSA For LGBT Catholics and their allies. and hope to meritorious students who are marginalized due to sexual Lesbian.uua. Queer Resources Directory (QRD) An electronic library with news Church Within a Church Movement A progressive Methodist movement dedicated to being the fully inclusive church. The Evangelical Network Churches. mentoring.sageusa. Institute for Welcoming Resources Resources supporting the unconditional welcome of people of all sexual orientations and gender identities and their families in the church home of their Religious Organizations (see Appendix B) Services and Advocacy for Jewish Mosaic: The National Center for Sexual and Gender Diversity Dedicated to helping the Jewish world become more open. http://www. and transgender older adults. Sponsored by the National Gay and Lesbian Task Lutherans Concerned For LGBT Lutherans and their Association of Welcoming and Affirming Baptists For LGBT Baptists and their allies. and friends. http://www. and Transgender Ministries For LGBT Unitarian Universalists and their Metropolitan Community Churches (MCC) Metropolitan Community Churches is ecumenical in nature and has historically had largely lesbian. and friends. http://www. families. sexual orientation. bisexual. http://www. http://www. Interweave–Unitarian Universalists for LGBT Concerns For LGBT Unitarian Universalists and their allies. bisexual. and friends. http://www. families. and Transgender Elders (SAGE) The country’s largest and oldest organization dedicated to improving the lives of lesbian. families. images. Christian workers. gay. newsletters.Point Foundation Provides financial support.mccchurch. Reconciling Ministries Network For LGBT United Methodists and their allies. http://www. political contact information. families. essays. http://gaybuddhist. bisexual. Based at a Jewish seminary. or gender expression. Lesbian. State Psychological Associations These often have therapist referral .thepointfoundation. hyperlinks.qrd. http://www.T-E-N. Gay and Lesbian Vaishnava Association For LGBT Hindus and their allies.wabaptists. and friends.aspx Appendix B Religious and Denominational 41 .

sdakinship. gay. 42 January 2012 ● American Psychologist Soulforce Committed to relentless nonviolent resistance to bring freedom to lesbian. http://www. http://rpifellowship. United Church of Christ Coalition for LGBT Concerns Provides support and sanctuary to LGBT people and their families and friends. bisexual transgender.ucccoalition. and queer people from religious and political oppression. Seventh-Day Adventist Kinship International LGBT-affirming organization for current and former Seventh-Day Adventists. and friends.Reconciling Pentecostals International For LGBT Pentecostals and their allies.

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