Summary of Pachankis, J.E., & Goldfried, M.R. (2004) Clinical Issues in Working with Lesbian, Gay, and Bisexual Clients




Heterocentrism, or the bias against the Lesbian, Gay, Bisexual, Transgendered, or Questioning (LGBTQ) population, can be seen at every level of our society, from laws restricting the rights and opportunities of LGBTQ individuals to homophobia manifested in face-to-face prejudice. Homophobia can even be turned inward, toward the self.



“Internalized homophobia” is seen when an LGBTQ individual assumes the negative bias of society against his/herself, often leading to anger and/or shame.  In a therapeutic setting, these beliefs present as anxiety, depression, relationship difficulties, suicide ideation, and the devaluation of LGBTQ activities.  Prejudices can be acted upon by even the most well-intentioned clinicians in various ways: assuming the client is heterosexual or excessive focus on orientation of the client, even if it is not an issue at hand.



Important issues that may require a clinician’s assistance have been identified by Clark (1987) as “encouraging LGB[TQ] clients to establish a support system of other LGB[TQ] individuals, helping clients become aware of how oppression has affected them, desensitizing the shame and guilt surrounding homosexual thoughts, behaviors, and feelings, and allowing clients’ expression of anger in response to being oppressed.” Identity development, couple relationships and parenting, families of origin and families of choice, as well as other relevant issues are of particular importance and can be especially difficult for LGBTQ individuals (Pachankis& Goldfried, 2004). It is the ethical responsibility of clinicians to be familiar with these issues and ensure their competency in addressing these with LGBTQ clients.



For more information about topics salient to the LGBTQ community as well as current research, please visit the American Psychological Association’s Division 44: Society for the Psychological Study of Lesbian, Gay, Bisexual, and Transexual Issues website




Pachankis, J.E., & Goldfried, M.R. (2004). Clinical issues in working with lesbian, gay, and bisexual clients. Psychotherapy: Theory, Research, Practice, Training,  41(3), 227-246.



Cassandra A. Sturycz, B.A.
Psychology Student Intern



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