How Sexual Orientation and Cultural Differences May Affect the Client – Therapist Relationship


The understanding of a possibly destructive relationship between the gay/lesbian and culturally diverse populations in concert with the predominantly heterosexual and majority culture environment is an important part of developing practice knowledge to work with gay/lesbian and diverse clients. If therapists are supposed to work with these clients, then a knowledge base and understanding of their different and specific needs is not expected but should be required.

The profession has set guidelines and standards to assist these various populations in receiving relevant care but what standards exist that ensure and guarantee their adherence. This paper will address some of the barriers that may exist with respect to these topics.


This research paper is intended to introduce barriers that may impede on the successful relationship between a therapist and their client when said client is culturally different or is of the gay/lesbian orientation. I believe these barriers are significant in the success or failure of the client receiving appropriate guidance from their therapist.

Although I don’t believe members of the profession are purposely trying to do harm to these populations, I am merely pointing out that ignoring the issues associated with these groups is harmful to the client.

I intend to provide credible data that highlight the beliefs of the general population (including psychologists) concerning gays/lesbians, and people who are culturally different from the dominant population. I will then show that such beliefs and biases create a burden on the groups aforementioned to seek useful therapy and causes therapists to misdiagnose the root cause of problems displayed by the clients.

In addition to biases that create barriers concerning therapy to these groups, I will focus on the need to highlight the issues, education for those who are want to work with these populations and the training of therapist to acquire the necessary knowledge and skills to treat persons of diverse cultures and sexual orientations that is different from their own.

I also intend to show that there should be an out for therapists who have personal biases about groups that are racially, ethically, culturally and sexually oriented from themselves.

There is a definite need for psychologist to examine themselves when considering working with diverse populations. There first need to be a real understanding of self. I will show that any therapist will ensure they are well versed on issues these areas, has the skills necessary to create an environment that is positively and nonjudgmental and will not feel uncomfortable discussing issues related to homosexuality and cultural differences.

The fact that many psychologists would work with a client that they don’t understand their lives and where they’re coming from because of various reasons is almost criminal. It’s not any different than having a foot doctor do open heart surgery on a patient. They won’t understand what the problem really is, how it came about or how to properly fix it. Refer this client to someone who is able to provide the necessary components of a therapeutic relationship.

I will write about that fact that people of diverse backgrounds, specifically gays/lesbians and culturally diverse groups) seek help from therapist to improve their situations, not come out with greater harm that when they started.

Gay & Lesbian Populations

Before beginning any treatment with a homosexual client, a therapist has the responsibility of making sure he or she is well versed on issues related to sexuality, has the skills necessary to create a positive and nonjudgmental environment, and will not feel uncomfortable discussing issues related to homosexuality. If a therapist believes homosexuality is wrong, sinful, immoral, or a mental illness, he or she should not work with gay clients. These clients should be referred to someone who is able to provide the necessary components of a therapeutic relationship.

Culturally Diverse Populations

A major assumption for culturally effective counseling and psychotherapy is that we can acknowledge our own ways we view and understand other cultures, and the limits our own culture places on our understanding. It is of great importance we understand our own cultural heritage and world view before we set about understanding and assisting other people (Ibrahim, 1985; Lauver, 1986). This understanding includes an awareness of our own philosophies of life and capabilities, recognition of different ways of reasoning, and an understanding of their effects on one’s communication and helping style (Ibrahim, 1985). Lack of such understanding may hinder effective intervention (McKenzie, 1986).


A distinguished result of this study is facts of a communication effect between therapist gender and client sexual orientation. First, male therapists pointed out a greater probability that LGB clients would threaten to hurt somebody than would heterosexual clients, and these ratings for LGB clients were considerably higher than female therapists’ ratings of all clients. Steady with the findings that male therapists are more likely than female therapists to typecast clients and that men show signs of more unenthusiastic attitudes toward LGB individuals than do women, this particular result gives supplementary proof that male therapists may judge LGB clients to be more pathological and more intimidating to others in contrast to heterosexual clients.

This study raises significant query in relation to precisely how LGB clients may be experienced and evaluated by male therapists and the degree to which typecasts about LGB people may have an effect on male therapists’ clinical results and evaluations. Can male therapists be more likely than female therapists to experience fear of or apprension about homosexuality or biphobia that would direct to a close that a client with an LGB sexual orientation is naturally threatening or unsafe to others? Alternately, can male therapists be more likely than female therapists to conceive LGB clients as less emotionally stable and more violent and unstable in dealing with complexities in contrast to heterosexual clients? In light of the affect of homophobic and biphobic reaction common within normal U.S. culture, and the not-so- distant practice of analyzing and discovering LGB sexual orientations as pathologically abnormal, it is suggested that psychologists be employed in further preparation, direction, and their own therapy to expand better insight in distinguishing how they experience and evaluate clients of conflicting sexual orientations and how typecasts about LGB people may add to their responses. For instance, Morrow (2000) postulated that homophobic and heterosexist manners stem at least in fraction from societal gender standards and stereotypes of LGB people— “lesbians as hypermasculine and gay men as effeminate” (p. 141). In fact, Fukuyama and Ferguson (2000) recognized that sociocultural shame connected to sexual orientation as a means of striking traditional gender roles—specially, that “boys are forced into masculine behaviors by threats of being called a ‘faggot’” (p. 85) and that femaleness in boys is believed to be more disgraceful than masculinity in girls. Increasing a greater understanding of potential influences on unconstructive outlooks toward LGB people is necessary for psychologists so that they can boost their awareness of their own attitudes, beliefs, and biases in order to work efficiently with LGB clients or any client with issues linked to sexual orientation.

The next important interaction effect was that female therapists expected greater development in depressive symptoms for bisexual clients than for heterosexual clients, and these ratings for bisexual clients were considerably higher than male therapists’ ratings of all clients.

This outcome is dependable with earlier findings documenting more optimistic attitudes toward LGB individuals among women than among men. It is not easy to understand female therapists’ higher prospects for improvement in depressive symptoms for bisexual clients purposely, chiefly because there has been little study of bisexuality to date. It may be that female therapists sympathized with bisexual individuals— who are frequently marginalized in both heterosexual and lesbian–gay group of people—as a consequence of having experienced sexist bias and domination themselves. It is likely that female therapists viewed bisexual clients as mostly able to gain from therapy to deal with depressive symptoms that may have been understood as at least partially alleviated by domineering sociocultural influences. Though such understanding are tentative in the absence of a more complete understanding of bisexuality, this study highlights that psychologists are conscious of the character of and causes for possible inconsistencies in how they assess clients of conflicting sexual orientations. Psychologists who are LGB themselves, for example, may have insight about sexual orientation or attitudes toward LGB or heterosexual clients that are knowledgeable by their exceptional experiences as members of an “invisible minority” (Fassinger, 1991, p. 157) that experiences continued bias, marginalization, and domination in typical U.S. culture. Furthermore, beliefs and awareness about sexual orientation differ among diverse cultural groups—a number of which do not stigmatize or marginalize LGB people and associations or do not think individuality to be based on sexuality. Self-exploration is a means for psychologists to sharpen their understanding of their beliefs, attitudes, and values about gender, gender role expectations, and sexual orientation issues. Assessment of biases and stereotypes, their sources, their senses, and their possible consequences is also suggested as element of the self-exploration development (Morrow, 2000). Given the difficulty of these subjects, psychologists should view the self-examination process within a broader perspective that consists of reflection on many sides of their individualities, such as the influence of their society or race. Psychologists are encouraged to discover their own genders and sexual orientations and the sense of both on their identities and in their lives more generally.

Therapists described the greater part of the helpful situations as those in which the therapist was well-informed, supportive, suitable, or affirming in dealing with the client’s sexual orientation or gender identity. Research finding is reliable with previous studies that established the significance of using lesbian, gay, bisexual, and transgender (LGBT)-affirming attitudes when advising lesbian and gay male clients. Research findings propose that even if the client’s main concern is not sexual orientation, it is probably significant that the therapist show helpful and affirming approach toward LGBT subjects.

The therapeutic relationship between therapist and client appeared as a vital variable that typified both the cooperative and uncooperative situations, as well as their consequences. Research found that building an optimistic therapeutic relationship distinguished about half of the cooperative situations, while experiencing the therapist as negative, uncaring, bitter, or disaffirming described about half of the uncooperative situations.

Research findings are reliable with research demonstrating that a good working relationship is distinguished by therapists’ respect for clients, clients recognizing their therapist as helpful and competent, client ratings of therapist understanding, lucidity, and helpful approach, and therapist affection and openness (Hersoug, Hoglend, Monsen, & Havik, 2001). Even though a number of therapists in the uncooperative situations created sufficient working relationships with their clients, the working association in this state of affairs was not at all well-built or optimistic compare to the cooperative situations and poor working association takes place completely in the uncooperative situations.

In the conditions of consequences of the circumstances, intensifying the therapeutic relationship was one of the most important results in the cooperative situations. These findings repeat the outcomes of two large meta-analytic evaluations of experiential literature on therapy result and association, both of which give way to a reasonable and reliable relationship between working association and therapy result across kinds of treatment, sorts of clients, or procedures of association (Horvath & Symonds, 1991). The worsening of the therapeutic association (as well as early termination) was the most common result in the uncooperative situations. In reality, client conflict to interventions and premature termination were accounted merely for the uncooperative situations.

The importance of the therapeutic relationship in distinguishing the circumstances and their consequences may reveal this well-established relationship between working agreement and goodwill of therapy. Another clarification is that the therapists used quality of working agreement as a principle for defining the circumstances as supportive or unsupportive; such a clarification would be constant with findings that therapist expectation of helpfulness is connected to therapist ideas of agreement. In any case, the therapeutic relationship appears to be a significant feature of therapy with LGBT clients, as it is with non-LGBT clients. These outcomes are mostly important considering the relationship between therapeutic agreement and therapy results (Horvath & Symonds, 1991).

Several types of presenting concerns or client situations may provide themselves more simply to flourishing treatment than others. For instance, sexual orientation/gender identity was an important presenting concern in cooperative situations. This may reveal that therapists have an apparent knowledge of how to work with LGBT clients when the clients are presenting for sexual orientation/ gender identity, while they may not be familiar with how to work successfully with LGBT clients’ other concerns. It may be predominantly demanding for therapists to be supportive to LGBT clients who are mandated to be given counseling.

The degree to which clients were experiencing numerous difficulties and marginalization distinguished the supportive from the unsupportive situations, a prototype that is probably the case for non-LGBT clients as well. Present only in the uncooperative situations were clients whose gender identity was male- to-female transgender, whose cultural group membership was African American, and/or whose socioeconomic status was low. Also present only in the uncooperative situations were therapists who were representing on a case management approach. Clients needing case management services may have been dealing with a more multifaceted collection of subjects and less economic stability than those looking for therapy alone. Even therapists who are well-informed about working with LGB clients may not be familiar with the distinctive needs of transgender clients (Israel, 2005). Group variables appeared to influence the concern of the situations as well. Even though helpful agency environments were present in both the cooperative and the uncooperative situations, problems with numerous services, managers, or supervision were features only of the uncooperative situations. Therefore, having an organization where staff members feel contented and having good, helpful supervision and affirming administrators may influence the experiences of LGBT clients getting services at these organizations.


This study recognized issues that may contribute to cooperative and uncooperative therapy experiences for LGBT individuals, as well as interpersonal, relational, and environmental factors, theoretical orientation, specific interventions, demographic characteristics, and conditions of therapy. Also, client characteristics, such as ethnicity, gender identity, socioeconomic status, types of needs, and the nature of their marginalization, should be measured when giving therapy for LGBT clients. LGBT clients who experience marginalization on numerous stages or have multifaceted needs may present a meticulous test for therapists.

The social structure of race and ethnicity in this country means that everybody experiences accidental biases, resulting in unfair, cruel behaviors that result in basic violence and other crimes. It is very likely that these outlooks and behaviors expand to the course of psychotherapy. Change engages awareness of biases, and the capability of psychotherapists to promote knowledge, attitudes, and skills significant to the cultures of those with whom they work. The therapeutic association, of considerable importance in an optimistic therapeutic result, may be completely or unconstructively influenced by the choices that psychotherapists make to overcome those biases. A variety of activities and experiences are recommended in the literature, and all practitioners have a liability to connect in those activities. The APA (2003) and others have recommended a selection of approaches to lessen bias and to promote a healthy and positive therapeutic agreement. The first and most vital is steady awareness of attitudes. Other approaches involve effort and practice in modifying the routine favorable insights of the White privileged group and negative insights of those whose historical characters in society have been left with unenthusiastic insights. Accordingly, psychotherapists can rewire their circuitry through open dispensation of their biases, interest with diverse groups and individuals; readings, training, and practice in performing in ways to change their subliminal awareness in the psychotherapeutic procedure (keep on adjusting to clients, representing cultural understanding, being respectful and open to worldviews). They can change their neural pathways developed through unconstructive biases and stereotypes in society. More research is suggested to evaluate the value of the therapeutic association and how that influences result for clients of color. This would be a complex effort, as consequences of studies examining the therapeutic association frequently consider different treatment modes, with typically diverse groups of patients with a range of disorders. On the other hand, it is a significant objective, both to determine the level to which it is a problem in the psychotherapeutic underutilization of services for clients of color, as well as to recognize the sole issues connected to the promotion of the therapeutic association in cross- cultural dyads.


Future research may gain from searching specially about therapists’ cooperative and uncooperative experiences with diverse subpopulations of LGBT clients. In this study, therapists talk about lesbian clients only in the circumstance of cooperative situations and nothing of the circumstances concerned a bisexual client. Therapists did not essentially view all of their experiences with lesbian clients as supportive; rather, it is likely that therapists are more willingly remembered cooperative situations with lesbians, because they may have held more constructive attitudes toward this group than toward gay men (Kite & Whitley, 1996). The lack of situations with bisexual clients may have been due to therapists not conceptualizing a client as lesbian or gay orientation. It is also likely that therapists did not depict their clients as bisexual because the clients themselves did not recognize as such, even if they had desires toward or sexual experiences with both women and men. In the background of a monosexist culture, it would not be unexpected that clients and therapists would see a nonheterosexual individual as lesbian or gay, rather than considering the likelihood of bisexuality. So, future studies should make inquiries especially about therapist experiences with bisexual clients and about uncooperative situations with lesbian clients.

Furthermore, the issue of the exceptional experiences of transgender individuals in therapy is comparatively new and barely researched and, therefore, be worthy of further concentration. There is potential for diverse experiences, not only of transgender clients in contrast to LGB clients, but also between female-to-male and male-to-female transgender clients. Future research should focus to the exclusive experiences of subgroups of LGBT individuals, together with ethnic minority LGBT individuals and those with more multifaceted social, physical, medical, or psychological concerns.

One significant subject for further examination is how therapists should deal with sexual orientation when it is not the client’s current concern. The findings of this study point out that sexual orientation were tackled more frequently in the cooperative situations than in the uncooperative ones, whether or not it was a presenting concern. In disparity, other studies have established that LGBT clients may find it unsupportive to center on sexual orientation when it is not the presenting concern (Israel, 2005). There is a call for additional simplicity on this topic. Other significant topics for more exploration are the hypothetical orientations and detailed interventions used with LGBT clients, as well as the diverse methods of therapy for this population, together with group, couples, and family therapy. Lastly, environmental variables, such as organization support and local community principles, should be looked into further to extend a fuller understanding of LGBT clients’ experiences in therapy.


  1. American Psychological Association. (2000). Guidelines for psychotherapy with lesbian, gay, and bisexual clients. American Psychologist, 55, 1440–1451.
  2. Bersoff, D. (Ed.). (2008). Ethical conflicts in psychology. American Psychological Association. (4th ed.). Washington, DC:
  3. Cayleff, S.E. (1986). Ethical issues in counseling gender, race, and culturally distinct groups. Journal of Counseling & Development, 64, 345 – 347.
  4. Fassinger, R. E. (1991). The hidden minority: Issues and challenges in working with lesbian women and gay men. The Counseling Psychologist, 2, 157–176.
  5. Fisher, C. B. (2003). Decoding the ethics code: A practical guide for psychologists. California: Sage Publications, Inc.
  6. Fukuyama, M. A., & Ferguson, A. D. (2000). Lesbian, gay, and bisexual people of color: Understanding cultural complexity and managing multiple oppressions. In R. M. Perez, K. A. Debord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 81–105). Washington, DC: American Psychological Association.
  7. Haas, L.J., Malouf, J.L., & Mayerson, N.H. (1988). Personal and professional characteristics as factors in psychologists’ ethical decision making. Professional Psychology: Research and Practice, 19, 35 – 42.
  8. Hersoug, A. G., Hoglend, P., Monsen, J. T., & Havik, O. E. (2001). Quality of working alliance in psychotherapy: Therapist variables and patient/ therapist similarity as predictors. Journal of Psychotherapy Research, 10, 205–216.
  9. Horvath, A., & Symonds, D. (1991). Relation between working alliance and outcome in psychotherapy. Journal of Counseling Psychology, 38,139–149.
  10. Israel, T. (2005)….and sometimes T: Transgender issues in LGBT psychology. Newsletter of the Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues, 21(3), 16–18.
  11. Kessler, L.E. & Waehler, C.A. (2005). Addressing multiple relationships between clients in lesbian, gay, bisexual and transgender communities. Professional Psychology: Research and Practice, 36, 66- 72.
  12. Kite, M. E., & Whitley, B. E., Jr. (1996). Sex differences in attitudes toward homosexual persons, behaviors, and civil rights: A metaanalysis. Personality and Social Psychology Bulletin, 24, 336– 353.
  13. Lasser, J. S., & Gottlieb, M.C. (2004). Treating patients distressed regarding their sexual orientation: clinical and ethical alternatives. Professional Psychology: Research and Practice, 35. 194 – 200.
  14. Morrow, S. L. (2000). First do no harm: Therapist issues in psychotherapy with lesbian, gay, and bisexual clients. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp. 137–156). Washington, DC: American Psychological Association.
  15. Pope, K.S. & Bajt, T.R. (1988). When laws and values conflict: A dilemma for psychologists. American Psychologist, 43, 828 -829.