Problems of Therapeutic Bias

Two particular therapeutic errors that are made with LGB patients require therapists to understand fully the context in which their patients live. Although several errors resulting from therapeutic bias have been identified, the two of primary concern are (1) overemphasizing sexual orientation as a concern in therapy when it is not a concern, and (2) ignoring sexual orientation as a concern when, indeed, it is of concern to the patient (Garnets,

Hancock, Cochran, Goodchilds, & Peplau, 1991). The first of these two errors occurs most frequently with therapists who are not used to working with LGB individuals. Cultural stereotypes suggest that it is very difficult to live as openly LGB persons, and therapists may assume that the problems associated with being members of a sexual minority always cause distress. In other cases therapists may still hold negative homosexual biases that lead them to suggest there is something wrong with being LGB, or to express judgment or open hostility to lifestyle decisions that are culturally acceptable within LGB communities but may not fit a heterosexual norm. Many LGB patients come to therapy with the same concerns as heterosexual patients— concerns about work, relationships, loss of loved ones, social anxieties, general depression, and so on. In many cases a therapist sees a depressed patient who just happens to be LGB. In a few cases, a therapist sees a patient who is depressed about being LGB. It is essential to differentiate between the two, and not to impose one's own agenda on the patient.

In summary, case conceptualization with LGB depressed patients consists of standard CT techniques. However, it is important to consider contextual factors, such as the impact of being a member of a sexual minority, the patient's definition of his/her sexual identity, how public he/she is about sexual orientation, his/her history of having been subjected to negative bias or abuse, and breadth of social support. All of these factors may influence the patient's beliefs about self, world, and others. Most LGB people are not depressed, and therapists need to understand that emotional distress is not a logical by-product of being LGB, although it can be a response to living in an unsupportive, invalidating, or abusive environment.

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