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A Survey of Clinical Psychologists on Treating Lesbian, Gay, and Bisexual Clients

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A Survey of Clinical Psychologists on Treating Lesbian, Gay, and Bisexual Clients Professional Psychology: Research and Practice Copyright 2002 by the American Psychological Association, Inc. 2002, Vol. 33, No. 2, 183–189 0735-7028/02/$5.00 DOI: 10.1037//0735-7028.33.2.183 A Survey of Clinical Psychologists on Treating Lesbian, Gay, and Bisexual Clients Julie A. Murphy, Edna I. Rawlings, and Steven R. Howe University of Cincinnati Should the average psychologist receive specific training on lesbian, gay, and bisexual (LGB) concerns? On the basis of a random sample of practicing psychologists, LGB clients are present in most caseloads. Respondents rated the most important therapeutic issues with LGB clients and identified training that would improve their work with LGB clients (including the topics of coming out, estrangement from family, support system development, and internalized homophobia). In addition, participants reported on the types of training that they are getting (most frequently reading articles, supervision, and continuing education). The implications for training programs and private practitioners are considered. Is the average psychologist qualified to work with lesbian, gay, gay men and 7% of their current clients were lesbians, and 2% of and bisexual (LGB) clients? The recent publication of the Guide- the respondents reported specializing in provision of services to lines for Psychotherapy With Lesbian, Gay, and Bisexual Clients lesbian and gay male clients. In a smaller study, 86% of therapists (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns surveyed (N ϭ 112, 18% of whom had doctorates) by Graham, Joint Task Force on Guidelines for Psychotherapy with Lesbian, Rawlings, Halpern, and Hermes (1984) reported that they had Gay, and Bisexual Clients, 2000; referred to hereinafter as the professionally counseled a lesbian or gay male client at some point Guidelines) demonstrates professional concern in regard to the in their careers. adequacy of psychologist knowledge and training on LGB issues. Lesbians and gay men have reported higher than average rates Indeed, one goal of the Guidelines is to provide practitioners with of therapy usage; of those surveyed, 25–77% reported having been “basic information and further references” (p. 1440) on working in psychotherapy at some point in their lives (e.g., Bell & Wein- with LGB clients. berg, 1978; Bradford, Ryan, & Rothblum, 1994; Liddle, 1997; Many authors (e.g., Buhrke 1989b; Buhrke & Douce, 1991; Mapou, Ayres, & Cole, 1983; Morgan, 1992; Saghir, Robins, Dworkin, 1992; Firestein, 1996; Greene, 1994; Iasenza, 1989) Walbran, & Gentry, 1970a, 1970b). Morgan found that lesbians have argued that more systematic training for mental health prac- expressed significantly more positive attitudes toward seeking titioners on LGB issues is crucial for providing quality services to professional psychological help than did heterosexual women. these populations. However, there has been little study of what Liddle also found that lesbian and gay respondents reported more type and quality of training is already taking place. The focus of therapists lifetime (M ϭ 4.32 therapists) compared with matched this article is on psychologists’ perspectives on their education, heterosexual respondents (M ϭ 3.08 therapists), and a greater training, and experience working with LGB clients. number of sessions with each therapist (82 sessions for lesbians This topic appears to be relevant for the vast majority of and gay men; 29 sessions for matched heterosexuals). American Psychological Association (APA) member practitioners. But why are LGB people such frequent users of psychotherapy? Garnets, Hancock, Cochran, Goodchilds, and Peplau (1991) ex- The findings are somewhat puzzling, given the extensive literature amined the proportion of lesbian and gay clients in the caseloads establishing that there are few significant differences between of a nonrandom sample of APA-member psychotherapists heterosexual people and lesbians and gay men on measures of (N ϭ 2,544). Ninety-nine percent of respondents reported that they psychological well-being, self-esteem, and psychological function- “had seen at least one gay male or lesbian client in psychotherapy ing (Coyle, 1993; Gonsiorek, 1991; Pillard, 1988; Rothblum, at some point during their careers” (p. 966). In addition, the 1994; Savin-Williams, 1990). Bradford et al. (1994) surveyed average respondent reported that 6% of their current clients were lesbians (N ϭ 1,925) and found similar rates of depression, rape, incest, sexual assault, and overeating as had been reported in previous literature. JULIE A. MURPHY received her MA in clinical psychology in 1999 from the At the same time, there is a body of literature that establishes University of Cincinnati. some specific mental health concerns that are shared by the ma- EDNA I. RAWLINGS received her PhD in clinical psychology in 1966 from jority of lesbians and gay men, including determining whether to the University of Wisconsin—Madison. She is a professor emeritus at the reveal one’s sexual orientation (i.e., “coming out”; Leserman, University of Cincinnati. DiSantostefano, Perkins, & Evans, 1994; Mapou et al., 1983; STEVEN R. HOWE received his PhD in social psychology in 1980 from the Trippet & Bain, 1990) and antigay verbal and physical harassment University of Cincinnati. He is an associate professor in the Department of Psychology at the University of Cincinnati. (Bradford et al., 1994; Herek 1989, 2000). Mapou et al. found that CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Julie A. a coming out factor accounted for 21% of the variance in psycho- Murphy, Department of Psychology, University of Cincinnati, Cincinnati, logical functioning in gay men, and Leserman et al. found that a Ohio 45221. E-mail: [email protected] gay identification factor accounted for 20% of the variance in 183 184 MURPHY, RAWLINGS, AND HOWE current level of mood and self-esteem in gay men. In addition, clients; and (d) determine the mental health concerns for which some mental health concerns, such as eating disorders and sub- psychologists report needing more training. stance use, may have risk factors associated with the combined The survey instrument was developed specifically for this study. factors of gender and sexual orientation (Bloomfield, 1993; Israel- The content was based on a literature search, interviews and stam & Lambert, 1986; Siever, 1994). pretesting with expert judges, and feedback from a pilot study. Given that at least some concerns of lesbian and gay male Interviews and pretesting were conducted with eight licensed clients are different from those of the general client population psychologists who identified themselves as specialists in LGB (one can infer that bisexuals also have some specific mental health psychology, three licensed psychologists who did not identify concerns), how do psychologists learn how to work with LGB themselves as LGB specialists, and one nonclinical psychologist clients? Two studies of graduate training suggest that there are who specialized in survey research and questionnaire design. shortcomings in addressing LGB concerns. Male and female psy- There were five major content areas: caseload, therapeutic is- chology doctoral students (N ϭ 97) in the southern California area sues, future training needs, training history, and demographics. reported that their training programs had failed to offer adequate Caseload questions covered the therapists’ number of appoint- preparation for them to do therapy with gay and lesbian clients ments by client sex and sexual orientation “last week.” This (von Kleist, 1992). In addition, 30% reported having discussed method of counting was developed to simplify the counting pro- lesbian and gay issues in their programs in the context of psycho- cess for the participants and to reduce the likelihood that they pathology. Almost 10% of the students had been taught that “it is would make estimates rather than cite exact numbers. This method best for homosexual clients to change and adopt a heterosexual also takes into account all variations in caseload in a normal week orientation” (p. 6617). Buhrke (1989a) found that 29% of women (e.g., sick clients, emergency appointments, etc.). doctoral students (N ϭ 213) in counseling psychology programs Questions regarding therapeutic issues covered the importance reported that lesbian or gay issues were not addressed in any of 20 concerns in the psychologists’ work with lesbian and gay course in their doctoral programs; the remainder reported that such male clients. Questions regarding future training needs asked what issues averaged 8% of course time and that they were addressed in additional training would help participants improve their work a “moderately positive manner” (p. 632). Students who had seen with lesbians and gay men. Because of the paucity of empirical lesbian and gay clients found supervision with these clients to be data on bisexual clients, concerns and training needs related to helpful, although not as helpful as supervision with their other bisexual clients were addressed in open-ended items. Questions clients because of lack of supervisor knowledge of lesbian and gay regarding training history covered specific psychologist training concerns. experiences, ranging from coursework to presentations. The publication of the Guidelines marks a significant advance in The sample consisted of 378 (400 originally sampled minus 22 the inclusion of LGB concerns in mainstream psychology litera- invalid names and/or addresses) currently practicing,
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