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, doctoral ture. Indeed, Buhrke, Ben-Ezra, Hurley, and Ruprecht (1992) level, licensed psychotherapists who were randomly selected from reported that between 1978 and 1989, only 42 (0.7%) of 6,661 the member database of the APA (26,036 members of APA met articles published in six major counseling journals addressed les- the selection criteria at the time of the survey). One hundred bian and gay issues. In October 1997, we conducted a more twenty-five practitioners (33%) returned usable surveys. An addi- extensive literature search, which resulted in a set of 223 (0.8%) tional 38 practitioners (10%) requested that their names be re- of 26,935 articles published in mainstream clinical journals. moved from the survey mailing list, citing the following reasons: Unfortunately, none of the reviewed research on therapy usage, (a) no time to respond, (b) could not respond due to personal mental health concerns, or training included questions regarding reasons, (c) thought they were ineligible because they did not see bisexuality; therefore, it is unclear what specific bisexual concerns any gay clients in the previous week, or (d) they did not like the might be and whether they are being addressed in training pro- questionnaire topic. grams. The other significant limitations of the reviewed research Although the sample size was small, it appears to be remarkably are the lack of random samples, and the failure, in most of the representative of APA members who met the sampling criteria. studies, to define the general category of “counseling.” Table 1 shows that the groups were nearly identical on all demo- graphic characteristics for which we have data. The most frequently endorsed theoretical orientations (more The Therapists’ Lesbian, Gay, and Bisexual Survey than one label was used by the majority of respondents) were some version of psychoanalytic or psychodynamic (45%), cognitive The present study was designed to address the shortcomings in (34%), behavioral (28%), and eclectic/integrationist (23%). the previous research by means of a survey of a nationally repre- Six percent of participants reported advertising a specialty in sentative sample of APA-member licensed psychologists. The LGB issues or doing target advertising to LGB communities and specific objectives of the study were to (a) estimate the proportion were therefore considered specialists in LGB therapy for purposes of LGB clients relative to the average caseload of APA members of this study. who are licensed psychologists and determine the characteristics of the psychologists who are and who are not seeing LGB clients; (b) Psychologists’ Caseloads determine what mental health concerns psychologists consider most important in therapy with LGB clients and whether these Respondents reported a mean of 25 appointments in the previ- concerns vary as a function of characteristics of either the client or ous week (SD ϭ 15.54, Mdn ϭ 24), of which 18.31 were with the psychologist; (c) determine what kind of training psychologists individuals (SD ϭ 12.68, Mdn ϭ 17); 6.66 were with couples, have received regarding therapy with, or the psychology of, LGB families, or children (SD ϭ 9.07, Mdn ϭ 3); and 1.74 were with PSYCHOLOGISTS TREATING LGB CLIENTS 185

Table 1 censed. Although there was a significant difference in proportion Participant Characteristics Compared With Characteristics of of LGB clients based on amount of training in LGB concerns in the American Psychological Association (APA) Members Who Met entire sample, there was not a significant correlation between the Sampling Criteria amount of training and mean percentage of LGB clients among the 56% of participants who saw at least one LGB client. Sample (%) APA members (%) Characteristic (N ϭ 125) (N ϭ 26,036) Mental Health Concerns of LGB Clients Sex Female 46 45 Participants who had seen at least one lesbian or gay client in the Male 54 55 reporting week were asked to rate the importance of 20 concerns Race/ethnicity in therapy with those lesbian or gay clients. Participants rated each Caucasian 92 92 African American 2 1 issue on a rating scale, ranging from 1 (relatively less important) Latino/a 2 2 to7(relatively more important). The most important concerns Middle Eastern 2 — (those rated greater than 5, on average) were relationship issues, Asian American 1 1 self-esteem, depression, and anxiety. The least important concerns Not specified 2 3 Age (those rated less than 3) were recovery from antigay violence, M 49.56 49.62 custody, job/housing discrimination, living with HIV/AIDS, reli- SD 8.58 9.43 giosity, relationship violence, being in a heterosexual relationship, Degree internalized homophobia, sexual dysfunction, and parenting/adop- PhD 88 88 tion issues. Those concerns falling in the moderate range (be- PsyD 6 7 EdD 3 5 tween 3 and 5) were support system development, family estrange- Not specified 3 0 ment, coming out, body image, substance abuse, and recovery Years practicing from sexual assault or abuse. M 15.06 16.63 Participants who had seen lesbian and gay male clients rated two SD 7.68 9.60 Primary practice setting concerns significantly differently: Living with HIV/AIDS was Private practice 66 63 rated as more important in therapy for gay men than for lesbians Hospitals 12 12 (z ϭϪ2.90, p ϭ .004), and recovery from sexual assault or abuse Universities 4 1 was rated as more important in therapy for lesbians than for gay Clinics 3 6 men (z ϭϪ2.79, p ϭ .005). There were no significant differences Other settings/not specified 14 13 Other human services — 6 between ratings of lesbian versus gay concerns for participants who saw only lesbians or only gay men in the reporting week. Note. A dash indicates that the data were not available or were not Twenty-nine participants (23%) answered an open-ended ques- obtained. tion regarding what concerns bisexuals bring to therapy that may be different from the concerns of lesbian and gay male clients. Participants wrote that bisexual clients may have more difficulty one or more known LGB clients (SD ϭ 3.83, Mdn ϭ 1). The with identity development because of the lack of acceptance by average caseload included approximately 3% each of lesbians and both the heterosexual and gay communities and pressure by both gay men and less than 1% bisexual people. communities to choose one identity. A related concern was that There were no significant differences in the total current pro- many clients believe that bisexuality is a developmental stage and portion of LGB clients by psychologists’ sex, sexual orientation, that they should be realizing their “true” identity. Therefore, par- race, degree, primary work setting (i.e., private office vs. public ticipants reported that many bisexual clients are confused when clinic), primary work location (i.e., urban vs. rural), number of they do not come to an identity of either heterosexual or homo- years in practice, year of licensure, or specialization in LGB issues. sexual. In addition, several therapists reported similar beliefs that However, the more training in LGB concerns a psychologist had, bisexual clients should be encouraged to explore whether they are the higher the proportion of LGB clients they had in their case- truly heterosexual or homosexual. Finally, several participants ␶ ϭ Ͻ loads (Kendall’s b .31, p .001). In addition, there was a wrote that bisexual individuals have more relationship difficulties significant interaction between the sex and sexual orientation of because of the perceived need to have sexual intimacy with both the client and the sex and sexual orientation of the therapist, such men and women. that lesbians and bisexual women were most often seen by lesbian therapists (followed by heterosexual women therapists), and gay Psychologists’ Training and bisexual men were most often seen by gay male therapists (followed by lesbian therapists). All of these interactions were Participants were asked about the types of training they had significant at the .001 level (Kruskal–Wallis test, ␹2[3, N ϭ 125]). been offered and had taken in regard to LGB issues. The most Fifty-six percent of participants had seen at least one LGB client common types of training taken were reading articles (64%), in the past week. Among these participants, the mean percentage supervision (46%; although only half of those reported that their of LGB clients was 12% (SD ϭ 13%), and there were no signif- supervisors were knowledgeable about LGB concerns), continuing icant differences in mean percentage of LGB clients seen by education (46%), attending presentations (36%), and reading psychologists’ specialty in LGB issues, sex, race, age, work set- books (32%). Regarding graduate and internship training, 10% ting, work location, degree, theoretical orientation, or year li- reported that a graduate course in LGB issues was offered (a little 186 MURPHY, RAWLINGS, AND HOWE more than half of those took the offered course); 22% reported that therapy with bisexual clients. Most respondents reported that train- their graduate training offered modules, seminars, or other types of ing on bisexual issues in general would help them work with training on LGB issues (the vast majority took these offered bisexual clients; in addition, many described a current practice of training opportunities); and 14% reported that they had internship guessing about bisexual issues on the basis of literature on lesbians or postdoctoral training offered on LGB issues (the majority took and gay men. Other participants listed specific issues on which these training opportunities). Finally, 18% listed “other” types of they would like more training. Those issues included “sexual training on LGB issues, including peer supervision; workshops satisfaction versus staying sexually exclusive,” choosing a mate that were not for continuing education credit; weekly case sharing; under “more pressure from family and friends,”“the true nature of consultation with experts on LGB issues; learning from their bisexuality,”“knowing what has been learned about psychody- clients; learning from friends; postdoctoral training at psychoana- namics and self-concept about bisexual individuals,” training on lytic or family therapy institutes; life experiences as a lesbian, gay, how to help clients clarify “which” orientation “they truly are,” or bisexual person; and predoctoral training. how to handle rejection by both heterosexual and homosexual A training score was calculated by assigning 1 point for each communities, how to help families “re-write their expectations,” type of formalized training taken. The six types of formalized “custody and children’s development,” and “relationship and iden- training were supervision, continuing education, research, graduate tity issues.” school course, other graduate school training, and internship or postdoctoral training. The mean sample training score was 1.40 (SD ϭ 1.30, Mdn ϭ 1), and 28% of participants reported that they Implications and Applications had no formal training. LGB participants had a mean training score of 2.56, compared Psychologists’ Caseloads with 1.31 for heterosexual participants (Mann–Whitney U test, z ϭ Ϫ2.91, p ϭ .004). In addition, participants who saw at least one We found a smaller proportion of LGB clients than reported in LGB client had a mean training score of 1.77, compared with 0.94 previous studies. There are a number of factors that may contribute for participants who had not seen any LGB clients (Mann– to this small proportion. The first is sampling strategy: This study Whitney U test, z ϭϪ3.25, p Ͻ .001). Finally, there was a has an advantage over previous studies in that it provides current significant correlation between the training score and the percent- caseload data, rather than career estimates. ␶ ϭ ϭ Another factor may be client screening. Liddle (1997) reported age of LGB clients (Kendall’s b .31, p .00). that many lesbians and gay men screen therapists for previous experience with lesbian or gay clients, or for gay-friendly attitudes. Participants’ Interests in Training In this survey, participants who had more formal training on LGB Participants rated the same 20 concerns as in the therapeutic issues were more likely to have LGB clients. Thus, it may be that issues section in terms of how training on any of the listed topics psychologists are more likely to pass LGB client screening pro- would improve their work with lesbians and gay men. Each issue cesses if they have some training on what issues are important to was rated on a scale ranging from 1 (would not improve)to7 such clients. (would improve substantially). All of the concerns were rated in Finally, some participants may have underreported the numbers the moderate range (between 3 and 5), suggesting that therapists of LGB clients they were seeing. For example, several participants feel that training on any issue could be helpful but also that no who had little to no training on LGB concerns commented that training would substantially improve the work of all therapists. All they do not feel that sexual orientation is an important factor of the following concerns were rated asa4orgreater (i.e., training affecting the psychology of their clients and that they do not ask would improve their work more than not): coming out, living with about a client’s orientation. It is possible that at least some par- HIV/AIDS, family estrangement, support system development, ticipants reported smaller proportions of LGB clients than they relationship issues, internalized homophobia, parenting/adoption, actually have because they are unaware that some of their clients being in a heterosexual relationship, custody, relationship vio- are lesbian, gay, or bisexual. This may be especially true for lence, sexual dysfunction, body image, self-esteem, recovery from bisexual clients, as several therapists reported disbelief in the sexual assault or abuse, and recovery from antigay violence. construct of bisexuality. Further research should be conducted to Participants rated training in two areas as improving therapy explore possible reasons for finding lower than expected propor- more for gay men than for lesbians: relationship violence (z ϭ tions of LGB clients (i.e., have LGB therapy clients been over- Ϫ3.23, p Ͻ .001) and living with HIV/AIDS (z ϭϪ2.76, p ϭ sampled in previous research, and are LGB clients seeking other .006). There were two significant correlations between the types of counselors?). training score and the rating of how much training would The present data provide graduate training programs with two improve work with LGB clients; participants who had higher important pieces of information: (a) LGB clients are very likely to training scores thought that training on these issues would be part of practitioner caseloads at some point, and (b) having improve their work more. Those correlations were for gay training on LGB concerns may improve a practitioner’s market- ␶ ϭ ϭ men’s body image (Kendall’s b .18, p .03) and for ability. Both seem sufficient to merit wider inclusion of LGB ␶ ϭ lesbians’ recovery from antigay violence (Kendall’s b .17, p concerns in graduate training programs. For private practitioners, it ϭ .03). There were no other significant differences in training may be wise to invest in continuing education courses that address ratings by participant characteristics. LGB concerns; this may increase the marketability of your practice Forty participants (32%) answered an open-ended question re- and would likely improve the quality of care you provide to your garding ways that training on bisexual issues would improve their clients. PSYCHOLOGISTS TREATING LGB CLIENTS 187

Mental Health Concerns of LGB Clients whether psychologists are finding the few articles in the mainstream literature, seeking articles outside of mainstream literature, Consistent with the findings of previous studies, participants or reading other types of articles, such as in newspapers or mag- identified the most important mental health concerns as those that azines (our question specified only articles). are common to people of all sexual orientations. However, they A number of researchers have called for more systematic train- also identified several concerns that are unique to LGB people ing in LGB psychology (e.g., Buhrke 1989b; Buhrke & Douce, (i.e., coming out or identity issues). This suggests that the generic 1991; Iasenza, 1989). Although one could argue that psycholo- preparation of practitioners is insufficient for work with LGB gists’ training is lacking in many areas (i.e., substance abuse, clients (although many practitioners may be seeking additional working with clients with particular diagnoses, etc.), sexual orien- training to facilitate their work, which is discussed more in the next tation appears to be different from those other concerns and may section). act in a manner similar to gender and race/ethnicity in the therapy An area where this insufficiency is most apparent is in the process. Although these factors may not always affect the partic- mental health concerns of bisexual clients. Participants reported ular mental health concerns, they are a filter through which clients conflict within clients in regard to choosing or realizing their see themselves and the world sees LGB people (Garnets & Kim- “true” heterosexual or homosexual identity and conflict within mel, 1993). Therapist familiarity with the filters may enhance their participants themselves in regard to the existence of bisexuality as ability to provide services to LGB clients. a “true” identity option. This ambivalence appears to be part of the bisexual identity development process for clients (A. Fox, 1991; R. Future Training Needs Fox, 1996). However, there are a number of recent publications that describe the inappropriateness of “either/or thinking” in con- Participants reported that training in many issues that are unique ceptualizing sexual orientation and the resulting shortcomings in to an LGB identity would improve their work with LGB clients, treatment of bisexual clients when this type of conceptualization is although these same issues were not rated as of more than mod- used by therapists (Blumstein & Schwartz, 1993; Klein, Sepekoff, erate importance in therapy with lesbians and gay men. This may & Wolf, 1985; Markowitz, 1995; Matteson, 1996; Ochs, 1996; reflect the impact that training can have on a practitioner’s per- Paul, 1996). Practitioners should become familiar with this liter- ceptions of what is important. For instance, if a therapist has no ature to increase their effectiveness with bisexual clients. training in an area such as coming out, she or he may choose not to focus on such issues in treatment. Or, if a client senses the Psychologists’ Training therapist is uncomfortable or lacks knowledge, he or she may not raise such issues again in therapy. Thus, the issue would be rated This study provides information on psychologists’ training that by psychologists as being of low importance in their treatment has not been addressed adequately in previous research. We found with LGB clients. In addition, many of the issues that were rated that the inclusion of continuing education and supervision creates as most important in therapy were rated as not being training a much brighter picture about therapists’ training to work with priorities. This may reflect psychologists’ ethical tendency to work LGB clients than previous literature has suggested. Most fre- only with issues on which they have sufficient training. quently, participants reported having had one or the other of these Because many concerns of LGB clients are the same as those of two types of training. Other types of formal training were infre- heterosexual clients, is there any reason special training on LGB quently offered and taken. In addition, LGB psychologists and concerns is needed? We believe so. For instance, previous litera- psychologists who were currently seeing at least one LGB client ture addresses the significance of internalized homophobia in a reported having sought out more formal training on LGB concerns. number of presenting issues, ranging from low self-esteem, de- Further research should be conducted to explore the reasons for pression, and anxiety to alcoholism and sexual dysfunction (Gon- this. For instance, do psychologists who see at least one LGB siorek, 1993; Meyer, 1995; Meyer & Dean, 1998; Shidlo, 1994). client seek formalized training to assist in their work with LGB To address these concerns without addressing the underlying in- clients, or do psychologists who have training pass the aforemen- ternalized homophobia is likely to make the work more frustrating tioned screening processes of LGB people who seek therapy? and less productive for both the practitioner and the client. However, the use of supervision as the primary or sole source of Another important finding was that several participants reported training in LGB concerns for many practitioners raises a question using the literature on lesbians and gay men to guess what to do regarding the quality of supervision. Approximately half of those with bisexual clients. This is an area that seems ripe for those who who had been supervised with LGB clients reported that their provide training, although marketers of the training will need to supervisors had limited or inadequate knowledge of LGB con- address the belief systems of many practitioners who are still cerns. This could propagate poor practice. Supervisors may not be entrenched in dichotomous thinking about sexual orientation. able to provide training for our graduate students on some thera- Overall, the current study confirms that LGB clients are a peutic issues if they do not have the requisite training. It would be significant part of the average caseload and that graduate training wise for future research to focus more extensively on the quality of is at best partially addressing these concerns. However, it also the various types of formal training for addressing LGB concerns. reveals that practitioners are frequently seeking training after their It is interesting to note that the most frequently endorsed type of graduate education. The recent publication of the Guidelines will training was reading articles on LGB issues. This finding is sur- likely make practitioner searches for information more efficient prising given the very small proportion of articles on LGB issues and productive, which bodes well for the profession’s ability to available in mainstream literature. Future research should address address the needs of LGB clients. 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