Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients

The Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients offers a brief introduction to the history of LGB activism and provides an overview of issues LGB clients may bring to therapy. This book serves as a good introduction to both the historical and contemporary psychological research on sexuality, and is accessible to both a general audience as well as psychotherapists. It is also an excellent resource for faculty wanting to assign individual chapters as standalone readings to supplement other courses. It is a volume that belongs on every clinician’s bookshelf. However, it should not stand alone on that shelf. Readers wishing to find theoretical depth are likely to be left unsatisfied, and although lengthy the book is short on specific resources of use with clients. It suffers from redundancy due to its structure as an edited volume of independently authored chapters, and those already familiar with LGB issues will find little new ground covered. There is also a significant weakness in its omission of issues affecting transgender clients.

Context and history form an integral part of many of the chapters in The Handbook, and since the American Psychological Association publishes it, it may be helpful for me to provide some background context of APA’s recent history with regard to sexual orientation. Psychology in the U.S. prides itself professionally at being in the lead in a progressive stance on GLBT issues. This can be seen in the present version of the American Psychological Association’s Guidelines for Doctoral and Internship Programs, which incorporates issues of sexual orientation into its requirement for the inclusion of cultural and individual differences in graduate curricula (most recently amended 1 January 2000). However, on second look the illusion of leadership begins to fade. For example, in the most recent APA questions-and-answers white paper for program directors on responding to the Guidelines (January 1997), cultural diversity and individual differences are detailed primarily in terms of ethnicity and linguistic differences, with only a passing reference to sexual orientation. Indeed, it was not until August 1997 that the governing body of APA formally denounced the reorientation "treatment" offered by some clinicians.

Several surveys of psychologists cited in The Handbook amply document how a majority of psychologists are in many ways still ill prepared to deal appropriately with issues of sexual orientation in therapy, and how even in the early 1990s most reported "little or no information about homosexuality" (xii). Other sources have documented homophobia and discrimination continuing throughout the 1990s in doctoral programs in psychology, leading some therapists to remain closeted. Although prejudice within the psychology may be outside the immediate scope of The Handbook, it certainly could have been addressed. For example, Chapter 15 addresses psychoeducational programming in terms of sexual orientation education in the community, but does not address changing attitudes with the profession.

The Handbook consists of eighteen independently authored chapters, in three sections: five chapters to "Social and Theoretical Perspectives," seven chapters to "Counseling and Therapy," and six chapters to "Relevant Issues for Therapy, Theory, and Research." Editorial consistency provides the illusion of an integrated book. Each chapter carefully refers to LGB clients using a single permutation of the acronym, each carefully refers to itself as a chapter in the larger Handbook. Most chapters appear to be written for a U.S. heterosexual audience being introduced for the first time to LGB issues. There is a disappointing tendency to be narrowly focused on certain groups, even this lack of inclusiveness is explicitly acknowledged in many chapters and excused due to considerations of length. Examples include a focus on Christianity in a chapter on religion, and in several chapters a view of psychotherapy and LGB history as being primarily U.S. endeavors. Further, psychiatry is rarely mentioned.

The structure of independently authored chapters is a strength in that it allows one or more chapters to be selected for advanced undergraduate or introductory graduate readings. However it creates two weaknesses: redundancy and shallowness. For example, coming out is mentioned in chapters 2, 4, 7, 8, 10, 11, 12 and 17. Although each chapter addresses coming out from a different perspective, each time it is addressed only in superficial terms. Were the book titled "An Introduction to Issues in Counseling and Psychotherapy," the lack of depth would be less disappointing. However, the title "Handbook" suggests a thorough, in-depth examination of important issues, which is not to be found.

Regretfully, The Handbook also fails to provide sufficient practical information. Many times clinicians are urged to be familiar with available resources, but these resources are never identified. A reference to the National Gay and Lesbian Task Force’s web site for clients needing legal support stands alone in its specificity. Since The Handbook is marketed to clinicians, this oversight is disappointing: managed care limits the time front-line therapists have to research client needs, and even LGB therapists may not be aware of the myriad organizations that exist to support various special needs of LGB clients. The problem is worsened for therapists working in rural areas.

The third weakness of The Handbook is its omission of transgender issues. It is astonishing that the authors missed this opportunity to assist in APA’s initiative to ease the prejudice against transgender individuals. The editors excuse this as follows, "In addition, there are no discussions of transgender issues in this edition of the book because of the lack of empirical research in this area" (p. 5). Yet Psychological Abstracts PsychINFO reveals 788 peer-reviewed articles and scholarly books or chapters on this topic through 1998 (generously allowing a two year lead time for publication). Indeed, in the hundreds of times the acronym LGB appears in The Handbook, I could not help but wince each time as if it had been castrated of its "T" in name of editorial consistency. This is not just a semantic excision, as discussion of transgender issues are relevant to many of the topics explored in The Handbook.

Although these shortcomings are significant, I would like to recommend The Handbook. It is a convenient collection of introductory readings that collectively survey a large body of empirical literature, and can be of use both to experienced clinicians as well as a general audience. It is especially strong as a starting point for exploring LGB issues in psychotherapy.

Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients