A systematic review of research on counselling and psychotherapy for lesbian, gay, bisexual & transgender people

Counselling and psychotherapy services for lesbian, gay and bisexual (LGB) people have developed against a historical background of medical and psychological pathologisation of homosexuality over the past 130 years. Prejudice against homosexuality amongst therapists and the rest of society is similar to prejudice against transgenderism, as, in contrast to discrimination against characteristics such as race or sex, both have been regarded as unnatural and morally perverse. Although a lesbian-, gay-, bisexual- and transgender(LGBT)- affirmative strand of mental health services provision has developed over the last 20–30 years, particular areas of need for knowledge and understanding remain to be addressed. These are: homosexuality as one of a range of acceptable sexual identities; LGBT people’s lifestyle, social networks and support systems; how sexuality and gender are understood and responded to within families and cultures; the difficulties of growing up LGBT, and how information and disclosure about LGBT identity is managed; the coming-out process; the expertise and sensitivity of therapists to these issues; therapist sexual orientation and its relevance to the process and outcome of therapy; and the particular mental health vulnerabilities and needs of LGBT people. Although there is evidence for effectiveness of psychotherapy, we know little about how talking therapies are provided for LGBT people, or the effectiveness of such therapies within this group.