Therapists’ Helpful and Unhelpful Situations With LGBT Clients: An Exploratory Study Tania Israel, Raia Gorcheva, William A. Walther, Joselyne M. Sulzner, and Jessye Cohen University of California, Santa Barbara The purpose of this exploratory study was to identify a broad range of variables that characterize psychotherapists’ perceptions of helpful and unhelpful therapy experiences of lesbian, gay, bisexual, and transgender individuals. In-depth, semistructured interviews were conducted with a diverse sample of 14 psychotherapists to identify such variables and patterns among them. Results suggest that a wide range of variables, including the therapeutic relationship, therapist response to the client’s sexual orientation/ gender identity, type of presenting concern, and the therapy environment, may affect the therapy experiences of this population. The data also suggest that factors such as ethnicity, gender identity, therapy needs, and socioeconomic status should be considered when providing mental health services to this population. Clients dealing with multiple types of marginalization may be particularly challenging for practitioners. Implications for future research and clinical practice are discussed. Keywords: LGBT, lesbian clients, gay clients, transgender clients, psychotherapy Research on the therapeutic experiences of lesbian, gay, bisex- ual, and transgender (LGBT) individuals is essential because of the relatively high rates of therapy use for gay men and lesbians (Bieschke, McClanahan, Tozer, Grzegorek, & Park, 2000) and the risk factors associated with sexual minority status, such as in- creased suicide rates, depression, and experiences of stigmatiza- tion or victimization (Cochran & Mays, 2000; Remafedi, French, Story, Resnick, & Blum, 1998; Safren & Heimberg, 1999). In addition, the American Psychological Association advocates for services that are responsive to the needs of LGB clients (Division 44/Committee on Lesbian, Gay, and Bisexual Concerns Joint Task Force on Guidelines for Psychotherapy With Lesbian, Gay, and Bisexual Clients, 2000), and current literature calls for the inclu- sion of transgender individuals in discussions of LGB psychology (Carroll, Gilroy, & Ryan, 2002; Gainor, 2000; Israel, 2005). Several studies have identified variables that affect the experi- ences of gay male and lesbian therapy clients in particular. Spe- cifically, in their seminal study, Garnets, Hancock, Cochran, Goodchilds, and Peplau (1991) found that the central factors that made therapy with gay and lesbian clients helpful were therapists exhibiting gay-affirming attitudes, understanding the effects of homophobia, helping clients to overcome internalized homopho- bia, not focusing therapy on the client’s sexual orientation unless the clients wanted to, and being aware of LGB community re- sources, among others. Other researchers identified additional fac- tors that were associated with more positive therapy outcomes for gay and lesbian clients: prescreening the therapist for gay- affirming attitudes (Liddle, 1999), type of therapist professional training (Liddle, 1999), and therapist disclosure of sexual orienta- tion (Atkinson, Brady, & Casas, 1981). Factors that have been TANIA ISRAEL received her PhD in counseling psychology from Arizona State University. She is an associate professor in the Department of Counseling, Clinical, and School Psychology at the University of Cal- ifornia, Santa Barbara. Her research and professional interests include mental health services for LGBT clients, social justice for historically marginalized populations, and community-based participatory research methods. RAIA GORCHEVA is a doctoral candidate in the counseling emphasis in the Department of Counseling, Clinical, and School Psychology at the Uni- versity of California, Santa Barbara, where she received her MA in coun- seling psychology. She is a predoctoral intern in Counseling and Psycho- logical Services at the University of Pennsylvania. Her areas of professional interest include the role of emotion in psychotherapy process and outcome, psychotherapy with LGBT clients, and working with college students. WILLIAM A. WALTHER received his MA in counseling psychology from the Department of Counseling, Clinical, and School Psychology at the Uni- versity of California, Santa Barbara, where he is working toward his PhD in the counseling emphasis. He currently works at the University of California, Santa Barbara, Counseling Services and is a student supervisor at the Hosford Counseling and Psychological Services Clinic. His areas of research include LGBT counseling, therapeutic outcomes, service delivery, and mental health issues facing college age populations. JOSELYNE M. SULZNER received her MA in counseling psychology from the Department of Counseling, Clinical, and School Psychology at the Uni- versity of California, Santa Barbara, where she is working toward her PhD in the counseling emphasis. Her areas of interest include human sexuality, individual and societal factors relating to sexual assault, and sexual assault education and prevention strategies. JESSYE COHEN received her MS in rehabilitation counseling from Virginia Commonwealth University, where she is currently a doctoral student in counseling psychology. Her research interests include health behavior change, LGBT issues in counseling, the psychotherapy process, and ad- justment to chronic illness. THIS RESEARCH WAS SUPPORTED by National Institute of Mental Health Grant K01MH063305. A poster based on this article was presented at the American Psychological Association’s annual convention, New Orleans, Louisiana, August 2006. CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Tania Israel, Department of Counseling, Clinical, and School Psychology, Ge- virtz Graduate School of Education, University of California, Santa Bar- bara, CA 93106-9490. E-mail: tisrael@education.ucsb.edu Professional Psychology: Research and Practice Copyright 2008 by the American Psychological Association 2008, Vol. 39, No. 3, 361–368 0735-7028/08/$12.00 DOI: 10.1037/0735-7028.39.3.361 361