Sharon Birman


The initial impression a client formulates about the therapist is critical to establishing a deep and meaningful working alliance. The traditional intake interview protocol is fraught with heterocentric biases and heteronormative assumptions, thereby failing to provide an affirming experience for non-heterosexual clients or potentially overlooks issues relevant to competently serve the psychological needs of LGB clients. This dissertation endeavors to respond to the growing need for the clinical application of LGB affirmative approaches. An overview of the following bodies of literature is offered: (a) consequences of heterosexism on the lives of LGB individuals, (b) heterosexism and the field of psychology, (c) perceived competence of therapists treating LGB clients, (d) current practices in working clinically with LGB clients, and (e) intersection of multiple cultural considerations. Based on a synthesis of the literature, feedback from experts in the field, and a critical review of existing intake protocols, preliminary suggestions for engaging in an LGB affirming initial therapeutic experience is offered. 4 major areas of clinical considerations for engaging in an affirmative intake process are discussed: (a) creating an affirming environment, (b) the initial intake process, (c) important considerations specific to members of the LGB community; and (d) therapist competencies. Finally, intake questions for consideration in intake forms or during the course of an intake interview are presented.

Library of Congress Subject Headings

Dissertations (PsyD) -- Psychology; Interviewing in psychiatry -- Technique; Heterosexism -- Prevention; Sexual minorities -- Mental health services; Sexual minorities -- Psychology

Date of Award


School Affiliation

Graduate School of Education and Psychology



Degree Type


Degree Name


Faculty Advisor

Asamen, Joy;