Providing Couples Therapy to Same-Sex Couples

same sex couples therapyCouples therapy can be a challenging event for both the couple…and the therapist. Often, when a couple has decided to engage in therapy, they have come to a place where they feel lost in the relationship, or have entered a space where they can no longer see, as I call it, “the light” in the relationship.

Communication, or lack thereof, has ceased to be effective. Bad habits and bad behavior have taken over. And the relationship appears to be broken. But the fact that the couple is coming to the room (or on the perpetual therapeutic couch) to address issues within their relationship reflects hope.

For the purpose of this article, I use the terms same-sex couple or gay/lesbian couples. That is not to discount that sexual behavior and attraction are not necessarily dichotomous, and this article does not intend to exclude those individuals who identify as bisexual or queer.

But, for the sake of simplicity and brevity, I have opted to limit my terminology. However, please be aware that individuals who may not necessarily label their sexual preference or behavior within these terms are very much considered when crafting this article.

Unique Concerns of LGBTQQI Couples

Depending on where one is practicing, the LGBTQQI (Lesbian Gay Bisexual Transgender Queer Intersex) community can be very small, and a couple may choose to seek services from a clinician not in their community. Because of this, it is important for clinicians to be aware of possible concerns or issues that are unique to the LGBTQQI community.

Remember, we live in a hereto-dominant society, and that alone, for gay/lesbian relationships, is a source of stress. No one wants to be considered an outsider. The political rhetoric surrounding gay marriage is a constant reminder that there are some that do not accept the relationship.

Furthermore, those of us who identify as heterosexual can sometimes be insensitive to the fact we are genderizing behaviors in same sex relationships. For example, identifying that gay men are more feminine and lesbians are masculine (Stein & Cohen).

We need to do more than just be allies of LGBTQQI community. We have to develop our cultural sensitivity. It is not enough to simply say, “I don’t see sexual orientation” (similar to the, “I don’t see color”). As a therapist who works within the LGBTQQI community, it is important for me to develop my cultural competency specifically as it pertains to the LGBTQQI experience.

Life Experience and LGBTQQI Romantic Relationships

Being gay or lesbian, or trans, or queer, has shaped each member of a couple—and each differently than the other. As a result of it, those experiences are contributing factors to the dynamics of the relationship.

The age of both the awareness of one’s sexual identity and coming out profoundly affects how one navigates through romantic relationships in the present. Therefore, the coming out experience can be radically different for each individual.

For some, it is an experience of acceptance by one’s family. For others, it is a traumatic event of rejection that leads to being a pariah within their own family system. As clinicians, it is imperative that we continuously adjust our lens in regard to these events and, going forward, be aware how these possibilities interact with the dynamic of the couple.

Another challenge for same-sex couples is conceptualizing healthy romantic partnerships. Where do same-sex couples go for help at Barnes and Nobles? There is no, ‘Women are from Venus,’ books in the self-help section. Historically, in psychotherapy, sexual orientation was pathologized and therefore we are just starting to cultivate our literature on the topic.

Another clinical area to be aware of is possible internalized feelings about one’s sexuality and how it impacts one’s sexual relationship with his or her partner. Exploration of the inner self and possible unresolved feelings of rejection and shame need to be acknowledged in the therapy room. This can be a sensitive area for the couple, as one partner may experience it as shame about the other …rather than shame of self. It is important for the therapist to understand these nuances and complexities when working with a couple.

Checking Your Assumptions at the Door

As providers of clinical service, it is important to be cognizant of our own assumptions and prejudices that exists in our subconscious. For heterosexual therapists, it is not uncommon to have fixed ideas about what a gay relationship should look like, and that one would need special skills or be LGBTQQI in order to be an effective therapist.

It is not uncommon to be asked by my peers how I, as a heterosexual woman, can possibly work with a same-sex couple? When asked this question, I, as a Haitian American Woman, always state the obvious: Can I only work with Haitian Americans females? Am I limited to that which is my experience? Indeed not.

At the end of the day, a therapist must understand that it is the therapist/client relationship that is at the core of being an effective therapist. A therapeutic relationship will be more effective if the therapist acknowledges their shortcomings and demonstrates cultural competency.

So, why write this? We need to debunk myths and generalizations about LGBTQQI relationships and focus on the individual and the couple.

I write this so that I can explore my own prejudices. I write this with the hope that those who read this will look into their own selves, understand and gain insight into their own thoughts and feelings. I write this so that we, as a community, may always hold each other accountable to our own cultural competency and heterosexism.

As therapists, we must enter the therapeutic relationship with an open heart and mind, and check our prejudices at the door.

References: Stein T.S., Cohen, C.J., (1986) Contemporary Perspectives on Gay and Lesbian Psychotherapy with Lesbians and Gay Men.  New York. Springer

Photo courtesy of Oteo on flickr 

Providing Couples Therapy to Same-Sex Couples

Melissa A. Jean-Charles, LICSW, CPRP

Melissa Jean-Charles is a licensed social worker in the Boston area. You can find her on LinkedIn.


APA Reference
Jean-Charles, M. (2015). Providing Couples Therapy to Same-Sex Couples. Psych Central. Retrieved on October 22, 2020, from


Scientifically Reviewed
Last updated: 12 Mar 2015
Last reviewed: By John M. Grohol, Psy.D. on 12 Mar 2015
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