Homophobia in the therapist and gay or lesbian client: Conscious and unconscious collusions in self-hate.

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Abstract
The biases of homophobia and heterosexism are present in everyone, in varying degrees, and can be largely denied by both the therapist and the gay or lesbian client. Denial of these biases in the therapist and the client, unless acknowledged and addressed, leads to a negative treatment outcome by a number of different conscious and unconscious collusions between therapist and client. Clinical examples of collusions are discussed according to the therapeutic stages of referral, history taking and diagnosis, treatment, collateral interventions, process, content, and outcome. Recommendations include correcting the problems in lack of training and education of mental health professionals, creating ongoing dialogue regarding self-examination of homophobia among practicing psychotherapists, using direct questioning of gay/lesbian clients regarding homophobia, and an affirmative psychotherapy approach.

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