Bisexual Stereotypes in Clinical Evaluation

Psychology of Sexual Orientation and Gender Diversity | 2024, Vol. 11, No. 4, p. 619-630

Bisexual Stereotypes in Clinical Evaluation

Ori Ferster; The Academic College of Tel Aviv–Yaffo

Alon Zivony; Birkbeck College, University of London; University of Sheffield

Psychologists nowadays tend to view same-sex attraction as a normal part of human sexuality, but it is less clear whether they still hold prejudicial views regarding bisexuality. Previous studies have demonstrated that psychotherapists’ clinical evaluation is affected by whether their client is bisexual. One plausible interpretation is that such differences stem from an uncritical adoption of bisexual stereotypes, namely, that bisexual people are confused, immature, and unable to maintain romantic relationships. However, an alternative hypothesis suggests that differences in evaluation may be based on the psychotherapists’ experience with bisexual clients. To adjudicate between these possibilities, psychotherapists and clinical psychology interns (N=229) were presented with a description of a hypothetical client– a bisexual man, a gay man, or a heterosexual man– seeking counseling for academic issues. Compared to non-bisexual clients, bisexual clients were evaluated as more likely to suffer from identity and relationship issues. These clinical evaluations were observed regardless of whether the therapist was personally acquainted with bisexual people or had any experience with bisexual clients. Instead, stereotypical clinical issues were perceived as particularly salient among psychotherapists who viewed the hypothetical bisexual clients as immature and confused. These results suggest that, like the general public, psychotherapists adhere to stereotypical beliefs about bisexual people. Such biases are likely to have negative impacts on bisexual clients’ diagnoses and overall satisfaction from therapy. We conclude that education may be key to curbing anti-bisexual bias among psychotherapists and ensuring better therapeutic outcomes for bisexual clients.

Bisexuality, stereotypes, bias, psychotherapy, prejudice

The field of clinical psychology has significantly evolved in its perception of same-sex attraction, yet "it is important to ask how psychotherapists view bisexuality, a sexual orientation still poorly understood and not accepted by large swaths of society." Although bisexual individuals "are grossly underrepresented in popular media and in the leadership of Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ) organizations," their experiences are often overlooked or conflated with those of gay and lesbian individuals, contributing to a "substantial knowledge gap regarding the therapeutic needs of bisexual individuals." The authors highlight that psychotherapists often report a "lack of knowledge, skills, and competencies in providing affirmative therapy to bisexual clients as compared to gay men and lesbian women," which can lead to "uncritically adopting negative or stereotypical views regarding bisexual people." These stereotypes, which include the belief that bisexual individuals are "confused about their identity" and "unable to maintain intimate relationships," can ultimately impact the quality of clinical care provided to bisexual clients. The study aims to examine whether psychotherapists’ evaluations of bisexual clients are "biased by these stereotypes" or are "accurately informed by experience with bisexual clients." (p. 619-620).

The primary objective of the study is to "adjudicate between these possibilities" by analyzing how psychotherapists evaluate bisexual clients compared to non-bisexual clients. The authors aim to assess whether these evaluations reflect "biased perceptions based on stereotypes" or "accurate clinical judgments informed by experience." The study also examines the impact of psychotherapists' "familiarity with bisexual people" on their clinical judgments (p. 621).

The study recruited "psychotherapists and clinical psychology interns (N = 229)" who were presented with "a description of a hypothetical client – a bisexual man, a gay man, or a heterosexual man – seeking counseling for academic issues." Participants were asked to evaluate the client's likelihood of experiencing various clinical issues, including "identity and relationship issues." The authors also assessed whether psychotherapists’ "personal familiarity with bisexual individuals" or "past clinical experience with bisexual clients" influenced their evaluations (p. 622-623).

The results revealed that "compared to non-bisexual clients, bisexual clients were evaluated as more likely to suffer from identity and relationship issues." These findings persisted "regardless of whether the therapist was personally acquainted with bisexual people or had any experience with bisexual clients." Instead, stereotypical clinical issues were "perceived as particularly salient among psychotherapists who viewed the hypothetical bisexual clients as immature and confused." The authors conclude that "like the general public, psychotherapists adhere to stereotypical beliefs about bisexual people," which may negatively impact "bisexual clients’ diagnoses and overall satisfaction from therapy." The study suggests that "education may be key to curbing anti-bisexual bias among psychotherapists and ensuring better therapeutic outcomes for bisexual clients" (p. 624-625).

“It is imperative that psychotherapists are educated on affirmative psychotherapy for bisexual people—content that is manifestly absent from most clinical programs and guidebooks (Barker, 2007; Hayfield, 2020). Unfortunately, previous studies that tested the effect of such educative programs on psychotherapists’ attitudes did not differentiate between attitudes toward bisexual people and attitudes toward gay men and lesbian women. Therefore, what kind of intervention would be most effective in reducing bisexual stereotypes among psychotherapists remains an open question. Broadly speaking, the two most common methods for reducing prejudice are based on either positive (direct or indirect) intergroup contact or multicultural education. Bartos et al. (2014) reviewed the intervention literature and concluded that, in the case of gay men and lesbian women, intergroup contact with an emphasis on empathy cultivation is the most effective method for reducing prejudice. Would the same be true for attitudes toward bisexual people? We suggest that it might not” (p. 627).

Unlike other stereotypes, intolerance and stereotypes toward bisexual people do not always go hand in hand. This conclusion was also supported in the current study, as no differences were observed in psychotherapists’ willingness to treat the hypothetical client. It has previously been suggested that bisexual stereotypes stem from incorrect assumptions about sexuality and from gender binarism. From these assumptions it follows that being sexually attracted to men and women is akin to being pulled in opposite directions, which would entail a persistent conflict for bisexual people and result in identity confusion and romantic turmoil. This “stereotype deduction” account can explain why psychotherapists who are not familiar with bisexual people and hold no explicit negativity toward bisexual people can still hold stereotypical beliefs about them: given the low visibility of bisexual people in society in general and in psychology in particular, these psychotherapists might not even know that their beliefs about bisexuality are prejudicial” (p. 627).

It is possible to reduce bisexual stereotypes, it is crucial to use interventions that also include multicultural education and dismantle incorrect assumptions about bisexual people in particular and about sexuality in general. Some support for this possibility has been found in studies that examine prejudice and bisexual stereotype reduction interventions in the general population…Thus, it seems that when it comes to attitudes toward bisexual people, multicultural education may be a necessary component in challenging prejudice and stereotypical beliefs. However, given the dearth of data on this issue, more research into bisexual-specific stereotype reduction interventions is needed. If the importance of multicultural education in such interventions is confirmed, it will suggest that psychotherapists’ bias may be substantially reduced by providing them with accurate information about the lived experience of bisexual people and by challenging the prevalent binary thinking about sexuality. With that knowledge at hand, psychotherapists may be in a much better position to reject bisexual stereotypes and to promote the wellbeing of bisexual clients” (p. 627).

“The current study has some clear limitations that might restrict the generality of our conclusions. For reasons of available sample size, the current study was focused on stereotypes about bisexual men and did not examine stereotypes about bisexual women and non-binary people…” (p. 626).

“One prediction stemming from the biased evaluation hypothesis was partially disconfirmed. We predicted that the participant’s evaluation of the client as confused and immature would correlate with their assumption that identity-related issues would be therapeutically relevant, but only among bisexual people. We did not expect to find such a significant correlation between the measures for bisexual people and non-bisexual people alike. In hindsight, this was an oversight, as psychotherapists’ evaluation of the two variables should be closely related, regardless of whether the evaluated person is bisexual or not” (p. 626).

“Our study is also affected by some methodological limitations. Some of our main hypotheses were tested using measures composed of one or two items. This raises the concern that our measures had low content validity and/or low reliability. While multi-item measures are superior in both regards, it has been suggested that even single-item measures can suffice if the “construct being measured is sufficiently narrow or is unambiguous” (p. 626).

“Finally, our study suffers from some limitations inherent to all analogue studies. Psychotherapists provided initial clinical evaluations after reading a vignette describing a client’s intake. Thus, while we are confident in the conclusion that this specific evaluation is affected by bisexual stereotypes, it is unclear to what degree these stereotypes would affect a therapeutic process with bisexual clients over multiple meetings. This question is beyond the scope of most analogue studies and can probably only be gauged with field studies that examine how psychotherapy with bisexual clients evolves over time. Nevertheless, there are good reasons to believe that bisexual stereotypes should have long-term effects on therapy beyond the initial evaluation” (p. 626).