The Power of Being Seen: Countering Bisexual Erasure In Psychological Practice

Bisexual people are the largest sub-population within the LGBTQ+ community and face widespread and deleterious effects of erasure. Bisexual in its broadest sense is an umbrella term used to describe the many sexualities that don’t adhere to categorical sexual or affectional binaries (i.e. gay/lesbian or heterosexual) such as pansexual, omnisexual, ambisexual, or queer. Erasure occurs when the existence and credibility of bisexual people is ignored or devalued. For example, erasure occurs when people incorrectly suggest that bisexual people can choose to be heterosexual and are, therefore, not truly LGBTQ+.

Due to biphobia or perhaps a lack of cultural competency, this form of identity invalidation can be perpetuated by mental healthcare providers, resulting in poorer health outcomes. Not only could exhibiting biphobia damage rapport, thereby decreasing the quality of the therapeutic relationship, but perpetrating bi-erasure may even contribute to a client’s decision to terminate treatment. These clients may hold unfavorable views of mental healthcare providers and abstain from pursuing services in the future.

Experiencing acts of biphobia, such as bi-erasure, may contribute to internalized biphobia and self-stigma as well. Internalized biphobia may encourage self-isolation, reduced sense of belonging, and worse mental health outcomes. In this article, we identify and describe common ways clinicians may inadvertently engage in bi-erasure when working with bi+ clients as well as approaches counselors can utilize to be more bi-affirming.

Erasure in Clinical Practice

Despite their best efforts to maintain supportive environments for clients, even the most well-meaning clinicians are not immune to exhibiting unconscious biases. To illustrate this point, we provide specific examples and recommended responses:

• A client presents for therapy having never been in a romantic relationship. They say they identify as bisexual, but they have not come out to anyone and they have no plans to do so. They just hint to others about their identity and then feel rejected when people do not pick up on their hints and/or affirm them.
• We recommend that therapists resist the urge to conceptualize this behavior as attention-seeking, confusion, and/or refusal to identify as gay/lesbian. Doing so could reinforce myths that bisexuality simply doesn’t exist. Even if someone has never engaged sexually or romantically with anyone, however they choose to identify is valid.
• A client presents for therapy married to a person of the “opposite” gender. They left the “sexual orientation” section of your intake form blank. In general, you have noticed that cisgender, heterosexual clients usually leave questions about gender identity and sexual orientation blank because they feel those questions do not apply to them.
• We recommend against assuming a client’s sexuality is based on the gender expression of a current or previous partner. By assuming someone in a same-sex relationship is queer  or someone in a different-sex relationship is heterosexual , a counselor may contribute to existing pressures bisexual individuals feel to prove the validity of their identity. Likewise, it can be invasive to jump into questions about sexual orientation. We suggest that important aspects of a client’s identity will come up in therapy if therapists leave space for clients to self-identify organically.
• A client presents for therapy after coming out to their parents as pansexual. The client states, “I mean, I did not come out as gay/lesbian, so I guess my parents don’t care. I am sure they just think it is a phase. I’m fine.”
• We recommend against minimizing and/or overlooking client concerns about the coming out process when conceptualizing client presenting concerns. By dismissing client concerns about coming out, counselors may be invalidating a bisexual identity by implying it is not queer enough to be taken seriously. Bisexual individuals may experience rejection, disapproval, discrimination and even overt hostility, assault, or bullying upon coming out to friends/peers, family members, and romantic partners. Bisexual individuals, like any other LGBTQ+ person, may have reasonable fears and hesitancies related to the coming out process that can to be validated.
• A bisexual client presents for therapy and clearly warrants further assessment for a personality disorder diagnosis based on disorganized, chaotic, and turbulent relationship patterns.
• We recommend against including bisexuality as part of the presenting concerns and/or pathologizing a client’s sexuality. Identifying a client’s sexuality as a symptom of psychopathology (e.g., part of the disorganized and boundaryless presentation) invalidates their orientation. Accrediting one’s sexuality as the cause of their problems also erases the identity as it implies the client’s issues are the consequences of choice. A variety of factors can contribute to unstable and contentious relationship patterns (e.g., attachment styles, previous trauma, history of intimate partner violence, substance misuse, etc.) Incorporating minority stress theory into your case conceptualization may also help to elucidate why certain relationship patterns are more likely to be present among bi+ clients. 

Countering Erasure as a Lifelong Journey

There are many steps providers can take to communicate a bi-affirming stance; however, clinicians cannot solve the pervasive problems caused by biphobia and bi-erasure overnight, and offering a comprehensive approach to countering erasure is beyond the scope of this article. Below our bios, we provide a list of affirming actions to consider and resources clinicians may reference for further study.

Future Directions for the Field 

Preventing clinicians from exhibiting bi-erasure in the first place will involve addressing biphobia before clinicians interact with clients. Therefore, areas for additional research could include exploring how bisexuality is discussed in graduate-level mental health programs, if at all. Faculty attitudes towards bisexuality and bisexual people could also be explored as an instructor’s biases may shape those of their students (i.e. future clinicians) as well.

Caroline Broughton, LMSW, RYT (she/her)  holds an MSW from the University of Texas at Arlington’s School of Social Work. Caroline is a research contributor in the Health Education and Rural Empowerment (HeARE Lab) at Oklahoma State University. Her research interests include queer embodiment, recovery from trauma/CSA, as well as LGBTQ+ resiliency and affirming care.

Douglas Knutson, PhD, LHSP, ABPP (he/him) is the Myron Ledbetter/Bob Lemon Counseling Psychology Diversity Associate Professor and Training Director in the Counseling Psychology Program at Oklahoma State University. He is a licensed health service psychologist in Oklahoma and is board certified in counseling psychology. Douglas is the director of the Health, Education, and Rural Empowerment (HEaRE) Lab, a consortium of scholars focused on research and advocacy for rural LGBTQ+ people. He also serves on the APA Committee on Rural Health, as an associate editor with the Journal of Rural Mental Health, and as director of the APA Division 17 Communications and Technology Board.

Resources for Further Study and Reflection 

Reflection and Self-Exploration Prompts

Becoming aware of the issues and disparities affecting the bi+ community is a great first step to becoming a bi-affirming clinician. Other actions that may help could include:

• Signaling safety with bisexual/pansexual pride flags, include bi+ texts in book shelves, and/or explicitly stating bi+ inclusion on practice websites, provider profiles, or in support group advertisements.
• Providing referrals to bisexual specific community resources when available.
• Reflecting on one’s own heterosexist and/or biphobic biases in order to work on them.
• Discussing safer sex practices within a variety of sexual contexts with your clients where appropriate.
• Utilizing gender-neutral language/pronouns when referring to a client’s previous or current romantic/sexual partners if their identities are unknown.
• Educating yourself on different styles of consensual non-monogamy (CNM). While polyamory is not any more common among bisexuals, some bi+ folks report CNM practices (sometimes including polyamory) as affirming and important to their bi+ identity.
• Exploring client experiences with rejection and introducing the role of biphobia (including internalized biphobia) where appropriate.
• Pursuing training in attachment-based approaches as this has been shown to be helpful in addressing biphobia within family systems as well as building resilience to biphobia in individual approaches.
• Respecting your client’s right to self-determination, especially in regards to the coming out process. Don’t pressure bi+ clients (or clients of any sexuality) to come out. If there is resistance, explore why that is and what factors may contribute.
• Conducting bi+ specific research or making an effort to not lump bi+ data within heterosexual or broadly queer data sets.
• Incorporating minority stress theory and intersectional feminist theories into your clinical approach.
• And, of course, validating, validating, validating.