What Your Therapist Needs to Know
to Support You Better
Get curious about your therapist’s Bi+ clinical competency
and your unique Bi+ challenges and mental health risks.
Being on the Bisexual Spectrum (Bi+) is still fraught. The strange thing is that it seems like it shouldn’t be. Aren’t we way past Bisexuality being an issue for anyone by now? This belief is actually part of the problem: the struggles Bi+ people grapple with continue to be dismissed, under-studied, and minimized, and we are cast as whiny, confused, and attention-seeking. This very dismissal prevents the struggles the Bi+ population’s experiences from being appropriately heard, understood, acknowledged, validated, and therefore addressed. Continuing to bring up the difficulties we face as Bi+ community members is framed as exactly the whiny, attention-seeking we are accused of. It is a catch-22-type trap! If we bring it up, we are dismissed; if we don’t bring it up, the harm existing in the status quo continues.
For years I have been living with, and thinking about, the struggles that people on the Bisexual Spectrum endure. As a Bi+ person, I have grappled with these issues since well before I had adequate understanding or language to describe them. Now, thinking through the topic as a Registered Clinical Counsellor (RCC) and Bi+ person, I want to articulate what I have learned about the challenges we in the Bi+ population continue to face, including significant invisibility.
The last place we want to feel invisible is with our therapists! Yet numerous Bi+ therapy clients are invisible to their therapists. This article may help you identify Bi+ affirming therapists, educate your therapist who may not be aware of the unique challenges you may face as a Bi+ person, and help you advocate for yourself better in the therapy room.
A note on terminology: Bi+
I am using the terms “Bi+” and “Bisexual spectrum” to refer to all who recognize themselves to be multi-sexual, including: bisexual, queer, pansexual, fluid sexuality, and others who know themselves to be non-monosexual. Language is fluid, and this is my current working terminology. Others may use these terms in slightly different ways — or even evolve new language.
An evolving acronym: 2SLGBTQI+ and the Invisible B
The queer community was once-upon-a-time referred to as the lesbian and gay community. Soon bisexuals were added, and an acronym was born. For a long time, it was called “the LGB”, and then “the LGBT”, community. Decades later, the acronym has grown substantially as the community works to be more inclusive of various gender expressions and sexualities. In 2025, it is known as the 2SLGBTQI+ community in Canada (it varies in other countries). Despite this progress toward inclusivity, Bisexuality still seems strangely absent from discussions about queerness, and a cursory foray into TikTok confirms continued invalidation. This article, along with many strong Bi+ advocates and writers, is part of trying to change this.
According to research, one-third of young people identify on the Bisexual Spectrum, yet one-fifth of the general population does not even believe such a spectrum even exists [1]. In addition, although the Bi+ population makes up almost 60% of the 2SLGBTQI+ population [2], many people within that community deny our existence. When Bi+ people are acknowledged, it is often as the subject of jokes, fetishizing narratives, or invalidating statements. If you are out as Bi+, then I bet you know what I am talking about. Who else has had a family member make threesome jokes about you at family gatherings? Ick!
Bi+ people are often presumed to be heterosexual, gay or lesbian based on the identities of their current partnerships. Such an oversight not only invalidates their sexuality, it also assumes sexuality cannot exist as a facet of who they are outside of a relationship. Sexuality is a human trait that is not contingent upon one’s current choice of partner: our sexuality goes with us — it is ours’. It belongs to us regardless of our partner.
Bi+ people are frequently missed by research and services that group us together with gays or lesbians. As a result, Bi+ people are under-recognized, under-served, and under-studied. This aspect of Bi+ invisibility has serious implications for competency in the practice of counselling therapy and for Bi+ therapy clients’ lives. If nothing else, the one place therapy clients should not be invisible or invalidated is in our counselling sessions with our therapists! I am hoping this article can help empower you with more knowledge about what to look for and expect in a therapist.
Bi+ Stressors and Challenges
When you are choosing a counselling therapist, is it important to understand that most them did not receive specific training in their counselling programs to help them understand the unique needs and challenges of the Bi+ population.
Bisexual-identified individuals experience unique challenges associated with their bisexuality. However, currently there is a paucity of research on how bisexual and monosexual experiences differ, as well as on what experiences facilitate or impede bisexual identity development and mental health. This lack of information leads to minimal mention of and virtual invisibility of bisexuality in the most commonly used textbooks directed at counseling diverse clients. [3]
It is important that counsellors be aware that their Bi+ clients have increased mental health risks in comparison with the general population and with their 2SLGBTQI+ peers.
Some of the reasons for Bi+ clients’ poorer mental health outcomes include: [4]
Our Bi+ sexual identities are perpetually contested
Stigmatization — we engage in ongoing effort to manage our identity to reduce the negative impact of stigmatization
We have higher incidence of poor physical and mental health outcomes
We have higher incidence of suicidal ideation and substance use
Bi+ invisibility, biphobia, bi-negativity and bi-erasure
Monosexism (see definition in sidebar)
We are frequently assumed to be more likely to cheat, or be less monogamous than others
We are more likely to be sexualized
We are more likely to be presumed to pass on sexually transmitted diseases
We have lower levels of self-disclosure, therefore tend to be less out than their queer peers
We have less community connectedness than 2SLGBTQI+ peers
We have higher risk of anxiety and mood struggles than lesbian, gay and hetero peers
We are more likely to receive pressure to change or lie about one’s identity, or are pressured to keep one’s identity secret and remain closeted
The lack of Bi+ community leads to increased isolation, and to miss out on the protective aspects of community that Gay and Lesbian peers benefit from
Bi+ women are more likely than hetero women or lesbians to experience intimate partner violence
Bi+ women face particular challenges due to a higher likelihood of being fetishized
Bi+ men face particular suspicion, scorn and doubts to their sexuality and masculinity
When trans and non-binary identities intersect with being Bi +, clients may face compounded erasure, misunderstanding, or invalidation
The trans and non-binary Bi+ populations are even more under-researched
We have more trouble finding Bi+ affirming therapists
Double discrimination: we are often maligned by both 2SLGBTQI+ and hetero populations
We engage in ongoing emotional labour of continuously having to come out over and over again
We experience invisibility in many spaces
While some of these challenges may be similar to those experienced by other marginalized populations, it is clear that Bi+ populations experience specific and unique challenges and mental health risks and may be some of the reasons we seek therapy support.
As I am writing this article, I am hyper aware of the trope of the “whiny bisexual”, and that writing this article feeds right into that minimizing piece of dismissive bi-negativity. If this type of thought crossed your mind, you too have been touched by bi-negativity! We get labelled “whiny” when we advocate for themselves.
What are counselling therapists missing?
As I reflect on being Bi+ through the lens of counselling therapy and as a therapist who primarily works with 2SLGBTQI+ clients, I continue to observe a deep need for improved Bisexual Clinical Competency (BiCC) among therapists. The therapist’s attitudes toward Bi+ sexuality influence clinical judgements, reactions, and therapeutic relationships. More than empathy, Bisexual Clinical Competency is predicated on a clinician’s attitudes toward Bi+ sexuality [5].
Part of being a counselling therapist is advocacy for their clients’ best interests. Happily, we have witnessed and experienced increased advocacy for therapists’ lesbian and gay clients, their BIPOC clients, their neuro-diverse clients, their trans clients, and more. We generally assume, and rightly expect, topics related to these groups will be addressed in counselling training, supervision, conferences, etc. However, the advocacy on behalf of Bi+ people has not yet had sufficient impact to ensure widespread and adequate Bisexual Clinical Competency among therapists. In fact, most 2SLGBTQI+ competency training conflates bisexuality with lesbian and gay experience and does not acknowledge this population’s particular challenges. As a result, Bi+ people are dismissed as not having unique problems or their problems are minimized.
Bisexual Clinical Competency (BiCC)
Bisexual Clinical Competency refers to a counselling therapist’s competency in serving their Bi+ clients in an affirming, welcoming, knowledgeable manner with the understanding that bisexuality is a stable, healthy sexuality. The counsellor would be aware of the specific types of challenges and stigmas Bi+ clients face and of the impacts on their mental health, relationships, and long-term health outcomes.
Therapists have a responsibility to create safer spaces for their Bi+ clients so that we are able to process our experiences — including topics that are unrelated to our sexuality. Improved competency will allow therapists to become more attuned to their Bi+ clients unique challenges. I believe the vast majority of therapists would welcome increasing their own competency and learning about their biases regarding their Bi+ clients! Share this article with your therapist! They may know this stuff already — yay — or may be unaware of some of what you encounter as a Bi+ person.
What does Bi+ affirming therapy look like?
The therapist is aware of the stigmas and unique challenges associated with being Bi+
They understand the impacts that bi-negativity, erasure, stereotypes, exclusion and the resulting bi-invisibility have on Bi+ clients’ health outcomes and daily lives
They are affirming and validating of their clients’ Bi+ identity and have an understanding of Bi+ sexuality as stable, healthy, and legitimate
They are aware that the therapeutic relationship may hold particular importance in reducing the feelings of isolation and loneliness, which research tells us Bi+ clients report higher levels of
They do not over-focus on the clients Bi+ identity
They have explored their own attitudes toward Bi+ sexuality and are able to acknowledge the implications of these on their counselling practice so as not to invoke stereotypes, stigmas, misinformation, or bi-negativity
If a therapist cannot uphold Bi+ affirming practices, they should be proactive about referring Bi+ clients to a therapist who can show up in an affirming manner
They are aware that voicing “an alternative normalizing narrative is needed — both in terms of the existence of Bi+ lived experience, and of living within a Bi+ negative and erasing society” [6], especially given the prevalence of Bi+ erasure and heteronormativity
They are aware that Bi+ identities can involve fluid experiences of self across time, context, and relationship — they would avoid framing this fluidity as confusion, immaturity, or pathology
As Bi+ clients and community members, we confront numerous challenges unique to our sexuality — the worst of which might be living an unseen life. “It is important to understand that invisibility is its own form of stigmatization. Many individuals who are members of marginalized groups find themselves caught in an ever-tightening vice of two types of dehumanization — stereotyping and invisibility.” [7]. My ultimate goal is to make bisexuality more visible and to create a dialogue that can increase therapists’ competency, improve counselling clients’ ability to identify Bi+ affirming therapists, and contribute to clients feeling more empowered in their own therapeutic process.
Though I have just scratched the surface of the interesting and surprising landscape that Bi+ therapy clients occupy, I hope this provides fodder for a deeper understanding (see additional resources for further reading [8]). Even if we as Bi+ people continue to be invisible, invalidated, or discriminated against out in public spaces, in the protected environment of our counselling sessions, we can ask and expect our therapists to show up as knowledgeable and validating practitioners who witness us when we feel invisible. They can hear about our particular struggles, assist us in making sense of our own experiences and, perhaps most importantly, help us feel less alone.
warmly,
Laurel
Laurel Swenson, RCC (she/they): I am a Registered Clinical Counsellor who operates a private practice called Mindsight Counselling and Wellness in Vancouver, BC, who predominantly serves the 2SLGBTQI+ community. With significant lived experience as person on the Bisexual Spectrum (Queer/Bi/Pan), I have a special interest in increasing Bi+ awareness in all communities, connecting with other 2SLGBTQI+ RCCs, and improving Bisexual Clinical Competency (BiCC) among counselling therapists so more Bi+ people may thrive.
Mindsightcounselling.ca | laurel@mindsightcounselling.ca
Note: If you want a version of this article that is aimed at therapists to share with your therapist, email me and I will be happy to send you a link to download a pdf.
Helpful terminology and definitions
Bisexual
“The potential to be attracted —romantically and/or sexually — to people of more than one sex and/or gender, not necessarily at the same time, not necessarily in the same way, and not necessarily to the same degree." [9]
Queer
I use the reclaimed term “queer” as a shorthand umbrella term for 2SLGBTQI+.
Monosexism
Monosexism is a social structure that presumes everyone is, or should be, monosexual, and privileges monosexuality and monosexual people, and is systemically punitive to those who are not monosexual. [10]
Heteronormativity
Heteronormativity is made up of cultural and social norms which posits that there are only two binary genders, and asserts that the only acceptable form of sexuality and romance is between a cisgender man and a cisgender woman. Heteronormative standards assert any behaviour or lifestyle that deviates from it is abnormal and should be changed to conform. (Eisner)
Bi-negativity / Biphobia
The negative, harmful, stigmatized ways Bi+ people are viewed, coupled with lack of support for Bi+ rights as people. This can originate from external sources, but also can become internalized. Though often used interchangeably, bi-negativity is a more accurate term than biphobia — because haters are not actually afraid of Bi+ people; they are mean-spirited towards them.
Bi erasure
“Bi erasure is a tendency to ignore, remove, falsify, or reexplain evidence of bisexuality. Examples of bi erasure could include referring to all same-sex couples as "gay marriages" — the active denial of the existence of bisexuality, or a history book ignoring or dismissing a figure's bisexuality and instead labeling them as gay or straight.” (Bi.org)
References
Brooks, L. M. & Inman, A. G. (2013). Bisexual counseling competence: Investigating the role of attitudes and empathy. Journal of LGBT Issues in Counseling, 7(1), 65-86. http://doi.org/10.1080/15538605.2013.756366
Gallop poll 2023: https://news.gallup.com/poll/611864/lgbtq-identification.aspx
Bonjo, L.A. (2013). How Counselors Are Trained to Work with Bisexual Clients in CACREP-Accredited Programs
Grant, S. (2023). Working with bi+ clients: Considerations for individual and relationship therapy. In S. Neves & D. Davies (Eds.), Relationally queer: A pink therapy guide for practitioners (pp. 87-106). Routledge. http://doi.org/10.4324/9781003260561
Brooks, L. M. & Inman, A. G. (2013). Bisexual counseling competence: Investigating the role of attitudes and empathy. Journal of LGBT Issues in Counseling, 7(1), 65-86.
Grant, S. (2023). Working with bi+ clients: Considerations for individual and relationship therapy. In S. Neves & D. Davies (Eds.), Relationally queer: A pink therapy guide for practitioners (pp. 87-106). Routledge. http://doi.org/10.4324/9781003260561
Brown, Brené. (2021). Atlas of the Heart: Mapping Meaningful Connection and the Language of Human Experience. Random House. (p. 177)
Shaw, J. (2022). Bi: The hidden culture, history and science of bisexuality. Abrams Press.
Ochs, Robyn. (2024) https://robynochs.com/2020/10/09/i-call-myself-bisexual-because/
Eisner, Shiri. (2013) Bi : notes for a bisexual revolution, Seal Press, Berkeley, CA (pp. 63)
Eisner, Shiri. (2013) Bi : notes for a bisexual revolution, Seal Press, Berkeley, CA (pp. 47)
Bi.org (2024) https://bi.org/en/glossary
Further reading
S. Neves & D. Davies (Eds.), (2023) Relationally queer: A pink therapy guide for practitioners. Routledge. http://doi.org/10.4324/9781003260561
Shaw, J. (2022). Bi: The hidden culture, history and science of bisexuality. Abrams Press.