Transference and insight in psychotherapy with gay and bisexual male clients: the role of sexual orientation identity integration.

Clinical writing has suggested that the therapeutic process and relationship in work with lesbian, gay, and bisexual clients may be influenced by the extent to which clients have accepted their sexual orientation and developed a social network supportive of their sexual orientation, a construct we refer to as sexual orientation identity integration. The present cross-sectional study investigated this proposition by examining the identity integration ratings of 90 gay and bisexual male clients in relation to elements of treatment as rated by both the therapist (insight, negative transference, working alliance, session depth, and client improvement) and client (working alliance, session depth, and client improvement). Participants were male-male therapy dyads recruited from lesbian, gay, and bisexual-affirming practices. Client identity integration was negatively associated with transference, and positively associated with ratings of insight, alliance, depth, and improvement. Insight, but not transference, uniquely mediated the positive association between identity integration and most indicators of therapeutic quality. Results from an exploratory model suggested that transference may indirectly influence therapeutic quality by serving as a barrier to insight.