Bisexual Women's Experiences of Receiving Help for Mental Health Difficulties Through Psychological Therapy: A Qualitative Exploration

Bisexual women face higher rates of mental health difficulties and worse treatment outcomes from psychological therapies than other groups within the lesbian, gay, bisexual, transgender, and queer (LGBTQ+) community. Yet, research exploring treatment outcomes has predominantly investigated LGBTQ+ individuals as a homogenous group. This study investigated bisexual women's experiences of receiving help for mental health difficulties through psychological therapy. Eight bisexual women participated in online, semistructured qualitative interviews that explored their experiences of receiving psychological therapy and views on how to improve services. Qualitative data were audio-recorded, transcribed, and inductively analyzed using Reflexive Thematic Analysis. Participants described challenges, such as experiences of discrimination, that came with being both bisexual and a woman, alongside exacerbating difficulties associated with being neurodivergent or part of a marginalized ethnic group. These experiences led them to anticipate biphobia from their therapist, which participants managed through strategies such as identity concealment. Negative help-seeking experiences included therapists pathologizing bisexuality. Positive experiences included where therapists adopted a nonjudgmental and collaborative approach. Participants emphasized the importance of feeling that their identity was understood but expressed differing opinions about whether client-therapist identity matching is necessary. Results highlight the challenges associated with navigating bisexuality within clinical encounters amongst other marginalized identities, alongside the need for bisexual women to actively manage these challenges to keep themselves safe. Clinical implications include the need for therapists to receive training about bisexual women's needs and to acknowledge the impact of social and systemic injustice relating to their marginalized identities within clinical formulations.Public Significance StatementThis study advances our understanding of bisexual women's experiences within psychological therapy which may help us to understand why they face poorer treatment outcomes than other groups. Our findings highlight that therapists should affirm bisexual women's sexual orientation and other marginalized identities (e.g., neurodivergence), be nonjudgmental and collaborative, and access training to increase their knowledge of bisexual women's issues.