Clinical Issues With Bisexuals

Counselors working with self-identified bisexuals need to assess their clients’ sexual behavior and identity issues and also focus on a range of psychosocial issues that may complicate substance abuse treatment of bisexual clients. Bisexual identity is not exclusively or necessarily defined by sexual behavior. Indeed, the contemporary conceptualization of bisexuality is that it should be understood as a sexual orientation in and of itself and distinct from heterosexuality and homosexuality. The current view has developed over time. Our understanding of bisexuality has not been historically fixed and, in fact, has shifted along a continuum of validation to a denial of its very existence. Sigmund Freud, for example, writing in 1925, affirmed his belief in “the constitutional bisexuality of all human beings” (Fox, 1996, p. 148) and reaffirmed this again in 1937. In stark contrast Bergler wrote in 1959 that “Bisexuality . . . is an out and out fraud,” suggesting that bisexuals were in denial about their homosexuality (Fox, 1996, p. 149). Although it is not uncommon for gay men and lesbians to look back at their coming out process and recall a time in their lives when they self identified as bisexual, this does not negate the fact that some individuals clearly are bisexual and that bisexuality can be understood as a distinct sexual orientation.


For some bisexuals, their bisexual identity is continuous and fixed across their lifespan. For others, sexual orientation may be more fluid and marked by changes from heterosexual to either lesbian or gay or vice versa. This observation may be behind some of the more common myths and misperceptions regarding bisexual individuals. These mistaken beliefs are prevalent among lesbians and gays as well as among the heterosexual population and unfortunately may also be internalized by bisexual individuals, thus complicating their treatment. Some of the more persistent myths are listed below.

Bisexuals are confused about their sexual orientation.

Bisexuals are afraid to be lesbian or gay because of social stigma and oppression by the majority.

Bisexuals have gotten “stuck” in the coming out process.

Bisexuals have knuckled under to the social pressure to “pass” as straight.

Bisexuals are in denial about their sexual orientation.

Bisexuals are hypersexual and will have sex with anyone.

Bisexuals are not “fully formed” lesbians or gay men.