1. Jerel Armstrong, Jonathan Preiss, and Carmen Wolf

2. Bisexuality
Bisexuality refers to the “human capacity for loving,
valuing, and sexually desiring other people in ways that
are not limited by gender. (Firestein, 2007).
Third and often forgotten or dismissed variation of sexual
orientation.
Bisexuality and pansexuality might be considered to be
on opposing ends of a spectrum regarding the
importance of gender. Strict bisexuality gives stronger
consideration of the gender of the person with whom
they are attracted. Pansexual individuals may not give
any consideration to gender and most likely reject a
bisexual identity.

3. Models of Bisexual identity development
D’Augelli (1994) model of development
encompasses both gay/lesbian identity
development as well as bisexual development.
D’Augelli’s theory consists of an interactive
model of development. This is in contrast to the
stage model developed by Cass (1979).
Cass does assert that bisexual, heterosexual
and homosexual can be taken as separate
identities with similarities and differences in
their developmental process.

4. D’Augelli (1994) model
Exiting heterosexual identity
• Recognition that one’s feelings and attractions are not
heterosexual as well as telling others that one is lesbian, gay, or
bisexual.
Developing a personal lesbian/gay/bisexual identity status
• A “sense of personal socio-affectional stability that effectively
summarizes thoughts, feelings, and desires” (D’Augelli 1994).
• One must also challenge internalized myths about what it means
to be gay, lesbian, or bisexual.
• Developing a personal identity status must be done in
relationship with others who can confirm ideas about what it
means to be nonheterosexual.
Adopted from: Bowling Green State University

5. D’Augelli Model continued
Developing a lesbian/gay/bisexual social identity
• Creating a support network of people who know and accept one’s
sexual orientation.
• Realizing people’s true reactions can take time.
• Reactions may also change over time and with changing
circumstances.
Becoming a lesbian/gay/bisexual offspring
• Disclosing one’s identity to parents and redefining one’s
relationship after such
disclosure.
• D’Augelli noted that establishing a positive relationship with one’s
parents can take time
but is possible with education and patience.
• This developmental process is particularly troublesome for many
college students who
depend on their parents for financial as well as emotional support.

6. D’Augelli Model continued
Developing a lesbian/gay/bisexual intimacy status
• This is a more complex process than achieving an intimate
heterosexual relationship
because of the invisibility of lesbian and gay couples in our society.
• “The lack of cultural scripts directly applicable to
lesbian/gay/bisexual people leads to
ambiguity and uncertainty, but it also forces the emergence of
personal, couple-specific,
and community norms, which should be more personally adaptive”
(D’Augelli, 1994).
Entering a lesbian/gay/bisexual community
• Making varying degrees of commitment to social and political
action.
• Some individuals never take this step; others do so only at great
personal risk, such as
losing their jobs or housing.

7. Weinberg et al. (1994)
4 stage model of bisexual development
•Initial Confusion
•People feel confused because their attractions for members of
both sexes are strong and anxiety provoking
•One’s self-labeling options include only “heterosexual” or
“homosexual”
•Difficulty acknowledging one’s same-sex attraction, a
phenomenon more common in men than women.
•Finding and Applying the Label
•Having enjoyable sex with members of both sexes after becoming
aware of the “bisexual” label.
•Negative attitudes about bisexual behavior, and stereotypes about
bisexuals added to their intermittent self-doubt or confusion
(Weinberg et al., 1994).
As cited in Brown (2002)

8. Weinberg et al. (1994)
Settling into the Identity
•More comfortable with their sexuality, often through social
support.
•Acceptance of bisexual feelings rather than to sexual or
emotional involvement with members of both sexes
Continued uncertainty
•After self-label as bisexual, it was common to experience
periodic confusion about sexuality
•Insufficient social validation and a lack of bisexual role
models and communities thought to contribute

9. Layercake Model of Bisexual Identity Development
Bleiberg et al. (2005)
Based on a sample of college age self identified bisexuals.
1. Socializes into a Heterosexual world; Develops Heterosexual
identity
•From birth to first encounter with homosexuality
2. Experiences Homosexual feelings, thoughts, and/or behaviors
•Begin to question heterosexual identity
1. Accepts homosexual attraction while maintaining heterosexual
identity
•Conscious of being rejected by homosexual and heterosexual
communities if they come out.

10. Layercake continued
4. Integrates and assimilates heterosexual and homosexual
identities
•Identify as neither gay or straight, but attracted to both
genders
•Sexuality as a continuum
•Anger and Frustration common as a reaction against
being invisible as a separate and legitimate sexual identity
•May start coming out process
5. Identifies as bisexual
•Develops own definition of bisexuality or self label

11. Models of Bisexual Identity Development
These models are of course broad and overly simplified from
multiple people’s experiences of developing their identity. Every
persons experience will be different but we can use these generic
models to help guide our conceptualization and understanding
about a client’s particular place on the development journey.
Ethnicity, gender, religion, age, culture will all contribute to an
individuals identity development process. The intersectionality of
all these components will present varied challenges and
difficulties that will need to be navigated in the clinical setting.
Research is sorely lacking regarding the influence of these
factors on bisexual identity development. Research into gay and
lesbian development can provide useful information, keeping in
mind that bisexual identity development is unique and may not
follow the same course as homosexual development.

12. Clinical
Application
Firestein (2007) explains that changes in identity constitute a
process of construction and reconstruction of the self. In order to
develop new ways of thinking about sexuality to make room for the
authentic sexual self, aspects of the self must be reconstructed.
This involves the reconstruction of the self, one’s own
psychosexual world, and sociocultural sexual world.
The therapeutic container can be a safe place for a person
developing their bisexual identity to “test” or “practice” their new
way of being. Also, therapy can help clients distinguish the
fundamental elements of their attraction to another person. For
instance is the client attracted to another person because of their
gender or is gender only secondary to their attraction. This
separation of attraction being tied to sex/gender can help a client
develop their own personal way of understanding and expressing
their developing identity.

13. Clinical Application Continued
A therapist can also help clients understand the nature of their
attraction to another person. Is their attraction, sexual, sensual,
friendship, platonic affection, admiration, or many other types of
feelings?
Firestein (2007) provides clinical tips for working with bisexual
clients:
“Assure Clients that attraction to men and attractions to women are
not mutually exclusive or contrary types of attraction” p. 24
“Give clients permission to see their sexuality as changing over the
life course” p.24
“Give clients permission to embrace identities within their own
unique narrative” (culturally sensitive)

14. Clinical Application Continued
“Provide outside resources”
Resources for bisexual clients may not be as available as
homosexual resources.
Do not wait to find resources until you have a client that needs
them. Find them now!!
Affirmative practice is ethical practice
Become adequately informed
Bisexual specific education is often lacking
Firestein (2002) recommends reviewing APA/Division 44
Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual
Clients (2000) as an adequate starting place for becoming
informed.
http://www.apa.org/practice/guidelines/glbt.pdf

15. “There is really no such thing as being
bisexual.” -Dr. Ruth (2005)
Societal influence on Bisexuality

16. Lack of Acknowledgement
 Western perspective on sexual orientation
views the construct as Binary (Bradford,
2004).
 For individuals who identify as bisexual
this means they are forced to choose a
label that isn’t fitting OR be invisible
(Bradford, 2004).
 The above pressure to choose not only
comes from the dominant culture but also
from others in the LGBT community
(Obradors-Campos, M. (2011).

17. Acknowledgement Cont’D
Capulet (2010) declared that activism
by LGBT organizations often fails to
“address bi-sexual specific problems (p
294).
Obradors-Campos (2011) notes that the
confusion around how bisexuality is
defined leads to misconstruing what it
means to be bisexual.

18. Risk Factors – Challenges for bisexuals
 Discrimination from dominant culture
because of being sexual minority
 Non-bisexuals, including other sexual minority
groups, view bisexuality as a transient phase
rather than a third sexual orientation
 Popular media portrayals often depict
bisexuals as wild and promiscuous.
Capulet, I. (2010). With reps like these: bisexuality and celebrity status. Journal of
Bisexuality, 10, 294-308. doi: 10.1080/15299716.2010.500962.

19. Impact on the Bisexual Self
Bisexual individuals are at risk of
internalizing the aforementioned
stereotypes and instances of
discrimination and oppression (Calzo,
Antonuuci, Mays, &Cochran, 2011).
Bisexuals are left with little room to
assert the identity and be validated
(Bradford, 2004)

20. Variability and Development
 The age at which an individual comes out and
acknowledges their bisexuality will have
influence on career development and sexual
identity development
E.g. For those who acknowledge their
bisexuality later in life their sexuality is a
more salient and significant part of their
life, whereas those who are younger tend to
view it as another aspect of their identity
Calzo et al. (2011)

21. Variability and Development
Cont’d
 For clients who begin to identify as
bisexual later in the developmental process
coming out is often associated with loss
(i.e. of privilege and social status).
 For individuals who begin to identify as
bisexual at an earlier stage of development
other areas (i.e. career development ) are
arrested while sexuality and sexual
orientation are explored.

22. Clinical Issues
Affirming the client
- Ask about orientation rather than assuming to
avoid marginalizing the client.
- Working from a strength based approach will
help to counteract the propensity to pathologize
this population.
Making sure the therapy space is also
affirming to the client (i.e. explicit
symbols of acceptance)
Bradford, M. (2004)

23. Clinical Issues Cont’d
 Externalizing society’s discrimination and
oppression as a problem that lies with them
rather than something faulty within the
client.
 Exploring issues of homophobia, biphobia
and how it affects the client.
 Being familiar with the community in
order to connect or refer clients to
appropriate resources
Bradford, M. (2004)

24. Bisexuality & Women

25. Invisibility in research
Barely any research on the B in LGBT
(Ross, Siegel, Dobinson, Epstein, and
Steele, 2012). Instead bisexuality is
generally clustered in with the gay and
lesbian populations.

26. Invisibility and how it is projected
on others
Things people say about bisexuality:
It’s just a phase
You are greedy
It’s not real
It’s a stop on the way to gay town
Bisexual individuals cannot be
monogamous

27. Media
 It’s either about sex
 Or it’s a joke:
 http://www.youtube.com/watch?
v=DamwesHr7pQ
 Here is a great video blog on bisexuality myths:
http://www.youtube.com/watch?
v=aGXCC9VCMF4
 And here is a clip from one of my favorite
shows unfortunately perpertrating those myths:
http://www.youtube.com/watch?
v=AEIWg6pV9g0

28. Objectification
 Pornography (lesbian & bisexual porn;
generally unrealistic or involves a man in
some manner)
 Music (I kissed a girl by Katy Perry, Nicki
Minaj recruiting women for Ushers song
Little Freaks, etc.)
 Video that shows the lack of healthy
representation of bisexuality in the media:
http://www.youtube.com/watch?
v=b6myqGvifRk

29. Increased Health Issues
Increased stress (low social support
from both the gay and straight
communities, judgment from both sides,
invisibility, etc.)
Increased substance abuse (cigarettes,
alcohol, etc.)
Increased chronic health issues
(diabetes, heart disease, etc.)
Increased mental health issues
(depression, anxiety, etc.)

30. Health Issues cont’d
• Increased sexual health issues (greater
risk for STD’s and infections)
• Less likely to have health insurance.
Stole this one from the teacher:
http://www.youtube.com/watch?
feature=player_embedded&v=CohtBDd
j66A
http://www.youtube.com/watch?
v=aGXCC9VCMF4

31. Minority Status and Health
• “Hispanic lesbians and bisexual women,
compared with Hispanic heterosexual women,
were at elevated risk for disparities in smoking,
asthma, and disability. Hispanic bisexual
women also showed higher odds of arthritis,
acute drinking, poor general health, and
frequent mental distress compared with
Hispanic heterosexual women. In addition,
Hispanic bisexual women were more likely to
report frequent mental distress than were non-
Hispanic White bisexual women” (Kim &
Fredriksen-Goldsen, 2012, p e9).

32. Age and health
• “Lesbian and bisexual women in the
Women's Health Initiative, a national study
of postmenopausal women over 50, were
less likely than heterosexual women to have
health insurance and more likely to be
smokers, to use alcohol, to report other risk
factors for reproductive cancer and
cardiovascular disease, and to score lower
on measures of mental health and social
support” (Valanis et al., 2000; as cited in
Ryan & Gruskin, 2006, p. 330).

33. Videos
 Several more videos I found informative (at
least partially) and/or funny (but you may not
agree):
 http://www.youtube.com/watch?v=t-
4w6NqfLAc
 http://www.youtube.com/watch?v=TIZ-
4CwWKVs

34. Implications for Conducting
Therapy with Bisexual Women
 Keep in mind that sexuality is fluid. Bisexual
individuals can change over time and now two
people are identical.
 Some bisexual individuals may like men more,
women more, or both equally…again sexuality
can be fluid.
 Be aware of internalized homophobia. For
example, a bisexual woman that is afraid of
being friendly with other women because she
fears they will think she is coming on to them.
She has internalized societies negative views of
the LGBT population and has fear while
interacting with others.

35. Implications cont’d
 Be aware that they may not be out with their
families and that this is there choice whether
they come out or not.
 Let the client define their sexual orientation
rather then making parameters for them. For
example, having are you gay or straight on a
form is not appropriate. A more appropriate
question may be “how do you define your
sexual orientation”, and then just let them
write it out in their own words.

37. Male Bisexual Considerations
Often not to be considered a legitimate sexual identity. Partly
due to many now homosexual males having identified as
bisexual during their gay identity development.
Previous research was
unable to identify
bisexual genital arousal
to both genders
(Rosenthal, Sylva,
Safron & Bailey, 2011).
Bisexual men are rarely
objectified in society to the
degree that female
bisexuals are.

38. Rosenthal, Sylva, Safron & Bailey, 2011
Found congruence between self identified bisexual males
subjective and sexual arousal. This provided evidence that
bisexuality actually exists.
Sexual arousal as a function of self-reported sexual orientation (Kinsey score). For both graphs, the
curve labeled “1” represents arousal to the more arousing sex (Maximum Arousal), and the curve
labeled “2” represents arousal to the less arousing sex (Minimum Arousal). Dashed lines in the panels
represent 95% confidence intervals. Dependent variable units are within-subjects standard deviations.

39. Male Bisexual Identity
Development Considerations
Weinberg et al. (1994) Model
as cited in Brown (2002).
Stage differences for males development specifically
Initial Confusion stage
• experience conflict between their gender role and their sexual
feelings.
• Same-sex attractions provoke anxiety.
• masculinity may be threatened
• feel intimidated and fearful of rejection by heterosexuals, gay
men, society, family members, and women.

40. Male Bisexual Identity Development
Considerations Continued
Finding and Applying the Label
“Once bisexual men find the label, they may not wish to apply
it to themselves due to feelings of anxiety, stigma, or
demasculinization” (Brown, 2002, p. 83).
Settling into the Identity
Social support is crucial during this stage. Due the nature of
bisexuals often being disregarded support may be lacking. This
may lead to a slower settling of their identity.
Men may emphasize the sexual nature of the developing
romantic relationships

41. Male Bisexual Identity Development
Considerations Continued
Identity Maintenance stage
“affiliation with a bisexual community and/or serial or concomitant
involvement with members of both sexes would be important for
maintaining a bisexual identity” p. 83.
Bisexual men may act upon their attractions towards members of
both sexes before labeling as bisexual, but not all men act upon their
attractions to members of both sexes prior to self-labeling as
“bisexual.”

42. Male Bisexual: Counseling Concerns
Page, E.H., in Firestein (2007) suggests therapists should:
Be mindful to validate bisexual orientation
Emphasize that bisexuality is a healthy sexual orientation identity
Use good clinical skills including respect, empathy, positive
inquisitiveness, and a “bias” in favor of the client’s uniquely unfolding
development.
Take an active stance on bisexuality issues
Be mindful of the degree to which bisexual clients have internalized
cultural bias deeply into their sense of self and well-being.
Use creative approaches to to strengthen the client’s positive self-
identity.
Accrue bisexual resources and tools such as, the Bisexual Resources
Guide (Ochs, 2001).

43. References
Bleiberg, S., Fertmann, A., Friedman, A., & Godino, C. (2005). The Layer Cake
Model of Bisexual Identity Development: Clarifying Preconceived Notions.
Campus Activities Programming, 37(8), 53-58.
Bradford, M. (2004). The bisexual experience: living in a dichotomous culture.
Journal of Bisexuality, 4 (1/2), 7-23.
Brown, T. (2002). A Proposed Model of Bisexual Identity Development that
Elaborates on Experiential Differences of Women and Men. Journal Of
Bisexuality, 2(4), 67.
Calzo, J. P., Antonuuci, T.C., Mays, V.M and Cochran, S.D. (2011). Retrospective
recall of sexual orientation identity development among gay and bisexual
adults. Journal of Developmental Psychology, 47(6) 1658-1673. doi:
10.1037/a0025508.
Capulet, I. (2010). With reps like these: bisexuality and celebrity status. Journal of
Bisexuality, 10, 294-308. doi: 10.1080/15299716.2010.500962.
Cass, V. C. (1979). Homosexual identity formation: A theoretical model. Journal of
Homosexuality, 4(3), 219-235.
Weinberg, M. S., Williams, C. J., & Pryor, D. W. (1994). Dual attraction:
Understanding bisexuality. New York: Oxford University Press.
Firestein, B. A. (2007). Becoming visible: Counseling bisexuals across the lifespan.
New York, NY US: Columbia University Press.

44. References cont’d.
Kim, H., & Fredriksen-Goldsen, K. I. (2012). Hispanic lesbians and bisexual women at
heightened risk or health disparities. American Journal Of Public Health, 102(1), e9-
e15. doi:10.2105/AJPH.2011.300378
Obradors-Campos, M. (2011). Cluster 2. Contests for bi phobia, bi negativity
deconstructing biphobia. Journal of Bisexuality, 11, 207-226. doi:
10.1080/15299716.2011.571986
Ochs, R. (Ed.) (2001). Bisexual Resource Guide (4th ed.). Cambridge: Bisexual Resource
Center.
Page, E. H., (2004) Mental health services expereinces or bisexual women and bisexual
men: An empirical study. Journal of Bisexuality, 3(3/4), 137-160.
Rosenthal, A.M, Sylva, D., Safron, A. & Bailey J.M. (2011). Sexual arousal patterns of
bisexual men revisited, Biological Psychology, 88(1), 112-115, ISSN 0301-0511,
10.1016/j.biopsycho.2011.06.015.
Ross, L. E., Siegel, A., Dobinson, C., Epstein, R., & Steele, L. S. (2012). I don't want to
turn totally invisible: Mental health, stressors, and supports among bisexual women
during the perinatal period. Journal Of GLBT Family Studies, 8(2), 137-154
Ryan, C., & Gruskin, E. (2006). Chapter 14: Health concerns for lesbians, gay men, and
bisexuals. Sexual Orientation & Gender Expression in Social Work Practice (pp.
305-342): Columbia University Press.
Schmidt, C.K. & Nilsson, J.E. (2006). The Effects of simultaneous developmental
processes: factors relating to the career development of lesbian, gay and bisexual
youth. Career Development Quarterly, 55 22-37. doi: 10.1002/j.2161-
0045.2006.tb00002.x