Sexual Minority Clients in College Counseling Centers

The Center for Collegiate Mental Health, a practice research network of over 650 university and college counseling centers, has produced many publications looking at mental health distress and treatment outcomes for different populations and demographic groups seeking services at counseling centers. One of the populations that has been frequently studied is LGBTQ+ students. In this blog, we summarize our findings related to this population with hopes that it will be helpful to clinicians working with college students.

Participating CCMH centers use standardized items to collect deidentified data from clients as part of the routine practice of receiving care at the centers. These standardized items include a measure of mental health distress through the Counseling Center Assessment of Psychological Symptoms (CCAPS), therapist identified presenting concerns through the Clinician Index of Client Concerns (CLICC), and demographic and mental health history items through the Standardized Data Set (SDS). This standardized data is then aggregated by CCMH, allowing for research on a large, nationally representative sample of college counseling center clients. Such a representative sample is ideal for examining data related to specific demographic groups. The SDS includes an item about sexual orientation asking, “Which of the following best describes your sexual orientation?” Response options include Heterosexual/Straight, Lesbian, Gay, Bisexual, Questioning, and Self-Identify (Note: After the research outlined in this blog, the response options for this item were updated in 2020 to include Asexual, Pansexual, and Queer). Throughout the blog, all studies and research efforts examined treatment-seeking clients with the exception of one article that specifically evaluated the general student body. Additionally, clients who shared any sexual orientation identity other than Heterosexual/Straight (e.g. gay, lesbian, bisexual, questioning, and queer identities, as well as clients who chose self-identify) are included in the LGBTQ+ group (commonly referred to as “sexual minority” in the research literature).

Within the latest 2019-2020 CCMH sample, 25.2% of students receiving services at college counseling centers identified as one of five minority sexual orientations.

Underscoring the rates of sexual minority clients within CCMH counseling center data, earlier research conducted by CCMH on a general student body sample indicated that sexual minority students sought services at university counseling centers at 2 to 3 times the rate of their heterosexual peers (McAleavey, Castonguay, & Locke, 2011). Together, these findings highlight the importance for clinicians to be familiar with the needs of the LGTBQ+ population, who represent a significant portion of university counseling center clients. The following blog summarizes CCMH research on sexual minority clients related to presenting concerns, treatment utilization, treatment outcomes, intersectionality, and key takeways.

Presenting Concerns

Research shows that individuals identifying as sexual minorities are at higher risk for psychological distress in comparison to those identifying as heterosexual (Meyer, 2003). Students who identify as sexual minorities present to treatment within college counseling centers with higher CCAPS scores on average than Heterosexual/Straight clients (Lefevor, Janis, & Park, 2017), especially in the areas of depression, anxiety, and social anxiety. Clients identifying as bisexual, pansexual, and questioning have the highest baseline CCAPS scores on many subscales. The following graph presents average baseline CCAPS scores by sexual orientation for Fall 2020. Similar differences between Heterosexual students and Gay, Lesbian, and Bisexual students were also found across CCAPS subscales in an earlier general student body sample (McAleavey, Castonguay, & Locke, 2011).

Beyond presenting distress on the CCAPS, research has also found differences in rates of trauma history by sexual orientation in women (Maloch et al, 2013). Specifically, female clients identifying as bisexual were more likely than heterosexual female clients to report experiencing unwanted sexual contact, harassing or controlling behavior, and a traumatic event. Clients identifying as lesbian were more likely than heterosexual female clients to report experiencing harassing or controlling behavior.

In a previous CCMH blog examining differences in presenting concerns by demographic group, sexual minority clients were also identified as having higher rates of Depression, Trauma, Suicidality, and Gender identity as clinician identified presenting concerns . The blog also reports that sexual minority clients had some of the highest rates of concerns related to sexual orientation and identity development, with gay and questioning clients having the highest rates. And finally, a recent CCMH examination on the impact of COVID-19 on mental health from the Fall 2020 discovered that students who identify as Bisexual, Questioning, Pansexual, Lesbian, and Queer reported higher rates of negative impacts from COVID-19 in areas including mental health, motivation or focus, loneliness and isolation, academics, and missed experiences or opportunities.

Treatment Utilization

In a general student body survey, college students who identify as sexual minorities are 2 to 3 times more likely to report seeking counseling services than students who identify as heterosexual (McAleavey, Castonguay, & Locke, 2011). Specifically, queer students showed the highest utilization rate of any sexual minority, at 14.3% of the study sample reporting currently receiving on-campus counseling services. On the other hand, students identifying as bisexual were less likely than those identifying as gay or lesbian to report that they received counseling. Sexual minority clients also attend slightly more sessions on average than heterosexual clients, with one CCMH study finding that sexual minorities utilized 4% more sessions (Janis, 2017). For clients presenting to treatment with their sexual identity as a primary concern, however, the difference in average length of treatment is more pronounced. The 2017 CCMH Annual Report found that clients presenting with concerns related to their sexual identity used an average of 8.4 sessions, compared to an average of 6.5 sessions for clients presenting with depression as their main concern (Center for Collegiate Mental Health, 2018). Although the group of students presenting to treatment with concerns about sexual identity represented .4% of the sample, this indicates that some sexual minority clients may necessitate longer treatments, which adds to the complexity of the demand/supply imbalance facing counseling centers. Overall, LGBTQ+ clients do appear to be accessing counseling services, which is encouraging data given the needs of this population.

Treatment Outcomes

Research on treatment outcomes suggests that sexual minority and heterosexual clients have comparable treatment outcomes in the areas that have been studied. Depressive symptoms decreased at similar rates during treatment across sexual identity groups (Effrig et al., 2014), which is consistent with subsequent CCMH research that found no differences in rates of change of anxiety and depression between heterosexual and sexual minority clients (Lefevor, Janis, & Park, 2017). While sexual minority clients did present to treatment with higher initial distress on average than heterosexual clients, both groups experienced symptom recovery at the same rate during treatment.

Although previous research in other settings has found sexual minority individuals to be at higher risk for suicide behavior than heterosexual individuals, research conducted within CCMH found that sexual minority clients did not attempt suicide while in treatment at significantly higher rates than heterosexual clients (Hayes, Petrovich, Janis, Yang, Castonguay, & Locke, 2019).

While more research is needed, these findings suggest positive outcomes for sexual minority clients at college counseling centers, comparable to heterosexual clients.

Intersectional Findings

No client presents to treatment with a single identity in isolation, and clients’ multiple identities often interact in ways beyond the effects of their sexual orientation alone. Members of sexual minority groups may experience intersectional forms of discrimination according to their race, ethnicity, gender, or other identities that may manifest in uniquely discriminatory experiences, which may be historical, recent, or ongoing in nature. Members of multiple minority groups are believed to experience additive or multiplicative effects of social stress prejudice (Meyer, 2003). CCMH has conducted several investigations examining outcomes and influential factors of individuals with accumulated minority identities. Membership in both minority sexual and religious identity groups has been found to be related to increased psychological distress relative to an individual identifying with one or no minority identities (Lefevor, Park, & Pederson, 2018). For Black sexual minority clients, family and social support, as well as religiousness were found to be related to lower mental health distress (Lefevor, Smack, & Giwa, 2020).

These sample findings related to intersectionality do not begin to cover the full range of intersectional identities, but they do suggest that intersectional minority identities interact in complex ways that transcend the effect of a single identity group and highlight the need for further research on the impact of intersectionality on student mental health.

Key Takeaways

In its history, CCMH has produced numerous research efforts related to the LGBTQ+ population. The following summarizes the findings and offers some key takeaways:

Summary of Findings

  • On average, 25% of students served in college counseling centers identify as LGBTQ+. Utilization is, on average, higher for these individuals, with LGBTQ+ students seeking care at rates of 2-3x of their heterosexual peers. Additionally, LGBTQ+ clients also attend slightly more sessions on average than heterosexual clients.
  • Students who identify as LGBTQ+ generally enter treatment at college counseling centers with higher psychological distress than heterosexual/straight clients, especially in the areas of depression, anxiety, and social anxiety. More specifically, clients identifying as bisexual, pansexual, and questioning have the highest baseline CCAPS scores in numerous areas of distress. In a recent examination of COVID-19 impact on mental health from the Fall 2020, students who identify as Bisexual, Questioning, Pansexual, Lesbian, and Queer reported higher rates of negative impacts in the area of mental health.
  • Research on treatment outcomes suggests that LGBTQ+ and heterosexual clients have comparable rates of symptom recovery during treatment, despite the fact that LGBTQ+ clients enter treatment with significantly more distress, on average.
  • Research on intersectionality has found that clients identifying as minority sexual and religious identity groups have increased psychological distress relative to an individual identifying with one or no minority identities.


  • Based on the summary of findings, Counseling Center staff should feel optimistic that LGBTQ+ students generally access care at higher levels and that counseling center services are producing comparable treatment outcomes for both LGBTQ+ and heterosexual clients. At the same time, it is clear that LGBTQ+ clients are, on average, presenting to treatment with significantly more distress, and more recently, Bisexual, Questioning, Pansexual, Lesbian, and Queer are reporting greater negative impacts due to COVID-19. Thus, centers should strive to provide outreach to LGBTQ+ communities, review external facing content (e.g., brochures and websites), and physical space to ensure they are LGBTQ+ welcoming. If feasible, explore offering diverse pathways for LGBTQ+ students to access services, such as drop-in support groups or “Let’s Talk” programs within LGBTQ+ centers.
  • In terms of professional development, it is important to offer counseling center staff ongoing access to the most up to date and effective approaches to supporting and treating LGBTQ+ students. Within the trainings, it is important consider the complexities and impacts of intersectionality and the most current findings on LGBTQ+ students, including the negative impacts from COVID-19. Finally, it is critical for clinicians to be aware of their own assumptions and biases regarding sexual and gender diversity while also considering the unique strengths, experiences, and therapeutic needs of each treatment-seeking LGBTQ+ student.
  • In terms of future research, it is essential for more comprehensive efforts to be undertaken that focus on the LBTQ+ population, particularly examining complex areas of intersectionality that will require robust data sets to successfully complete. Relatedly, in 2020, CCMH took steps to strengthen their clinical and research efforts with LGBTQ+ students by initially consulting with CCMH members, the CCMH Advisory board, and national experts in gender/sexuality research and healthcare to update the response options for the sexual orientation SDS item. The eventual changes prioritized the inclusion of more ways for clients to identify with the additions of Asexual, Pansexual, and Queer. These efforts quickly benefited the field, allowing CCMH to provide a more nuanced evaluation of the impact of COVID-19 on the LGBTQ+ population in the Fall 2020. As more information is collected in 2021 and beyond, CCMH is hopeful that our collective understanding of the strengths and challenges of the LGBTQ+ population will significantly evolve.

This blog post was written by CCMH Business Team member, Katie Davis, M.S. Katie is a Doctoral Student in Clinical Psychology at PSU and a part of the Castonguay Lab. 


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