Individuals who experience sexual identity confusion and/or conflict face unique stressors and life circumstances for which they may seek psychotherapy; however, little specific guidance exists for therapists working with clients who experience sexual identity confusion and/or conflict. To meet this need, we present a framework for therapists whose clients experience distress related to sexual identity confusion and/ or conflict. We first define and describe sexual identity confusion and conflict, situating both in developmental theories of sexual identity. We then review clinical approaches that have been used historically to inform treatment with clients experiencing sexual identity confusion and/or conflict. Next, we discuss guiding ethical and clinical principles to inform such a clinical approach. Then, we provide assessment and treatment recommendations. We conclude by discussing considerations for working with clients who are diverse in gender identity, race/ethnicity, age, sexual orientation, and religious affiliation. Clinical Impact StatementQuestion: This article explores how to provide ethical and effective therapy for individuals who experience sexual identity confusion/conflict. Findings: We provide definitions of key terms, a review of theory, and clinical approaches, guiding ethical and clinical principles, assessment and treatment recommendations, and special considerations for clinicians to use in their applied practice. Meaning: We encourage therapists to be mindful of their biases around sexual identity confusion/conflict, to focus on helping clients explore at the client's pace and from their perspective, and to ensure that therapists' efforts do no harm. Next Steps: Future research should seek to investigate the generalizability of the principles discussed and to understand how these principles apply for gender identity confusion/conflict.
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