Clinical Considerations in Working with Clients in the Coming Out Process


  • Daniel Chazin
  • Sam Klugman



coming out, affirmative therapy, intersectionality, sexual minorities, LGBT, sexual orientation, case formulation, psychotherapy, case study, clinical case study


Mandel (2014) describes the conceptualization, assessment, and treatment of "Adam," a hybrid client presenting with depression, cannabis abuse, perfectionism, and distress related to his sexual orientation, which appeared to be fueling these psychological problems. In this commentary, we examine theoretical and clinical issues raised by this case regarding clients’ experiences with coming out. Drawing on the case and pertinent research, we highlight clinical challenges involved in helping clients navigate issues of identity development and intersection, interpersonal disclosure, internalized homophobia, and community connectedness. We present specific strategies for tailoring interventions to the diverse experiences and needs of sexual minority clients. Throughout the commentary, we reflect on potential intrapersonal, interpersonal, and systemic processes that may impact clients’ identity integration and psychological well-being.

Author Biographies

Daniel Chazin

Dan Fishman, Ph.D. Editor-in-Chief, Pragmatic Case Studies in Psychotherapy Professor of Clinical and Organizational Psychology Graduate School of Applied and Professional Psychology Rutgers University Mailing address: 57 Jaffray Court Irvington, NY 10533 914-693-8549 fax: 603-917-2567 email:

Sam Klugman

Sam Klugman




How to Cite

Chazin, D., & Klugman, S. (2014). Clinical Considerations in Working with Clients in the Coming Out Process. Pragmatic Case Studies in Psychotherapy, 10(2), 132–146.