Conservative religions that condemn homosexual sexual orientation and acts as unnatural and sinful pose significant challenges for gay persons whose faith is a core part of their identity. The condemnation presents a serious barrier to the acceptance and integration of their sexuality, a primary task of psychosexual development. As a result, they can manifest depression, anxiety, suicidal ideation, and even suicide attempts. The ecclesiastical censure also imposes an untenable dilemma for homosexuals in that they feel pressed to reject their sexual identity or renounce their spiritual identity and heritage. Psychotherapists who treat gay persons caught in this quandary can find themselves facing a similar problem: how to help their homosexual client reconcile their proscribed sexuality with their spiritual commitments. The case presented here recounts the treatment over many years of a gay man suffering from such a conflict and his eventual accommodation of both his homosexuality and his faith. Recommendations are offered for constructive treatment with those torn between two conflicting core identities.

This introduction presents an overview of the current issue (73, 8) of Journal of Clinical Psychology: In Session. This issue features a series of articles, with clinical cases, each presented to illustrate the challenges faced by individuals and couples whose sexual and gender identities and expressions do not comport with traditional and cultural norms. These articles also document the challenges to the therapists who treat them. Considered individually, each article underscores the need to recognize the importance of evidence in guiding psychotherapy in cases involving sexuality. The discussions in each article offer recommendations meant to help and guide psychotherapists. Considered collectively, they raise important questions and considerations about shifting paradigms of human sexuality. Implications for assessment and treatment of cases involving sexuality and gender identity are discussed and recommended.

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McWilliams addresses many of the problems that psychologists face in practice and in research. She emphasizes the importance of integrating evidence from research in practice, but expresses caution about the strict use of clinical treatment guidelines. While agreeing with her concern, this commentary examines, from the perspective of a clinician, underlying epistemological factors implicit in her article. It uses an example from the author's practice to illustrate and underscore the importance of understanding underlying cognitive assumptions in order to provide care that is consistent with the best research has to offer. It also expresses its own cautions about the interpretation and application of research in practice.

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