Many clinicians, situated in a culture that privileges a dichotomous understanding of sexual orientation, are often challenged by the complex issues presented by bisexual clients. The aim of this article is to provide an expanded and contextualized understanding of bisexuality that will inform effective intervention with the clinical concerns presented by this frequently marginalized population. An overview of evolving perspectives on sexual orientation and bisexuality is followed by a discussion of treatment concerns relevant to bisexuals. A review of treatment approaches offers clinicians a fundamental framework to begin to effectively address the unique clinical concerns of bisexual clients.

Consumer satisfaction is widely used as an indicator of treatment quality; however, recent research in public clinics has found very little relationship between satisfaction and problem change. No research on private practice satisfaction has been reported. The current study compared satisfaction with a variety of outcome measures for 93 adult private practice clients and found no significant relationships. Satisfaction is inappropriately construed as an outcome measure and may be of more limited value than widely held. Quality assurance standards should rely more on assessments of adjustment, perhaps using brief measures.What is the connection between client satisfaction and problem change in psychotherapy? Can we assume that satisfied clients are ones who improve, and that dissatisfied clients are ones who do not improve? Given the wide usage of satisfaction surveys and reliance on them as indicators of service quality (Bilbrey & Bilbrey, 1995;Lambert, Salzer, & Bickman, 1998), these are important questions with both clinical and policy implications. Moreover, there are fundamental questions about whether satisfaction differs in public and private practice settings.The recent emphasis on evaluation of psychotherapy in standard practice settings (Burlingame & McCollam, 1998) has provided even more reason to do satisfaction surveys. Assessments of consumer satisfaction have the methodological advantage of being very brief (often as few as 3-8 items), and they often involve one-time-only administrations. They have been widely used since the 1970s (Berger, 1983;Lebow, 1982) and continue to be highly regarded in all kinds of mental health treatment settings (Bilbrey & Bilbrey, 1995;Lambert et al., 1998). Although often considered a traditional outcome measure, there are only low-to-moderate correlations between satisfaction and other measures of outcome

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Dusty Miller and Laurie Guidry present a manual for the group treatment of individuals struggling with the complex interaction of trauma and addictions. According to the authors, the goal of this manual is to create a theoretical and practical bridge between the words of consumers and those of providers. The authors state that, in their experience, when childhood trauma co-occurs with addiction, the professional helping system often responds with a fragmented and unsuccessful approach. The addiction counselor, focusing solely on the addiction, and the mental health provider, focusing mainly on the trauma and its sequelae, often find themselves working at crosspurposes. Miller and Guidry acknowledge that it is a major challenge to coordinate the treatment and needs of anyone suffering the co-occurring disorders of trauma-based mental health and addiction symptoms. They attempt to face this challenge head-on by providing a manual that specifically outlines a treatment model for both addiction recovery and trauma recovery.According to Miller and Guidry, the Addiction and Trauma Recovery Integration Model (ATRIUM) is intended for a wide range of people, including individuals with substance abuse and other addictive behaviors, who addictively engage in harmful relationships; who self-injure; who have serious mental diagnoses; who are survivors of sexual and psychical abuse; and who enact violence and abuse against others. The model can be used by an individual, in a self-help group format, or in conjunction with an addiction recovery program or another trauma recovery model. It is designed for use by survivors, counselors, and professional therapists.The ATRIUM model consists of a 12-week structured treatment protocol designed to heal the body, the mind, and the spirit. Miller and Guidry provide a detailed and well-organized outline for each of the 12 90-minute

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