Group counseling is another form of psychotherapy that can be advantageous for LGBT elders (Ross et al. 2007). Group counseling offers different opportunities for individuals that are not available in individual counseling sessions. Some unique features of this modality are a therapy environment that replicates real-world situations, an opportunity to practice interpersonal skills, real-time feedback from peers, and social support (Yalom and Leszcz 2005). In the group setting, individuals are able to have their issues normalized by meeting with others who share similar issues or problems. This commonality allows them to not only work on their own specific issues, but to help others with their problems as well.

Frost (1997) notes that group psychotherapy can be advantageous for senior gay males, primarily because the format itself forces them to address a number of significant issues. Because typically in groups, there is an agreement to “stay until the work is done” (p. 275), members are forced to stay and deal with their interpersonal anxiety rather than leaving a stressful situation. He also notes that group psychotherapy may provide a way for gay men to increase their sense of self-worth by practicing new ways to relate positively to other men. For many group members who struggle with intimacy and vulnerability, the group dynamic provides a way to build a healthy sense of trust and connection with other group members (Ritter and Terndrup 2002).

Same-sex couples seek counseling for issues similar to those affecting all couples. Communication problems, infidelity and affairs, substance abuse, and decision-making about staying together or separating are issues faced by all clients (Cabaj and Klinger 1996). Besides these common issues, however, LGBT couples have unique issues that impact their relationships. According to Green (2004), most same-sex couples face similar issues, including (1) coping with societal homophobia and heterosexism; (2) defining a relationship despite the lack of a societal or legal model for same-sex relationships; (3) creating social networks that provide emotional support and establishing families of choice; and (4) maintaining flexible gender roles (thus avoiding over-dependency in female couples or emotional disengagement and competition in male couples).

Additional issues that may face same-sex couples are coming out issues. Stages of coming out may differ for each person in the relationship thus creating tension for the couple as to how “out” they are to other people. In other words, if one member is out to family and friends and the other is not, this may create tension in the relationship. Additionally, family dynamics may cause problems for same-sex couples. If the families of origin are not supportive, same-sex couples may have to negotiate discrimination not only from society, but also from their families. Being in a relationship that is not validated by one’s family can add to sexual minority stress (Connolly 2004).

With the legalization of same-sex marriage, some same-sex couples may be facing adjustment issues surrounding their newly defined relationships. While in the past they may have had to downplay or disguise their relationship, they are now able to openly share their relationship publicly. This may cause some issues of adjustment for the couple. Couples counseling may include ways to adjust to this new dynamic (Segal and Novack 2008).

Many older LGBT people may have felt oppressed by and now subsequently feel alienated from the religious traditions into which they were born (i.e., their spiritual traditions of origin). This may be especially true of those whose religious traditions are highly rigid or fundamentalist (Blando 2009). However, for some LGBT elders, organized religion and spirituality have been and continue to be a source of comfort and support (Halkitis et al. 2009; Rostosky et al. 2012) especially if the religious organization to which they belong is seen as gay-affirming (Sowe et al. 2014). If a client presents in counseling with issues surrounding religion and spirituality, it would be germane for the clinician to address those issues as thoroughly as possible within the scope of their training. At times, it may be best to refer the client for pastoral counseling if the issues fall beyond what the clinicians feel they are able to provide. Pastoral counseling may be provided by individuals specifically trained in religious counseling techniques. While each counseling situation is unique, pastoral counseling might be indicated for LGBT elders with strongly self-identified religious backgrounds, individuals having a type of religious crisis, or those contemplating existential or end-of-life issues (Halkitis et al. 2009). Clinicians should be sure to discuss pastoral counseling with the client before making a referral to be sure they both agree that it is therapeutically appropriate.