Sexual orientation refers to the person's attractions, desires and fantasies, that is, whether they refer primarily to persons of the same sex (homosexual), persons of the opposite sex (heterosexual) or persons of both sexes (bisexual).

Sexual orientation is a relatively stable feature of the person's identity, while his/her sexual behavior is a more variable aspect. LGBT people seek therapy for various reasons, some of which have nothing to do with the LGBT identity. Even when the goals for therapy are related to the LGBT identity, this identity is experienced in different ways by different people, at different moments in time and in different contexts, so each process is unique.

However, there are some common themes in LGBT clients. These are mainly related to the additional difficulties and stresses that affect people with a minority sexual orientation. These themes may be related to identity development («coming out»), couple relationships, parenting and family relationships (with families of origin and families of choice).

All of these issues need to be addressed considering the backdrop of an heterocentric (and sometimes homophobic) culture.