Objective: This qualitative study examined the social dynamics of communities and clinic settings that impede the delivery of culturally relevant services to lesbian, gay, bisexual, and transgender (LGBT) people living in rural areas.
Methods: Ethnographic interviews were conducted with 20 providers in rural areas to document their perceptions of LGBT mental health care.
Results: A majority of rural providers claimed that there is no difference between working with LGBT clients and non-LGBT clients. This neutral therapeutic posture may be insufficient when working with rural LGBT clients. Despite providers' claims of acceptance, lack of education about LGBT mental health issues, and homophobia influenced services for rural LGBT people. LGBT clients had been denied services, discouraged from broaching sexuality and gender issues by providers, and secluded within residential treatment settings.
Conclusions: The challenges of ensuring access to quality care for this population are magnified by provider discourses of "therapeutic neutrality."