Common Issues and 5 Helpful Questions to Use with Gay Male Couples

Although I have always enjoyed doing couples work with gay men, I am hardly a specialist in this area. So at times when I’ve had questions I’ve turned to my colleagues Rick Miller and Clinton Power. Rick’s practice in the Boston area specializes in work with gay men and Clinton’s in Sydney serves the LBGTQ population.

So for this month’s blog, I reached out to Rick and Clinton to help readers who work primarily with heterosexual couples and want to expand your knowledge base for helping gay men. I’ll start with some of Rick’s insights on common issues for gay male couples and follow up with a set of questions from Clinton that open communication lines and pave the way for your work.

Rick Miller has been a popular presenter at the annual Couples Conferences that we co-sponsor with the Milton Erickson Foundation. Last year his presentation was framed around potentially difficult conversations a therapist might initiate with gay couples in the areas of sex, money and vulnerability.

I know from my own practice and also from the many cases therapists have brought to me for consultation that these issues can be especially challenging to heterosexual therapists working with gay couples. So I am pleased to share Rick and Clinton’s information with you.

Rick repeatedly stresses the challenge for men of being vulnerably expressive with one another. Being independent and strong comes so much more easily than acknowledging what might be viewed as softer emotions. Western culture supports strength in men and belittles deep internal vulnerability or insecurity.

This is compounded by the internalized shame carried by most gay men. Imagine the challenge of growing up having to hide feelings of love and sexuality and knowing those feelings are unacceptable – even dangerous – in the larger culture.  Gay men face disapproval or worse if those emotions are visible. Being able to hold men in those vulnerable feelings is a core skill for your couples sessions to work.

Rick also emphasized the necessity of being able to talk explicitly about sex. So many common sexual myths exist. For example:

  • No gay couples are monogamous
  • Gay couples don’t have sexless relationships
  • All gay men like anal sex
  • Gay men don’t have erection issues

He suggested opening the topic of sexuality with some initial questions.

  • Are you open or monogamous?
  • How often do you masturbate?
  • Do you use porn-alone or together?

Rick also asked heterosexual therapists to challenge their own biases about open relationships and hook-ups.

In addressing financial issues, Rick suggested noticing who is paying for therapy and why. And do they have any joint checking accounts? Why or why not?

Have they fallen into specific rolls around who provides financial support and who does chores and housework? Were these agreed to or accidentally structured? Is this adding to stress in the relationship?

Rick has observed in his practice that open relationships work best with the following structure:

  1. The partners agree about open relationships that are either sexual, romantic or both.
  2. They have similar reasons for opening their relationship.
  3. They agree on guidelines that they respect and keep.
  4. They communicate openly and actively with one another and especially if they stretch beyond their agreements.

Clinton’s Questions

I recently asked Clinton Power to give me a list of questions that heterosexual therapists might not know to ask gay couples. Here are some excellent questions he gave me for your consideration.

  1. How comfortable are you with showing affection to each other in public, such as holding hands, kissing, hugging, or acknowledging publicly you're a gay couple?
  2. Do you have preferred sexual roles? Who's top, who's bottom, or are you versatile? And what role does this play in your relationship? Are you happy with how this works or is it an issue in your relationship? Would you like to discuss that here?
  3.  Do you have a monogamous, open, or polyamorous relationship? If open or polyamorous, what agreements, if any, have you made around negotiating sex with others? How well do these agreements work for each of you?
  4.  Are you both out to friends and family? If not, who is not out and how is it impacting on your relationship and your personal happiness? If you are out, what was the reaction of family and friends? What impact has coming out had on your life?
  5.  Do you have a joint will or estate planning, or separate wills? Have you discussed what will happen when one of you dies before the other? Do you have financial power of attorney? Do you have joint bank accounts or credit cards? If not, why not?

I’m grateful to Clinton and Rick for their help. For more information you can contact Clinton at and Rick at

Meanwhile, I’d like to tell you about a resource that’s helpful for almost every couple in your practice. Stepping Stones to Intimacy introduces couples to the stages of relationships. It explains and normalizes many challenges that couples face. The brochures are sold in packs of 25 so you can give them to your couples. Click here to learn more or order.

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Pete Pearson
Pete Pearson

These are great questions that heterosexual therapists may not think about in gay relationships. I think evidenced-based approaches don’t take the perspective of specific situations like specific challenges of the gay, lesbian etc communities.
Thanks for the invited responses from other experts.

Reply to  Pete Pearson

Yes Pete, I think many therapeutic approaches take a narrow mindset and assume social structures that do not apply to everyone, including the LGBTTQ+ communities. (Little tip: the full acronym – or at least a more robust attempt, cause the acronym certainly fluctuates – is a really lovely thing to incorporate into your language. No one wants to see themselves as the ‘etc.’!)

Ephraim Frankel
Ephraim Frankel

Thanks Ellyn, Clinton and Rick. This offering is illuminating and reassuring. I like how the conversations are being opened up and expanded; and, that previously neglected or suppressed issues are now seeing the light of reality honesty and authenticity.
I also appreciate how much the energies and commitments of the Differentiation Principle empower all partners to live more vibrantly and more intimately.

Jean Pollock
Jean Pollock

Terrific questions. Thanks for sharing Clinton and Ricks’s work. I’ve started asking straight couples whether they’d define their relationship as open or monogamous as well.


I appreciate that this article begins to open up potentially hidden issues in gay male partnerships, and to dispel myths about such partnerships. I noticed, in this exploration of those issues, that there may be some implicit myths about heterosexual partnerships that could use some attention! 🙂

1) It is indeed a myth that gay partnerships do not all operate within an open or polyamorous structure. If “Assuming Nothing” is not something you are already in the habit of doing, it could suggest that you are operating on the incorrect assumption that heterosexual couples are automatically monogamous and do not need this question asked of them. (Thanks to Jean Pollock who noted this in their comment!)

2) A couple thoughts on sexual roles: Firstly, variation in sexual roles is not unique to gay male partnerships. Heteronormativity is harmful to your clients that present as heterosexual/cisgendered, and shuts the invitation for them to express invisible creative/alternative gender identities (and how that manifests sexually /romantically/ socially), explorations and expressions of kink, and non-normative expressions of masculinity and femininity. Second, if your gay male clients identify as tops or bottoms, kindly do not assume that top = dominant and bottom = submissive. Apart from the fact that every person enmeshes with these identities differently, there are also nuances here that can only be known by inviting your client to share more than just this label. A simple example: one can be a submissive top, or a dominant bottom. Fun right? 🙂

Reply to  Liana

About my own comment – a MAJOR TYPO!!

“It is indeed THE TRUTH that gay partnerships do not all operate within an open or polyamorous structure.” Yikes!!


Do queer people fall into rolls? I have an image of the dough boy. Replace with roles, bake for 25 mins at 350!

Jan Frigo
Jan Frigo

How Can I Read the Content of the Stepping Stones Brochure prior to purchase. I don’t know if I would use it in my private practice unless I can read it first.
The questions are helpful.

Robert Grimes
Robert Grimes

I see no difference with hetero or gay with all the info and questions supplied in this article. There are roles, lack of vulnerability, sexual issues, shame, open or monogamous in all intimate love relationships. I think this is more about how comfortable a couple counsellor is with whatever relationship dynamics that are present with the couple. I see both hetero and gay couples and I don’t treat them any different however, as I am gathering info and assessing, I will ask questions relevant to that couple.

Clinton Power
Clinton Power

Thanks for inviting me to comment, Ellyn! I too see a lot of similarities between working with straight and gay couples, but the main difference in the gay male couples I work with is they often place a lot of importance on sex and present for therapy when there are sexual problems, betrayal issues, they want to explore and negotiate some form of non-monogamy, or a non-monogamous arrangement is not working. They are a great population to work with. I hope your community found my questions helpful.

Reply to  Clinton Power

I am in a gay male relationship with my partner, I love him. When we started in the relationship, he said he was staying with his father, but later on, the relationship went complicated to an extent that I went to his place to see him. When I got to his place, I found out that he was actually staying with his boyfriend. My love did not end there, he continued with loving me but at the same time with loving his boyfriend as well. Later on their life became complicated and they were chased out of the room to rent because they had no money for rent. I helped them and I paid R4000 for them. They were stranded not knowing what to do and where to go. I took them to my place. They both stay with me. I still love the boyfriend I met with. But I am in lot of doubts about the destination of our relationship. What can I do in this case? I can’t even freely give him gifts because I doubt there’s a good destination for our relationship. He is a bottom, me and his boyfriend are tops. We have sex with him at the same time on one bed. When we gout for dinner we all go out together but I am the one who pay the bills, his boyfriend doesn’t work, he also don’t work. I need advice on what I can do. I am kind but I want to avoid bad consequences of my kindness.


Any advice on how to *find* that partner later in life? How do I know what I want in a partner now that I’m 62 and alone again?

Dr. Ellyn Bader

Dr. Ellyn Bader is Co-Founder & Director of The Couples Institute and creator of The Developmental Model of Couples Therapy. Ellyn is widely recognized as an expert in couples therapy, and since 2006 she has led innovative online training programs for therapists. Professionals from around the world connect with her through internet, conference calls and blog discussions to study couples therapy. Ellyn’s first book, "In Quest of the Mythical Mate," won the Clark Vincent Award by the California Association of Marriage & Family Therapists for its outstanding contribution to the field of marital therapy and is now in its 18th printing. She has been featured on over 50 radio and television programs including "The Today Show" and "CBS Early Morning News," and she has been quoted in many publications including "The New York Times," "The Oprah Magazine" and "Cosmopolitan."

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