Culturally determined gender roles influence relationships between different-sex partners, and cultural values affect attitudes towards sexual variation. LGBT patients face stigma, discrimination and prejudice and have specific issues related to a number of factors, in addition to the nature of sexuality. These factors affect help-seeking and also cause delays in pathways to care. In specific instances, gay, lesbian and transgender individuals show higher than expected levels of psychopathology. The clinician's attitudes affect therapeutic adherence and therapeutic alliance. LGBT patients may also have specific issues related to “coming out” and this may influence their relationships directly and indirectly. Furthermore, they may experience a reluctance to share their sexual orientation. Matching of therapists may offer one way forward but this is not always possible, and may not work due to a number of reasons.