The present chapter provides a review of some of the primary psychological issues confronting sexual minorities (i.e., individuals with same-sex attractions and relationships). Our goal is to provide a flexible set of preliminary questions that can be used to help sexual-minority clients to articulate their own idiosyncratic experiences and give voice to their own unique needs. We begin by addressing two of the most common and important clinical issues faced by sexual minorities: generalized “minority stress” and acceptance and validation from the family of origin. We then turn attention to the vast—and vastly underinvestigated—population of individuals with bisexual attractions and behavior, who actually constitute the majority of the sexual-minority population, despite having been systematically excluded from most prior research. We review the increasing body of research suggesting that individuals with bisexual patterns of attraction and behavior actually face greater mental health risks than those with exclusive same-sex attractions and behavior, and we explore potential processes and mechanisms underlying this phenomenon, focusing particular attention on issues of identity development and transition over the life span. We conclude by outlining a number of areas for future clinically oriented research.