While gender roles have a profound effect on individuals in our culture, there has been a dearth of research on the impact of counselor and client gender roles on the therapy process. Also, the research and theory that do exist on this topic suffer from the misguided assumption that biological sex is equivalent to socialized gender role behaviors. The authors review and critique the research and theory on sex, gender roles, and the process of therapy. A new paradigm through which to view and conduct this research is offered, and a number of potentially fruitful directions for future research are suggested.