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Psychotherapeutic work with lesbians is confounded by both sexist and heterosexist factors. This paper traces three aspects of women's socialization—self-concept, feminine sex-role behavior, and sexuality— which have particular implications for lesbians and discusses the implications of these three in therapy. The impact of women's conditioning to base self-esteem on acceptance by others is noted, particularly as such conditioning combines with the cumulative stresses of lesbian life. Finally, examples of ways in which heterosexual bias may become apparent in therapy are given, and alternative therapeutic approaches are discussed.