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Rob rushed into his first session with me, gym bag on one shoulder, briefcase on the other, 10 minutes late and out of breath. He set his bags down, gently put his Blackberry on the table in front of him, and heaved himself onto the couch. As he paused, awaiting my response, quite honestly, I was awaiting my response as well. I knew this was not Rob's first experience in therapy and that a lot was riding on what I was about to say. Rob had been referred by a former client of mine he'd met in an Alcoholics Anonymous meeting. Just out of alcohol rehabilitation treatment, he'd begun attending AA meetings, where he'd shared parts of his story. He described a long struggle with his sexual orientation, growing up in a devoutly Roman Catholic family, where he learned that his sexual attraction to men was cause for eternal damnation.

It was the height of the Aids crisis and she was in the waiting room of an inner-city STI clinic, frequented by those most at risk of HIV: gay men, injecting drug users, sex workers. A positive result, back then, would have been a death sentence. In the clinic a friendly gay counsellor asked Megan to step into his room and asked her if everything was OK. No, she said.

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