Researchers examining clinically-relevant trends for sexual minority women have found evidence of psychological distress and greater utilization of mental health services compared to heterosexually-identified women. However, the results of many research studies with this population have methodological limitations surrounding recruitment of participants, cross-sectional methods, and participant report of clinical services utilized. Few researchers have sought to analyze actual clinical presentation, service utilization, or clinical outcome of sexual minority women in a treatment-setting. This study is an in-depth clinical analysis of 215 sexual minority woman who sought services at a large Midwestern university counseling center over a period of two years and nine months. The analyses conducted allowed for the initial clinical presentation, service utilization, and clinical outcome of sexual minority women to be described and compared to comparative samples of service-seeking female college students. Sexual minority women were found to have a greater incidence of prior suicidality and prior counseling compared to heterosexual women at the same agency. Sexual minority women also reported greater symptoms of social anxiety, eating concerns, and family distress than heterosexual women at the same agency. Of seven examined predictors of service utilization, sexual minority identity label, age, and academic term of service initiation differentiated brief and extended service utilization from moderate service utilization. Prior use of counseling, psychological distress, racial-ethnic minority status, and time in the semester of initiation of services were not significant predictors of service utilization. Implications and limitations of these findings are presented, and future directions for research and intervention are discussed. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://bibliotheek.ehb.be:2222/en-US/products/dissertations/individuals.shtml.]