This article presents understandings about how noninclusive occupational therapy environments are developed and maintained. The data are drawn from a study that, in part, explored the experiences of lesbian or bisexual occupational therapists working in a health care system. Ten participants each engaged in two to five in-depth audiotaped interviews. The narrative data were analyzed with a modified form of grounded theory. The data provide insight into how heterosexist occupational therapy work climates are created and maintained through four processes: heterosexual discourse, homophobic comments, assumed heterosexuality, and perceived stereotypes. The way in which heterosexist occupational therapy work climates may impede the professional growth of therapists also is presented. The knowledge gained from this study can help practitioners, professors, and students in their attempts to sustain an inclusive environment with respect to persons who are lesbian, gay, and bisexual.