Sexual Compulsivity in Gay Men: Controversy and Treatment

Compulsive sex among some gay men has been made a more significant issue by the AIDS epidemic. There is controversy as to whether or not compulsive sex is a disorder or if it should be thought of as addiction. The clinical usefulness of the addictive model is discussed, along with the commonalities between the two most prevalent and successful approaches used to treat this disorder: namely, group treatment and the self-help Twelve Step addictive model.     

Cognitive-Behavioral Treatment of Men and Anger: Three Single Case Studies

The treatment of men with anger problems presents significant challenges for practitioners. This article discusses a cognitive-behavioral, individual therapy, approach within the framework of three single case studies involving men. Treatment challenges and methodology are presented. Key treatment issues included: establishing a therapeutic relationship; facilitating understanding of the cognitive basis of anger; and addressing male-role socialization messages and male-identity schema that contributed to the experience and expression of anger in these men. Limitations relative to the small sample (n = 3) and the lack of a randomized control group preclude any definitive statements regarding the effectiveness or generalizability of the intervention. Nevertheless, the study highlights important theoretical and practical concerns for practitioners and future researchers to consider when working with men and anger.     

Integrated Cognitive-Behavioral Therapy for Social Anxiety and HIV/STI Prevention for Gay and Bisexual Men: A Pilot Intervention Trial

Given the alarmingly high HIV and sexually transmitted infection (STI) incidence among gay and bisexual men (GBM) worldwide, there is a critical need for HIV prevention interventions specifically for GBM. Social anxiety, or anxiety about being evaluated in interpersonal situations, is a risk factor for condomless anal sex (CAS) among GBM (e.g., Hart & Heimberg, 2005; Hart, James, Purcell, & Farber, 2008). Social anxiety may also increase substance use in sexual situations, which is another risk factor for HIV/STIs in this risk group (Semple, Strathdee, Zians, McQuaid, & Patterson, 2011). The goal of the Sexual Confidence Study was to provide initial evidence of efficacy for a 10-session integrated cognitive-behavioral therapy for social anxiety, substance use management in sexual situations, and HIV sexual risk reduction for HIV-negative GBM. Diagnostic and self-report assessments were completed at baseline, posttreatment, 3-month follow-up, and 6-month follow-up. In this open trial design, we observed a 50% reduction in engagement in HIV/STI sexual risk behavior at 6-month follow-up. We also observed large uncontrolled treatment effect sizes for reductions in social anxiety disorder and problematic alcohol use. These preliminary findings suggest that the present treatment may offer an efficient way of concurrently reducing social anxiety, problematic alcohol use, and the risk of contracting HIV and STIs via CAS with serodiscordant partners among HIV-negative GBM.     

Mental Health Stereotypes About Gay Men

Three studies were conducted to examine the mental health stereotypes about gay men among college student and therapist trainee samples. Results from Study 1 indicated that (a) college students and therapist trainees endorsed a stereotype of the mental health of gay men that was similar in terms of its content and strength, and (b) the stereotype was consistent with five DSM-IV-TR disorder categories: mood, anxiety, sexual and gender identity, eating, and personality disorders. In Study 2 and 3 we investigated whether homophobia or a tendency to report cultural beliefs could account for the lack of difference between college students and therapist trainees. Results did not support either explanation.     

Cognitive-Behavioral Therapy for Depression in an Older Gay Man: A Clinical Case Study

Although strong evidence supports cognitive-behavioral therapy for late-life depression and depression in racial and ethnic minorities, there are no empirical studies on the treatment of depression in older sexual minorities. Three distinct literatures were tapped to create a depression treatment protocol for an older gay male. Interventions were deduced from the late-life depression literature, culturally adapted CBT protocols for racial minorities, and the emerging social and developmental psychological theories for lesbian, gay, and bisexual populations. Specific treatment interventions, processes, and outcomes are described to illustrate how these literatures may be used to provide more culturally appropriate and effective health care for the growing, older sexual minority population.     

Psychological Adjustment of Lesbians and Gay Men

Previous research has documented that lesbians and gay men proceed through a series of stages in developing a positive lesbian and gay identity. The relationship between lesbian and gay identity and subsequent psychological adjustment has not been evaluated. These empirical studies found that positive lesbian and gay identity is related to psychological adjustment as measured by lower neurotic anxiety and greater ego strength in both an older and a younger sample of lesbians and gay men. Two coping strategies—self-labeling as a homosexual and self-disclosure of sexual orientation to others—were related to development of a positive lesbian or gay identity. These findings suggest that development of a positive lesbian or gay identity is an important task in promoting the psychological adjustment of lesbians and gay men.     

Gay Identification and Psychological Health in HIV-Positive and HIV-Negative Gay Men1

This paper reports a study of HIV-positive and HIV-negative gay men focusing on comparisons between the HIV-positive and HIV-negative on gay identification, the interrelationships among gay identification variables, and the psychological correlates of gay identification. We hypothesized that better psychological health would be related to gay self-acceptance, participating in gay organizations and groups, socializing with other gay men, and parental disclosure and acceptance of being gay. The sample was composed of 169 gay men, including 98 asymptomatic HIV-positive and 71 HIV-negative men. The findings are largely consistent with our hypotheses. A strong and consistent relationship of the gay identification measures with psychological variables was observed, explaining up to one fifth of the variance in current level of mood and self-esteem. Among the HIV-positive subjects, participating in gay organizations and groups and having parents who accepted their sexual orientation were important correlates of psychological adaptation. Despite this, 36% of subjects had parents who disapproved of their sexual orientation, and 69% of HIV-positive subjects were not in any gay organizations or groups. Among the HIV-negative subjects, gay self-acceptance and disclosing their sexual orientation to parents were associated with better psychological adjustment. These results suggest that the psychological health and outlook of gay men may be influenced by gay self-acceptance, participation in gay groups, and parental disclosure and acceptance of their children's sexual orientation.     

Spiritual Experiences of Gay Men and Lesbians

The spiritual and religious lives of gay men and lesbians are often misunderstood by counselors who have too little information about this rich and diverse population. This article offers an explication of the challenges facing gay persons, a model that will be useful in counseling sessions, and a list of resources for further information.     

Gay Identity and HIV Risk for Black and Latino Men Who Have Sex with Men

Strong gay identity among white men who have sex with men (MSM) has been associated with decreased HIV risk, but data for black and Latino MSM (BLMSM) are inconclusive. We examined gay identity and HIV risk among BLMSM to inform social and structural HIV intervention strategies. BLMSM were administered a computerized survey as part of an HIV research study during 2011–2012 conducted in New York City. We used a brief scale of Gay Identity Questionnaire. After data analysis, Stage I (not fully accepting) and Stage II (fully accepting) gay identity were determined based on participant responses. We used logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the association between gay identity with HIV risk and social determinant factors. Among 111 self-identified BLMSM (median age = 32 years, 68.4% with some college or higher education), 34.2% reported receptive anal sex without condoms in the previous three months. Gay Identity Questionnaire Scale assessment indicated that 22 (19.8%) were Stage I, and 85 (76.6%) were Stage II in this BLMSM sample. Stage II gay identity was more likely seen among BLMSM with high involvement in the gay community (aOR 3.2; CI 1.00, 10.26) and less likely among BLMSM who exchanged sex for food or shelter (aOR 0.15; CI 0.02, 0.98). Fully accepting gay identity may be protective for BLMSM as it relates to transactional sex; these factors warrant further research and consideration as part of HIV prevention strategies.     

Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder

Cognitive-behavioral therapy can be effective for many clients who have obsessive-compulsive disorder. Despite its effectiveness, many treatment guidelines fail to describe cognitive-behavioral therapy procedures in adequate detail. The present paper will review the literature on cognitive-behavioral therapy for OCD in an attempt to provide concise, meaningful guidelines for the psychological treatment of this disorder. Cognitive-behavioral therapy includes four general components: initial preparation for therapy, development of applied coping skills, exposure with ritual prevention, and relapse prevention. The four general treatment components are described, and clinical examples are provided.     

Cognitive-Behavioral Treatment of Social Phobia

Social phobia can be a chronic disorder, capable of restricting a client's social and occupational functioning. Cognitive-behavioral therapy can help many clients learn to overcome their social inhibitions, and make lasting changes in their interpersonal style. Cognitive-behavioral therapy for social phobia includes four general components for helping clients learn to manage their social anxiety. First, therapy begins with the establishment of a sound therapeutic alliance, a focus on assessment, diagnostic interviewing, and education regarding anxiety symptoms and their treatment. Second, the therapist helps clients to develop competence in social skills, relaxation training, and cognitive restructuring. Third, therapy uses exposure to social situations in order to help clients confront their fears and refine their coping skills. Fourth, relapse prevention strategies are used to help clients learn to tolerate feelings of discomfort and confront challenging social interactions. This treatment framework can be adapted to the specific needs of different clients.     

Career Counseling with Gay Men: Issues and Recommendations for Research

This article reviews the available literature on career issues facing gay men, identifies potentially crucial issues confronting practicing career counselors, and suggests how to work with gay men regarding career issues. Suggestions for future research are also presented.     

Cognitive-Behavioral Treatment of Generalized Anxiety Disorder

Generalized Anxiety Disorder (GAD) can be treated effectively with cognitive-behavioral therapy. When working with clients who have GAD, therapy can focus on four central areas that help to promote therapeutic change. The initial focus of therapy is on developing a sound therapeutic alliance and educating the client about anxiety symptoms. Skills training focuses on relaxation training and cognitive changes that can help clients confront their worries in a constructive manner. Then, exposure to internal and external aspects of the anxiety can help clients test and refine their coping skills. Finally, because of the chronic nature of GAD, relapse prevention strategies can be used to help maintain treatment gains over time. These strategies allow a broad but flexible treatment plan that can be adapted to the unique needs of each individual client.     

Intimate Partner Violence Within Gay Male Couples: Dimensionalizing Partner Violence Among Cuban Gay Men

Using a quantitative–qualitative mixed design, the current study investigated relationship violence within 35 gay male couples living in Santiago, Cuba. Informants narrated how violence was enacted within their relationship. Qualitative analyses revealed men’s construction of masculinity and the sequelae of economic hardships—which led to economic emasculinization—were primary contributors to relationship abuse. Gendered interpretations to the display of heightened masculinity contributed to intimate partner violence. Enacted interpersonal violence was not meaningfully associated with alcohol consumption or to personality measures. We suggest the economic constraints that are perceived by couples to precipitate relational stress may be similar across heterosexual and gay/lesbian couples, and that the relational power accorded to economic privilege cannot be aligned fully by gender.     

Understanding and Counseling Gay Men: A Developmental Perspective

The author reviews current concepts and research concerning homosexuality with emphasis on understanding gay men and their relationship behaviors. Because the current focus is on homosexuality as a developmental process, counseling considerations are presented from a developmental perspective and a case example is included.     

Issues of Identity Development Among Asian-American Lesbians and Gay Men

This study examined the factors that affect an Asian-American individual's choice of identification with Asian-American and lesbian or gay identity. Nineteen Asian-American lesbians and 16 Asian-American gay men belonging to Asian-American lesbian or gay organizations answered survey questionnaires. Results indicated that most of the respondents identified more strongly with their lesbian or gay identities than with their Asian-American identities; however, most indicated that acknowledgment of both aspects of identity was preferred. Other situational factors, including disclosure of lesbian or gay identity to family and to the Asian-American community, as well as discrimination because of sexual orientation, race, and gender, were examined in regard to identity development.