Integrated Cognitive Behavioral Therapy for Social Anxiety and HIV Prevention for Gay and Bisexual Men

Little information is available to cognitive-behavioral therapists about how to integrate HIV prevention into standard cognitive behavioral (CBT) treatments among gay and bisexual men, especially for those gay and bisexual men who are at risk for contracting HIV due to their social anxiety. The purpose of the present paper is to assist cognitive behavioral therapists who are treating HIV-negative gay and bisexual men who have high social anxiety. This paper provides an overview of the extant research on social anxiety and its effects on sexual risk behaviors and how to integrate these two types of problems into a coherent treatment plan for gay and bisexual men. The treatment described here uses the framework of CBT for social anxiety (e.g., Hope, Heimberg, & Turk, 2010) and adapts it to include substance use management in interpersonal situations and to reduce sexual risk behavior. The application of empirically supported therapy techniques to reduce both social anxiety and HIV risk behavior for gay and bisexual men is illustrated using three case examples. The present treatment is potentially appropriate for HIV-negative gay and bisexual men who present with social anxiety and who wish to remain HIV-negative by decreasing their sexual risk behavior.     

Well,That Was Awkward: When Clients Develop Romantic Feelings for Therapists

Clients can develop feelings of romantic or sexual attraction to their therapists. From a cognitive-behavioral perspective, how should therapists handle these situations? Although the topic of client attraction is comprehensively covered in the psychoanalytic and psychodynamic literature, it is woefully neglected in our cognitive-behavioral therapy (CBT) focused training programs and literature. This paper aims to address this gap by using CBT principles to provide explanations for why clients develop feelings of attraction to their therapists. In addition, this paper offers general guidelines for how to manage client attraction from a CBT perspective. Three case vignettes are used to illustrate those concepts. Recommendations for future research and training in this area are also provided.     

Lesbians,gay men and family therapy: a contradiction in terms?

This paper seeks to review the history of discussions about lesbian and gay male sexuality in family therapy theory and practice. It examines whether homophobic and heterosexist attitudes are present in family therapy thinking. Possible connections are explored between attitudes towards lesbian and gay issues and the professional backgrounds of family therapists, wider debates on homosexuality within society, and conceptualizations of the family life cycle. The question of why relatively little has been written on the issues raised by lesbians, bisexuals and gay men in therapy is discussed. The implications of this oversight on practice are addressed and suggestions made for future work.     

“I'd Rather Be Dead Than Gay”: Counseling Gay Men Who Are Coming Out

Until recently, most articles about gay men have focused on etiology or cure. This article focuses on the initial phase of counseling male clients who have a negative gay identity and want help accepting their homosexuality. The article includes some basic concepts in gestalt therapy and how they can be applied when working with men who are acknowledging their homosexuality. It also includes tools and guidelines for therapists who want to work effectively with gay men desiring a positive gay identity.     

Treatment of PTSD in Older Adults: Do Cognitive-Behavioral Interventions Remain Viable?

The literature examining trauma among older adults is growing, but little is known about the efficacy of empirically supported interventions for PTSD within this population. Clinical writing on this topic often implies that cognitive-behavioral treatments may be ineffective or inappropriate for older adults with PTSD given physical and/or cognitive vulnerabilities. Review of the limited research in this area, however, provides little support for the claim that cognitive-behavioral interventions are ineffective in treating PTSD among the elderly. In an effort to explicate specific issues related to treatment process and outcome among older survivors of trauma, a case series is presented outlining the treatment of three older adults within the context of a structured, cognitive-behavioral group intervention. Observations from this case series suggests that cognitive-behavioral interventions continue to be useful in treating PTSD with this population. Specific treatment issues unique to older adults are explored and recommendations for future research are discussed.     

Differences in relationship investments between gay and heterosexual men

Previous Investment Model research found that investments are a weaker predictor of relationship commitment for gay men compared with heterosexual men. The present study examined whether this effect is characteristic of investments in general or whether it is specific to certain types of investments. Results indicated that tangible investments significantly predicted commitment among heterosexual men, but not among gay men. In contrast, intangible investments predicted commitment regardless of sexual orientation. Furthermore, adding measures of tangible and intangible investments to the traditional Investment Model variables significantly increased explained variance in commitment for both gay and heterosexual men. These findings highlight the importance of reevaluating how relationship investments are conceptualized and suggests that not all investments are equally consequential across different romantic involvements.     

Reactions to gay men: Contact and overcorrection in an employee selection simulation

The current study examines the role of contact on reactions to gay and heterosexual targets by U.S. heterosexual college students. Aversive bias research finds that minority group members receive unfavorable evaluations only when non-category-based information justifies bias. We argue that under other conditions, namely absence of conditions justifying bias, minority group members receive more favorable evaluations than non-minorities, an effect we term overcorrection. We apply this research to the study of attitudes toward gay men. The current study examines this effect on evaluations of a highly qualified male job candidate who is either gay or heterosexual and flawed or not flawed. We predicted and found, among 180 college students, that the overcorrection effect was present only for those individuals who have experienced no friendships with gay men. Those individuals who do have gay male friends did not exhibit overcorrection. We interpret this result as an indication that individuals who have gay friends (contact) ignore category information such as gay/ heterosexual and are more likely to exhibit truly egalitarian ratings. Implications for aversive bias and outgroup covariation perspectives are discussed. We presented portions of this paper at the 2000 Western Psychological Association conference, Maui, HI.     

Reactions to gay men: Contact and overcorrection in an employee selection simulation

The current study examines the role of contact on reactions to gay and heterosexual targets by U.S. heterosexual college students. Aversive bias research finds that minority group members receive unfavorable evaluations only when non-category-based information justifies bias. We argue that under other conditions, namely absence of conditions justifying bias, minority group members receive more favorable evaluations than non-minorities, an effect we term overcorrection. We apply this research to the study of attitudes toward gay men. The current study examines this effect on evaluations of a highly qualified male job candidate who is either gay or heterosexual and flawed or not flawed. We predicted and found, among 180 college students, that the overcorrection effect was present only for those individuals who have experienced no friendships with gay men. Those individuals who do have gay male friends did not exhibit overcorrection. We interpret this result as an indication that individuals who have gay friends (contact) ignore category information such as gay/ heterosexual and are more likely to exhibit truly egalitarian ratings. Implications for aversive bias and outgroup covariation perspectives are discussed. We presented portions of this paper at the 2000 Western Psychological Association conference, Maui, HI.     

Racialized Sexual Discrimination (RSD) in the Age of Online Sexual Networking: Are Young Black Gay/Bisexual Men (YBGBM) at Elevated Risk for Adverse Psychological Health?

Young Black gay/bisexual men (YBGBM) are a highly marginalized population across multiple health outcomes. Most research on YBGBM health has focused on HIV/sexual health, but there is a demonstrable need for research examining racism and psychosocial functioning among this population. Racialized Sexual Discrimination (RSD), also known as sexual racism, is an important but under-investigated phenomenon that may have implications for the psychological health and well-being of YBGBM. This paper provides an overview of empirical research on RSD as experienced by gay/bisexual men of color in online partner-seeking venues. First, the researchers discuss how racialized experiences are a documented online phenomenon, with a variety of manifestations, and identify the potential effects that this phenomenon may have on the psychosocial health of YBGBM, and gay/bisexual men of color as a whole. Second, the researchers synthesize the RSD literature with a broader literature examining psychological well-being across race and sexual orientation. Third, the researchers present a theoretically grounded conceptual model detailing the pathways between RSD and psychological well-being using a stress and coping framework. The paper concludes with recommendations for future research on this topic, including scale development and hypothesis testing.     

Conceptual and Application Issues: Emotionally Focused Therapy With Gay Male Couples

Therapists working with couples are likely to see gay male couples in their practice yet there is a lack of training to prepare therapists to work with gay couples. Emotionally Focused Therapy (EFT) is an empirically supported approach to couples therapy and offers a clear structure and map for working with gay male couples. This article reviews some of the issues that are specific to EFT work with gay men. Given the range of minority stressors that gay men contend with EFT is particularly appropriate for work with gay male couples because of the focus on the attachment bond. Building a secure relationship is an important source of resilience that can buffer against prejudice and discrimination and provide a secure base for individual and couple exploration.     

Countertransference issues in psychotherapy with lesbian and gay clients

This article briefly reviews literature on responses towards same-sex (lesbian and gay) sexualities from psychoanalytic and ‘lesbian and gay affirmative’ psychotherapeutic perspectives. An analysis is presented of reports of countertransferential reactions to lesbian and gay clients, obtained from interviews with fourteen psychotherapists who work in a lesbian and gay affirmative manner and eighteen clients who had received affirmative psychotherapy. Data were subjected to grounded analysis. Participants consistently attended to the thoughts, feelings and values that therapists held in relation to lesbian and gay clients and how these affected the meanings and practices available to them. These were linked with the therapist's sexual identity among other factors. Negative countertransferential reactions were regarded as potentially occurring among heterosexual and lesbian and gay therapists and were seen as arising from therapists’ conscious and unconscious fears about same-sex sexualities. These findings indicate a need to continue debating these issues more widely in the professional arena.     

Lesbians, gay men, and their parents: family therapy for the coming-out crisis

It is considered psychologically healthy for lesbians and gay men to come out and live outside of the closet. However, parents tend to react with shock, disappointment, and shame when they learn of a son's or daughter's gay sexual orientation. Disclosure often precipitates a painful family crisis, which can lead to cutoffs between members. This article describes family therapy theories and interventions that can aid therapists in sheparding families through the initial stages of the coming-out crisis. Family therapists are advised to acknowledge and address the distinct emotional needs of coming-out individuals and their parents. Parents must grieve and obtain accurate information about gay lifestyles. Lesbians and gay men need support as they struggle to cope with their parents' negative reactions. Family members should be coached to maintain non-combative communication following the disclosure, even if contacts are initially brief and superficial. Case examples, drawn from the author's clinical work, will demonstrate how to address the separate needs of lesbians, gay men, and their parents while maintaining (or rebuilding) family relationships and ultimately guiding families toward successful resolution of this crisis.     

A Systems Approach to Sex Therapy with Gay Male Couples

SUMMARY

Sex therapy with gay male couples is difficult for many family and relationship therapists. Family therapists lack knowledge of the nature of sex therapy, gay male culture and sexuality, the dynamics of gay male couples, and the sexual issues gay male couples are likely to bring to sex therapy. Countertransference also makes sex therapy with gay male couples difficult for some family and relationship therapists. This paper addresses those issues and then explains a systems approach to sex therapy with gay male couples.     

Significant and other: systemic family therapists on lesbians and gay men

This paper discusses a questionnaire survey done with a sample of 130 systemic family therapists, which investigated their training in, and experience of, working with lesbian and gay male clients and attitudes towards lesbians and gay men using the Index of Attitudes to Homosexuals. The findings indicate that the majority of respondents had received relatively little training in working with this client group within their systemic training. It also indicated that their attitudes towards lesbians and gay men generally may have been influenced by the degree of social, professional or familial contact that they had with them.     

Improving clinical outcomes in psychiatric care with touch-screen technology

Patient-focused research, which uses clinical characteristics to predict outcomes, is a field in which information technology has been effectively integrated with practice. The present research used touch-screen technology to monitor the daily self-report measures of 1,308 consecutive inpatients and day patients participating in a 2-week cognitive-behavioral therapy group. Providing regular feedback was effective in reducing symptoms for patients at risk of poor outcomes (Newnham, Hooke, & Page, 2010b). The use of touch screens in psychiatric monitoring encourages a collaborative dialogue between patients and therapists and promotes engagement in the process of progress monitoring and treatment evaluation.     

Are Gay Men in Worse Mental Health than Heterosexual Men? The Role of Age, Shame and Guilt, and Coming-Out

Previous studies reporting that gay individuals are in worse mental health than heterosexuals have typically employed young or mixed-age samples, ignoring the role of age. Mental health problems may show greater age-related improvement among gay than heterosexual men as indicated by the findings of the present study. In this study, the following indices of mental health are examined, and found to be comparable, among 86 heterosexual and 81 gay men aged 18–48: depression, suicidality, anger, anxiety, negative self-esteem, emotional instability, and lack of emotional responsiveness. Most indices show age-related effects among gay men, with less severe symptoms reported by older individuals. Among heterosexual men, effects of age are less widespread, although older men do report fewer symptoms of anger. Chronic shame and chronic guilt are related to mental health problems and a lessening in shame accounted, in part, for the age-related decline in depression among gay men. Different approaches to disclosing/concealing sexual identity are also linked with shame, guilt, and mental health among gay men.     

Ambulante manualisierte Verhaltenstherapie bei Anorexia nervosa

Anorexia nervosa is a serious illness leading to high morbidity and mortality. Its treatment poses a particular challenge to psychotherapists offering outpatient treatment. Often therapists follow or work according to a treatment manual. Supervision in the treatment of anorexia nervosa patients intends to promote quality assurance as well as to foster therapists’ mental hygiene. It offers the opportunity to collect plenty of practical experiences. Some of these will be presented here to provide suggestions and support to therapists working with anorexia nervosa patients. Certain treatment modules of cognitive-behavioral therapy (CBT) such as motivation, eating behavior, case formulation and relapse prevention will be considered. Regarding the therapist-patient relationship ambivalent relation shaping and motivational interviewing will be targeted.     

Gay Identity Issues Among Black Americans: Racism,Homophobia, and the Need for Validation

There is little available literature on gay and lesbian identity among Black Americans. This exploratory study involved interviewing a total of six Black-American gay men and lesbian women regarding gay identity development issues. Data pertaining to the interviewees' experiences of gay identity development were obtained through a questionnaire of six open-ended questions and an interview with each participant lasting 1 to 2 hours. This article presents some of the significant challenges faced by those who were interviewed regarding their sense of self-acceptance, both as Blacks in the predominantly White gay and lesbian community and as gay men and lesbian women in the predominantly heterosexual Black community. The implications of these issues for future research and counseling intervention are discussed. In this article the term gay identity is generally used in reference to both men and women. When women are being discussed exclusively, however, the term lesbian identity is used.     

Sense of coherence as a protective factor for psychological distress among gay men: a prospective cohort study

Gay men face a greater risk of psychological distress than heterosexual men, yet research on protective factors among gay men has been limited. This prospective cohort study investigated whether a sense of coherence (SOC), as a form of coping, helps to protect against psychological distress among middle-aged and older gay men. A nationwide online survey was conducted among a baseline sample of 1135 Australian gay-identified men aged 40 years and older, with a follow-up survey 12 months later. SOC was measured using the 13-item SOC Scale. Psychological distress was measured using the K10 Psychological Distress Scale. Hierarchical regressions were conducted, with analyses controlling for several potential risk factors for distress. Over half of participants had moderate or high psychological distress. However, baseline distress was significantly lower among those with stronger baseline SOC. In addition, baseline SOC significantly predicted distress 12 months later. This predictive effect of SOC was independent of baseline distress levels and occurred despite a strong correlation between baseline and follow-up distress. With SOC appearing to be a protective factor, strategies among middle-aged and older gay men that strengthen SOC may assist in the prevention and treatment of anxiety and other psychological distress in this vulnerable population.     

A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization Into Clinical Research and Practice

The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, and queer (LGBQ)-affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights common associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and this case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.