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.     

Clinical Issues with Gay Male Couples

SUMMARY

Although gay male couples share with all couples three essential tasks of couplehood-creating boundaries in order to form a couple identity, negotiating closeness and distance, and accommodating to their individual differences-gay male couples face special complications in each task. These complications, examined herein, are largely the result of the marginalization gay men experience from living in a homophobic culture, and male gender acculturation that makes male-to-male intimacy difficult. A model of brief couple therapy for gay men is presented that is designed to honor, as well as challenge, the relationship the men have co-constructed and specifically addresses the difficulties men have in maintaining intimate bonds. A case study illustrates the treatment of clinical issues presented by male couples.     

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.     

Therapeutic Experiences of Lesbian Couples

Abstract

This study explores the therapeutic experience of lesbian couples who had received couples psychotherapy earlier in their relationship. It examines their feelings regarding their own levels of acceptance, disclosure of sexual orientation, and connectedness with the professional providing services using qualitative methodology. The perspectives of both members of the lesbian couple were taken into account and explored. Lesbian couples who had accepted their sexual orientation appeared to have higher levels of satisfaction in their therapeutic experience and reported having an improved sense of self. Couples who had a therapist that portrayed a positive acceptance of homosexuality, low levels of heterosexism, and knowledge of issues relevant to the lesbian community reported an experience that was conducive to growth and development thus leading to an enriched relationship.     

The Use of Metaphors with African-American Couples

SUMMARY

There is a dearth of data in the literature on African-American couples. This omission probably reflects the assumption that interventions that are effective with one race are effective with others. This paper explores the use of metaphor as a tool for working with an underserved and neglected population. Since the African-American culture is extensive in its use of metaphor, this medium provides a fertile channel for therapeutic communication.     

Resources on Same-Sex Couples for Therapists and Clients

SUMMARY

This article provides a brief annotated bibliography of resources for working with same-sex couples. We provide summaries of articles, book chapters, books, and web sites which we have found to be particularly helpful in working with same sex couples. Books covered include those targeted to therapists as well as those targeted to clients (self-help and bibliotherapy books).     

Participant Perceptions of Relationship Education Programs Adapted for Same-Sex Couples

Mixed methods data were collected from 57 couples who participated in the Strengthening Same Sex Relationships (SSSR) Programs, relationship education programs adapted for same-sex couples. Quantitative and qualitative data yielded key themes, including high program satisfaction, appreciation that the program was designed specifically for same-sex couples, and requests for more detailed content addressing same-sex couples' unique needs. Participants expressed preferences for specialized programs for male or female same-sex couples. Women strongly preferred female sexual minority program leaders; men valued leader competency over match in gender or sexual orientation. Results can inform efforts to provide culturally sensitive relationship education to same-sex couples.     

What Do We Know About Gay and Lesbian Couples?

Abstract— Research on gay and lesbian couples is highlighted with regard to household labor, conflict, satisfaction, perceived social support, stability, and the variables that predict relationship quality. Relative to partners from married heterosexual couples, partners from gay and lesbian couples tend to assign household labor more fairly, resolve conflict more constructively, experience similar levels of satisfaction, and perceive less support from family members but more support from friends. The limited data available indicate that gay and lesbian couples may be less stable than married heterosexual couples. The factors that predict relationship quality tend to be the same for gay, lesbian, and heterosexual married couples. Overall, research paints a positive picture of gay and lesbian couples and indicates that they tend to be more similar to than different from heterosexual couples.     

Providing Relationship Interventions to Same-Sex Couples: Clinical Considerations,Program Adaptations,and Continuing Education

Despite remarkable similarities to different-sex couples in terms of core relationship processes and outcomes, same-sex couples differ from different-sex couples in important ways, including relational strengths (e.g., more egalitarian) and challenges associated with their sexual minority identity (e.g., discrimination). Given that most cognitive-behavioral relationship interventions have been designed for and tested on different-sex couples, clinicians wishing to serve same-sex couples will need to make appropriate adaptations to these interventions in order to remove heterosexist bias and sensitively meet the unique needs of same-sex couples. Further, clinicians should strive to be culturally competent in serving this population by developing knowledge of same-sex couple dynamics and issues, and by building a sense of comfort working with these families, which may involve addressing personal biases. The current paper seeks to provide an introduction to same-sex couple relational processes, and offers clinical recommendations and intervention adaptations to better serve this population. Some examples will refer to the development of the Strengthening Same-Sex Relationships programs, culturally sensitive relationship education programs specifically designed for and successfully piloted with male and female same-sex couples.     

The Drama of Couples Therapy

In the author's view, the intensity of couples/family treatment arises from a suppressed acknowledgment of reciprocity, of interconnectedness among family members, beyond the often familiar dynamics of blaming and deprivation. Eliciting a recognition of profound interdependence raises anxiety, and stands in opposition to culturally prescribed concepts of autonomy and independence. To this end, a dramaturgical model of couples/family is proposed and discussed, involving the therapist's participation as director, witness or audience, and protagonist.     

Using Mixed Personal Growth Groups to Reduce Biases With Same-Sex Couples

Counselors serve numerous multicultural clients, such as individuals in same-sex relationships. However, some counselors-in-training (students) are reluctant to provide therapy to same-sex couples (SSCs). This article provides counselor education programs with creative guidelines/strategies for students to work with SSCs. Specifically, this article recommends a mixed personal growth group for counselors-in-training to develop better social-relational capabilities and multicultural sensitivity/awareness.     

Discrepant Alcohol Use,Conflict, and Couples Satisfaction in a Community Sample

Abstract

Discrepant alcohol use between partners has been shown to impact couples’ relationship functioning, emphasizing couples therapists’ need for careful assessment and informed treatment. This study recruited 514 participants from online crowdsourcing platforms to participate in an online survey. Participants were predominantly male (62.4%), heterosexual (76.1%), and Caucasian (47.6%). Ages ranged from 18 to 65 years and mean age was 33. Results indicated a negative association between couple satisfaction and both alcohol-related conflict and discrepant alcohol consumption. Being female combined with higher levels of alcohol discrepancies and couple satisfaction predicted increased alcohol-related conflict.     

Family Mobilization: Work with Angry Elderly Couples in Declining Health

When elderly angry couples face difficulties in caring for each other, the ability to monitor each other's health problems is reduced, prompting the mobilization of the family. This article presents three sets of questions that examine for patterns of family mobilization: positive wedging, disentanglement failure, positive in-and-out participation, and defensive paralleling. In our clinical impression, these patterns often accompany the health monitoring problems of angry elderly couples. Brief case studies are used to describe approaches for assisting these couples in terms of both health monitoring and marital interactions involving anger during health decline. A procedure of deliberate paralleling for working with couples who display an especially inflexible interpersonal arrangement is outlined. Implications are drawn for therapists' education.     

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.     

The association of idealization and intimacy factors with condom use in gay male couples

The purpose of this study was to assess the relationship of idealization and three specific intimacy factors (relationship satisfaction, excitement, and closeness) to reported condom use in gay male couples. It was expected that there would be negative associations of idealization and the intimacy factors with condom use. Both members of 45 gay male couples completed a questionnaire that assessed these factors. This study found (a) idealization to have a significant negative correlation with condom use, suggesting that the more the individuals idealized each other, the less likely that condoms were used during sex; (b) a significant negative association between relationship satisfaction and condom use, implying that as the couples experienced more satisfaction within their relationships, condom use decreased; (c) a significant negative correlation between excitement and condom use, suggesting that as excitement increased, condom use decreased; and (d) no significant association between closeness and condom use.     

Using Contextual Therapy to Treat Depression with Couples

Abstract

Though depression is one of the most common presenting problems treated by systemic therapists, there have been relatively few attempts to describe how specific systemic therapy models can be applied to treat couples dealing with depression. In this paper, we discuss how contextual therapy can be used to treat depression in couples therapy. We identify multidirected partiality as an intervention and as a characteristic. We introduce letter writing and internalized other interviewing as contextual interventions that help to facilitate partiality and understanding between clients. A clinical vignette illustrates our discussed concepts.     

Resolving the Curious Paradox of the (A)Sexual Lesbian

SUMMARY

Lesbians' erotic lives have been bracketed by opposing sexual narratives. According to a variety of experts, sex between two women is an unnatural and unlikely event. Data from a number of other sources suggest that lesbian sex is both frequent and ecstatic. For many long term partners, these polarized narratives serve as filters, screening out a myriad of middle ground practices and scenarios. Because more subtle possibilities are invisible or discounted, couple's only alternative-after the passionate courtship phase of the relationship has ended-is lesbian bed death. In such cases, renewed erotic contact depends on the restoration of the erased sexual middle-ground. This paper focuses on the strategies clinicians can use to neutralize the hegemonic either/or lesbian sexual narratives and expand their client's erotic repertoires.     

Couples Therapy for Drug Abusing Women in an Inpatient Setting: A Pilot Study

This article describes a pilot study to examine the usefulness of adding a couples therapy component to inpatient drug and alcohol treatment for women. The treatment model was modified from a 12-week integrative systems model that has been empirically supported in outpatient treatment settings. A team of student-therapists received intensive training and supervision in the modified version. This article discusses the ability of chemical dependency counselors to implement this model, includes pre and post treatment comparisons, and qualitative findings regarding the efficacy of the project. The treatment model promises to be usable, safe, and practical in inpatient settings, and merits a more thoroughgoing clinical trial.     

Healing Rituals for Couples Recovering from Adultery

Recovery from the trauma of adultery is a process that is full of points where the couple can get stuck. We describe an experiential model that utilizes healing rituals. We start with a general exploration of the use of rituals in marriage and family therapy. The key elements of effective rituals are described. We describe stuck points in these relationships including: 1) knowing the details, 2) releasing the anger, 3) showing commitment, 4) rebuilding trust, and 5) rebuilding the relationship. Ritualized interventions are described for each of these stuck points.