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.     

The Healthy Aging Group: A Proposed Treatment Model for Societal & Individual Aging Empowerment

A number of unique physical, psychological, and social factors affect individuals as they achieve late life including, unfortunately, societally imposed, and internalized ageism. Women face a unique challenge in this regard, as this “-ism” often intersects with and compounds lifelong disempowering social forces (Rosenthal, 1990 Rosenthal, E. R. (1990). Women and varieties of ageism. Journal of Women & Aging, 2, 1–6. doi:10.1300/J074v02n02_01[Taylor & Francis Online] , [Google Scholar]; Saucier, 2004 Saucier, M. G. (2004). Midlife and beyond: Issues for aging women. Journal of Counseling & Development, 82, 420–425. doi:10.1002/j.1556-6678.2004.tb00329.x[Crossref], [Web of Science ®] , [Google Scholar]). Furthermore, a majority of caregivers are women, which places additional burdens on this group. The current article proposes a time-limited, skills-based cognitive-behavioral treatment model based on feminist principles that targets the myths and misconceptions regarding aging in order to improve quality of life and decrease depressive symptoms in older adults and their caregivers.     

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.     

Relational aggression and victimization in gay male relationships: the role of internalized homophobia

This article presents two studies that are the first to examine relational aggression and relational victimization in gay male peer relationships. A qualitative pilot study provides a strong rationale for a subsequent empirical investigation of 100 young adult, self-identified gay males. Results of both studies demonstrate that relational aggression and relational victimization are common experiences in gay male relationships. They also reveal forms of relational aggression and victimization that appear to be unique to gay males (e.g., outing). Results of the empirical study found significant relations between engaging in relational aggression against gay males and experiencing relational victimization and between experiencing relational victimization and internalized homophobia. However, there was no significant correlation between internalized homophobia and engaging in relational aggression. A multiple regression analysis found that experiencing relational victimization was correlated more strongly with the combination of engaging in relational aggression and internalized homophobia together than with relational aggression alone. Results are discussed within the framework of Allport's "traits due to victimization" theory and Meyer's theory of "minority stress." Implications for the prevention of relational aggression/victimization in gay male relationships are offered.     

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.     

The nature of stress experienced by lesbians and gay men

Abstract

This study examined both the meanings and sources/causes of stress from the perspectives of lesbians and gay men (n=30), using a series of focus groups. The findings suggest that stress is considered a part of life itself, and is perceived to contain both negative (e.g. detrimental effects on health and overall functioning, unfairness, out-of-control), and positive (e.g. a motivator, growth-facilitator) elements. The sources/causes of stress (i.e. stressors) identified include stress experienced from the “coming out” process, stress in family relations and intimate relationships, conflict over one's sexuality given society's homophobic and heterosexist attitudes toward lesbians and gay men, as well as stress from financial and work-related issues. More importantly, this study suggests that culture/ethnicity, gender, and aging, which are interconnected with one's sexual identity, play an important role in shaping the experiences of stress among lesbians and gay men.     

Experiencing gay affirmative therapy: An exploration of clients' views of what is helpful

Gay affirmative therapy is a counselling approach that emphasises an affirming, non‐pathologising approach to therapeutic work with lesbian, gay and bisexual clients. In this study, lesbian and gay clients who had experienced counselling that they defined as affirming identified what they perceived to have been helpful. Questionnaires and interviews were used to collect the views of a sample of lesbian, gay and bisexual informants. The material gathered was analysed using a grounded theory approach, which generated six main categories: communicating a non‐pathologising perspective on homosexuality; the counselling relationship; the counselling space; what the counsellor brought to the relationship; humanity; and the counsellor adopting a holistic approach. Some of these identified affirming elements are unique to gay affirmative therapy and cannot be attributed to other factors. The possible significance of the findings for practitioners is discussed.     

The Mpowerment Project: community-building with young gay and bisexual men to prevent HIV1

The Mpowerment Project is a community-level HIV prevention intervention for young gay and bisexual men ages 18–27. The program seeks to build a strong, supportive young gay and bisexual men's community where young gay and bisexual men nurture and protect each other, particularly with regard to HIV prevention. The program's theoretical framework draws from the areas of diffusion of innovations, community organizing, peer influence, and personal empowerment. The Mpowerment Project promotes a norm for safer sex through a variety of social, outreach and small group activities. The project is run by a Core Group of 12–15 young gay and bisexual men who, with volunteers, design and carry out all project activities. Implemented in 4 communities (Eugene, OR; Santa Barbara, CA; Albuquerque, NM; Austin, TX), the Mpowerment Project has proven to be effective in reducing high risk sex. This paper discusses the development and implementation of the program and various challenges encountered.     

The STEPPS Group Treatment Program for Outpatients with Borderline Personality Disorder

The authors describe a new cognitive-behavioral systems-based group treatment for outpatients diagnosed with borderline personality disorder (BPD). The program is identified by the acronym STEPPS, which stands for Systems Training for Emotional Predictability and Problem Solving. The STEPPS program was developed to address the cognitive distortions and behavioral dyscontrol typical of clients with BPD, and combines this with skills training and a systems component. The latter involves clients with BPD and those in their system including family members, significant others, and health care professionals. The program is fully manualized, and involves 20 two-hour weekly group meetings; specific goals (or lessons) are identified for each session. Preliminary data from the US and the Netherlands have shown that the group achieves high levels of acceptance from clients and therapists and that the model may be effective in helping to relieve the symptoms associated with BPD. Work is now underway to confirm the effectiveness of the model through a randomized controlled trial.     

Integrated group psychotherapy for the treatment of depression in the elderly

Depressive disorders in the elderly are common, and demonstrate a high prevalence, morbidity and chronicity. Psychosocial interventions, notably group psychotherapy can play an important role in the acute and maintenance phases of treatment. Synthesis of the contributions made by developmental, psychodynamic and cognitive-behavioral group approaches, into an integrated model of group therapy, reflects an ever-increasing trend in the psychotherapy field towards the development of applicable and effective clinical interventions. In this model, the overarching principle is the implementation of a group therapy intervention that addresses the objectives of stabilization and restoration of the individual’s sense of self, increased interpersonal competence and acquisition of cognitive and behavioral skills to aid in coping with depression and demoralization.     

Opportunities for development via group psychotherapy in the nursing home

This paper illustrates the benefits of group therapy within the nursing home, and considers the enhancing and problematic factors in conducting groups within this setting. Growth which empowers staff and residents is possible and can be achieved despite significant challenges and social change. A lifespan developmental perspective can assist residents to achieve their maximum developmental maturity and group therapy can be effective in accomplishing that goal. This paper discusses the effect of the nursing home environment and staff on the resident, the task of the therapist in the nursing home, the value of group therapy, therapeutic goals in group therapy, what precipitates the need for group therapy in nursing homes, and the issue of group therapy with the cognitively impaired.     

Group Psychotherapy and Existential Concerns: An Interview with Irvin Yalom

Group psychotherapy can be used to help clients deal with most forms of emotional distress or problems with interpersonal functioning. Also, group therapy can be useful when helping clients to confront existential concerns such as isolation or meaning in ones life. During a recent interview, Irvin Yalom discussed a variety of issues related to group processes and existential matters that are involved in effective psychotherapy.     

Group Session Rating Scale: Preliminary psychometrics in substance abuse group interventions

Background: Although ultra‐brief outcome and process measures have been developed for individual therapy, currently there are no ultra‐brief alliance measures for group therapy. Method: The current study examined 105 clients in group therapy for issues related to substance abuse or with issues related to the substance abuse of a significant other. We tested whether a newly developed group therapy alliance measure – the Group Session Rating Scale would be related to other commonly used group process measures (Working Alliance Inventory, Group Cohesion, Group Climate) and early change (change over the first four sessions of group therapy). Results: The findings provided support for reliability based on Cronbach alphas and test‐retest coefficients. Additionally, the GSRS was a one‐factor measure that was related to other group process measures as well as predicted early change. Discussion: Clinical implications for how to utilise ultra‐brief outcome and alliance measures are provided.     

Group choice: the ideal free distribution of human social behavior

Group choice refers to the distribution of group members between two choice alternatives over time. The ideal free distribution (IFD), an optimal foraging model from behavioral ecology, predicts that the ratio of foragers at two resource sites should equal the ratio of obtained resources, a prediction that is formally analogous to the matching law of individual choice, except that group choice is a social phenomenon. Two experiments investigated the usefulness of IFD analyses of human group choice and individual-based explanations that might account for the group-level events. Instead of nonhuman animals foraging at two sites for resources, a group of humans chose blue and red cards to receive points that could earn cash prizes. The groups chose blue and red cards in ratios in positive relation to the ratios of points associated with the cards. When group choice ratios and point ratios were plotted on logarithmic coordinates and fitted with regression lines, the slopes (i.e., sensitivity measures) approached 1.0 but tended to fall short of it (i.e., undermatching), with little bias and little unaccounted for variance. These experiments demonstrate that an IFD analysis of group choice is possible and useful, and suggest that group choice may be explained by the individual members' tendency to optimize reinforcement.     

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.     

Family Therapy Study Group: The Mumbai Experience

Family therapy training in India is not provided in a systematic manner. Only one institution, the National Institute of Mental Health and NeuroSciences at Bangalore, offers this training, in the form of a three-month program. Consequently, a workshop on basic skills in Family Therapy was conducted in February 2003, at Mumbai, by a trained family therapist from Bangalore. The workshop resulted in founding the Family Therapy Study Group (Mumbai), a non-registered body, in March 2003 so that learning could continue to occur. The group meets once a month for two hours and has had 18 such meetings at this writing. This paper describes the objectives, activities, significant achievements, and future plans of the study group.