How do you see me? Coming out in counselling

Recent large-scale survey research has raised serious concerns in both the counselling community and the mass media about the ways in which counsellors work with lesbian, gay and bisexual (LGB) clients. The current questionnaire-based research focused on client experiences of their own, and their counsellor's, self-disclosures of sexuality. Most clients did not require counsellor disclosure. However, failure of the counsellor to disclose could result in problems and assumptions being made by the client. We conclude that LGB awareness is improving, but there is still much need for training in this area to challenge limiting assumptions by some counsellors and to avoid the need for clients to educate them.     

Christian counsellors' views on working with gay and lesbian clients: Integrating religious beliefs with counselling ethics

Thirty‐one counsellors who identified themselves as practising, committed Christians, returned completed questionnaires that investigated how they integrate their Christian beliefs with their professional ethical code when counselling gay and lesbian clients. It was found that although most respondents believed that they were able to accept gay and lesbian clients, a minority demonstrated incongruence in relation to members of this client group, and were judgmental about perceived gay/lesbian behavious. Counsellors who took a rational stance in their understanding of the Bible and Christianity expressed more open and accepting views. Counsellors with a literalist approach to the Bible appeared to be lacking in acceptance and were unaware that they may not be offering the core condition of respect to their gay or lesbian clients. These findings are discussed in terms of their implications for supervision, research and practice.     

Addressing disparities: The impact of a lesbian,gay, bisexual,and transgender graduate counselling course

Background: Lesbian, gay, bisexual and transgender (LGBT) individuals experience serious mental health disparities and treatment inequities. Counsellor education has been identified as both a contributing factor to these problems as well as an ameliorating mechanism to address these inequalities. Aim: The purpose of the current study was to evaluate the impact of an LGBT‐affirmative counselling course. Method: A total of 23 students enrolled in a graduate LGBT counselling course were administered the Sexual Orientation Counselor Competency Scale (SOCCS, Bidell, 2005) and the Lesbian, Gay, and Bisexual Affirmative Counseling Self‐Efficacy Inventory (LGB‐CSI, Dillon & Worthington, 2003) pre‐ and post‐course. In addition, a comparison group of 23 matched counselling students was obtained from an existing data source in order to make further assessments of the course's effectiveness. Those in the comparison group were not enrolled in the LGBT course, but were administered the SOCCS at analogous time intervals. Results: After completing the LGBT course, enrolled students demonstrated significant improvements regarding their sexual orientation counsellor competency and self‐efficacy. In addition, these students showed significant gains in SOCCS scores versus those in the comparison group. Implications: Results from this study show the positive effect a full‐credit LGBT psychotherapy course can have on graduate counselling students' sexual orientation counsellor competency and self‐efficacy. The findings also indicate that such a course can significantly impact counselling skills, a facet of LGBT cultural competency found to be the most attenuated. Findings are discussed in conjunction with LGBT‐affirmative counsellor training and clinical practice.     

“We are better and happier if we are inclusive.” Therapist perspectives on the importance of LGB cultural competence in a mental health setting

Lesbian, gay and bisexual people are more likely than their heterosexual counterparts to report dissatisfaction after accessing a counselling or psychological service. Greater dissatisfaction may result from therapists who focus on psychopathology without considering cultural context. Research has demonstrated therapists' cultural competence (attitudes, knowledge and skills) may influence effective service provision to LGB people. Counsellors and psychologists (N = 10) were interviewed to determine the sources of information influencing the cultural competence and LGB cultural competence practices used by therapists in their clinical practice. Three themes were developed from semistructured interviews: (1) the importance of multiple sources of cultural competence; (2) applying cultural competence improves the therapeutic process; and (3) ensuring visual cues of affirmation are affirming, not pathologising. Theme 1 highlighted that initial professional training, cultural competence training and lived experience could be triangulated to assist therapists in improving their cultural competence. Theme 2 highlighted that cultural competence improves the therapeutic process by ensuring therapists can demonstrate affirming attitudes, knowledge about LGB people and culturally affirming skills to work effectively with LGB clients. The final theme explored the need for therapists to create an inclusive space for LGB clients. Recommendations for improving clinical practices and tools to enhance cultural competence are discussed.     

African American Counselors‐in‐Training,the Black Church,and Lesbian‐, Gay‐, and Bisexual‐Affirmative Counseling: Considerations for Counselor Education Programs

This article examines the challenges that may be particular to African American counseling students who identify as Christian in learning to provide competent and affirming counseling to lesbian, gay, and bisexual (LGB) clients. The role and importance of the Black Church, race survival consciousness, and cultural constructions of sexuality and mental health may present unique barriers for these students in affirming LGB clients. Recommendations for counselor education programs are discussed.     

Going against the grain: supporting lesbian, gay and bisexual clients as they 'come out'

It has been acknowledged in principle that those who provide counselling or support should respect differences and the diversity inherent within any society or culture. In this article we focus upon sexual orientation as a resource: a means by which it is possible to expand upon skills and understand the experiences of those who have embarked upon alternative trajectories of sexual development. We consider the process of development from the perspective of the 'everyday' and, based upon interviews with 16 lesbians and gay men, explore the process of identity formation and the role of those professionals and volunteers who provide support during this transitional period in a person's life. We suggest that it is important for those providing counselling or support to an individual who is lesbian, gay or bisexual to understand the role of context and social influence in their personal and interpersonal development. We suggest that working with lesbian, gay and bisexual clients can provide the practitioner with insights and opportunities to further expand their supportive skills through an exploration of what it means to grow up as a member of a minority group.     

Narrative Therapy Pathways for Re-authoring with Parents of Adolescents Coming-out as Lesbian, Gay, and Bisexual

Narrative therapy with parents as they are coming to terms with their adolescent sons’ and daughters’ coming-out as lesbian or gay provides a framework for reauthoring stories and revisioning identities as they negotiate the challenge of becoming lesbian/gay-membered families. Recognized for complementing the elements of multicultural practice, narrative therapy offers therapeutic interventions that are culturally sensitive and acknowledge the role of power and privilege in socially imaging what it means to be lesbian or gay. In this article the familiar storylines that these families bring into therapy are illustrated, and family work with parents of lesbian, gay, and bisexual adolescents is conceptualized using a narrative therapy lens.     

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.     

Addictions Counselors' Attitudes and Behaviors Toward Gay,Lesbian, and Bisexual Clients

This study surveyed addictions counselors to determine factors that predict affirmative attitudes and behaviors with all clients and with gay, lesbian, and bisexual clients (GLB) in particular. Three factors were predictive with regard to all clients, and 5 factors were predictive with regard to GLB clients. Nonheterosexist organizational climate was the only factor predictive in both situations. The implications of these results are discussed with regard to practice, research, and training.     

Gay men's experiences of therapy

Fourteen gay men were interviewed using a structured interview schedule to explore their experiences of being in therapy. Particular importance was given to their perceptions of how their sexual orientation impinged on the counselling process and how their assumptions about counsellor sexual orientation affected the therapeutic relationship. The limitations of using structured interviews in qualitative research are acknowledged. Some significant findings were made, which were not well documented in the literature, such as the impact on the therapeutic relationship of internalised homophobia within gay men themselves. These findings hold the potential to inform counselling practice with gay male clients. Recommendations are made in relation to both practice and further research.     

Couples therapy with gay clients: Issues facing counsellors

Couples therapy is widely practised by a range of different counselling professionals, but, as yet, concentrates on heterosexual clients, to the exclusion of gay people. This paper argues that couples therapy should be more readily available for gay clients. A review of the major issues which need to be addressed by counsellors before embarking on couples therapy with gay men is presented, with illustrative case material. It is concluded that established forms of intervention are effective with gay clients, providing that the specific needs and problems of the gay community are recognized by the counsellor.     

The client as a self‐aware agent in counselling and psychotherapy

Clients' recollections of their experiences of counselling and psychotherapy were stimulated using the technique of Interpersonal Process Recall. Their reports were analysed in terms of the grounded theory method of qualitative research. The analysis resulted in the interpretation that the core category of their experience is clients' reflexivity, or self‐awareness and agency flowing from it and returning to it. The focus of this paper is directed at the client's reflexivity in response to the counsellor's operations. Its organizing theme is that how clients respond to counsellors' operations depends on what clients desire and what they feel they can say safely. Particular desires arise from an over‐arching desire either to enter into or avoid inner experience. Moreover, the relation with self is influenced by the relationship with the therapist. This complexity makes it difficult to predict responses to non‐directive and directive counsellor performances alike. Vignettes selected from the participants' reports illustrate the theme. Implications for the practice of counselling and psychotherapy are discussed.     

Responses to Marriage Counselling

The experiences of clients who received marital counselling from trained volunteer marriage guidance counsellors were investigated. Fifty-one clients from 42 marriages were interviewed and questioned about why they chose the agency, what expectations they held, what happened during counselling, how they felt about the counsellor, and what if anything was achieved through counselling. They were also asked how they had fared since. Rating scales were used after the interview to evaluate satisfaction with counselling, benefit from counselling, aspects of the counselling relationship, etc. The clients were also asked to do a card-sort of statements about counselling to determine what aspects had been valuable and disappointing. Some of the preliminary results of the study are presented and discussed.     

Client perspectives: The therapeutic challenge of domestic violence counselling – a pilot study

Aims: This qualitative pilot study explored the perceptions of four female domestic violence clients regarding counselling they had concluded in order to identify a preliminary client‐preferred domestic violence counselling approach. Method: Semi‐structured interviews asking about significant events during counselling were held. An adapted grounded theory and narrative methodology was used. Results from the analysis were reviewed with two of the participants. Participants were offered additional counselling support if required after the research interview. Results/Findings: Domestic violence clients found starting counselling particularly difficult after years of keeping the abuse to themselves. Participants actively withheld and managed information for several sessions and needed to know they had time to explore their experiences. The counsellor being consistent and non‐judgemental, and understanding domestic violence and its effects was helpful. Having a clear ending was appreciated by the participants. Discussion: The initial development of the therapeutic relationship benefited from active discussion of how domestic violence could affect behaviour and emotions. Good early therapeutic relationships showed elements of the three main psychological schools. Participants benefited from a pro‐active discussion of endings. A key limitation of this research is the small sample size. Implications for practice: The research suggests that counsellors would benefit from knowledge and skills from different psychological schools and specific training in domestic violence. Allowing flexibility on the number of sessions available to clients may be helpful. Conclusions: Further work is required to explore these preliminary findings. However, early indications suggest that domestic abuse clients may benefit from non‐time‐limited specialist counselling services.     

Resisting and Conforming to the ‘Lesbian Look’: The Importance of Appearance Norms for Lesbian and Bisexual Women

Appearance is one way in which lesbian and bisexual identities and affiliation to lesbian, gay, bisexual (LGB) subculture can be demonstrated. ‘Butch’ and ‘androgynous’ styles have been used by lesbian women to communicate a non‐heterosexual identity. However, some LGB appearance researchers have argued that there has been a mainstreaming and diversification of lesbian style in the last couple of decades, which has resulted in less distinction between lesbian and straight looks. This research draws on the Social Identity approach to explore contemporary style in lesbian and bisexual communities. Fifteen lesbian and bisexual women took part in semi‐structured interviews which were analysed using thematic analysis. Although some participants reported a diversification of lesbian style, most used the term ‘butch’ to describe lesbian style, and a ‘boyish’ look was viewed as the most common contemporary lesbian style. By contrast, most participants could not identify distinct bisexual appearance norms. The data provide evidence of conflicting desires (and expectations) to visibly project social identity by conforming to specific lesbian styles, and to be an authentic, unique individual by resisting these subcultural styles. Copyright © 2013 John Wiley & Sons, Ltd.     

What difference does counselling make? – The perceptions of drug‐using clients on low incomes

Context: This paper reports on a qualitative study looking at the perceptions of clients who use drugs and are on low income. Research suggests that counselling services can experience difficulties in reaching and retaining such clients, and outcomes of counselling can be disappointing. Aim: To learn from clients who had engaged in counselling for over six months what difference it had made to their lives. Method: Grounded theory methodology was used to analyse semi‐structured interviews with six participants. Findings: Findings included changes in the clients’ internal world, their connectedness with society, their familiarity with counselling, and their perception of the relationship with the counsellor. Factors within the counselling process which helped and hindered change were identified. The study documents how participants were able to use counselling to improve their lives.     

Clients talk about their experience of seeking counselling

The purpose of this study was to explore the help-seeking behaviour of a sample of counselling clients using a questionnaire and follow-up, semi-structured interviews with 20 counselling clients who were seen at a walk-in, affordable counselling agency located in a mid-sized city in New Zealand. Specifically, clients were asked if they had received counselling previously, what efforts they had made to solve their problems before seeking counselling and with what success, why they chose this particular agency, their initial impression of their relationship with their counsellor, and their reactions to participating in the research. The data were analysed to ascertain themes associated with their decision-making and choices. Findings were discussed in relation to the literature on seeking counselling, how clients determine their need for counselling and the process they go through in deciding when and where to get it. Implications for counsellors are discussed.     

A Review of “Relational Competence Theory: Research and Mental Health Applications”

Within the Couple and Family Therapy literature, there are few articles directly linking theory to treatment within the lesbian community. Utilizing contextual theory, the author presents a gay affirmative therapeutic approach to work with lesbian couples. The fundamental concepts of contextual therapy are uniquely suited for work with lesbian clients; particularly the four dimensions of individual psychology, relational ethics, systemic interaction, and facts. A case study is presented to highlight this therapeutic process. This article is one step in a larger systemic change related to the challenge of adapting theoretical methodology and gathering evidence for effective treatment of marginalized groups.     

“Out on the edge of my comfort”: Trainee counsellor/psychotherapists' experiences of spirituality in therapy—A qualitative exploration

The integration of spirituality into counselling and psychotherapy poses complex challenges. Personal spirituality, professional competency and ethical considerations may impact on trainees' experiences of integrating spirituality into therapy. This study adopted an inductive, qualitative approach to explore trainee counsellor/psychotherapists' experiences and perceptions of integrating spirituality into therapy. Six trainee counsellors and psychotherapists were recruited using purposive sampling from a professional counsellor and psychotherapist training institution in the UK. In‐depth, semi‐structured interviews were conducted, audio‐recorded and transcribed verbatim. Thematic analysis of the interviews revealed two overarching themes: spirituality provides support but needs a warning; and spirituality is relevant but undervalued. These themes encompass a wide range of trainee concerns associated with integrating spirituality into therapy. Participants reported that they felt unprepared to work therapeutically with clients' spiritual beliefs. However, the value of spirituality in providing support to both the trainee and their clients was highlighted by several participants. Some participants described integrating clients' spirituality as having a positive impact on the therapeutic relationship, but often felt threatening to the trainee. This research has implications that are important for counselling and psychotherapy training and developing enhanced consideration of client spirituality and the interpersonal environment in which therapy is delivered.