Psychodynamics of Suicide in Lesbian,Gay, Bisexual,or Transgender Youth

Lesbian, gay, bisexual, and transgender (LGBT) youth are a vulnerable population at high risk of suicide and, as such, benefit from an informed psychotherapeutic approach to treatment. While it is clear that sexual orientation and gender identity are independent dimensions from psychopathology, LGBT youth are frequently marginalized and may face unique challenges with self-acceptance and identification with peers, family, and society, increasing risk of social isolation, which in turn increases vulnerability to anxiety, mood disorders, substance use, and suicide. We elaborate on the common phenomenon of ambivalent repression of the sexual self in adolescents associated with intertwined themes frequently expressed in suicidal lesbian, gay, transgender, bisexual, and queer patients on the inpatient adolescent unit: anger directed toward internal and external objects; desire for self-punishment, atonement, and possibly rebirth; and desperation and desire to escape psychic pain. We enhance our discussion with case examples and practical therapeutic considerations that emerge from these themes that can be harnessed across treatment settings.     

A significant "dream within a dream"

This brief clinical note is an attempt to clarify Freud's remarks regarding the significance of real occurrences of the "dream within a dream". There is affirmation of the reality of an actual event in the manifest dream (the "tickling" in adolescence). Certain representations regarding real events are alluded to in the manifest dream and are confirmed by the latent dream thoughts (the underlying homosexual theme involving the patient's mother and herself). Within the ongoing transference neurosis, a new understanding led this patient to experience intense sexual affects which were recalled for the first time during the course of an analytic session. The analyst's attention to this "dream within a dream" led to a facilitating active interpretation of the repressed sexual feelings. At the same time it was possible to observe a developmental arrest which had interfered with the consolidation of the patient's adolescent maturation begin to be undone by interpretation. The process of disengaging the patient from her unconscious bond with her mother (the undoing of the negative oedipal involvement) had been set in motion. The "dream within a dream" seems to represent a special defensive effort of the dream work to encapsulate the memory of one or more related actual events and the intense affects associated with them--affects whose pressure for discharge threaten to arouse the sleeper. The form the dream assumes is related to its hidden sexual origins and engages the active participation of both patient and analyst.     

Queens and Jesters of YouTube: Communicating Gay/Lesbian Identities Through Humor in YouTube Channel <Emphasis Type="Italic">Spanish Queens</Emphasis>

Considering the transformative potential humor has for minorities who experience exclusion and marginalization, I seek to explore how Spanish gay and lesbian youth construct and communicate gay/lesbian identities using humor as a rhetorical tool. Furthermore, I explore the potential implications of their use of humor for social relations, both within gay and lesbian communities and with the broader society. I approach this discussion though a critical discourse analysis of videos from Spanish Queens—a collaborative YouTube channel, in which LGBTQ youth from diverse parts of the country share their experiences, thoughts, and opinions about being LGBTQ in Spain. Stereotypical humor was the primary form of humor used by SQ vloggers when addressing gay and lesbian issues related to both identification and social relations. Looking at how SQ vloggers most frequently use stereotypical humor, three common functions emerged in all ten videos: (a) affirming identity and separating gay and lesbian experiences from those of other groups, including making a distinction between sexual orientation and gender identity; (b) challenging the conflation of sexual and gender identities (i.e., contesting the notion of gay men and lesbians identifying as members of the opposite sex); and (c) disarming discourses that construct gay and lesbian individuals as threats at both interpersonal and societal levels.     

Implicit and explicit measures of sexual orientation attitudes: in group preferences and related behaviors and beliefs among gay and straight men

The relations among implicit and explicit measures of sexual orientation attitudes and sexual-orientation-related behavior and beliefs among gay men (Study 1) and straight men (Studies 1 and 2) were explored. Study 1 found relations between implicit and explicit measures of sexual orientation attitudes, large differences between gay and straight men on both implicit and explicit measures, and that these measures predicted sexual-orientation-related behaviors among gay men. Also, only straight men exhibited a negative relation between their attitudes toward homosexuality and heterosexuality. Study 2 found that as straight men held more negative attitudes toward homosexuality, they more strongly endorsed the importance of heterosexual identity and of traditional masculine gender roles. These endorsements mediated the negative relation between their attitudes toward heterosexuality and homosexuality. Implications for assessing attitudes toward sexual orientation and their relations for sexual orientation identity are discussed.     

LGBTQ and Heterosexual Adolescents’ Use of Indirect Forms of Aggression

In this study, researchers investigated whether lesbian, gay, bisexual, transgender, and questioning (LGBTQ) adolescents use indirect aggression and exhibit prosocial behavior in their relationships at rates comparable to their heterosexual peers. In a sample of 666 college students (median age = 19.5 years), LGBTQ adolescents (N = 22) used relationally and socially aggressive behaviors at a level consistent with their heterosexual peers. This suggests that sexual orientation identification does not appear to differentially affect the use of indirectly aggressive behaviors during social interactions. There were also no differences in self-reported interpersonally mature behaviors (e.g., use of prosocial skills) exhibited by heterosexual and LGBTQ adolescents in this sample, which indicates that sexual and gender identity were also unrelated to the use of prosocial behaviors.     

Retrospective recall of sexual orientation identity development among gay, lesbian, and bisexual adults

Although recent attention has focused on the likelihood that contemporary sexual minority youth (i.e., gay, lesbian, bisexual [GLB]) are "coming out" at younger ages, few studies have examined whether early sexual orientation identity development is also present in older GLB cohorts. We analyzed retrospective data on the timing of sexual orientation milestones in a sample of sexual minorities drawn from the California Quality of Life Surveys. Latent profile analysis of 1,260 GLB adults, ages 18-84 years, identified 3 trajectories of development: early (n = 951; milestones spanning ages 12-20), middle (n = 239; milestones spanning ages 18-31), and late (n = 70; milestones spanning ages 32-43). Motivated by previous research on variability in adolescent developmental trajectories, we identified 2 subgroups in post hoc analyses of the early profile group: child onset (n = 284; milestones spanning ages 8-18) and teen onset (n = 667; milestones spanning ages 14-22). Nearly all patterns of development were identity centered, with average age of self-identification as GLB preceding average age of first same-sex sexual activity. Overall, younger participants and the majority of older participants were classified to the early profile, suggesting that early development is common regardless of age cohort. The additional gender differences observed in the onset and pace of sexual orientation identity development warrant future research.     

The Language of Love: Sex, Sexual Orientation, and Language Use in Online Personal Advertisements

Stereotypes and biological theories suggest that psychological gender differences found in predominantly heterosexual samples are smaller or reversed among gay men and lesbians. Computerized text analysis that compares peoples language style on a wide range of dimensions from pronoun use to body references offers a multivariate personality marker to test such assumptions. Analysis of over 1,500 internet personal advertisements placed by heterosexual men, heterosexual women, gay men, and lesbians found little evidence that orientation alters the impact of gender on linguistic behaviors. Previously reported gender differences were replicated in the gay as well as the heterosexual advertisements studied. Main effects of sexual orientation indicated that gay people of both sexes apparently felt less need to differentiate themselves from potential mates than did heterosexual people. Virtually no crossover sexual orientation by sex interactions emerged indicating that several popular models of sexual orientation are not supported on a linguistic level.     

Safe and supportive schools for LGBT youth: Addressing educational inequities through inclusive policies and practices

Inclusive policies that attend to sexual orientation and gender identity (SOGI) are associated with more supportive school environments for lesbian, gay, bisexual, and transgender (LGBT) youth. We use the 2013–2015 California Healthy Kids Survey (n = 113,148) matched with principal reports of school policies from the 2014 California School Health Profiles to examine differential effects of SOGI-focused policies for LGB and transgender youth. SOGI-focused policies had a direct association with less truancy, and moderated the association between sexual orientation/gender identity and other school outcomes. SOGI-focused policies were associated with more positive experiences and perceptions of school climate for LGB youth and, to a lesser extent, transgender youth. Findings underscore the importance of inclusive policies, especially those that address the unique needs of transgender students.     

Applying Person‐Centered Counseling to Sexual Minority Adolescents

Drawing attention to the very unique and complex needs of stigmatized sexual minority youth, the authors explore the therapeutic potential of person‐centered counseling in helping lesbian, gay, bisexual, transgender/sexual (LGBT) adolescents who are working toward the acceptance and disclosure of their sexual identity. They suggest that person‐centered counseling embodies 6 aspects that are particularly helpful to LGBT adolescent clients and propose 3 additional methods that compensate for the limitations of the person‐centered approach in this particular helping context.     

Resistance and countertransference in child and adolescent psychotherapy

Countertransference brings to light the influence of both anxiety and family processes on the child's or adolescent's maturation and character development. The significance of developmental, dynamic, and family-interpersonal factors have all been stressed as part of the latent communication inherent in resistance. Family influences on resistance and countertransference have to be the subject of analytic scrutiny. The engagement of children and adolescents in the therapeutic process seriously threatens parents' defensive operations both as couples and as individuals. Countertransference responses afford the opportunity not only to clarify the meaning of resistances but also to pinpoint anxieties that have been reexperienced by the child or adolescent with the analyst at points of threat and disorganization. The twofold therapeutic task with children and adolescents consists of delineating and counteracting the family's negative impact on the child's development and self, in addition to addressing the children's contribution to their own pathological traits and immaturities. Countertransference anxiety confirms the dynamic and family implications of the analyst's participation with the patient. Countertransference resistance suggests the analyst's lack of openness in investigating how the treatment has evoked the child's anxiety, the parent's anxiety, and the analyst's anxiety. Resistance-transference-countertransference exchanges reveal the child's or adolescent's efforts to move towards health while emerging from the internalized family.     

Finding our way in perplexity: the meanings of sex in the analysis of a gay man.

As preconceptions about the meaning of sexual orientation are increasingly abandoned, analysts are left with the question of how these matters are to be addressed in clinical work. These problems are explored as they emerged in analytic work between a "gay" man and a "straight" analyst. Emphasis is placed on how the search for personal meaning is impacted by the intellectual and social context inhabited by analyst and patient.     

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.     

Sexual orientation and gender identity in schools: A call for more research in school psychology—No more excuses

Research focused on sexual orientation and gender identity among youth is scarce in school psychology journals. Graybill and Proctor (2016; this issue) found that across a sample of eight school support personnel journals only .3 to 3.0% of the articles since 2000 included lesbian, gay, bisexual, transgender (LGBT)-related research. It appears that special issues are a mechanism for publishing LGBT-related scholarship. This commentary includes a call for more research in school psychology and other related disciplines that intentionally addresses experiences of LGBT youth and their families. Two articles in this special section are summarized and critiqued with clear directions for future scholarship. Researchers and practitioners are ethically responsible for engaging in social justice oriented research and that includes assessing gender identity and sexual orientation in their studies and prevention program evaluations.     

The disclosure dilemma for gay men and lesbians: "coming out" at work

This study examined disclosing sexual orientation at work for 220 gay men and 159 lesbians. Self-acceptance, the centrality of one's identity, how "out" one is to friends and family, employer policies, and perceived employer gay-supportiveness were associated with disclosure behaviors at work for gay/lesbian employees. Disclosing at work and working for an organization perceived to be more gay supportive was related to higher job satisfaction and lower job anxiety. Reactions of coworkers to gay or lesbian workers mediated the relationship between disclosure and gay/lesbian workers' job attitudes. Implications and solutions for management are discussed.     

Gay Stereotypes: The Use of Sexual Orientation as a Cue for Gender-Related Attributes

This study investigated whether gay men and lesbians are assumed to have attributes stereotypically associated with the other gender. Participants were 110 male and female undergraduates from a private, Midwestern, U.S. university. Participants were randomly assigned to one of four conditions (i.e., gay male, lesbian, heterosexual female, heterosexual male) and rated their given target on possession of traditionally masculine and feminine occupational interests, activities, and traits. Results revealed that, despite some changes in the status of gay men and lesbians in society, stereotypes regarding sexual orientation were similar to those seen in studies conducted 20 years ago. Specifically, gay males were viewed as less masculine/more feminine than heterosexual males, and lesbians were viewed as more masculine/less feminine than heterosexual females.     

Two Gay Men Seeking Two Lesbians: An Analysis of Xinghun (Formality Marriage) Ads on China’s Tianya.cn

China has an estimated 30 million gay population, many of whom marry unknowing heterosexual partners due to family and societal pressure. Some pursue an alternative by entering Xinghun, also known as formality marriage or fake marriage, between a gay man and a lesbian. Such relationships are asexual and formulated solely for familial, social, and reproductive purposes. Analyzing 150 Xinghun ads posted on Tianya.cn, this is an exploratory study of an unique relationship behavior, to shed light on the lived experiences of this traditionally voiceless minority group. The qualitative theme analysis found that the ads emphasized some traits that are consistent with traditional Chinese values such as filial piety, compatibility, and traditional gender roles. The ads also showed the advertisers negotiating ways for their private sexual identity and public social identity to coexist. On the one hand, clarity in one’s sexual orientation and the commitment to one’s same-sex relationship was offered and sought after as a desirable trait; on the other hand, the advertisers emphasized that they did not live the stereotypical gay lifestyle and that they were private about their sexual preference. The ads illustrate the existence of a subculture of Chinese gays and lesbians, trying to cope with heteronormative social and cultural expectations, and to negotiate between the public and the private, between sexual activities and sexual identity, and between “playing gay” and “being gay.” Future research directions are discussed.     

Creating analysts, creating analytic patients

This paper applies a contemporary, 'two-track'- transformational as well as archaeological - perspective on psychoanalytic process to clinical issues in the creation of analytic patients: case finding, recommending analysis, and recommending and negotiating the intensification of frequency of sessions in analytic psychotherapy. Central importance is assigned to the role of the mind and analytic identity of the analyst, including the analyst's capacity to maintain an internal analytic frame and analyzing attitude from the very first contact with the patient and throughout the treatment, the analyst's confidence in and conviction about the usefulness of analysis for a given analytic dyad and the role of the analyst's theory, which must be broad and consistent enough to allow the analyst to feel that he or she is operating analytically when addressing non-neurotic (unrepresented and weakly represented mental states) as well as neurotic structures.