Addressing multiple relationships between clients and therapists in lesbian, gay, bisexual, transgender communities

Therapists working in lesbian, gay, bisexual, and transgender (LGBT) communities are likely to experience the potential to engage in multiple relationships with their clients. Currently, the American Psychological Association's (2002) ethics code and the related literature base offer minimal direct guidance to therapists practicing in LGBT communities. In this article, the authors review current literature regarding multiple relationships in psychotherapy, considering how this literature addresses issues specific to practitioners working within LGBT communities, present a case study highlighting the negotiation of a multiple relationship between a client and therapist who both identify as lesbian, and offer recommendations for practitioners working within LGBT communities.     

Self-esteem among lesbian,gay, bisexual and same-sex-attracted Mormons and ex-Mormons

Lesbian, gay, bisexual and same-sex-attracted (LGB/SSA) individuals in conservative religions often experience stigma, shame, and psychological distress in reconciling their religious and sexual identities, yet religion can also provide existential comfort and social support. We investigated relationships among self-esteem, participation in the Mormon Church, and sexual identity acceptance among 348 LGB/SSA Mormons and ex-Mormons in 2013–2014 and found that the two groups reported similar self-esteem. By testing plausible mediators (family support, gay/SSA identity acceptance, and agreement with Mormon Church policy prohibiting same-sex behaviour) through a path model, results revealed different pathways to self-esteem. Practicing LGB/SSA Mormons reported higher family support and lower gay/SSA identity acceptance than ex-Mormons, while those self-identifying as SSA but not gay reported lower gay/SSA identity acceptance. We suggest that religiously active Mormons demonstrate low self-acceptance of their gay/SSA identity while ex-Mormons suffer loss of familial and social support, resulting in equal self-esteem across church status groups.     

Integrating gay, lesbian, and bisexual issues into mainstream psychology.

Despite the growing clinical and research literature dealing with gay, lesbian, and bisexual (GLB) issues, mainstream psychology has tended to ignore much of the work that has been done in this area. This article illustrates how clinical and research writings on GLB issues continue to remain invisible to mainstream psychology in such areas as life span development and aging, teenage suicide, substance abuse, victimization and abuse, and family and couple relationships. It also deals with some of the determinants of well-being among GLB individuals, such as family support, and notes the benefits accruing to mainstream psychology from studying GLB issues. A network of family members within psychology having GLB relatives has been formed--AFFIRM: Psychologist Affirming Their Gay, Lesbian, and Bisexual Family--and is dedicated to supporting its own family members, encouraging other family members to do likewise, supporting research and clinical work on GLB issues, and closing the gap between GLB clinical and research work and mainstream psychology.     

Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority

Family and couples therapy in the main concentrates on heterosexual clients, and has thus been described as limited in its outlook, or discriminatory. It is argued that family and couples therapy is at present not offered to gay and lesbian clients because of an absence of appropriate referrals, the inability of therapists to recognize the sexual orientation of their clients, a belief that skills held by therapists are not appropriate for this client group, or because of the homophobia of the therapist. It is suggested that family and couples therapy should be more readily available for gay and lesbian clients, and a number of different issues which these families might face are discussed. This includes problems associated with the gay adolescent and the gay or lesbian parent, as well as the gay or lesbian couple. It is concluded that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist.     

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.     

Personality,spirituality, suicide,and self-injury proneness among lesbian,gay, and bisexual adults

The present study sought to clarify gaps in current knowledge integrating personality, spirituality, and risk for suicide/self-harm among sample of 336 lesbian, gay, and bisexual community members. It was hypothesised that Neuroticism would positively predict, and Extraversion and Agreeableness would negatively predict, measures of suicide and self-injury proneness. Additionally, it was predicted that spirituality, defined as Spiritual Life Integration (SLI) and Social Justice Commitment, would interact with personality traits to attenuate risk for suicide and self-injury. Results supported the role of Neuroticism, and identified an unexpected predictor of Conscientiousness, at the main effect level. Moderation patterns were observed such that Agreeableness and Extraversion interacted with SLI to attenuate risk, such that high levels of each trait and high levels of spirituality were protective against suicide and self-injury proneness. Theoretical and practical implications with emphasis on counselling intervention implementation and future research are discussed.     

Student prejudice against gay male and lesbian lecturers

The authors examined whether gay men and lesbians are evaluated more negatively than individuals of unspecified sexual orientation when attributional ambiguity surrounds evaluations and whether they are evaluated similarly to unspecified others when no attributional ambiguity is present. One male and one female lecturer delivered either a strong or a weak lecture to students who either (a) believed that the lecturer was a gay man or a lesbian or (b) did not receive sexual orientation information. Contrary to predictions, the quality of the lecture did not influence the ratings of known gay male and lesbian lecturers, although lecture quality strongly influenced ratings of lecturers whose sexual orientation was unspecified. After strong lectures, participants rated known gay male and lesbian lecturers more negatively than they did lecturers whose sexual orientation was unspecified. After weak lectures, participants rated known gay male and lesbian lecturers more positively than they did the others. The authors discussed the possibility that students might moderate their ratings to avoid discriminating against gay and lesbian lecturers.     

Giving voice to emerging science and theory for lesbian, gay, and bisexual people of color

Lesbian, gay, and bisexual (LGB) people of color may experience multiple layers of oppression, as they often not only contend with the negative societal reactions to their sexual orientation but also may experience racial prejudice, limited economic resources, and limited acceptance within their own cultural community. Despite the range of psychosocial issues that may be encountered by this population, and the need to understand factors that promote resiliency and well-being, the empirical psychological literature has virtually ignored LGB people of color. This article provides general background regarding the empirical research needs and concerns regarding LGB people of color and introduces the articles included in this special issue. Recommendations for increasing research with LGB people of color are offered.     

Sexual ethics, marriage, and sexual autonomy: the landscapes for Muslimat and lesbian, gay, bisexual, and transgendered Muslims

Muslims today are increasingly re-examining gender and human rights in the light of Qur’anic teachings, and these issues crucially intersect in the terrain of sexual autonomy. The Qur’an insists that men and women are spiritually equal, yet dominant interpretations of sexual rights in Islam are not gender symmetrical. This paper asks whether Islam’s depiction of sexuality and marriage allows a space for female, and non-heterosexual, sexual autonomy. It also explores current interpretations of Islam, sexuality and same-sex relationships amongst British Muslims who identify as Lesbian, Gay, Bisexual and Transgendered. Large issues are at stake for contemporary Muslims re-examining their institutions and identity. Does marriage remain authoritative when paradigms of sexuality shift, and what does this mean for sexual autonomy in the wider Muslim consciousness?     

Substance use in lesbian, gay, and bisexual populations: an update on empirical research and implications for treatment

Historically, substance use problems were thought to be more prevalent in lesbian, gay, and bisexual (LGB) populations, and correcting skewed perceptions about substance abuse among LGB individuals is critically important. This review provides an update on empirical evidence on LGB substance use patterns and treatment outcome, with specific focus on clinical implications of findings. Compared to earlier studies, the recent research included in this review has used more sophisticated methodologies and more representative samples, and also has investigated multiple dimensions of sexual orientation in relation to substance use patterns. Findings from recent research suggest that lesbians and bisexual women are at greater risk for alcohol and drug use disorders and related problems, and that gay and bisexual men are at greater risk for illicit drug use and related problems. Several sociocultural factors have emerged as correlates of substance use patterns in LGB populations (e.g., affiliation with gay culture, HIV status), and several demographic characteristics (e.g., female, older age) do not appear to be as robust of protective factors against substance abuse for LGB individuals compared to heterosexual populations. Bisexual identity and/or behavior in particular seem to be related to increased risk for substance abuse. In terms of treatment outcome, limitations of extant research prevent conclusions about the relative impact of LGB-specific interventions, and further research that includes women and uses more equivalent comparison interventions is needed. Clinical implications of research findings are discussed for case identification, selection of treatment goals (e.g., moderation vs. abstinence), targets for intervention, and specific treatment modalities.     

Culture, trauma, and wellness: a comparison of heterosexual and lesbian, gay, bisexual, and two-spirit native americans

In a community-based sample of urban American Indian and Alaska Native adults, 25 lesbian, gay, bisexual, and two-spirit participants were compared with 154 heterosexual participants with respect to sociodemographic characteristics, Native, cultural participation, trauma, physical and mental health, and substance use. Compared with their heterosexual counterparts, two-spirit participants reported higher rates of childhood physical abuse and more historical trauma in their families, higher levels of psychological symptoms, and more mental health service utilization. Two-spirit participants reported differences in patterns of alcohol use and were more likely to have used illicit drugs other than marijuana. Discussion and recommendations for health promotion interventions and future research are presented in consideration of an "indigenist" health model and the multiple minority status of two-spirit people.     

What schools can do to help gay/lesbian/bisexual youth: a harm

In recognition of the fact that heterosexism is one of the most significant realities of adolescents' day-to-day experiences in school, this paper examines the school environment in terms of disempowering and empowering aspects. It is argued that failure to take a proactive stance to help youth with gender identity issues is a major cause of psychological problems, leading in some cases to suicide, alcohol and other drug abuse, and homelessness.     

Mental health of lesbian, gay, bisexual, and heterosexual siblings: effects of gender, sexual orientation, and family

Self-identified lesbian, gay male, and bisexual (LGB) individuals were recruited via convenience sampling, and they in turn recruited their siblings (79% heterosexual, 19% LGB). The resulting sample of 533 heterosexual, 558 lesbian or gay male, and 163 bisexual participants was compared on mental health variables and their use of mental health services. Multilevel modeling analyses revealed that sexual orientation predicted suicidal ideation, suicide attempts, self-injurious behavior, use of psychotherapy, and use of psychiatric medications over and above the effects of family adjustment. Sexual orientation was unrelated to current psychological distress, psychiatric hospitalizations, and self-esteem. This is the 1st study to model family effects on the mental health of LGB participants and their siblings.     

Prejudice,social stress,and mental health in lesbian,gay, and bisexual populations: conceptual issues and research evidence

In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.     

Understanding the unprotected sexual behaviors of gay, lesbian, and bisexual youths: an empirical test of the cognitive-environmental model.

The cognitive-environmental model (CEM; M. Fishbein et al., 1991) was used to understand the unprotected sexual behaviors of 156 gay, lesbian, and bisexual youths. Unprotected anal sex among the males was associated directly with poor protection skills (e.g., incorrect use of barrier methods, such as condoms), poor intentions to use barrier methods, and poor norms by sexual partners concerning barrier methods. Furthermore, the association between low self-efficacy and increasing unprotected anal sex was attributed to poor intentions. Direct associations of unprotected oral sex with poor intentions and poor partner norms also emerged, as did an indirect relation between unprotected oral sex and low self-efficacy via poor intentions. These last 3 findings were replicated when examining unprotected oral or vaginal-digital sex among the females. Relations among the CEM factors supported some CEM-theoretical propositions.     

Minority stress and health: Implications for lesbian,gay, bisexual,transgender, and questioning (LGBTQ) young people

Historically, the pathologization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) orientations shaped research and professional practice, while the impact of stigma was not considered. Within a minority stress conceptualization however, stigma-related prejudice and discrimination experienced by LGBTQ people constitute chronically stressful events that can lead to negative health outcomes. Minority stress has been linked to psychological distress among gay men and lesbians and may contribute to elevated rates of distress frequently observed among LGBTQ youth. This study explored the impact of minority stress on psychological distress among LGBTQ youth in Ireland. Measures assessing three components of minority stress (sexual identity distress, stigma consciousness, and heterosexist experiences) were administered online to LGBTQ youth aged 16–24 years (N = 301). Each minority stressor had a significant independent association with distress. Stepwise regression analyses identified the linear combination of minority stressors as significantly predictive of distress [F(3,201) = 30.80, p ≤ 0.001]. Results suggest that the oppressive social environment created through sexual/transgender identity-related stigma negatively impacts on the well-being of LGBTQ youth. These findings have implications for health professionals and policy makers interested in the concerns of LGBTQ youth experiencing difficulties related to minority status and will facilitate the development and tailoring of interventions aimed at reaching those most at risk.