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.     

‘Coming out’ in therapy? Perceived risks and benefits of self‐disclosure of sexual orientation by gay and lesbian therapists to straight clients

Primary objective: The study's primary objective was to investigate the experiences of gay and lesbian therapists, when considering self‐disclosure of their sexual orientation to straight (i.e. heterosexual) clients. This qualitative study set out to ascertain the key factors gay therapists take into account when considering this decision and to explore the effects this self‐disclosure may have on themselves, their clients and their therapeutic relationships. Research design: The research design was based on the use of semi‐structured interviews, undertaken with a non‐random, purposive sample of counsellors and psychotherapists (n=8) in current practice. The rationale for this method was to aid exploration of therapists' experiences of the process of self‐disclosure. Methods and procedures: Inclusion criteria were for therapists who self‐identified as being gay or lesbian, and who were experienced in clinical work with straight clients. Transcribed data was analysed using inductive thematic analysis. Main outcomes and results: Some therapists reported being confident with self‐disclosure relating to their own sexual orientation. However, a common theme related to the reportedly high levels of anxiety and vulnerability, which therapists identified. Key themes emerged around: respondents' fears of client judgement; a need for therapist self‐protection; self‐awareness of the potential impact of their own fears and prejudices on the therapeutic relationship; and the potential relevance of internalised homophobia, as an overall constraining factor. Conclusions: Self‐disclosure of their sexual orientation to straight clients is constructed, in this initial survey, as being potentially problematic and risky for some gay therapists.     

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.     

Christian Pastors’ Perspectives and Insights on the Practice of Family Therapists Referring LGB Clients: Exploring the Role of Religion

Abstract

This qualitative study explored Christian pastors’ perceptions and insights for family therapists who refuse to work with lesbian, gay, and bisexual (LGB) clients by consistently referring them. Twenty-one pastors from diverse Christian traditions were interviewed. Thematic analysis identified the following themes related to the pastors’ perceptions of the practice of referring LGB clients: (1) Best Interest of the Client and Therapist, (2) Discriminatory Practice, and (3) No Referrals will be Provided. The following themes represent pastors’ advice for family therapists: (1) Develop a Well-Thought-Out Referral Plan; (2) Be Accountable for Your Own Beliefs; and (3) Engage in Conversations.     

Minority stress and mental health among Dutch LGBs: examination of differences between sex and sexual orientation

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the "gay-friendly" Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed.     

Intake Interviewing with Lesbian, Gay, Bisexual, and Transgender Clients: Starting from a Place of Affirmation

Initial interactions between lesbian, gay, bisexual, or transgender (LGBT) clients and psychotherapists can reveal existing biases from both parties. LGBT clients may have previous experiences with the mental health establishment and legitimate concerns about being pathologized. Psychotherapists may approach clients with openness and acceptance, but are likely to have little training in working with LGBT individuals. In this article, we discuss affirmative practices as a framework for clinicians beginning the intake process with LGBT clients. Through a brief history and overview of LGBT mental health, we provide mental health professionals with an appreciation of the multiple influences on LGBT individuals’ well-being. We then discuss the intake interview process in relation to each subgroup of the LGBT acronym, as each of these four populations face different (yet inter-related) challenges. While there is clearly no “formula” for working with LGBT individuals, in keeping with the principles of multicultural competency (Sue, The Counseling Psychologist, 29:790–821, 2001), our goal is to encourage therapists to reflect on their existing biases and to gain knowledge and skills for working with this diverse population. Overall, we hope this article demonstrates to therapists how to conduct an affirmative intake interview that minimizes heterosexual and dualistic gender assumptions that remain so pervasive in our society and in therapeutic practice.     

Was it a phase? Young women's relinquishment of lesbian/bisexual identities over a 5-year period

There have been many anecdotal accounts of individuals who self-identify as lesbian, gay, or bisexual only to relinquish these identities later. The current study examines this phenomenon among a sample of young nonheterosexual women who underwent 3 interviews over a 5-year period. Over a quarter of these women relinquished their lesbian/bisexual identities during this period: half reclaimed heterosexual identities and half gave up all identity labels. These women did not differ from those who maintained lesbian/bisexual identities regarding the age at which they underwent sexual identity milestones, the factors that precipitated their sexual questioning, or their recollection of childhood "indicators" of same-sex sexuality. Women who relinquished their identities for heterosexual identities had smaller ratios of same-sex to other-sex attractions across the 5-year assessment period, but their attractions did not significantly change. Only 1 woman described her previous same-sex identification as a phase; the rest emphasized changes in how they interpreted or acted on their attractions.     

The Sexual Orientation Matrix for Supervision

SUMMARY

The Sexual Orientation Matrix for Supervision (SOMS) was created in order to assist supervisors and trainers in preparing supervisees to work with lesbian, gay, and bisexual (LGB) clients. The SOMS was developed around two core concepts: (1) degree of heterosexual bias, and (2) degree of acceptance of LGB orientations and behavior. Supervisors can employ the matrix to explore both their own and their supervisee's levels of comfort, knowledge, and experience in working with LGB clients including same-sex couples. This article describes the development of the matrix, an exploration of the concepts underlying this tool, and an explanation of how to use the matrix, including suggested tasks for supervision of therapists working with same-sex couples.     

Is it Really Just About Being More Like a Fag? Confronting the Gay Male Model Mantra

Although the debate between feminism and queer is by now a fairly old and some might argue, trite and overwrought one, in this paper I direct my attention to a specific feminist assessment of queer that I find to be especially unhelpful and pernicious: the automatic linkage of queer with the exaltation of a gay male subjectivity. This article is informed by my own ethnographic research on lesbian/queer public sexual cultures; specifically, two Canadian lesbian/queer bathhouses, where public sex and sexual exploration are encouraged. I argue that this contention, that lesbians who espouse queer are aping (gay) male sexuality and subjectivity—due to the privileging of non-normative sexual practices found within the gay male community—does two things: (re)essentializes genders and sexualities, and, more importantly, robs non-gay male subjects (e.g., women, lesbians, butches, trans identified individuals) of their own agency. In sum, I believe that this linkage to a supposed gay male imitation, and concomitantly, viewing lesbian/queer sexual cultures, behaviors, configurations, and signifying sexual economies as mere derivatives of gay male culture, reinforces lesbian/queer invisibility and (re)centers the heterosexual matrix. For the sake of lesbian/queer subjects’ own viability, lesbian/queer sexualities must thus be pulled out of this discursive trap.     

Frames of Homosexuality: Comparing Los Angeles Times’ Coverage of California’s Proposition 6 (1978) and Proposition 8 (2008)

In this essay, I use qualitative framing analysis to discern frames of homosexuality, lesbian and gay identity, and same-sex attraction present in the Los Angeles Times’ coverage of Proposition 6 (1978) and Proposition 8 (2008)—propositions aimed to regulate the rights of lesbian and gay persons. I specifically describe differences between the coverage of each proposition, and I illustrate how the news coverage of homosexuality, lesbian and gay identity, and same-sex attraction, at least by one source, has changed over the span of 30 years.     

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.     

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.     

Christian Counselors and Affirmative Counseling of Lesbian and Gay Clients

In this phenomenological study, we interviewed 12 counselors who identified as both religious and able to provide ethical and competent counseling to lesbian and gay clients. Participants discussed their lived experiences providing counseling. Our analysis revealed three primary themes: seeking congruence, responding to lesbian and gay clients, and cultivating competency. We discuss these findings and identify implications for counselor training and practice.     

An exploration of lived religion in same-sex couples from Judeo-Christian traditions

Religious involvement has been found to be associated with higher levels of commitment and relationship satisfaction among heterosexually married individuals (Mahoney et al., 1999). Little is known, however, about the religiosity of gay, lesbian, bisexual (GLB) individuals, and virtually nothing is known about religious involvement in same-sex couples. The purpose of this qualitative interview study was to examine couples' experiences of incorporating religious involvement into their committed relationships. In a sample of 14 same-sex couples, we found that couples used their spiritual/religious values to understand and undergird their relationships. In this process, they negotiated intra-couple differences in religious practices, involved themselves in activities that have religious or spiritual meaning to them, created religious social support for their relationships, and experienced some non-supportive or rejecting interpersonal interactions with religious family members, congregants, and strangers. These findings are instructive to therapists who work with same-sex couples and the family members of GLB individuals. We conclude with specific suggestions for practitioners.     

Willingness to date across race: differences among gay and heterosexual men and women

Willingness to date members of other races was examined among 200 men with same-sex dating preference (n = 100) and opposite-sex dating preference (n = 100), and 200 women with same-sex dating preference (n = 100) and opposite-sex dating preference (n = 100) who were randomly selected from an Internet dating web site. Overall, results indicated a greater willingness among gay participants than heterosexual participants to date people of other races. A 2 (Sex) x 2 (Sexual Orientation) analysis of variance showed an interaction, with lesbian women more willing to date other races than gay men, while among heterosexual participants men were more willing than women to date other races. The role of mate selection theory, and the importance of the status afforded various races in U.S. society, were applied to interpret people's willingness to date other races.     

The Religious Origins and Destinations of Individuals Identifying as a Sexual Minority

Religion has been, and continues to be, a source of external hostility and internal struggle for many sexual minorities. This has potential implications for the observed religious origins and current religious affiliations of individuals identifying as a sexual minority. Regarding origins, self-identified sexual minorities might be less likely than heterosexuals to have come from religious traditions that have tended to be hostile to minority sexualities, as individuals raised within those traditions might be hesitant to identify as a sexual minority even if they have same-sex attractions. Regarding destinations, self-identified sexual minorities might be more likely than heterosexuals to switch away from religious traditions that have tended to be hostile to minority sexualities. We examine these expectations using nationally representative survey data from the 2008 to 2014 General Social Surveys. The analysis shows that sexual minorities do not significantly differ from heterosexuals by the religious traditions in which they were raised. Sexual minorities are, however, more likely than heterosexuals to move away from Christian traditions and towards disaffiliation or reaffiliation with “other” traditions that include Judaism, Buddhism, and liberal nontraditional religions such as Unitarian Universalism. For gay and lesbian individuals, these patterns of disaffiliation and reaffiliation can be attributed to higher on average education and lower likelihood of being married and having children; however, these sociodemographic factors do not explain the disaffiliation and reaffiliation of bisexual individuals. Further research should explore the different religious experiences of sexual minority sub-groups.     

“I’m Not Sure I Trust the System Yet”: Lesbian Service Member Experiences With Mental Health Care

The purpose of this research was to understand lesbian service member experiences with mental health care. Individual and organizational factors were explored, including the influence of military policy (e.g., “Don’t Ask, Don’t Tell”) on service member utilization of mental health services. Thirty-seven participants responded to a survey containing 16 open-ended items regarding the impact of “Don’t Ask, Don’t Tell” on one’s professional life, relational life, identity, and willingness to access mental health services. Data were analyzed through an open- and axial-coding and constant comparative method. The findings indicated a lesbian service woman’s likelihood of accessing mental health services was impacted by confidentiality concerns, fear of repercussions, and a sense that military culture lags behind policy changes. Recommendations for therapists included renewed focus on safety through affirmative practices, need for competency in military and lesbian/gay culture, and sensitivity to the effects of systemic oppression on self-esteem. Implications and future research are discussed.     

Nettersexuality: The Impact of Internet Pornography on Gay Male Sexual Expression and Identity

The Internet, as an integral part of global culture, has become a location offering a smorgasbord of pornographic images and films depicting multiple and fluid ways of being sexual. For males who identify as gay and/or queer, the Internet offers opportunities to explore same-sex sexualities in ways that have heretofore been challenging; thus, constructions of sexual identity can be interrogated, (re)examined, and (re)imagined. New explorations of sexualities may be the result of interface with Internet pornography, which opens spaces for not yet experienced ways of being sexual. Using qualitative methodology, this project engages the voices of three males who identify as gay and/or queer and focuses on how the Internet, particularly pornography on the Internet, impacts their sexual experiences and their sexual identities. Indeed, we argue here that the Internet does impact sexuality, and these men help to raise questions about what is possible with regard to sexuality and sexual identity.     

Pro-Active Intercultural Pastoral Care and Counseling with Lesbian Women and Gay Men

Clinical work with persons from lesbian and gay communities requires a clear sense on the part of the clinicians about how understandings of homosexuality shape our interactions. The importance of the religious and theological claims of the counselor cannot be underestimated in their ability to support and nurture, or to damage, the spiritual lives of lesbians and gay men. This paper first describes four religious perspectives on homosexuality, arguing for one that is proactive and affirmative. Second, this paper explores the multiple issues presented by lesbian and gay clients, including the role of marginalization, racial and ethnic heritage, internalized homophobia and heterosexism. Third, this paper closes with an invitation to counselors to participate in the public debates about homosexuality as a way of making the world a safer and healthier place for lesbians and gays to live.