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.     

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.     

The Journal of Couples Therapy Entelechy Institute CEU Quiz

SUMMARY

The majority of gay male couples are not monogamous. Relationship clinicians can help gay male couples to have a healthy sexually open relationship by working from a family systems perspective. This approach requires the therapist to have an understanding of family systems theory, the Enneagram (a personality topology), gay male sexual culture, as well as being clear of negative countertransference. Assessment of functionality of sexually open gay male relationships is described.     

What Do We Know About Gay and Lesbian Couples?

Abstract— Research on gay and lesbian couples is highlighted with regard to household labor, conflict, satisfaction, perceived social support, stability, and the variables that predict relationship quality. Relative to partners from married heterosexual couples, partners from gay and lesbian couples tend to assign household labor more fairly, resolve conflict more constructively, experience similar levels of satisfaction, and perceive less support from family members but more support from friends. The limited data available indicate that gay and lesbian couples may be less stable than married heterosexual couples. The factors that predict relationship quality tend to be the same for gay, lesbian, and heterosexual married couples. Overall, research paints a positive picture of gay and lesbian couples and indicates that they tend to be more similar to than different from heterosexual couples.     

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.     

Introduction

Abstract

This article provides a beginning exploration of the pro cess involved in becoming an emotionally focused therapist. The under lying assumptions of emotionally focused therapy (EFT) are identified and examined in relation to how the theory affects therapeutic practice with couples and families. A number of themes are outlined including fit between the therapist and EFT, the challenges of working within this model and transference issues. The authors utilize examples from their supervisory experience in training therapisLs to illustrate common strug gles, pitfalls and the necessary clinical set required in becoming an emo tionally focused therapist.     

“Hold Me Tight”: The Generalizability of an Attachment-Based Group Intervention to Chinese Canadian Couples

“Hold Me Tight” (HMT) groups are an adaptation of emotionally focused therapy (EFT) for couples and have emerged out of 30 years of research into the efficacy and process of EFT. The goal of this study was to test the effects of a Chinese-language version of the HMT relationship enrichment program in a sample of Chinese Canadians. Twenty-three men and 23 women (N = 46) in committed couple relationships completed an HMT relationship education program with their partners in Toronto, Ontario, Canada. Results indicated statistically significant improvements in participants' satisfaction with their attachment relationships, in their attachment security, and in their family functioning. The implications of these findings are discussed in light of relevant cross-cultural literature on attachment and couple relationships.     

Fostering Strength and Resiliency in Same-Sex Couples

Abstract

Same-sex couples are presented widiin tiieir cultural contexts to examine how those contexts might influence me strength and resilience of their relationships. We are particularly interested in the ability of the couple relationship to fulfill family functions that serve the social, psychological, and physical needs of each of the partners and society (Patterson, 2002a). Three family functions: family formation and membership, nurturance and socialization, and protection of vulnerable members, are particularly germane to same-sex couples. We examine several topic areas related to these three functions in order to assist clinicians in identifying factors that may prohibit same-sex couples from becoming and remaining strong and resilient.     

Group psychotherapy with the aging gay male: Treatment of choice

This article summarizes many issues facing gay men as they age. Aging for gay men is a complex phenomenon involving identity, self-esteem, internalized homophobia, stereotypes about older gay men, and the paucity of positive gay male images or role models to help direct their development. In this article, I will attempt to illuminate some of the complex variables of aging, as well as illustrate through case examples that group psychotherapy is a particularly helpful forum for skills development for middle age and older gay men. The themes covered include: 1) commitment struggles—especially anxiety management and conflict resolution, 2) self-esteem regulation, 3) projections and internalizations, 4) capacity for intimacy, and 5) unresolved grief and loss due to the impact of AIDS: Alone vs. Lonely.     

Addressing power in couples therapy: Integrating socio-emotional relationship therapy and emotionally focused therapy

Romantic relationships are more satisfying and fulfilling when power is balanced relatively equally between partners (Leonhardt et al., Journal of Family Psychology, 34, 2020, and 1). Yet, few couples therapy models explicitly outline how to confront relational power issues (Knudson-Martin & Huenergardt, 2015, Socio-emotional relationship therapy: Bridging emotion, societal context, and couple interaction, Springer). Emotionally Focused Therapy (EFT; Johnson, 2020, The practice of emotionally focused couple therapy, Routledge) is a well-established, evidence-based therapy modality that many therapists use with couple clients, yet despite its effectiveness, it does not provide direction for explicitly addressing and treating power differentials in couple relationships. In this paper, we explore the integration of EFT with Socio-emotional Relationship Therapy (SERT), a model overlay that acknowledges the impact of social discourse on enactments of power in intimate couple relationships. We first address the importance of understanding power in couple relationships, addressing power in couples therapy, and provide a brief overview of SERT and EFT. We then introduce an integration of the models intended to help therapists balance power, increase connection, and secure attachment bonds between romantic partners.     

The Efficacy of Behavioral Couples Therapy and Emotionally Focused Therapy for Couple Distress

Twenty treatment outcome studies, 13 of which evaluated behavioral couples therapy (BCT) and seven of which evaluated emotionally focused therapy (EFT) were reviewed, leading to the following conclusions. BCT leads to short and long-term gains for moderate to severe couple distress. In the long term BCT probably leads to no better outcomes than its constituent components—behavioral exchange training and communication and problem solving skills training. Addition of a cognitive therapy component to BCT or the use of a variety of treatment formats does not improve the efficacy of BCT. Integrative couples therapy and insight-oriented marital therapy may be more effective than BCT, but studies supporting this conclusion require replication. EFT leads to short and long-term gains for mild to moderate couple distress. Addition of a cognitive therapy component to EFT does not enhance its efficacy. EFT may be more effective than problem solving therapy and less effective than integrated systemic therapy, but the two studies supporting this conclusion require replication.Michael Byrne, PhD, is a Clinical Psychologist, Midland Health Board, Ireland; Alan Carr, PhD, is Director of the Clinical Psychology Training Programme, Department of Psychology, Arts Building, University College Dublin, Belfield, Dublin 4, Ireland (alan.carr@ucd.ie). Marie Clark, PhD, is Lecturer, Department of Psychology, University of Surrey, United Kingdom.     

Intercultural Therapy with Latino Immigrants and White Partners

SUMMARY

Interethnic and interracial marriages of Latinos and White Americans are on the rise and will continue to reshape the identities of individuals, couples, families, and communities. Clinicians working with these intercultural couples find no systematic training to address what is becoming a significant segment of our society. Couple therapists, however, cannot be culturally competent and effective based solely on knowledge of some dimensions of a couple's cultural backgrounds. Using clinical and theoretical ideas, the author defines clinical work with these couples as an explicit intercultural exchange. Our task as clinicians requires a rethinking of our conversations with these couples. It involves a caring therapeutic approach that is sustained on relational and systemic levels, and intercultural conversational skills inspired by clinical and other literatures that are explicitly dedicated to work with cultural difference and the “other.”     

Family Mobilization: Work with Angry Elderly Couples in Declining Health

When elderly angry couples face difficulties in caring for each other, the ability to monitor each other's health problems is reduced, prompting the mobilization of the family. This article presents three sets of questions that examine for patterns of family mobilization: positive wedging, disentanglement failure, positive in-and-out participation, and defensive paralleling. In our clinical impression, these patterns often accompany the health monitoring problems of angry elderly couples. Brief case studies are used to describe approaches for assisting these couples in terms of both health monitoring and marital interactions involving anger during health decline. A procedure of deliberate paralleling for working with couples who display an especially inflexible interpersonal arrangement is outlined. Implications are drawn for therapists' education.     

Affective responses to non-sexual imagery depicting gay men and lesbian women

ABSTRACT

When examining negative attitudes and behaviors directed toward gay men and lesbian women (i.e., homonegativity), researchers tend to use measures that require participants to respond to belief statements. This methodology is problematic for two reasons: 1) it focuses on the social categories “gay men” and “lesbian women” and ignores the practices of relational intimacy engaged in by gay and lesbian persons (practices that, arguably, are at the crux of homonegativity); and 2) it overlooks the affective responses that sexual minorities evoke in heterosexual people. These issues were tackled in the current study. Specifically, heterosexual participants (N = 241) were asked to report their affective state using six basic emotions while viewing photos depicting male-male, female-female, and heterosexual couples. Findings demonstrated that participants, regardless of gender, reacted most negatively to images of female-female couples engaging in everyday intimacies. Theoretical explanations for these findings are explored.     

“I'd Rather Be Dead Than Gay”: Counseling Gay Men Who Are Coming Out

Until recently, most articles about gay men have focused on etiology or cure. This article focuses on the initial phase of counseling male clients who have a negative gay identity and want help accepting their homosexuality. The article includes some basic concepts in gestalt therapy and how they can be applied when working with men who are acknowledging their homosexuality. It also includes tools and guidelines for therapists who want to work effectively with gay men desiring a positive gay identity.     

Emotionally-focused therapy and treatment as usual comparison groups in decreasing depression: A clinical pilot study

Abstract

Decades of research have shown that depression can have deleterious effects on couple relationships. Emotionally-focused therapy (EFT; Johnson, 2004 Johnson, S. M. (2004). The practice of emotionally focused couple therapy: Creating connection. East Sussex, UK: Brunner-Routledge. [Google Scholar]) is an empirically validated form of couple therapy, which has shown effectiveness in reducing depressive symptoms in couples where the wife has depression. The aim of the current pilot study was to examine the extent to which EFT and the comparison treatment as usual (TAU) therapy group decrease depressive symptoms in distressed couples. Results show that both groups were effective in decreasing depressive symptoms, with EFT showing a clinically significant reduction. Clinical implications and future research are discussed.     

Improving Young Male Couples’ Sexual and Relationship Health in the 2GETHER Program: Intervention Techniques,Environments of Care,and Societal Considerations

Young male couples are at high risk for acquiring human immunodeficiency virus (HIV). However, few HIV prevention programs meet the needs of young male couples that express an interest in how to maintain healthy relationships. As such, we developed 2GETHER, a couple-based program that integrates HIV risk reduction and sexual health information into a relationship education program specific to young male couples. 2GETHER was guided by cognitive-behavioral theories of HIV risk reduction and relationship functioning and was informed by a social–ecological perspective to address factors within and outside the couple that can impact sexual and relationship health. As a micro-level intervention, 2GETHER intervenes directly with couples via psychoeducation and cognitive-behavioral strategies to change couples’ communication patterns, sexual health behaviors, and relationship satisfaction. Successful implementation of 2GETHER requires mezzo-level interventions that create an affirming environment of care for sexual minority individuals and facilitators who are culturally competent in working with young male couples. Although macro-level interventions to change societal acceptance of and policies germane to sexual minority couples are beyond the scope of 2GETHER, we discuss how clinicians can advocate for systemic changes to improve sexual minority couples’ health, and how 2GETHER addresses the impact of such macro-level factors on the couple’s relationship. Our experience developing and testing 2GETHER indicates that HIV prevention programs for young male couples should reflect the unique contexts shaping sexual minority individuals’ relationships and lives, and that programs should intervene within and across multiple levels when possible to improve health for sexual minority men.     

Same-sex parent families in Italy: Validation of the Coparenting Scale-Revised for lesbian mothers and gay fathers

Even though Italy is still struggling to establish equal rights and access to assisted reproduction techniques for sexual minorities, an increasing number of lesbian women and gay men are now becoming parents. There are only a few studies that have evaluated coparenting in same-sex couples. However, these addressed adoptive couples and not the lesbian and gay parent families through donor insemination or surrogacy, respectively. This study examined the psychometric properties of the Coparenting Scale-Revised and its relationship with dyadic adjustment, discipline management, and internalized sexual stigma in Italian same-sex-planned families. The factor structure showed a satisfactory internal consistency and criterion validity with correlates of coparenting behaviours. While Family Integrity factor was confirmed, Disparagement and Reprimand dimensions collapsed into Conflict factor. Non-genetic parents showed lower levels of conflict than genetic parents. Most importantly, coparenting emerged as a significant function not shaped by gender, but influenced by parental status and internalized sexual stigma.