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.     

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.     

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.     

Clinical Approaches to Conflicts Between Religious Values and Same‐Sex Attractions: Contrasting Gay‐Affirmative,Sexual Identity,and Change‐Oriented Models of Therapy

The literature germane to the care of clients presenting for psychotherapy with conflicts between their sexual orientation and religious values typically addresses the topic from within a particular therapeutic approach. This article addresses the issue from a broader perspective that takes into account 3 different paradigms: gay‐affirmative therapy, sexual identity therapy, and change‐oriented therapy. The authors describe the 3 approaches, compare and contrast them across several different key dimensions of theory and practice, and identify some strengths and potential limitations of each approach for assisting clients who are attempting to navigate the resolution of their conflict.     

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.     

The Gay and Lesbian Affirmative Development (GLAD) Model: Facilitating Positive Gay Identity Development

The Gay and Lesbian Affirmative Development (GLAD) model, a proactive, gay‐affirmative counseling approach, is proposed Parallels are drawn between Cass's (1979) Homosexual Identity Formation model and Ivey's (1990) cognitive‐behavioral Developmental Counseling Therapy model to help counselors assess and facilitate gay and lesbian clients' cognitive development related to the formation of a positive sexual orientation identity.     

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.     

Emerging issues in research on lesbians' and gay men's mental health: does sexual orientation really matter?

Theoretical writings and research suggest that the onset, course, treatment, and prevention of mental disorders among lesbians and gay men differ in important ways from those of other individuals. Recent improvements in studies of sexual orientation and mental health morbidity have enabled researchers to find some elevated risk for stress-sensitive disorders that is generally attributed to the harmful effects of antihomosexual bias. Lesbians and gay men who seek mental health services must find culturally competent care within systems that may not fully address their concerns. The affirmative therapies offer a model for intervention, but their efficacy and effectiveness need to be empirically documented. Although methodological obstacles are substantial, failure to consider research questions in this domain overlooks the welfare of individuals who may represent a sizable minority of those accessing mental health services annually.     

Grasping the nettle: gay men's experiences in therapy

Qualitative research was carried out into gay men's experiences of being in therapy. One of the findings was that, while the overall experience of being in therapy was usually perceived to be helpful, the experience of discussion of areas relating to the clients’ experience of their sexuality was not. A common reaction was that this aspect of their experience had been silenced or not adequately explored. This finding gives rise to a consideration of what 'gay-affirmative' counselling means – and in particular to the ideas of whether affirmative counselling can be implicit or must involve a more active stance on the part of the therapist. These differing approaches and the implications which arise are discussed.     

Family therapy ‘lite’? How family counsellors conceptualise their primary care family work

A number of current developments in the field potentially provide opportunities for preventative relationship and family interventions to be integrated into primary care. In this context, it is important to understand what family counselling is and how it might differ from family therapy. Thus, this paper investigates how the service of one low-intensity family counselling provider, Relate, is conceptualised and practised by counsellors on the ground. Questions about practice were posed to five focus groups of family counsellors and these were analysed using thematic analysis. The findings suggest that Relate family counselling is seen as ‘family therapy lite’, with a flexible, eclectic and integrative use of concepts and techniques within a systemic framework. Implications of this conceptualisation of family counselling for training, practice and research are discussed.     

Theoretical orientation and reported practice: A survey of eclecticism among counsellors in Britain

There is an increasing trend for counsellors to report that their practice is based on a combination of methods and approaches, rather than being grounded in a 'pure' model. However, there has been a lack of research on the proportion of counsellors in Britain who define themselves as eclectic or integrative in orientation. This study reports on a survey of eclecticism and integrationism in counsellors and other therapists in Britain. Results indicate that as many as 87% of counsellors can be regarded as taking a 'non-pure-form' approach of some kind. Issues in interpreting data on counsellors' self-reports of orientation are discussed, and implications for training and further research are outlined.     

Support and self-care: professional reflections of six New Zealand high school counsellors

In many Western societies there is increasing demand for counselling; in turn, heightened levels of support needs have been identified for counsellors themselves. Despite calls for practitioners to adopt a more proactive approach to self-care, research suggests many still pay insufficient attention to alleviating on-the-job stress or achieving ‘work–life balance’. These issues were examined within the context of inviting six high school counsellors in New Zealand to talk generally about their professional lives. The authors suggest findings support calls for counsellor education programmes to offer structured opportunities for trainees to reflect upon the task of discursively constructing professional roles.     

Counsellors' experiences of changing their practice: Learning the psychodynamic‐interpersonal model of therapy

Seven counsellors were interviewed about their experiences of learning and applying a new approach to therapy: the psychodynamic‐interpersonal model. These interviews were analysed using grounded theory — a qualitative approach. Under the core category of ‘changing counselling practice: applying the PI model of therapy’, the material was organised into 10 major categories: difficult feelings; new awareness; therapeutic identity; identifying reasons for choosing how to work; experiencing difficulties in adherence; attributing causes of difficulties; ways through the difficulties; understanding how change in practice occurs; changing interventions; and specific other inputs. Examples from the interviews are used to cast light on the difficulties experienced by counsellors in the process of changing their practice.     

Training counsellors in the process-experiential approach

The process-experiential approach to counselling stresses the importance of active, process-directive interventions oriented toward deepening experiencing within the context of a person-centred relationship. This implies a shift in the training of counsellors in experiential-humanistic approaches in the last decade, from a focus on training counsellors in Rogers' facilitative conditions to training them to be process experts in facilitating cognitive-affective tasks. A model is described for training counsellors in the process-experiential approach, and specifically in facilitating a particular cognitive affective task, called the unfolding of problematic reactions. Four phases of counsellor training are outlined. The difficulties that need to be dealt with during training, and the merits of the model for counsellor education, are discussed     

'Psychodynamic and Religious?' Religiously committed psychodynamic counsellors,in training and practice

This article supports a case for an increased research focus upon and within counsellor training with consideration of the counsellor's religious orientation. This aspect of professional diversity was investigated via in-depth interviews with eight religiously-committed psychodynamic counsellors. Their accounts of experiences in training, supervision, personal therapy and professional practice were subjected to qualitative analysis using grounded theory methods. Three major themes were identified: changes occurring in participants' religiosity; aspects of disclosure of personal religious commitment; and the non-inclusion of religious issues within the counsellor training process. The latter theme emerged considerably more forcefully than the others, and produced an array of questions to stimulate further research.     

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.     

Pupil perceptions of counselling: A case study

Using a case-study school with a highly-developed counselling service employing three trained school counsellors, pupil perceptions of counsellors are examined in terms of their duties within the school and their potential helpfulness. Despite the fact that many of the features of the school were ideally adapted to the effective development of counselling, the counsellors were broadly perceived as senior teachers with a great deal of administrative responsibility. Few of the pupils indicated a willingness to approach any of the counsellors voluntarily with a personal problem.