Therapy

Bepko, C. & Johnson, T. (2000). Gay and lesbian couples in therapy: Perspectives for the contemporary family therapist. Journal of Marital and Family Therapy, 26, 409-419.
Outlines issues and concerns of gay and lesbian couples who seek therapy. The authors examine 4 "external" factors influencing lesbian/gay couples' functioning: (1) homophobia and heterosexism, (2) gender norms, (3) issues around coming out to others, and (4) social support from family of origin and family of choice. Also examined are internal aspects of lesbian/gay couples' functioning, the dydadic interaction patterns between the partners, and intrapsychic underpinnings of those patterns. Throughout the article, therapy methods are described that address the unique concerns of lesbian and gay couples, with special sensitivity to heterosexist and homophobic bias. It is concluded that effective work with lesbian and gay couples requires therapists to be familiar with the unique norms of the lesbian/gay community to avoid pathologizing what may be normative behavior for couples in that community.

Bowers, A. M., & Bieschke, K. J. (2005). Psychologists' clinical evaluations and attitudes: An examination of the influence of gender and sexual orientation. Professional Psychology: Research and Practice, 36, 97-103.
Becoming aware of factors that may affect differential treatment of clients is necessary for psychologists to practice competently. Scholarly writing and empirical studies have suggested that therapist gender, client gender, and client sexual orientation are 3 such factors. This study examined therapist gender, client gender, and client sexual orientation in relation to psychologists' attitudes and clinical evaluations for clients. Results indicated that female psychologists held more positive attitudes and treatment expectations for clients than did male psychologists and that some psychologists hold inconsistent attitudes toward female clients generally and lesbian, gay, and bisexual clients in particular. Continuing education and consultation are recommended to increase psychologists' awareness of gender and sexual orientation issues and potential influences in treatment.

Burckell, L. A., & Goldfried, M. R. (2006). Therapist qualities preferred by sexual minorities. Psychotherapy Theory, Research, Practice and Training, 43, 32-49.
Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed.

Crawford, I., McLeod, A., Zamboni, B. D., & Jordan, M. B. (1999). Psychologists' attitudes toward gay and lesbian parenting. Professional Psychology: Research & Practice, 30, 394-401.
How does the average practicing psychologist view a gay or lesbian couple wishing to adopt a child? Psychologists (N = 388) from across the United States read and rated 1 of 6 vignettes describing a couple interested in adopting a 5-year-old child. The vignettes were identical except that the couples' sexual orientation was depicted as gay male, lesbian, or heterosexual and the child was either a girl or boy. Results indicated that participants who rated the gay male and lesbian couples with a female child were less likely to recommend custody for these couples than participants who rated the heterosexual couples. Before psychologists provide mental health services to gay and lesbian people and their children, they should complete formal, systematic training on sexual diversity.

Davison, G. C. (1978). Not can but ought: The treatment of homosexuality. Journal of Consulting and Clinical Psychology, 46,170-172.
Responds to E. T. Sturgis and H. E. Adams's critique of the present author's proposals to terminate change-of-orientation programs for homosexuals. The author notes that his earlier proposals rest on moral not empirical grounds, and suggests that arguments based on whether therapists can or cannot alter sexual preferences are irrelevent. Therapists, moreover, have no abstract responsibility to accede to requests from clients for certain types of treatment; they work within a host of personal, conceptual, and even legal constraints. It is suggested that (a) therapists are characterized better as secular priests than as professionals applying ethically neutral techniques, (b) therapists should attend to large-scale social and political factors in their clients' lives as conscientiously as they attend to intrapsychic and interpersonal variables, and (c) their students should study philosophy and politics as well as learning theory and research design. To urge that therapists desist from sex reorientation programs is not tantamount to exhorting them not to see homosexuals in therapy; indeed, renouncing these widely used programs can help professionals focus on the problems homosexuals (and others) have, rather than on the so-called problem of homosexuality.

Eubanks-Carter, C. F., Burckell, L. A., & Goldfried, M.R. (2005). Enhancing therapeutic effectiveness with lesbian, gay, and bisexual clients. Clinical Psychology: Science and Practice 12, 1-18.
With increasing public acceptance of lesbian, gay, and bisexual (LGB) individuals, therapists can expect to encounter more opportunities to work with LGB clients. As therapists, we need to be certain that we can provide competent care to this population, which has been poorly served in the past by practitioners taught to view homosexuality as pathological. Most therapists have never received training in working affirmatively with LGB clients. We may be unaware of how the pathological view of homosexuality continues to influence our thoughts, feelings, and behaviors in subtle ways. By becoming more aware of our attitudes toward LGB individuals, and by learning more about issues that many LGB individuals face, we can increase our clinical effectiveness with LGB clients.

Garnets, L., Hancock, K. A., Cochran, S. D., Goodchilds, J., & Peplau, L. A. (1991). Issues in psychotherapy with lesbians and gay men: A survey of psychologists. American Psychologist, 46, 964-972.
In 1984, a task force of the American Psychological Association (APA) Committee on Lesbian and Gay Concerns was charged with investigating bias in psychotherapy with lesbians and gay men. The task force surveyed a large and diverse sample of psychologists (2,544 of whom completed a questionnaire) to elicit information about specific instances of respondent-defined biased and sensitive psychotherapy practice. Open-ended responses were used to separately identify major themes of biased and sensitive practice and to illustrate each with concrete examples. Results suggest that psychologists vary widely in their adherence to a standard of unbiased practice with gay men and lesbians. To bring individual practice into accord with APA policy will require continued and expanded efforts to educate practitioners about sexual orientation.

Haldeman, D. C. (2002). Gay rights, patient rights: The implications of sexual orientation conversion therapy. Professional Psychology: Research and Practice, 33, 260–264.
Therapies designed to change sexual orientation have come under increasing scrutiny from the profession and the public. The proposition that sexual orientation can be changed therapeutically is widely questioned, and there is concern that such therapies reinforce social devaluation of homosexuality and bisexuality. At the same time, conservative religious individuals wish to seek treatment appropriate to them, which may include attempting to change or control sexual orientation. The ethical questions and clinical and social implications of this complex issue are discussed. Guidance to practitioners interested in this issue is offered, including references to policies of the American Psychological Association.

Pachankis, J. E., & Goldfried, M. R. (2004). Clinical issues in working with lesbian, gay, and bisexual clients. Psychotherapy: Theory, Research, Practice, and Training, 41, 227–246.
This article discusses some of the key clinical issues for therapists to consider when working with lesbian, gay, and bisexual (LGB) clients. After a discussion of the biases that can influence psychotherapy, guidelines are given for conducting LGB-affirmative therapy that avoids these biases. Issues that therapists need to be familiar with in working with LGB clients include LGB identity development; couple relationships and parenting; LGB individuals as members of families; the unique stressors faced by individuals who are underrepresented in the LGB research literature (e.g., older LGB individuals, ethnic minorities, religious LGB individuals, bisexual individuals); and legal and workplace issues. An examination of the published literature is offered with particular emphasis given to the available empirical research.

Radkowsky, M, & Siegel, L. (1997). The gay adolescent: Stressors, adaptations, and psychosocial interventions. Clinical Psychology Review, 17, 191-216.
Examines literature and research studies on the effects of social stigmatization which may hinder gay adolescents' ability to achieve a sense of identity and self-esteem, and peer and familial relationships. Due to these factors, gay adolescents are susceptible to loneliness, isolation, depression, AIDS, and suicide. The authors suggest intervention strategies for clinicians working with gay youth including examining one's own biases about homosexuality, validation of affectional and erotic feelings to normalize their adolescence, providing education, and providing clients and their families with peer groups of other gay youth and parents of gay youth.

Roth, S. (1985). Psychotherapy with lesbian couples: Individual issues, female socialization, and the social context. Journal of Marital and Family Therapy, 11, 273-86.
Argues that relationship patterns in lesbian couples vary systematically from relationship patterns in heterosexual couples in ways that are related to the exclusively female composition of these couples, their stigmatizable identity, and the lack of social recognition and acceptance for such family units. These pattern differences are addressed from a systematic perspective in the 5 major issues most often presented by lesbian couples at the beginning of therapy: distance regulation and boundary maintenance, sexual expression, financial arrangements, breaking up, and stage differences in coming out and development of lesbian identity. It is concluded that effective therapy with lesbian couples requires that the therapist be skilled at seeing the interrelationships among the individual, couple, and larger social systems.

Safren, S. A., Hollander, G., Hart, T. A., & Heimberg, R. G. (2001). Cognitive behavioral therapy with gay, lesbian, and bisexual youth. Cognitive and Behavioral Practice, 8, 215-223.
The purpose of this article is to sensitize cognitive-behavior therapists to issues that are faced by many lesbian, gay, and bisexual youth. Little information is available to cognitive-behavioral therapists about same-sex sexual attractions in lesbian, gay, and bisexual youth, or how to incorporate these concerns into one's functional analysis and treatment plan. However, lesbian, gay, and bisexual youth may be at risk for a variety of clinical problems amenable to cognitive-behavioral therapy. The authors provide necessary information for the incorporation of issues concerning same-sex sexuality into one's case formulations when working with lesbian, gay, and bisexual youth, illustrated by case examples and clinical vignette.

Schneider, M.S., Brown, L. S., & Glassgold, J. M. (2002). Implementing the resolution on appropriate therapeutic responses to sexual orientation: A guide for the perplexed. Professional Psychology: Research and Practice, 33, 265–276.
This article provides background information and concrete examples to assist practitioners in the implementation of the American Psychological Association's Resolution on Appropriate Therapeutic Responses to Sexual Orientation. It provides some general information about psychosocial aspects of lesbian, gay, or bisexual identities. It examines the issues surrounding the assertion that sexual orientation can be changed and the implications for practice. Vignettes, based on actual case studies, are used to illustrate how practitioners might respond appropriately to clients who are struggling with issues surrounding their sexual orientation.

Shidlo, A., & Schroeder, M. (2002). Changing sexual orientation: A consumers' report. Professional Psychology: Research and Practice, 33, 249–259.
What motivates individuals to pursue conversion therapy and ex-gay groups? How do they perceive its harmfulness and helpfulness? In this study, 202 consumers of sexual orientation conversion interventions were interviewed to answer these questions. The results indicated that a majority failed to change sexual orientation, and many reported that they associated harm with conversion interventions. A minority reported feeling helped, although not necessarily with their original goal of changing sexual orientation. A developmental model that describes the various pathways of individuals who attempt to change their sexual orientation is presented

 

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AFFIRM Network, c/o Marvin Goldfried | Psychology Department, SUNY at Stony Brook, Stony Brook, NY 11794-2500 | marvin.goldfried @stonybrook.edu