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