Gay and lesbian couples in therapy: perspectives for the contemporary family therapist

Deliberate Context-Driven Conceptualization in Psychological Assessment

Clinical formulation and case conceptualization in clinical psychological assessment typically organize a client's presenting problems within a psychological framework and narrative that explains the cluster of symptoms, etiological and maintenance factors, and explaining both how and why a client is struggling or suffering. However, many of the most commonly used models of case conceptualization, as well as the preponderance of tests and measures used in psychological assessment, minimize or ignore the impacts of contextual factors, including dominant culture's expectations for normative behavior and the client's history of trauma and adverse and negative events. This paper presents a rationale and model for encouraging psychologists conducting clinical psychological assessment to be deliberate in first considering contextual factors in case conceptualization before relying entirely on primarily intrapsychic models. While contextual conceptualizations will not always replace (or join) intrapsychic models of case formulation, being deliberate and explicit about at least considering them is an important way to mitigate some of psychologists' biases and has the potential to situate a narrative of client difficulties in a way that takes at least some of the burden off the client.

[Becoming Another: Transformations in the Therapist Who Works with Gay and Lesbian Couples]

OBJECTIVE

To recognise the changes experienced by the therapist who works with gay and lesbian couples.

METHOD

Qualitative with biographical-narrative method. Seven therapists were interviewed in Medellin.

RESULTS

Three moments in the life trajectory of the participants were identified: Before: closeness and distances between families and the school were found (distances, makes reference, among others, to discourses about homosexuality. During: showed the conspiracy of silence in the undergraduate and postgraduate training of therapists, and in the clinical approach with homosexual couples they perceive in the reasons for consultation, a spectrum between everyday conflict and imposed exclusion. After: makes reference to the changes that this clinical work has generated in them, how they have become different, while others have been defined as: political subjects who resist normalization and become learners of artistic territories and artisans of their own lives.

CONCLUSIONS

The task of becoming another is a poetic, aesthetic and ethical process like the beautiful creation of the own existence. These transformations are connected with presence, social, politic and artistic contexts, reflexive labour and criticism about themselves.

To Refer or Not to Refer: Exploring Family Therapists' Beliefs and Practices Related to the Referral of Lesbian, Gay, and Bisexual Clients

This study explored how negative beliefs toward lesbian, gay, and bisexual (LGB) individuals and LGB clinical competence influenced family therapists' beliefs and practices regarding referring based on the sexual orientation of the client. The sample consisted of 741 experienced clinicians. The results of this study indicated that the majority of the participants believe it is ethical to refer LGB clients; however, most had never made such a referral. Furthermore, participants who had referred based solely on the client's sexual orientation reported higher levels of negative beliefs toward LGB individuals and lower levels of LGB clinical competence. Finally, negative beliefs toward LGB persons not only predicted the practice of referring, but also the belief that it is ethical to refer an LGB client.

The Relationship between Social Support and Suicide Risk in a National Sample of Ethnically Diverse Sexual Minority Women

This study examined the relationship between three types of social support and suicidal ideation and lifetime attempts among a national sample of ethnically diverse sexual minority women (SMW). Participants (N = 150) completed measures of social support and suicidal ideation/attempts. After controlling for socioeconomic status, social support explained 12.3% of the variance in past suicidal ideation and 10.7% in lifetime suicide attempts. Social support from family and significant other were both inversely associated with suicidal ideation, and social support from family inversely with lifetime attempts. Interventions that strengthen family relationships could be a buffer of suicidality in this population.

Reflections on the challenges of understanding racial, cultural and sexual differences in couple relationship research

In the field of systemic psychotherapy there has been much recent interest in the areas of culture and reflexivity, and in working with couples. In this article we reflect on the process of conducting research in these areas. Drawing on findings from a large, national, empirical mixed-methods study on long-term relationships, we use two examples from the data to illustrate the complexity of researching across racial, cultural and sexual differences, in terms of research design and sampling, fieldwork and research practice, and making sense of multidimensional data. We point to findings that suggest that notions of coupledom are culturally constructed and thus challenge straightforward ideas of the procreative, sexually active couple dyad, separate from intergenerational extended families. The clinical significance of the findings for both lesbian, gay, bisexual or queer and culturally diverse couples and families are discussed.

PRACTITIONER POINTS

Cultural or racial matching is not a sufficient condition for engagement and empathy with couples and families.Critical reflexivity about similarity and difference is essential in cross-cultural systemic practice.'The couple' and its distance from the extended family may be defined differently in different cultures.One research tool used in this project, the emotion map, appears to have utility in clinical practice with couples and families.

The Poetics of Parent-Son Encounters Following Negative Parental Reactions to the Disclosure of Gay Identity

The disclosure of gay identity is considered an important step in the process of gay identity development. However, disclosure—especially to parents—is stressful for sexual minority individuals. Research suggests that most parents respond negatively to the news of their son’s gay identity, and that such negative reactions pose significant risks to that child’s well-being. In this article, the author presents selected findings from his dissertation research, a poetic inquiry into the lived experience of facing negative parental reactions to the disclosure of gay identity. The article begins with a review of the gay identity development, sexual minority stress, and family disclosure literature. Next, the author describes his selected method, poetic inquiry, as an approach to research that aligns with humanistic psychotherapy. In the results section, six poetic transcriptions detailing four participants’ narratives about postdisclosure interactions with parents provide an in-depth look at the challenge gay men face when negotiating negative parental reactions. Finally the article concludes with a brief summary and a discussion of the reasons that poetic inquiry was chosen for research on this topic.

Negotiating heteronormativity: Exploring South African bisexual women’s constructions of marriage and family

Although heteronormativity remains firmly in place in many contexts, challenges to a construction of heterosexuality as natural and superior increasingly emerge. However, despite increasing visibility of such challenges, bisexuality remains largely absent from such debates. Bisexual women occupy a potentially interesting position in discourses around heteronormativity and this paper explores how heteronormativity functions in the accounts of 13 South African bisexual women. Through a discourse analysis of interview data, a discourse of heterosexual marriage as normative and socially valued is identified as exerting a powerful influence on participants’ constructions of relationships and families. The findings further explore ways in which bisexuality is complicated by such a heteronormative marriage discourse and indicate a lack of integration of a bisexual identity in participants’ accounts. We suggest that drawing bisexuality into debates around heteronormativity can contribute to increased positions from which to challenge the coercive effects of heteronormativity.

Spouses in mixed-orientation marriage: a 20-year review of empirical studies

Empirical studies on mixed-orientation marriage in social science journals from 1988 to 2008 were reviewed. Fifteen articles published in eight peer-reviewed journals were identified and discussed in terms of sampling, design, measures, rigor, theoretical framework, and literature review. An overview of each study is provided along with a summary of critical findings. Implications and recommendations for future research and education are offered.

Deconstructing heterosexism: becoming an LGB affirmative heterosexual couple and family therapist

The purpose of this article is to propose a three-step model to help heterosexual therapists become more aware of the influence of their own heteronormative assumptions, heterosexual privileges, and heterosexual identities on the therapy process. This article also provides definitions of concepts central to the practice of affirmative therapy with lesbian, gay, and bisexual clients and strategies that therapists and clients can use to deconstruct heterosexism in the context of therapy.

What's the confusion about fusion?--differentiating positive and negative closeness in lesbian relationships

This study differentiated between closeness and fusion in lesbian relationships, and examined whether age, adult attachment style, social support, outness, and relationship satisfaction were associated with these variables. Participants consisted of 77 women in long-term, lesbian relationships. Overall, women who reported showing greater closeness toward their partners were more satisfied in their relationships. Age and attachment style were better predictors of closeness and fusion than were social support and outness. The theoretical implications of these findings are discussed. Findings highlight the need for therapists to distinguish between positive and negative types of closeness in lesbian relationships, and avoid pathologizing high levels of closeness in lesbian relationships simply because they may deviate from a heterosexual norm.

Does affirmative training matter? Assessing CFT students' beliefs about sexual orientation and their level of affirmative training

This study examined couple and family therapy (CFT) students' beliefs about sexual orientation, their self-reported competency working with lesbian, gay, and bisexual (LGB) clients, and the level of affirmative training students received in their CFT programs. One hundred and ninety students from accredited CFT programs completed the study. While participants reported feeling only somewhat competent to work with LGB clients and less than half reported receiving any training on affirmative therapy, the majority of the participants did appear to hold positive attitudes toward LGB clients. The results support the literature arguing for CFT programs to include specific training on affirmative therapy practices, as the level of affirmative training was directly related to participants' self-reported clinical competency working with LGB clients.

Gay and lesbian couple relationship commitment in taiwan: a preliminary study

Due to the traditional values on marriage and heterosexual relationships, gay and lesbian couple relationships were long ignored in Taiwan. This study attempted to look at gay and lesbian couple relationship commitment. Questionnaires were used in this study. Due to the difficulties of getting gays and lesbians to participate in research, snowballing method was used. The sample included 218 participants in a stable couple relationship for at least six months. Through multiple regression analyses, the result showed that the influencing factors of gay and lesbian couples' commitment fit Rusbult's Investment Model closely.

Integrative module-based family therapy: application and training

The field of marriage and family therapy is currently at a crossroads. The challenge for contemporary therapists is how to incorporate the wisdom of previous models with the accountability that comes from evidence-based practice. The Integrative Module-Based Family Therapy treatment model provides a formalized series of steps that clinicians can use in their case planning and implementation. It is based on nine clinically relevant modules for assessment and intervention that are consistent with current best practices and empirically supported treatments. It thus meets the need for a structured family therapy practice and training approach that is respectful of the "art" of family therapy while still adhering to the principles of the "science" of evidence-based treatment.

Fusion or internalized homophobia? A pilot study of Bowen's differentiation of self hypothesis with lesbian couples

Bowen, using the concept of differentiation, hypothesized that the way individuals learn to deal with their relationships with families of origin will influence the way they manage their relationships with their partners. This study surveyed a group of 53 lesbian couples on differentiation of self, internalized homophobia, and relationship satisfaction. We found that lesbian couples were not significantly different in their level of differentiation than random pairs. We also found that there was a positive relationship between differentiation of self and relationship satisfaction and that when considered together, internalized homophobia had the more significant connection to relationship satisfaction than did differentiation of self Implications for therapy are drawn from these findings.

Divulgation de l’orientation sexuelle, soutien de la famille d’origine et adaptation conjugale chez des mères lesbiennes ayant eu leur(s) enfant(s) dans le contexte d’une relation hétérosexuelle. Étude exploratoire

Les couples lesbiens se distinguent des couples hétérosexuels par le fait qu’ils sont contraints de développer leurs relations de couple dans un contexte de sanctions sociales, ce qui pourrait augmenter l’importance de la qualité des liens avec l’entourage. De plus, la divulgation de l’orientation sexuelle représente une caractéristique de cette population qui agit sur l’ajustement psychologique et qui pourrait influencer le soutien familial. Cette étude examine l’effet du coming-out et du soutien familial sur l’ajustement conjugal des mères lesbiennes ayant eu leur(s) enfant(s) dans le contexte d’une relation hétérosexuelle. Nous nous attendons à ce que le soutien familial soit un médiateur du lien entre le coming-out et l’ajustement conjugal. Cinquante-cinq mères lesbiennes en couple ont rempli des questionnaires portant sur la perception du soutien familial, le coming-out et l’ajustement conjugal. Les résultats révèlent un lien positif entre le coming-out et le soutien familial et entre le soutien familial et l’ajustement conjugal, mais aucun lien entre le coming-out et l’ajustement conjugal. Le modèle de médiation n’est pas confirmé. Les implications de ces résultats sont discutées.

Commitment in same-sex relationships: A qualitative analysis of couples' conversations

Theoretical constructs and meanings of relational commitment for same-sex couples have typically been generalized from heterosexual relationships. Same-sex couples, however, face a unique set of challenges in constructing committed relationships. To expand our knowledge of the meaning of commitment, same-sex couples described their lived experiences in defining and creating a committed relationship. Transcripts of the conversations of 14 same-sex couples (7 male and 7 female couples) were subjected to analysis using the Consensual Qualitative Research (CQR) method (Hill, Thompson, and Williams, 1997). Seven domains emerged, revealing that these same-sex couples constructed the meaning of commitment through comparisons, costs, intra-couple differences, investments, personal and relationship values and ideals, rewards, and sexual boundaries. Unique aspects of commitment are discussed as well as the implications of these findings for future research and service delivery.

Integrative module-based family therapy: a model for training and treatment in a multidisciplinary mental health setting

Thirty years ago, leaders in psychiatry expressed hope for more interdisciplinary collaboration with family therapy. Since then marriage and family therapy (MFT) has entered the mainstream of clinical practice in psychiatry and psychology. It is mandated for training in psychiatry and psychology. We propose a model for collaboration, training, and treatment in interdisciplinary mental health settings that strives to integrate empirical bodies of knowledge in MFT, psychiatry, and psychology and to provide a usable and testable clinical approach to treatment. It can be taught to trainees with various or limited training in MFT This model delineates nine critical domains that guide treatment. Flexibility is central to this model, focusing on techniques and clinical methods based on empirically supported treatments, when available, and best-practice standards.

Motivational, ethical, and epistemological foundations in the treatment of unwanted homoerotic attraction

A recent special section of the Journal of Marital and Family Therapy (October, 2000) focusing on the mental health needs of gay, lesbian, and bisexual individuals neglected to address the clinical needs of homosexual persons who desire to increase their heterosexual potential. This article attempts to correct this omission by outlining common motivations for pursuing change, updating the current state of knowledge regarding the effectiveness of change efforts, and providing some ethical guidelines when therapists encounter clients who present with unwanted homoerotic attraction. Finally, to assist marriage and family therapists (MFTs) in more deeply understanding divergent perspectives about reorientation treatments, an examination of the role of moral epistemology is presented and some examples of its potential influence are described. MFTs are encouraged to recognize and accept, rather than ignore or deny the valid needs of clients who seek to modify their same-sex attraction.

Incorporating sexual orientation into MFT training programs: infusion and inclusion

Many authors have questioned the preparedness of family therapists to deal with sexual minority clients. Even though the Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) has called for the integration of sexual orientation into the curriculum of marriage and family therapy training programs, the subject continues to be marginalized. The purpose of this article is to encourage trainers to examine their programs' curricula for evidence of heterosexist bias and introduce ways that they might integrate issues related to same-sex affectional and sexual orientations into their programs via the classroom and the clinic.