Working with Gay Men and Lesbians in Private Psychotherapy Practice

Christopher J Alexander

• Publisher: Routledge
• Year: 2020
• Print ISBN: 9781560231257
• eBook ISBN: 9781317789734
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Working with Gay Men and Lesbians in Private Psychotherapy Practice is written for private practitioners solely by private practice clinicians who specialize in the treatment of gay men or lesbians. Focusing on numerous clinical issues that gays and lesbians often deal with, Working with Gay Men and Lesbians in Private Psychotherapy Practice also offers you proven guidance for maintaining and promoting your psychotherapy practice as a business.You will explore issues such as whether the therapist should disclose her/his sexual orientation, and how the therapist should address the degree to which internalized stigma about sexual orientation may impact the client's concerns about the process of therapy in general. This insightful volume also focuses on the special complexities introduced to psychotherapy by managed care. You'll find detailed, practical information about:

• a strategic plan for establishing, marketing, and developing a private practice in l/g/b psychology
• staying abreast of the latest research and trends in gay/lesbian mental health
• treatment planning with gay and lesbian clients
• lesbian/gay couples counseling
• multiple identity and gender issues particular to culture and ethnicity
• boundary issues Working with Gay Men and Lesbians in Private Psychotherapy Practice tackles how to therapeutically respond to the issues of gay men and lesbians. The practical strategies and specific suggestions can be directly incorporated into your work with gay and lesbian clients to ensure your success in confronting the specific issues and challenges they face.

Staying Current with Gay and Lesbian Research and Practice Knowledge

Joel C. Frost

SUMMARY. The field of gay and lesbian psychotherapy has grown dramatically over the last two decades. Indeed, there is an increasing number of professional journals and books, which makes staying current in any area of mental health a full-time job. Many clinicians can feel daunted by having to remain up-to-date in their subspecialty, as well as in the mental health field in general. In addition, there are many allied fields of medicine, sociology, biology, and gerontology which contribute to the richness and complexity. We are a heterogeneous community, mixed by gender, race, ethnicity, class, religion, and other demographics, each of which has special characteristics for us to know and understand. Being current and remaining current are two distinct and formidable tasks. This paper will focus upon how clinicians in private practice stay current in the field of research and practice knowledge while working in the gay and lesbian community. While hoping to provide some sources of information, this paper only begins to address some of the areas of research which affect our communities. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-342-9678. E-mail address: [email protected]]

The title assigned to this paper seems to imply two things: that a clinician is able to be “current” at some point in time, and that a clinician can stay current with ongoing research and developments as a field matures. I believe both implications create difficulty for us all.

The field of gay and lesbian mental health has been growing and changing dramatically. There is a proliferation of books and articles on multiple aspects of gay and lesbian life. There is an ever-increasing number of out gay and lesbian clinicians advertising their services to the gay and lesbian community. In one Boston gay newspaper there are now 37 clinicians who advertise such services. One clinician even advertises “State-of-the-Art Psychotherapy.” “State-of-the-Art” implies that one is on the cutting edge of new developments in a particular field.

Mental health with gays and lesbians has now become a specialty area to which some clinicians devote their entire clinical practice, while others have a blended practice of gays, lesbians, heterosexuals, and bisexuals. Yet, as our field expands as a specialty, staying current in any area of clinical research is more a hope than a reality, and in a blended practice one has to consider research from a plethora of clinical areas. Each clinician has to consider the developments relative to his/her theoretical orientation, clinical modality (individual, group, couple’s, family psychotherapy), type of intervention (long-term, short-term, crisis-intervention), focus of intervention (psychotherapy, support, psychoeducation), general issues vs. special focus (e.g., eating disorders, trauma, substance usage), or type of population serviced (coming-out, aging gays or lesbians, adolescents, disabled). As we become more mainstream, we are increasingly faced with a daunting task of keeping informed even in our own field, as we broaden and deepen areas of expertise.

I have been in private practice for twelve years, and out of graduate school for fourteen years. My clinical training in graduate school was primarily psychoanalytic, and did not include courses in gay and lesbian theory, gay and lesbian development, or psychotherapy as applied to gays and lesbians. The only books on the topic were the traditional psychoanalytic texts which presented homosexuality only in pathological terms. It became a welcome relief to begin to find literature which was positive about homosexuality and homosexuals. Thus, my own base of knowledge has had to come from elsewhere, leaving me feeling that I never experienced a time when I was “current.” In addition, I had to undo and re-work what little I was taught regarding homosexuality.

Graduate education has changed in that some universities do presently include courses on gay and lesbian theory and development, and do so in a positive manner. Therefore, as a large selection of practicing clinicians, we might be divided into those who had to undo, or make up for, what we were taught, or not taught, in graduate school, and those who have been relatively well provided for in their training. Those of us in the first group have had to rely upon alternative sources for our education and training.

What does it mean to stay current with gay and lesbian research? Indeed, in the twenty-four years since the American Psychiatric Association’s 1973 official decision to discontinue labeling homosexuality as a diagnosis, there has been an ever-growing body of research and practice knowledge to review. In this paper, “research” will include data from research studies as well as theory, developmental work, and writings on various areas which affect psychotherapy with gay men and lesbian women.

In addition, there have been major shifts in our awareness of bisexuality. Historically, bisexuals have been seen by both the gay and lesbian community much the same way as by the heterosexual community—we were waiting for the bisexual to make up his or her mind and declare membership in one camp. It would seem that bisexuality has become a camp of its own, with a growing membership, and a growing body of research and literature (Buxton, 1994; D’Augelli & Patterson, 1995; Firestein, in press; Rotheram-Borus & Koopman, 1991; Weinberg, Williams, & Pryor, 1994).

I have written this paper from the point of view of a clinician in full-time private practice, who has little available time and resources to do the research required to remain continually “current.” I have a hospital appointment where I supervise and teach group theory. This appointment in effect forces me to read. There is also some pressure to publish. The combination of these pressures actually helps me to stay as current as I can, knowing that there is always too much to read in too little time.

Some colleagues do find the time to read, while others do not. It seems that most gay and lesbian psychotherapists draw much of their practice knowledge from their own life experiences, a position which has been confirmed in informal conversations with other therapists. Most clinicians augment this practice knowledge with what they learn in their work with gay and lesbian clients.

A perennial issue has always been the question as to whether clinicians use research at all in their practices. Many clinicians seem to eschew participating in, or even reading, hard research following the completion of their doctoral dissertation. As the years pass since receiving our doctorate, we can begin to feel less familiar with how to read, evaluate, understand, and figure out how to apply research to our everyday clinical work. In the present state of mental health, many clinicians find themselves working more hours to make the same income. With increased pressure, many clinicians in private practice may find themselves becoming increasingly isolated, with less time and energy to devote to enhancing their research and practice knowledge. In talking with colleagues, most clinicians seem to rely upon conferences and workshops for this infusion of knowledge. However, this means that we must trust that those leading the workshops are staying current as they transmit the knowledge to us. As daunting as this task is, we all should consider that it is very important that we work to stay as current as possible as the field constantly changes and grows. This paper is an attempt to organize some information, and to point the reader in some directions.

I have broken this task down into a number of categories to provide an overview: General Approach, and Methods to Become and Remain “Current.” In addition, I will address possible sources for clinicians: Internal and Personal, Internal to One’s Clinical Practice, External Sources, Community Sources, and Miscellaneous Sources. Finally, I will include an area for Additional and Associated Research Areas. Even so, this will only be an attempt at broaching the subject; hopefully others will add to the process in additional articles.

GENERAL APPROACH

As psychotherapists, we help people change. As a group, we have witnessed a long history of mental health professionals devoted to changing more than was asked for by the gay or lesbian patient or client. Thus, as a professional group we may be more sensitive than other clinicians regarding what we will agree to attempt to change, and at whose request. It is not unusual for me to have clients initially entering psychotherapy request that I help them to alter their being gay, to help them become heterosexual. My response to them is based upon my understanding of the etiology of homosexuality, my role in the therapeutic relationship, my theoretical orientation, and the options that I can pose for their consideration. I also present that conversion therapies have not been found generally helpful over the lives of clients who have chosen that route. With all of this said, I am also aware that I have my own bias, which is in part based upon my own life choices.

In the clinical work with gays and lesbians, clarity of role relationship is a central starting point, as is theoretical orientation and an understanding of developmental theories. There continues to be much ongoing research regarding the possible biological, familial, environmental, and genetic “causes” of homosexuality. Whatever response that we have to the felt need for such research, and the lack of similar research zeal to find the “causes” of heterosexuality does not negate the fact that we all must have some stance as to etiology, even if our position is that we do not know (D’Augelli, 1994; Frost, in press; Isay, 1986a; Lewes, 1988; Stein, 1996).

Each clinician works within a framework of a theory base; however, there are many theories from which to choose. Freud and psychoanalytic theories, or Ego Psychology theories, help us to have an understanding of the development of internal structures. Mahler’s work with children help...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• About the Editor
• Foreword
• Introduction
• Staying Current with Gay and Lesbian Research and Practice Knowledge
• The Business of Private Practice: Marketing Strategies for Gay and Lesbian Therapists
• Lesbian Therapists and Lesbian Clients: Therapeutic and Practical Considerations, with Implications for Private Practice
• Clinical and Practical Considerations in Private Practice with Lesbians and Men of Color
• Boundary Issues in Gay and Lesbian Psychotherapy Relationships
• Treatment Planning for Gay and Lesbian Clients
• Index