Solution-Focused Brief Therapy with the LGBT Community

Creating Futures through Hope and Resilience

Rebekka Ouer

• Publisher: Routledge
• Year: 2015
• Topic: Social Sciences
• eBook ISBN:
  9781317591894
• Subtopic: Mental Health in Psychology
• Index: Social Sciences

Solution-Focused Brief Therapy with the LGBT Community is a practical guide for mental health professionals who wish to increase their therapeutic skills and work more effectively with LGBT clients. This book shows how to help clients reach their goals in tangible, respectful ways by identifying and emphasizing the hope, resources, and strength already present within this population. Readers will increase their knowledge about the practical application of SFBT through case examples and transcripts, modified directly from the author's work with the LGBT community, and by learning more about the miracle question, exceptions, scaling, compliments, coping, homework, and more.

1The LGBT community

DOI: 10.4324/9781315744360-1

I think one of the marks of our profession is being very accepting of the other person, where they're at right now. That's been something that we try to instill in our students in our trainings. Golly, it's really hard.

(Insoo Kim Berg, cited in Yalom and Rubin, 2003)

The not-knowing stance

Solution-focused practitioners generally work from a stance of seeing clients as the sole experts of every aspect of their lives and situations, and thus we harbor a willingness to learn from them, especially those who are culturally different from us (Berg and Steiner, 2003). This core belief, one that has guided my work for years, left me wondering about the best way to approach this chapter. If you truly take on this stance of not knowing and allowing your clients to be the experts of their lives and their unique solutions, why would it be helpful to learn about the LGBT community in general? My opinion is that if you are able to be a blank slate, and stubbornly keep this not-knowing stance no matter what might come up in-session with your clients, this chapter may not be very useful to you. For some though, knowing what might come up, how clients might define themselves, their relationships, or their unique solutions, can help clinicians to stay more focused and disciplined with the solution-building process when those unique situations appear in their therapy room.

Further, sometimes, cultural norms and the solutions that are found to be useful with LGBT individuals, couples, and families can be very different from what those outside this community are accustomed to. Remaining a blank slate, then, might become problematic with this community if you hold a strong belief that homosexuality is a sinful lifestyle, or that being in a non-monogamous relationship is simply not as healthy as being monogamous with your partner. The clinician who holds these beliefs, or other beliefs that would challenge their ability to simply ‘not know’ with their LGBT clients, might find using SFBT difficult with this community. So as you read through this chapter, the definitions, and some of the unique differences found within this community, I challenge you to ask yourself if holding a not-knowing stance is truly possible for you in your work with this community. If the answer is “no,” my hope would be that you would avoid working with this community until that changes. If the answer is “yes,” than maybe this chapter will further your knowledge and allow that “yes” to be even more confident than it was before.

This chapter, then, will provide information about the ever-variant and evolving LGBT community, so that you can be more aware and competent with your knowledge of these clients, and how they might define themselves, their relationships, and their families.

If you are a clinician who works or lives within this community, this chapter might just be a bit of review for you; if you haven't yet worked or lived in this community, then I hope this chapter is useful as you learn what might come up in future sessions.

Who is the LGBT community?

I recognize that the term “LGBT” is limited in scope. It is, however, the briefest and most widely used and recognized term for gender and sexual minorities, which is specifically why I chose it over other options.

I want to clarify here that although the term “LGBT” is not all-inclusive, this book is about how to apply solution-focused brief therapy with any client who identifies as a gender or sexual minority.

So who is that exactly?

Sexual minorities

The term “sexual minorities” refers to individuals who are not heterosexual. This includes a wide range of individuals whose attractions vary greatly, most of whom are defined below.

Gender minorities

Gender minorities are individuals whose biological sex is different from their gender identity. This can include individuals who identify as transgender, demigender, agender, genderqueer, or something else. All of these are defined below.

The difference between gender and sexuality

I think the first lesson about gender and sexuality should always be that they are two completely separate things. The best way that I have ever heard this distinction explained is that sexuality is about who you go to bed with, while gender is about who you go to bed as. Somebody who identifies as a transgender male, for example, might identify as straight and only be attracted to women; they might identify as gay and only be attracted to men; or they might identify as bisexual, or any other sexuality as defined below. Until they tell you, there is simply no way to know a person's sexuality based solely on their gender expression.

Definitions

Throughout this book I will be using terms that you may not be familiar with, and in ways that might be different to how you have either used or heard those terms previously. I will list the terms I may use here, with definitions for your reference. This is in no way a comprehensive list of definitions within the LGBT community; it is simply a list of the current most commonly used terms, in my recent experience here in Dallas, Texas. The LGBT community is ever-changing and therefore the terminology is evolving on a regular basis, and it changes from day to day, city to city, state to state, and country to country. It is advisable for a clinician who works with this community to remember two important steps to keep up with current terminology:

1. Listen to your clients, and ask them how they identify or how they define their gender or sexuality. (There will be a lot more about how and when to do this in Chapter 2.)
2. Keep current on readings, especially with trusted resources on the web for up-to-date terms and definitions. Many universities have pages dedicated to LGBT terminology, what's respectful and what's out-of-date.

Sexuality Terms

Heterosexual: A person who is only sexually/romantically attracted to people of the opposite sex/gender.

Gay: An individual who is sexually/romantically attracted to those of the same sex/gender.

Lesbian: A woman who is sexually/romantically attracted only to other women.

Bisexual: A person who is sexually/romantically attracted to both men and women.

Pansexual: A person who is sexually/romantically attracted to people of any sex or gender identity.

Asexual: A person who lacks sexual or romantic attraction to any person regardless of sex or gender identity.

Thrupple/triad: A romantic relationship involving three consenting adults (typically male, but not exclusively).

Top: The partner in a relationship who is typically more dominant, and likely the one who is the penetrator, during sex.

Bottom: The partner in a relationship who is typically more submissive, and likely the one who receives penetration during sex.

Positive: Referring to HIV status, typically in gay or bisexual men, and meaning that they have been diagnosed with HIV.

Negative: Referring to HIV status, typically in gay or bisexual men, and meaning that they do not have HIV.

Open relationship: Referring to a kind of relationship in which each partner is free to be sexually intimate with individuals outside of the relationship.

Gender Terms

Gender: How a person self-identifies (i.e. male, female, genderqueer, etc.) regardless of biological sex.

Gender dysphoria: A diagnostic term referring to a feeling of discomfort within an individual as a result of a mismatch between their biological sex and their gender identity.

Cisgender: A person whose self-identity conforms with the gender that corresponds to their biological sex.

Transgender: A person whose biological sex is different from their self-identified gender.

Trans-man/trans-boy: A person who was identified female at birth but who now identifies as male.

Trans-woman/trans-girl: A person who was identified male at birth but who now identifies as female.

Genderqueer: A person whose gender is somewhere between male and female, and who may identify as male one day and female the next, or somewhere in the middle.

HRT – hormone replacement therapy: A form of therapy where an individual who identifies as transgender receives hormones of the gender in which they identify. A trans-male would receive testosterone and a trans-female would receive estrogen.

GAS – gender affirmation surgery: A surgical procedure wherein an individual who identifies as transgender, genderqueer, or another form of gender minority, modifies their body to conform with their gender identity and alleviate gender dysphoria.

Bottom surgery: Surgery in the genital area designed to create a body in line with a trans-person's gender identity.

Top surgery: Surgery for the construction of a male-type chest for trans-males, or for breast augmentation for trans-females.

Binding: When a trans-male wears a binder on his breasts to have a more masculine or flat-appearing chest.

Puberty suppression: The medical process of suppressing puberty for gender minority teenagers to ease gender dysphoria before they fully transition.

Important considerations for sexual minorities in therapy

Males and sexual freedom

One of the lessons I learned about working with the gay male community is that it is typically more sexually open than other communities. In one study of 566 gay male couples in San Francisco, 47 percent of those couples had an agreed-upon open relationship (Hoff, Beougher, Chakravarty, Darbes, and Neilands, 2010), while another study reported about 43 percent of gay male couples have openly had sex outside the relationship, (Solomon, Rothblum, and Balsam, 2005). So the lesson here is that open relationships are a part of working with gay male couples, and they have found numerous ways to make it work.

Women and sexual fluidity

Author Lisa Diamond (2008) addresses the phenomenon of sexual fluidity in women, and believes that for some females, sexuality is not rigidly heterosexual or homosexual, but fluidly changing throughout their lives. So what does that have to do with LGBT clients? Well, when you see a woman, in any kind of situation, it's important to know that her relationship doesn't define her sexuality, and further, that her sexuality today does not necessarily define her sexuality yesterday, or tomorrow. For example, in your work with this community you will likely speak with many women in lesbian relationships who do not identify as lesbians.

Important considerations for gender minorities in therapy

Preferred name and pronouns

Two of the most important things to consider with gender minorities in therapy are preferred pronouns and preferred name – which is frequently not their legal name, or...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Dedication
• Table of Contents
• Foreword
• Acknowledgments
• Introduction
• 1 The LGBT community
• 2 SFBT and the LGBT community
• 3 The hopeful LGBT client: Eliciting a destination description
• 4 Connecting with and getting to know your LGBT client
• 5 The preferred future
• 6 Scaling
• 7 Feedback, homework, and closing the initial session
• 8 Subsequent sessions
• Conclusion
• References
• Index