Relationship Therapy with Same-Sex Couples

Jerry Bigner, Joseph L. Wetchler

• Publisher: Routledge
• Year: 2014
• ISBN:
  9781317786887
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychische Gesundheit in der Psychologie

Use new knowledge of the LGBT culture to ably counsel same-sex couples! Relationship Therapy with Same-Sex Couples provides psychologists, therapists, social workers, and counselors with an overview of the array of treatment issues they may face when working with couples from the LGBT community. This book highlights the experiences of therapists who have encountered concerns particular to LGBT clients—especially those in intimate relationships. This intriguing resource covers clinical issues, sex therapy, special situations, and training issues for helping therapists successfully counsel same-sex couples. Relationship Therapy with Same-Sex Couples explores the therapist's role in working through universal issues in couples therapy—such as communication problems, infidelity, and decision-making—with a focus on how therapy should differ for same-sex couples. This important guide also identifies which problems are unique to couples as an aspect of their sexual orientation, including gender role socialization and societal oppression. With this book, you will be able provide appropriate therapy without over- or under-attributing a couple's problems to their LGBT status. This book shows how experienced therapists have developed methods for working with:

• gay and lesbian parents
• heterosexual spouses and ex-spouses
• couples in HIV serodiscordant relationships
• "lesbian bed death"
• couple and family dynamics supporting transgender and sexual reassignment issues
• and more!

Relationship Therapy with Same-Sex Couples contains several features for you to utilize in your own practice, including the Sexual Orientation Matrix for Supervision (SOMS) to assist supervisors and trainers in preparing supervisees to work with lesbian, gay, and bisexual clients. The book also offers guidelines for heterosexual therapists who plan to work with same-sex couples and how to overcome any residual homophobia or heterosexual guilt. Lastly, this essential sourcebook reviews several articles, book chapters, books, and Web sites that are relevant to same-sex couples and the therapists who work with them.

CLINICAL ISSUES WITH SAME-SEX COUPLES

Clinical Issues with Same-Sex Couples: A Review of the Literature

Colleen M. Connolly

Colleen M. Connolly is Assistant Professor, Southwest Texas State University, EAPS/Education Building 4016, 606 University Drive, San Marcos, TX 78666.

SUMMARY. While universal issues exist for all couples, same-sex couples present distinct clinical concerns that impact relational health. After reviewing the current literature in the field, two major issues emerged as significant: societal oppression and relational issues distinctive to same-sex gay, lesbian, and bisexual couples. Societal oppression includes homophobia, heterosexism, and the internalization of these dynamics. Additionally, the “coming out” process and gender role socialization uniquely impact the same-sex couple. Other areas that therapists need to consider when working with this population include multiple cultural variables, dyadic stage-related issues, and the couple’s negotiation and maintenance of “family.” [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworth press.com> Website: <http://www.HaworthPress.com> © 2004 by The Haworth Press, Inc. All rights reserved.]

KEYWORDS. Same-sex couples, oppression, gay, lesbian, homophobia, heterosexism, coming out, gender role socialization, couple stages, maintaining family

Same-sex couples seek therapy for issues that are universal to all couples, such as communication problems, infidelity, substance abuse, and decision-making about staying together or separating (Cabaj & Klinger, 1996). However, the predominant issues that distinguish gay, lesbian, and bisexual same-sex (GLB) couples from heterosexual opposite-sex couples are the impact of gender role socialization and the societal oppression generalized as homophobia and heterosexism. I say “generalized” because the very existence of homophobia (Brown, 1995; Granvold & Martin, 1999; Ossana, 2000; Slater, 1995) and heterosexism (Brown, 1995; Granvold & Martin, 1999; Ossana, 2000; Reynolds & Hanjorgiris, 2000; Slater, 1995) lead to a multitude of couple stressors, including internalized homophobia (Brown, 1988; Cabaj & Klinger, 1996; Falco, 1996; Shernoff, 1995; Slater & Mencher, 1991; Slater, 1995).

Similarities and differences also exist among the same-sex GLB couple population. Parallels include being forced to make decisions about keeping their couplehood hidden or lifting the mask and revealing their identity (Goldenberg & Goldenberg, 1998). Couples also must evaluate if it is safe or wise to disclose (Scrivner & Eldridge, 1995) in the social, familial, and professional arenas.

The differences are mainly two-fold. First, our culture historically has diverse reactions to males who are gay or bisexual and females who are lesbian or bisexual, with a much more negative reaction to male-male interaction (Goldenberg & Goldenberg, 1998). Second, most GLB individuals grow up in a heterosexual-based family of origin (Slater, 1995), and role models for same-sex couples have been considered limited (Young & Long, 1998), lacking (Ossana, 2000), and absent (Falco, 1996). Same-sex couples must manage major life transitions, as in creating, transitioning, or dissolving their relationship (Granvold & Martin, 1999), while experiencing a deficiency in normative support systems or rituals (Slater, 1995).

The purpose of this article is to summarize the most predominant clinical issues when working with same-sex couples. Two external factors of primary importance, cultural oppression and the impact of gender role socialization (Brown, 1995), will be reviewed. I will then highlight how these repressive features can affect and distress the same-sex relational dyad.

SOCIETAL OPPRESSION

A pivotal clinical issue with same-sex couples is cultural oppression, with heterosexism and homophobia–and the internalization of both–intruding into an individual’s functioning and permeating the same-sex couple dynamic (Brown, 1995). Indeed, Brown (2000) suggests that all couples “function in the context of these two interlocking forms of oppression” (p. 275).

Homophobia

Societal homophobia takes many forms and can range from violence (Granvold & Martin, 1999; Ossana, 2000) and victimization (Dworkin, 2000) to everyday slights and slurs occurring in casual conversation (Davison, 2001). Homophobia is institutionalized (Simons, 1991) and legitimized by discriminating and denying the GLB population their intrinsic human and civil rights (Bigner, 2000).

This homophobia extends to a lack of legal recognition and protection for same-sex partners and their families (Ossana, 2000; Young & Long, 1998). Legislated homophobia, reflected in the absence of legal protection, can result in a couple’s marginalization or loss in a variety of areas: child custody rights (Ossana, 2000; Shernoff, 1995; Slater, 1995), important medical decisionmaking power for the partner (Ossana, 2000), employment (Granvold & Martin, 1999; Slater, 1995), shelter (Slater, 1995; Slater & Mencher, 1991), health care, and in social services (Granvold & Martin, 1999).

Societal homophobia (Ossana, 2000; Reynolds & Hanjorgiris, 2000) is inherently discriminatory (Granvold & Martin, 1999; Ossana, 2000) hostile, and prejudicial (Ossana, 2000). The label “homoprejudice”–versus homophobia–appears to be a more precise representation (Logan, 1996); however, this term has not yet taken hold in the literature.

Heterosexism

Heterosexism, or the belief that an opposite-sex-based relationship is superior and preferable to a same-sex relationship, is oppressive (Bigner, 2000). Unfortunately, these ideas still linger in clinical practice theory models (Basham, 1999). However, they can take on a more subtle and insidious form (Bigner, 2000; Ossana, 2000). For example, couples do not see the media highlighting happy, satisfied, and successful same-sex couples. In addition, when the media does portray gay men and lesbian women, they appear as single individuals (Ossana, 2000). All people are influenced as these beliefs are “acquired, communicated, and reinforced throughout society over the entire life span of individuals” (Bigner, 2000, p. 279).

Internalized Homophobia

The enculturation of homophobia and heterosexism dramatically affects the GLB individual and couple. The internalized homophobia and biphobia (Dworkin, 2000) result in feelings of some how being “defective” (Schiemann & Smith, 1996). When homophobia is internalized it can result in self-hatred, guilt, and pessimism about the possibility of longevity in same-sex relationships (Ossana, 2000).

Couples might question the viability of the relationship, and the presumption that the relationship is temporary, platonic, or incidental undermines relational confidence (Slater & Mencher, 1991). Often a couple’s faith in their bond is at risk (Slater, 1995). The therapist, who might be the only witness (Simmons, 1991) and historian (Schiemann & Smith, 1996) to their relationship, plays an important role in their life.

Time and again it becomes the couple’s own task to verify and validate the relationship. The lack of external validation increases internalized homophobia (Slater & Mencher, 1991). Furthermore, this internalization process can have a tumultuous effect on dyadic functioning (Cabaj & Klinger, 1996) and contribute to difficulties in identity formation (Brown, 1988; Reynolds & Hanjorgiris, 2000), identity management (Reynolds & Hanjorgiris, 2000), and the “coming out” process (Cabaj & Klinger, 1996) as a GLB person.

The “Coming Out” Process

Invisibility is central to the functioning of homophobia (Simons, 1991) and heterosexism. The decision to come out as gay, lesbian (Ossana, 2000; Reynolds & Hanjorgiris, 2000) or bisexual (Dworkin, 2000) is more than an individual decision; it is also “a matter of couple identity, synchronism, and resource mobilization” (Patterson, Ciabattari, & Schwartz, 1999, p. 342).

On a more explicit level, same-sex couples frequently maintain multiple identities and expend extra energy safeguarding (Davison, 2001) and compartmentalizing different relationships in diverse environments. This confounding dynamic may lead to feelings of lack of power and control in separating “those who know” and “those who don’t know” (Slater, 1995).

Implicitly, couples are denied the aid, comfort, and support heterosexuals frequently experience during times of crisis (Roth, 1985) and contend with a wide-range invisibility of milestones (Johnson & Colucci, 1999). So same-sex couples can be in a double bind: Do they endure the stresses of invisibility or risk the consequences of disclosure (Slater, 1995)? Another challenge lies in negotiating the private and public identity (Slater, 1995; Slater & Mencher, 1991) as couples frequently function in two separate and conflicting worlds (Slater, 1995).

Deciding not to come out can be based on fear. However, it may be a strategic choice that carries no hidden meanings about identity acceptance (Patterson, Ciabattari, & Schwartz, 1999). One important distinction might be, is the decision based on a perceived need to save “unnecessary pain” or on a persistent self-hatred (Shernoff, 1995, p. 912)?

Either way, revealing one’s identity is a continual process (Falco, 1996) further complicated by gender and culture (Dworkin, 2000). To disclose heightens the risk of rejection and marginalization, whereas to not disclose may result in isolation and the “duress of leading a ‘double life’” (p. 283) that lends itself to behaviors that invalidate the relationship (Ossana, 2000).

Gender Role Socialization

An additional area of distinction with same-sex GLB couples is the impact of gender role socialization (Brown, 1995; Cabaj & Klinger, 1996; Goldenberg & Goldenberg, 1998; Granvold & Martin, 1999; Johnson & Colucci, 1999; Ossana, 2000; Scrivner & Eldridge, 1995; Young & Long, 1998). All members of society are enculturated with gender norms. According to Brown (1995), both members of a same-sex couple “possess variations on the theme of the same benefits and deficits of essentially similar patterns of gender role development” (p. 274).

Scrivner and Eldridge (1995) identified three dyadic themes affected by gender role socialization: emotional intimacy, sexuality, and power. When approaching emotional intimacy, women are socialized to care and nurture. Men are more socially valued when expressing their autonomous and separate selves.

From a sexual expression framework, Scrivner and Eldridge contend that men generally are socialized to express the sexual before the emotional, whereas women prefer an affectional relationship before initiating the sexual aspect. Power, with the issue of equality versus power differential in couples (Scrivner & Eldridge, 1995), and power as demonstrated by financial resources and sharing (Johnson & Colucci, 1999) is impacted by our socialization as gendered males and females.

There are, of course, variations and exceptions to these concepts, but clearly society exerts social pressure through prejudice and gender socialization (Young & Long, 1998).

RELATIONAL ISSUES

Societal oppression may also affect the couples from a relational standpoint. These include cultural variables, stage-related issues, and the couple’s maintenance and negotiation of family.

Cultural Variables

Same-sex partners frequently juggle multiple and diverse identity positions. Couples are often more dissimilar than opposite-sex couples in race (Young & Long, 1998; Patterson, Ciabattari, & Schwartz, 1999), ethnicity, socioeconomic position (Young & Long, 1998), age, and education (Patterson, Ciabattari, & Schwartz, 1999). Moreover, GLB identity “has very different meanings in different racial or ethnic groups, accepted or tolerated in some and considered an abomination or even an impossibility in others” (Basham, 1999, p. 148). The GLB population is an incredibly diverse group drawn together by limitations in places to gather and meet (Patterson & Schwartz, 1994). The GLB identity is not always seen as primary (Johnson & Colucci, 1999), and couple conflict may ensue as a result of divided loyalties (Granvold & Martin, 1999) among orientation, culture, and family identity.

Stage-Related Issues

Three stage-related issues were summarized in the literature: partner differences in the coming out process, differing generational factors, and discrepancies in couple stage development. “Stages” of the coming out process frequently affect partners differently, and more typically than not, one partner within the couple is usually at a different stage from the other partner (Mattison & McWhirter, 1987; McWhirter & Mattison, 1996). The more “experienced” partner may worry if the relationship is transient; the less experienced partner may feel threatened by partner’s degree of disclosure and involvement in the GLB community (Ossana, 2000).

An additional stage-related issue is the generational factor in which identity formation is variable and based on historical and sociopolitical contexts (Barón & Cramer, 2000). Ossana (2000) reflected on some possibilities in this regard. What was the societal attitude at the time of coming out? Was it before or after the GL liberation movement? Was the community conservative or liberal, rural or urban? What were family and peer reactions, including cultural and religious beliefs?

Additionally, the concept of relational stage discrepancy was identified as it related to male couples. Mattison and McWhirter (Mattison & McWhirter, 1987; McWhirter & Mattison, 1996) identified six developmental stages of relationship: blending, nesting, maintaining, building, releasing, and renewing. The authors suggest that a “stage discrepancy” occurs with frequency. For example, one partner may be in a comfortable position of maintaining the relationship while the other partner remains “dependent and clinging” (McWhirter & Mattison, 1996, p. 330).

While the stages may not be exact for female couples, stages do occur and discrepancies exist for these couples also. Without understanding the coming-out stage, generational-stage differences, or relational-stage discrepancy, same-sex couples often consider their difficulties as a personal or relational flaw rather than recognizing that differences are typically correctable or manageable by relational growth and development (Mattison & McWhirter, 1987; McWhirter & Mattison, 1996).

Negotiating and Maintaining “Family”

When addressing issues of family, same-sex couples perceive less support than married couples do (Patterson, Ciabattari, & Schwartz, 1999) and commonly lack extended family support, particularly if they are not out (Granvold & Martin, 1999).

Frequently family of origin has the assumption of heterosexuality, with expectations of an opposite-sex partner and children with that partner (Matthews & Lease, 2000). The dynamics of secrecy among “unchosen” families (Patterson, Ciabattari, & Schwartz, 1999, p. 341), such as those families that one is born, adopted, or fostered into, are frequently in full play.

Same-sex dyads also experience loss around the “heterosexual privilege” in their family of origin (Young & Long, 1998) and in the wider culture. It is not uncommon for a full-cycle grief process to exist for the entire family (Matthews & Lease, 2000).

Roth (1985), in identifying issues affecting female couples, suggests that family members and the heterosexual environment regularly invalidate the same-sex couple. This invalidation repeatedly leads couples to seek therapy early in the development of their relationship.

Some couples experience bond-invalidating activities, such as rendering the relationship invisible or acting as if the relationship exists but then disqualifying it as “not genuine” or “a stage” (Roth, 1985, p. 276). At other times, the couple’s relationship is directly invaded, such as excluding the partner in holidays and family rituals, or giving separate rooms when visiting (Roth, 1985).

Often an unwillingness exists in accepting the same-sex couple as a legitimate union (Granvold & Martin, 1999), with families and others actually undermining the relationship (Brown, 1988). Families and the heterosexually-bound world over and over again treat a partnered member either as single (Brown, 1995; Granvold & Martin, 1999) or as a perpetual adolescent (McGoldrick, 1989), who is expected to return home without their partner (Brown, 1988).

However, the recognition among the therapeutic community that “family” for the GLB population can either be chosen (Granvold & Martin, 1999; Patterson, Ciabattari, & Schwartz, 1999) or created (Granvold & Martin, 1999) has come to the forefront. Therefore, there can be structured alternatives in “chosen” families and communities (Patterson, Ciabattari, & Schwartz, 1999). The process of negotiating and maintaining family requires overtly- or covertly-made decisions about who family might be, and so...