Psychotherapy With Lesbian Clients

Theory Into Practice

Kristine L. Falco

• Publisher: Routledge
• Year: 2013
• Print ISBN:
  9780876306222
• Edition: 1
• eBook ISBN:
  9781134852536
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

An explanation of who lesbians are, how psychotherapy with this population is unique, how therapists and patients are influenced by homophobia and what the therapist brings to the therapeutic relationship. It presents models of lesbian-affirmative psychotherapy and offers guidelines for therapists.

I

THE CONTEXT OF THERAPY

1

INTRODUCTION

Until 1973, homosexuality was considered a mental illness by most mental health professionals. In that year, homosexuality was deleted from the mental disorders of the Diagnostic and Statistical Manual of the American Psychiatric Association. Over the next 15 years, other professional therapist organizations have made policy statements in recognition of the nonillness status of homosexuality. Such policy statements have come from the National Association of Social Workers, the American Association of Marriage and Family Therapists, and the American Psychological Association, among others. Typical of this new stance is the American Psychological Association's policy, which states:

1. Homosexuality implies no impairment of judgment, stability, reliability, or general social or vocational capabilities;

2. Mental health professionals should take the lead in removing the stigma of mental illness long associated with homosexuality; and

3. All discrimination against gays is to be deplored, and civil rights legislation is urged to meet that end.

Many further efforts have been made by mental health professionals to see lesbians and gay men in a more realistic, nonpathological light. For example:

• The American Psychological Association has an official division called the Society for the Psychological Study of Lesbian and Gay Issues (Division 44) as well as a Committee for Lesbian and Gay Concerns.

• An independent group of psychologists has formed the Association of Lesbian and Gay Psychologists.

• The American Psychiatric Association has developed the Committee on Gay, Lesbian, and Bisexual Issues and the Caucus of Homosexually Identified Psychiatrists.

• An independent group of psychiatrists has formed the Association of Gay and Lesbian Psychiatrists.

• The National Association of Social Workers has established the Committee on Lesbian and Gay Issues.

• The Association of Marriage and Family Therapists has established the Caucus of Gay, Lesbian, and Bisexual Concerns.

Other organizations of mental health professionals have undertaken similar approaches. In addition, many professional journals publish theory, research, and clinical articles that represent a nonillness model of homosexuality. Two specialty journals are now in print: Journal of Homosexuality and Journal of Gay and Lesbian Psychotherapy. (The addresses for these journals and committees can be found in Appendix C, Resources.)

The newer outlook on lesbians and gay men not only attempts to eliminate negative judgment, but it seeks to actively portray the positive value of this lifestyle. As psychologist Don Clark (1987) describes it,

Gay is a descriptive label we have assigned to ourselves as a way of reminding ourselves and others that awareness of our sexuality facilitates a capability rather than creating a restriction. It means that we are capable of fully loving a person of same gender by involving ourselves emotionally, sexually, spiritually, and intellectually, (pp. 144–145)

Similarly, in their text Counseling with Gay Men and Women, Woodman and Lenna (1980) state:

Being gay is not merely the ability and willingness to engage in homosexual behavior. Indeed, being gay is being different, having a distinct identity, frequently in a way that is felt even before it is conscious or sexually expressed. Gayness is a special affinity and a special feeling toward people of the same gender; it is not the inability to love and relate to others, nor is it a denial of the opposite sex. Rather it is a special capacity and need to love and to express one's love for people of the same gender in all the meanings of the term “love.” (p. 11)

In the more recent literature, a distinction is being made between male and female homosexuals. Lesbians, because of their femaleness, experience a different life course than do their gay male counterparts. And the dynamics of two women in couplehood are being seen as distinct from the dynamics of two men in couplehood, and from the dynamics of a man and a woman in couplehood (Roth, 1985). The process of coming out for a lesbian is also different from that of a gay man (deMonteflores & Schultz, 1978). Further, the more recent psychological literature takes into consideration the sociological and phenomenological aspects of gayness. That is, the personal experience of gay men and lesbians is being viewed as the most central aspect of describing gay existence, as descriptions move away from the purely behavioral.

Lesbians have received considerably less attention in the psychological, psychiatric, and counseling literature than have gay men, despite the recent changes to a more phenomenological and sociological focus. Only in the mid-1980s did such notions as a “psychology of lesbianism” or specific psychotherapy issues for lesbian clients begin to be seriously considered (see Boston Lesbian Psychologies Collective, 1987, for example). This is an important and much-needed change from the former treatment of lesbians by psychology, psychiatry, and medicine, which included such atrocities as aversion therapy, electroshock treatments, clitoridectomy, hysterectomy, lobotomy, and various drug and hormone therapies (Katz, 1976). Such methods were singularly aimed at asexualization or heterosexual reorientation, which invariably involved a negative value judgment of lesbianism.

All of these trends point toward the emergence of a new field of knowledge for psychotherapy, and especially for the practice of clinical psychology, psychiatry, counseling, and social work. This new field views lesbians and gay men in a positive manner, it does not seek to “cure” a pathology, it acknowledges minority status, and it considers the distinctly different experience of lesbians from that of gay men.

In spite of these changes, many myths, stereotypes, and misunderstandings prevail. Homosexuality is still largely considered immoral by religious standards, criminal by many state and civil standards, and sick or merely tolerated by many members of the psychology and medical professions.

Both a psychology of lesbianism and an understanding of clinical treatment issues for psychotherapy with lesbians are in a preliminary stage, and will require many years and many volumes of literature to be addressed adequately. I hope to make a contribution toward that end by providing a compilation of the literature on psychotherapy with lesbian clients—with women identified as lesbian and with women not identified as lesbian but as women whose lives encompass the love of other women. I have attempted to present both the literature itself and practical guides and clinical examples to offer therapists a resource for working with many aspects of lesbian issues.

TRAINING PSYCHOTHERAPISTS TO WORK WITH LESBIAN CLIENTS

Why the need for specialized training for therapists working with lesbian issues? As with any subspecialty in clinical psychotherapy (for example, alcoholism treatment, neuropsychology, treatment of survivors of sexual abuse, treatment of phobias, treatment of racial minorities), the ethical standards of most therapists require that therapists who are working with lesbian clients be appropriately trained and competent to do so. For example, guidelines 1.5 and 1.6 of the American Psychological Association's Specialty Guidelines for the Delivery of Services by Clinical Psychologists (1980) state the following:

1.5. Clinical psychologists maintain current knowledge of scientific and professional developments to preserve and enhance their professional competence; and

1.6. Clinical psychologists limit their practice to their demonstrated areas of professional competence.

Psychiatrists, social workers, and other counselors are under similar professional guidelines.

The American Psychological Association's Board of Professional Affairs has recently affirmed that psychotherapy with lesbian and gay clients is an “area of special competence” that calls for specialized training (K. A. Hancock, personal communication, October 30, 1986). At present, no specific standards for competence to do psychotherapy with lesbians have been developed. However, the Association's Committee for Lesbian and Gay Concerns plans to undertake such a project, setting standards that reflect a positive view of lesbianism and a more complete understanding of the lesbian's experience and based on previously forged informal standards (for example, Brown, 1984 and 1985; Schlossberg & Pietrofesa, 1978; Kingdon, 1979).

A 1984 study by Graham, Rawlings, Halpern, and Hermes demonstrated unequivocally the need for psychotherapists to be trained in counseling both gay men and lesbians. They collected data from 112 psychotherapist respondents in the Cincinnati area who worked in private or public inpatient or outpatient settings. A measure of therapist attitudes showed that the vast majority held positive attitudes toward homosexuality:

• 81% agreed with the American Psychological Association's and the American Psychiatric Association's positions that homosexuality is not a mental disorder;

• 77% stated that homosexuals can be just as well adjusted as heterosexuals (those who did not think so placed blame on society's negative attitude rather than on the homosexual person); and

• 94% or more stated that homosexuals belong in roles such as teachers, parents, child psychologists, physicians, nurses, and religious leaders.

In contrast to these fairly positive attitudes, the therapists in this study demonstrated only a modicum of basic information about gay men and lesbians that is available in the scientific literature:

• Only half were aware that most homosexuals have had sexual experiences with members of the other gender;

• 62% incorrectly agreed with a statement that it is possible for therapy to change a person's sexual orientation; and

• 26% felt that helping clients to make other people aware of their sexual orientation was not applicable or never came up in therapy, despite the relationship demonstrated in the literature between psychological health and openness about sexual orientation (which will be elaborated upon in Chapters 4 and 5).

Eighty-three of the respondents stated that special training and knowledge are needed by therapists for counseling gay men and lesbians. They stated a need for:

• workshops to help them get in touch with their own feelings toward homosexuality (82%),

• knowledge of current research on homosexuality (66%),

• attendance at conference presentations on homosexuality (59%), and

• sensitization through contact with gay and lesbian groups (58%).

Although 63% of the respondents stated that they would attend such training if it were available locally, they in fact did not do so; on two occasions the authors of this study scheduled training workshops and both had to be cancelled due to lack of participants. The authors conclude that their findings raise serious questions about the quality of services that many gay men and lesbians apparently are receiving due to lack of training and inaccurate information on the part of therapists. They also point out that the many therapists who provide services to these populations and who are not trained to do so are acting irresponsibly. I have had similar experiences, where attendance is very low at “voluntary” continuing education training on lesbian and gay issues in therapy, yet trainings in “mandatory” settings, such as university classes and practicums, are well received.

Psychotherapists then must be trained before conducting psychotherapy with lesbian clients if ethical, and even humanistic, standards are to be met.

A very few references already exist for the therapist who wishes to gain expertise in doing psychotherapy with lesbian clients (Clark, 1987; Woodman & Lenna, 1980; Moses & Hawkins, 1982; Gonsiorek, 1982a; and Stein & Cohen, 1986). These are all high-quality references; however, they either do not address lesbians and gay men separately or they do not describe the lesbian's experience in a comprehensive way; thus they are lacking critical information for the psychotherapist about the distinctly different experience of lesbians. I hope to have supplemented these previous references by reviewing empirical and theoretical materials published since 1980 and applying these to psychotherapy with lesbians.

SOME PRELIMINARIES

There are six areas of knowledge that provide important adjunctive reading to this volume, especially for readers with limited exposure to lesbians. Suggested readings are provided in each area to offer background material.

1. Demographics. The recent literature has shown without question that it is much more accurate to talk of “homosexualities” than of “homosexuality.” There is no single way to describe the typical lesbian. Demographically, she comes from all socioeconomic classes, education levels, career paths, sex-role choices, styles of upbringing, religions, and races. All facets of her life are highly individualized: sexual activity and techniques, types of partnerships sought, interfacing with the mental health community for professional help, the role of friendships, interfacing with the legal system, and the level of openness about her lesbianism to the outer world, among other things. Demographically, lesbians are just as diverse as their nonlesbian counterparts and therefore cannot be well described as a group. However, as further reading of this volume will indicate, certain pressures, self-representations, and environmental systems may be unique to lesbians as a group and can have an effect on their interaction with the mental health community.

For further information on the demographics of both lesbians and gay men, see Bell and Weinberg's (1978) excellent report of their 10-year study of nearly 1,000 gay people in the San Francisco Bay Area. Lesbian/Woman (1983) by Martin and Lyon is another fine descriptive work.

2. Language. Lesbians often have a jargon of their own, a jargon that changes with the times. For example, for some lesbians, it can be an important self-defining and political choice to use the word “lesbian” rather than “gay” to describe herself; for others this is not so. Some prefer not to use the word lesbian as a noun (“I am a lesbian”), but rather as an adjective (“I am a lesbian person”). Some use “dyke” or “queer” to identify themselves, but in a positive manner (by reclaiming and redefining a term that is pejorative in t...

Table of contents

• Cover Page
• Halftitle Page
• Title Page
• Copyright
• Dedication
• Table Of Contents
• Preface
• Acknowledgments
• PART I. THE CONTEXT OF THERAPY
• PART II. THE CONTENT OF THERAPY
• Appendix A: Exercises
• Appendix B: Annotated Bibliography
• Appendix C: Resources
• References
• Name Index
• Subject Index