peter c. russell, ph.d. glbt issues in psychotherapy

PETER C. RUSSELL, PH.D.

GLBT GLBT ISSUES ISSUES

IN PSYCHOTHERAPYIN PSYCHOTHERAPY


PETER C. RUSSELL, [email protected]@UCSD.EDUCLINICAL PSYCHOLOGISTLIAISON, SCHOOL OF MEDICINEUCSD PSYCHOLOGICAL & COUNSELING SERVICES


HOW CAN YOU COMMUNICATE SAFETY TO CLIENTS ?

1. 10% U.S. LGB= 30 MILLION

2. PARENTS= 60 MILLION

3. GRANDPARENTS= 60 MILLION

4. SIBLINGS= 60-120 MILLION

5. FRIENDS= 60 MILLION

6. TOTAL= 270 MILLION


SEXUAL AND ETHNIC-RACIAL IDENTITY

• REMOVE ANY WATCH, BRACELET, OR RING YOU ARE WEARING, AND PUT IT ON THE OPPOSITE HAND OR ARM

• NOTICE HOW IT FEELS TO YOU ON THE OPPOSITE HAND OR ARM AS WE CONTINUE WITH OUR DISCUSSION TODAY


SEXUAL ORIENTATION

• ONE’S SEXUAL, EMOTIONAL,

SPIRITUAL, AND / OR AFFECTIONAL

ORIENTATION TO MEMBERS OF THE

OPPOSITE, SAME, OR BOTH GENDERS


SEXUAL ORIENTATION


MODELS OF SEXUAL ORIENTATION

MONOSEXUALITY-BISEXUALITY(Zinik 1985, Rust, 1992)

MONOSEXUALITY BISEXUALITY


SEXUAL IDENTITY

• THE GROUP WE IDENTIFY WITH MOST STRONGLY WITH REGARD TO

OUR SEXUAL ORIENTATION

• THE GROUP OTHERS ASSUME WE IDENTIFY WITH BASED ON OUR

APPEARANCE AND OR BEHAVIOR


GENDER IDENTITY

• THE GENDER WE EXPERIENCE OURSELVES TO BE

• MAY BE THE SAME OR DIFFERENT FROM ONE’S OWN PHYSICAL, GENETIC,

CHROMOSOMAL GENDER

• MALE, FEMALE, TRANSGENDER INTERSEX


GENDER “SEX” ROLE

• OUR EXPERIENCE OF GENDER WITH REGARD TO STEREOTYPED IDENTITY AS MASCULINE OR FEMININE:

*VARIES WIDELY BY CULTURE

• ANDROGENY REFERS TO THE POSESSION OF BOTH MASCULINE AND FEMININE QUALITIES


SEXUAL BEHAVIOR

• HOW ONE ACTS BEHAVIORALLY ON FEELINGS OF

SEXUAL ATTRACTION

• WHAT SOME PEOPLE FEAR WILL BE DISCUSSED OR PROMOTED BY

THOSE WHO ARE GAY, LESBIAN, OR BISEXUAL


IN THE CLOSET

• MAINTAINING SECRECY ABOUT ONE’S TRUE SEXUAL ORIENTATION

• OFTEN IN ORDER TO AVOID DISCRIMINATION, VIOLENCE, BUT CAUSING IT’S OWN KIND OF PSYCHIC PAIN


COMING-OUT

• THE PROCESS OF BECOMING AWARE OF ONE’S OWN SEXUAL ORIENTATION, ACCEPTING IT, ACTING ON BEHAVIOR, AND TELLING OTHERS ABOUT IT

• OR MAY SIMPLY INVOLVE CONFRONTING THE INNACURATE ASSUMPTIONS OTHERS MAKE


HETEROSEXISM

• AN UNCONSCIOUS BELIEF SYSTEM WHICH RECOGNIZES THE EXISTENCE OF ONLY HETERO- ORIENTATIONS

• NON-CONSCIOUS BIGOTRY


HOMOPHOBIA

•FEAR AND INTOLERANCE OF GAY, LESBIAN, BISEXUAL, AND TRANSGENDER ORIENTATIONS OR IDENTITIES

•IMPLIES A CONSCIOUS PREJUDICE OR BIGOTRY AGAINST GAY, LESBIAN, BISEXUAL, AND / OR TRANSGENDER PERSONS


INTERNALIZED HOMOPHOBIA

• ONE’S AVERSION TO THE SELF DUE TO

THE RECOGNITION OF A GLBT

ORIENTATION AND / OR NON-

TRADITIONAL GENDER ROLE

• EXPERIENCED BY GAY AND LESBIAN

PEOPLE DUE TO THEIR SOCIALIZATION

WITHIN A HETEROSEXIST AND

HOMONEGATIVE CULTURE


DIFFICULTIES FOR GAY, LESBIAN, BISEXUAL AND TRANS ADOLESCENTS

WHY IS IT SUCH A STRUGGLE FOR GLBT YOUTH TO DEVELOP THEIR IDENTITIES?


WHERE DO GLBTQ ADOLESCENTS FIND

SUPPORT AVAILABLE?

• FRIENDS

• PARENTS

• FAMILY / SIBLINGS

• SCHOOL

• CLERGY

• ORGANIZED CLUBS

• ATHLETICS


DIFFICULTIES FOR GAY LESBIAN AND BISEXUAL ADOLESCENTS

• RELATIVE SOCIAL INVISIBILITY

• SOCIAL PENALTIES ASSOCIATED WITH HOMOSEXUAL OR GENDER EXPRESSION

• LEGAL PENALTIES ASSOCIATED WITH HOMOSEXUAL / GENDER EXPRESSION

• STRONG SOCIETAL FOCUS ON SOCIAL APPROVAL AND SPECIAL HETERO- PRIVILEGE


ISSUES FACING GLBT YOUTH

40% SUFFER VIOLENCE DUE TO THEIR PERCEIVED OR ACTUAL

GLB SEXUAL ORIENTATION(MARTIN & HETRICK, 1988)



25% WILL BE THROWN OUT OF THEIR OWN HOMES UPON DISCLOSING A NON-HETERO

IDENTITY TO PARENTS OR FAMILY

(GLSEN)



25%OF ALL HOMELESS YOUTH LEFT HOME OR WERE THROWN OUT DUE TO ISSUES OF

SEXUAL ORIENTATION

(GLSEN)



21% ATTEMPT SUICIDE AT LEAST ONCE BEFORE AGE 20

(GLSEN)



IN THE U.S., AN ADOLESCENT ATTEMPTS SUICIDE EVERY 35 MINUTES DUE TO SEXUAL ORIENTATION ISSUES

(GLSEN)



AN ADOLESCENT SUICIDES EVERY 5 HOURS AND 48

MINUTES (GLSEN)



28% OF GAY YOUTH DROP OUT OF HIGH SCHOOL DUE TO DISCOMFORT IN

THE SCHOOL ENVIRONMENT (GLSEN)



GLBT YOUTH ARE 6x MORE LIKELY TO DEVELOP DRUG AND ALCOHOL PROBLEMS

THAN THEIR HETERO PEERS

(GLSEN)


PSYCHOTHERAPY

• 1973

THE AMERICAN PSYCHIATRIC (APA) AND

PSYCHOLOGICAL ASSOCIATIONS (APA) STRIKE

“HOMOSEXUALITY” FROM THE DIAGNOSTIC AND

STATISTICAL MANUAL OF MENTAL DISORDERS [DSM]


PSYCHOTHERAPY

• 1998 APA MAINTAINS POSITION THAT HOMO- AND

BI-SEXUALITY DO NOT REPRESENT MENTAL

DISORDERS

• LGB ORIENTATIONS ARE ACCEPTABLE

ALTERNATIVES TO HETEROSEXUALITY WHICH

IMPLY NO DIFFERENCE IN PSYCHOLOGICAL,

SOCIAL, VOCATIONAL FUNCTIONING, OR ABILITY

TO PARENT


PSYCHOTHERAPY

• PSYCHOLOGISTS TAKE THE LEAD IN

REMOVING THE STIGMA LONG ASSOCIATED

WITH GAY AND LESBIAN ORIENTIONS

• PSYCHOLOGISTS MUST PROVIDE CLIENTS

WITH ACCURATE INFORMATION ABOUT

SEXUAL ORIENTATION


PSYCHOTHERAPY

• PSYCHOLOGISTS RECOGNIZE THAT

CLIENTS MAY SEEK PSYCHOLOGICAL

SERVICES IN ORDER TO RID THEMSELVES

OF A SEXUAL ORIENTATION WHICH IS

“UNACEPTABLE” DUE TO SOCIETAL

PRESSURES


PSYCHOTHERAPY

• APA STRONGLY DISCOURAGES

CONVERSION THERAPIES

• NO EVIDENCE THAT SEXUAL

ORIENTATION CAN TRULY BE ALTERED

• EVIDENCE SUGGESTS THAT

ATTEMPTING TO CHANGE SOMEONE’S

SEXUAL ORIENTATION MAY RESULT IN

SIGNIFICANT HARM


AMERICAN PSYCHIATRIC ASSOCIATION 1998)AMERICAN PSYCHIATRIC ASSOCIATION 1998)

REPARATIVE THERAPY IS DANGEROUSLY MISGUIDED:

"THE POTENTIAL RISKS OF 'REPARATIVE THERAPY' ARE "THE POTENTIAL RISKS OF 'REPARATIVE THERAPY' ARE GREAT, INCLUDING DEPRESSION, ANXIETY AND SELF-GREAT, INCLUDING DEPRESSION, ANXIETY AND SELF-DESTRUCTIVE BEHAVIOR, SINCE THE THERAPIST'S DESTRUCTIVE BEHAVIOR, SINCE THE THERAPIST'S ALIGNMENT WITH SOCIETAL PREJUDICES AGAINST ALIGNMENT WITH SOCIETAL PREJUDICES AGAINST HOMOSEXUALITY MAY REINFORCE SELF-HATRED HOMOSEXUALITY MAY REINFORCE SELF-HATRED ALREADY EXPERIENCED BY THE PATIENT.”ALREADY EXPERIENCED BY THE PATIENT.”


GLB ISSUES IN PSYCHOTHERAPY

• SEXUAL SECRET EXERCISE

• GUIDED IMAGERY EXPERIENCE

• HOW DO YOU FEEL?

• HOW CAN YOU SHOW SUPPORT TO GAY, LESBIAN, BISEXUAL CLIENTS?

• HOW DO YOU DISCUSS ISSUES OF SEXUAL ORIENTATION AND GENDER IDENTITY WITH CLIENTS?


• FRIENDSHIPS WITH MEN & WOMEN

• ROMANTIC RELATIONSHIPS

• HAVE YOU EVER FALLEN IN LOVE?

• CLOSENESS TO THOSE OF SAME AND

OPPOSITE/OTHER GENDER

• SIGNIFICANT RELATIONSHIP HISTORY

• SEXUAL HISTORY

• FANTASY LIFE

• SEXUAL HEALTH & WELL-BEING

TALKING WITH CLIENTS ABOUT

SEXUAL IDENTITY


A MODEL OF IDENTITY DEVELOPMENT

VIVIAN

CASS (1979)


I. IDENTITY CONFUSION

• BEGIN TO QUESTION WHETHER ONE MIGHT BE LESBIAN, GAY, BISEXUAL

• ALTERNATES BETWEEN DENIAL & CONFUSION

• COULD I BE LESBIAN, GAY, BISEXUAL?

(CASS 1979)(CASS 1979)

MODEL OF GAY & LESBIAN IDENTITY DEVELOPMENTMODEL OF GAY & LESBIAN IDENTITY DEVELOPMENT


IDENTITY CONFUSION CHALLENGES

• MAY AVOID INFORMATION ABOUT GLBT ISSUES

• MAY INHIBIT BEHAVIOR- DENY HOMO FEELINGS

• EXPERIMENTING* , AN ACCIDENT* , JUST DRUNK*

• MALES MAY SEPARATE EMOTIONAL & SEXUAL CONTACT

• FEMALES: STRONGLY EMOTIONAL, NON-SEXUAL

RELATIONSHIPS


IDENTITY CONFUSION CHALLENGES

• EXPLORE INTERNAL (+) & (-) JUDGMENTS

• UNCERTAINTY RE: SEXUAL IDENTITY IS OK

• EDUCATE ABOUT SPECTRUM OF SEXUAL

BEHAVIOR AND IDENTITY

• ENCOURAGE IDENTITY EXPLORATION JUST AS

YOU WOULD CAREER OR SOCIAL IDENTITY


II. IDENTITY COMPARISON

• ALIENATION FROM WHAT HAS BEEN FAMILIAR

• MAYBE I AM LESBIAN, GAY, OR BISEXUAL?

• I’M ALL ALONE WITH THIS

(CASS 1979)(CASS 1979)



IDENTITY COMPARISON CHALLENGES

• GRIEVE HETERO IDENTITY LOSSES

• STRONG AWARENESS OF THE PRICE FOR EMBRACING

SEXUAL ORIENTATION

• MAY COMPARTMENTALIZE SEXUALITY

• DIFFERENTIATES GLBT BEHAVIOR FROM IDENTITY

• MAY VIEW SAME SEX RELATIONSHIP OR BEHAVIORS AS

TEMPORARY


IDENTITY COMPARISON CHALLENGES

• DEVELOPMENT OF PERSONAL DEFINITIONS

• NEEDS INFORMATION ABOUT SEXUAL IDENTITY

• NEEDS LGBT COMMUNITY RESOURCES

• MAY GRIEVE LOSS OF LIFE EXPECTATIONS

• BALANCE NEW WITH OLD IDENTITY FEATURES


III. IDENTITY TOLERANCE

• ACTIVELY SEEKS OUT OTHER LGBT PEOPLE AND ENCOUNTER POSITIVE SUPPORT

• WHERE ARE OTHER LGBT PEOPLE?

(CASS 1979)(CASS 1979)



III. IDENTITY TOLERANCE CHALLENGES

• NEW SOPHISTICATION WITH THE ISSUES

• RECOGNITION THAT GLB IDENTITY DOES NOT PRECLUDE OTHER OPTIONS

ACCENTUATES THE DIFFERENCE BETWEEN THE SELF AND HETEROS

(+) CONTACT WITH GLBT CULTURE LEADS TO (+) SELF-ESTEEM

(-) CONTACT LEADS TO DEVALUATION OF THE CULTURE & STUNTS GROWTH, MAY EXPERIMENT WITH STEREOTYPICAL ROLES


III. IDENTITY TOLERANCE CHALLENGES

•HELP EXPLORE SHAME DUE TO INTERNALIZED

HOMOPHOBIA & HETEROSEXISM

• SUPPORT IN FINDING (+) GLBT COMMUNITY

CONNECTIONS

• VERY IMPORTANT TO FAMILIARIZE WITH

COMMUNITY RESOURCES


IV. IDENTITY ACCEPTANCE

• PREFER CONTACT WITH LGBT PEOPLE OVER HETEROS

• SELECTIVE COMING OUT

• I AM LESBIAN, GAY, BISEXUAL, TRANS

• I CAN COME OUT TO SOME PEOPLE

(CASS 1979)(CASS 1979)



IV. IDENTITY ACCEPTANCE CHALLENGES

• ACCEPTS NEW GLBT SELF IDENTIFICATION

• MAY COMPARTMENTALIZE "GAY LIFE"

• DECREASED CONTACT W/ HETERO COMMUNITY

• ASSIMILATES INTO GLBT COMMUNITY WITHOUT CHALLENGING NORMS

• SELECTIVELY DISCLOSES SEXUAL IDENTITY

• INCREASED COMFORT WITH BEING SEEN WITH GLBT OTHERS OR GROUPS


IV. IDENTITY ACCEPTANCE CHALLENGES

•CONTINUE EXPLORING GRIEF AND LOSS OF

HETEROSEXUAL LIFE EXPECTATIONS

CONTINUE EXPLORING INTERNALIZED

"HOMOPHOBIA" & ACQUIRED SHAME FROM

HETEROSEXIST SOCIETY

NEEDS SUPPORT FOR DECISIONS ABOUT WHERE,

WHEN, AND TO WHOM HE OR SHE SELF-DISCLOSES


V. IDENTITY PRIDE

• PRIDE IN NEW IDENTITY AND REJECTION OF ATTEMPTS TO DEVALUE LGBT PEOPLE

• I AM PROUD TO BE LESBIAN, GAY, BISEXUAL, TRANS

• I DON'T (AND WON'T) PASS FOR STRAIGHT

(CASS 1979)(CASS 1979)



V. IDENTITY PRIDE CHALLENGES

• MAY DIVIDE WORLD INTO "GAY" (GOOD) AND

"STRAIGHT" (BAD)

• MAY EXPERIENCE MORE STRESS IN HETERO

COMMUNITY LESS LIKELY TO “FIT IN”

• GLBTQ CULTURE AS SOLE SOURCE OF SUPPORT;

ALL GAY FRIENDS, BUSINESS CONNECTIONS, SOCIAL

CONNECTIONS


V. IDENTITY PRIDE CHALLENGES

• NEEDS SUPPORT TO EXPLORE ANGER ISSUES,

HOMPHOBIA, & HETEROSEXISM

• COPING WITH REACTIONS AND RESPONSES TO

DISCLOSURE OF SEXUAL IDENTITY

• LEARNING TO MANAGE DEFENSIVENESS


VI. IDENTITY SYNTHESIS

• ACCEPTANCE AND INTEGRATION OF NEW IDENTITY

• ACCEPTANCE AND REJECTION OF ASPECTS OF HETEROSEXUAL CULTURE

• TYPICALLY OUT TO MOST PEOPLE.

“I HAPPEN TO BE GLBT”

(CASS 1979)(CASS 1979)



VI. IDENTITY SYNTHESIS CHALLENGES

• GLBTQ IDENTITY SHIFTS FROM

FULL FOCUS OF IDENTITY TO

THAT OF JUST ONE PARTICULAR

ASPECT OF THE SELF


VI. IDENTITY SYNTHESIS CHALLENGES

• INTENSITY OF ANGER RELATED TO HETEROSEXISM MAY DECREASE

• SELECTIVE TRUST OF OTHERS (STRAIGHT OR GLBTQ) BUILDS

• GLBTQ IDENTITY BECOMES MORE INTEGRATED WITH ALL ASPECTS OF THE SELF

• ABLE TO MAINTAIN OWN DISTINCT IDENTITY EVEN WITHOUT EMERSION IN GLBTQ CONTEXT


ETHNIC & SEXUAL IDENTITY DEVELOPMENT

A MODEL FOR MULTIPLE IDENTITY

DEVELOPMENT

(MORALES, 1990)


SEXUAL IDENTITY DEVELOPMENT AND ETHNICITY

(MORALES, 1990)

I. DENIAL OF CONFLICTS

II. BISEXUAL VS. GAY OR LESBIAN

III. CONFLICTS IN ALLEGIANCE

IV. ESTABLISHING PRIORITIES IN ALLEGIANCES

V. INTEGRATION OF COMMUNITIES

• GENERAL POPULATION• ETHNIC/RACIAL/CULTURAL COMMUNITY• GLBTQ COMMUNITY



(MORALES, 1990)

I. DENIAL OF CONFLICTS

• MINIMIZATION OF THE REALITY OF RACIAL-ETHNIC DISCRIMINATION

• FORCLOSURE ON INITIAL SEXUAL ORIENTATION

• (-) CONSEQUENCES OF S.O. MAY NOT BE FULLY APPRECIATED




(MORALES, 1990)

II. BISEXUAL VS. GAY OR LESBIAN

• MAY BE MORE LIKELY TO IDENTIFY INITIALLY AS BISEXUAL DUE TO THE (-) CONSEQUENCES OF GAY OR LESBIAN IDENTITY WITHIN COMMUNITIES OF COLOR

• ACTUAL SEXUAL BEHAVIOR MAY NOT DIFFER SIGNIFICANTLY FROM THOSE WHO IDENTIFY MORE EXCLUSIVELY AS GAY OR LESBIAN




(MORALES, 1990)

III. CONFLICTS IN ALLEGIANCE

• DUAL STATUS AS ETHNIC-RACIAL AND SEXUAL

MINORITY GENERATES HIGH ANXIETY

• MAY SEGMENT OR COMPARTMENTALIZE IDENTITIES

TO OPERATE EFFECTIVELY IN 3 DISTINCT

COMMUNITIES (GEN POP, ETH/RACIAL, & OR GLBT)

• MAY EXPERIENCE MULTIPLE COMMUNITY

AFFILIATIONS AS A BETRAYAL OF ONE OR THE OTHER




(MORALES, 1990)

IV. ESTABLISHING PRIORITIES IN ALLEGIANCE

• PRIMARY IDENTIFICATION WITH RACIAL-ETHNIC IDENTITY PREVAILS

• RESENTEMENT DUE TO THE POOR INTEGRATION OF COMMUNITIES (SPLITTING OF SOCIAL SUPPORT)

•ANGER AND RAGE ARISE IN RESPONSE TO REJECTION EXPERIENCES WITHIN THE GLBT COMMUNITY DUE TO RACISM




(MORALES, 1990)

V. INTEGRATION OF COMMUNITIES

• INTEGRATION OF LIFESTYLE AND ETHNIC IDENTITY/IES BECOMES OF MAJOR CONCERN

• ANXIETY, ISOLATION, OR ALIENATION MAY ARISE IN RESPONSE TO ATTEMPTS AT INTEGRATION

• NOT ALL INDIVIDUALS WILL CHOOSE TO COMPLETELY INTEGRATE ALL IDENTITIES



TRANSGENDER IDENTITY DEVELOPMENT

A MODEL OF TRANSGENDER IDENTITY

DEVELOPMENT

(MASTERS, 1993)


TRANSGENDER IDENTITY DEVELOPMENT(MASTERS, 1993)

I. CHILDHOOD AWARENESS

A. EARLY AWARENESS OF CROSS-GENDER IDENTIFICATION

B. SENSE OF BEING DIFFERENT FROM OTHERS

C. PREFERENCE FOR OPPOSITE GENDER PLAYMATES

D. A NATURAL STATE OF LIFE BEFORE SOCIALIZATION



II. GOING INTO THE CLOSET

A. INTERNALIZATION OF SOCIETY’S STANDARDS

B. SOCIALIZATION TO THE PRESCRIBED GENDER ROLE

C. ALIENATION FROM TRUE SENSE OF SELF (GOING INTO

THE CLOSET

D. MOTIVATED BY NEED FOR FREEDOM FROM REPRAISAL



III. PASSING

A. CONTINUED DENIAL OF TRUE GENDER IDENTITY

B. TREMENDOUS EMOTIONAL TURMOIL

C. ADHERENCE TO SOCIALLY PRESCRIBED ROLE

D. MAY CROSS-DRESS TO RELIEVE PRESSURE

E. ATTEMPTS TO RELIEVE PRESSURE CAN CAUSE FURTHER DISTRESS AND CONFUSION



IV. COMING OUT

A. RE-EMERGENCE FROM DENIAL

B. REDISCOVERY OF TRUE GENDER IDENTITY

C. REGAINING EMOTIONAL HEALTH

D. RECOGNITION OF ONE’S NORMAL STATE, A STATE OF TRANSGENDER IDENTITY



V. PRESENTING

A. SEARCH FOR COUNSELING AND ADVICE

B. SEARCH FOR SELF-UNDERSTANDING & INNER PEACE

C. PROFOUND IDENTITY CONFUSION (BODY REVULSION)

D. BUILDING SELF-ACCEPTANCE, SOCIAL ACCEPTANCE AND SELF-ESTEEM

E. RECONCILING IDENTITY WITH SOCIETAL EXPECTATIONS

F. HIGH SUICIDE POTENTIAL IF ACCESS DENIED TO SUPPORT SERVICES



VI. TRANSITION

A. PRESENTATION TO SOCIOTYPICALLY CONFORM TO TRUE GENDER

B. MALES WILL BEGIN LIFE AS WOMEN

C. FEMALES WILL BEGIN LIFE AS MEN

D. HUMAN RIGHTS CHALLENGES: CAREER, HOUSING AND CONSUMER SERVICES CAN BE THREATENED

E. OVERALL LOSS OF ACCESS TO SOCIETY



VII. CROSS-LIVING

A. MAY SIGNAL THE END OF THE FIGHT

B. ADJUSTMENT TO NEW LIFESTYLE SORTED OUT

C. CROSS-LIVING IN A STRUCTURED WAY

D. MALES WILL BE SOCIALLY INTEGRATED AS WOMEN, FEMALES AS MEN

E. DECISION: SEX-REASSIGNMENT SURGERY?

F. CONTINUED CHALLENGES OF DAILY LIFE



STAFF PSYCHOLOGIST

PSYCHOLOGICAL & COUNSELING SERVICES

peter c. russell, ph.d. glbt issues in psychotherapy

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