Bisexuality in the therapy room: identity & experience

1. Bisexuality in the therapy room: identity & experience Emily Hodgkinson PhD, Dip POP, UKCP mlyhodgkinson@yahoo.co.uk

2. Why focus on bisexuality? Publication of Pink Therapy, 1996: “People who have relationships with both sexes may have been counted within … research into homosexuality [or] excluded from the data. … We believe it is important to conduct research into bisexual psychology to see how it compares with lesbian and gay psychologies. In the absence of such evidence, we are assuming that the psychology of bisexuals is not very different to that of lesbians and gay men.” (Davies & Neal) .

3. Post-1990: Bisexual communities & voices begun to be heard (books, internet, lobbying L/G community spaces) • Specific, separate research into bisexuality • Bisexual psychologies are substantially different to lesbian and gay psychologies • Confirms anecdotal evidence. Emerging research: Bi people have significantly worse mental health than lesbian, gay or straight people: anxiety, depression, suicidality, self-harm. Why?

4. Mental health: recent research • Bisexuals have higher levels of certain mental health problems than straight, lesbian or gay people1,2,3 • Anxiety, depression, self-harm, suicidality, negative affect. Why? 1 Page, 2007 in Firestein (ed), Becoming Visible; 2Bi report, 3Dodge & Sandfort, 2007 in Firestein (ed).

5. What is bisexuality? Part 1 If a client tells you they are bisexual, what does this tell you about them? I’m bisexual

6. Beliefs about sexual orientation • There are 3 categories: straight, gay & bisexual. • You have to choose between men and women. • There are many genders. • Sexual attraction is on a spectrum between male and female. • We all have a core sexuality that we’re trying to discover. • We’re all born bisexual.

7. Conflicting models of (beliefs about) sexual orientation • Essentialism vs. Constructionism vs. ....??? • Foucault: sexual orientation is a relatively recent product of Western culture. • Could say bisexuality is a biphobic concept? (for some). • Intersections with gender & culture: bisexuality is culture-specific and dependent on binary model of gender. • pansexuality, genderqueer, etc • Identity, behaviour & attraction: how public society deals with the contradictions.

8. Clinical implications • Clients already have models, conscious or not, which may not be congruent with experience. • E.g. ‘One must have a sexual orientation’ • ‘You have to choose’ • Dissonance between model and experience leads to inner conflict. • Experience and model interact in feedback loop, to modulate awareness & identity • Bi identity development happens at the meeting point between experience and model. It’s doing my head in, mate!

9. Identity development: L/G-centric models Part 2 • Several stages from confusion/denial towards acceptance/integration. • ‘Identity confusion’ a common early stage, implicitly pathologised and to be resolved. • Assume fixed ‘stable identity’ or ‘identity maintenance’ as desired outcome. • E.g. “Here a woman feels a sense of settling down that is similar to finishing adolescence. She often develops a ‘chosen family’ of accepting friends… often an ongoing committed relationship is formed.” (Lewis 1984)

10. Bisexual development: ‘My home is not a place but a process’ • A constant interaction between changing flow of experience and different models & communities. • Does not necessarily have a desired end-point. • Experience is not necessarily constant over time & social or relationship context. Identity not maintained or supported by choice of partner or community. • Intersectionality: bisexuality is culture-specific and dependent on binary model of gender, e.g. pansexuality, genderqueer, etc.

11. Identity development: a B/T-centric model (Meyer1) • Identity formation is culturally specific to Western industrial society. Bi-genderist. ‘One must have an identity’ – often difficult or impossible for bisexuals. • Sexual identity as a never-ending process of co-creation between self and society. • E.g. woman in same sex relationship attended lesbian events. Now with male partner, so her social identity changes. • E.g. Poly life: constant shifts in social environment 1 Meyer, in Alexander & Yescavage (eds), Bisexuality & Transgenderism: Intersexions of the Others, 2003.

12. Oppression & marginalisaton: inner and outer Part 3 Key themes: • Stereotyping • Invisibility • Biphobia, homophobia • Hetero- and mono-normativity And the effects of all this on: • Mental health • Relationships • Living in society

13. Invisibility (is hard to spot) How? • Not noticing/not seeing • Tacking onto LGBT (e.g. no Bi-specific services) • ‘It doesn’t exist’/ ‘Just a phase’ • Seeing sexual orientation defined by current relationship • ‘Straight or gay?’ Where? • In mainstream AND LGBT communities • Research, books, media • Social intercourse (e.g. women’s social group) • Gender-based social structures (e.g. speed dating)

14. Mental health: recent research • Bisexuals have higher levels of certain mental health problems than straight, lesbian or gay people1,2,3 • Anxiety, depression, self-harm, suicidality, negative affect • Most studies: bi identity; one study: bi behaviour 3 • Bi women’s problems more serious overall1 • Bi men’s sexual identity issues more serious1 1 Page, 2007 in Firestein (ed), 2Becoming Visible; Bi report, 3Dodge & Sandfort, 2007 in Firestein (ed).

15. Mental health – possible answers • Greater adversity, less support & acceptance from family & friends, less likely to be out • Higher substance use • Theory of dual oppression • 1 study: bi men worse mental health than gay men while bi women & lesbians had similar levels3 • 1 study found bi females and Trans people had higher levels of mental health than bi males. 4 • Invisibility: greater experience of not fitting society’s models? 4 Mathy et al, 2003, in Alexander & Yescavage (eds)

16. Relationships& sexual health • Invisibility whoever you’re with; relationship determines your social world • Hetero- and mono-normativity, e.g. assuming orientation towards one gender, e.g. biases towards monogamy; ‘but which do you prefer?’, etc • Finding relationships & creating relationship & family structures • Coming out as bi to a non-bi partner (& issues for non-bi partner) • Homophobia & biphobia in same and other-sex relationships. • MSM: often less acess to safer sex education & materials

17. Society & community • In the mainstream: • less likely to be out • less support & acceptance • The B in LGBT • Same problems. B is tacked on but marginalised • The Bi scene • Often small, hard to access • White, educated, online • Relatively Trans-friendly

18. Therapeutic models & reflexive practice Part 4 Outline: • Setting & context of therapy • Your therapy paradigm • Your personal model of sexual orientation • What clients want – and get - from therapists & counsellors: study

19. Reflecting on your therapeutic paradigm • Identify elements of your therapeutic paradigm that relate bisexual experience, identity & identity development. • Can you describe a possible ‘model of bisexuality’ implied by your paradigm? • Identify its strengths & possible limitations.

20. Reflexive practice: your personal model of sexual orientation • What is your personal model of sexual orientation? • What kind of bisexual lifestyle or model of identity could you most easily empathise with? • What about a bisexual client’s beliefs, lifestyle or experience would you find most hard to empathise with or threatens your identity? Why? • What worldview or personal history/experience is challenged in you?

21. What Bi clients want from therapists (& what they get)1 Raising Bi issues in therapy/counselling: • 20% sought help for bi issues, 1/3 for other reasons but bi issues came up • 20% never/rarely disclose to clinician • Bi as stress: 40% some; 33% difficult or hardest thing • Clinicians less helpful than for L/G issues 1 From Page, 2007 in Firestein (ed): study of bi clients seeking MH services

22. Main problems in therapy Invalidation, invalidation, invalidation • Saying bisexuality does not exist • Seeing as part of pathology • Refusing to engage unless they choose men or women • Assuming bisexuality connected to clinical goals when it isn’t • Recommend improvement by limiting interest to one or other sex. • Attempting conversion to straight, lesbian or gay.

23. Common stereotypes held by clinicians • Indecisive • Current relationship = true orientation • It’s a phase or in transition • Accept gay but not bi • Dysfunctional • Manifestation of problem your with men • “One experience doesn’t make you bi”

24. Top Bi needs in therapy • Validation, validation, validation! • See Bisexuality as healthy • Knowledge • Skill in helping with bi issues • Apply skills to supporting positive bi identity & lifestyle • Proactively intervene to support bi issues

25. Knowledge wishlist • Variability of sexual attraction & relationships • Validate non-monogamous relationships as real • Aware of het/L/G cultural bias & bi stereotypes • Appropriate language • Understand difficulty in finding relationships

26. Skills & attitudes wishlist • Acceptance, understanding, support,non-judgmental, confidence in clients’ healthy development • Recognise & challenge homo- and bi-phobic thinking proactively • Provide information & resources proactively • Advocate with colleagues & society • Frame that assumes clients have been impacted by homo- and bi-phobia • Sensitive to how clients may have internalised cultural bias