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GLBT ISSUES IN PSYCHOTHERAPY

GLBT ISSUES IN PSYCHOTHERAPY. PETER C. RUSSELL, PH.D. PCRUSSELL@UCSD.EDU CLINICAL PSYCHOLOGIST LIAISON, SCHOOL OF MEDICINE UCSD PSYCHOLOGICAL & COUNSELING SERVICES. HOW CAN YOU COMMUNICATE SAFETY TO CLIENTS ?. 10% U.S. LGB= 30 MILLION PARENTS= 60 MILLION GRANDPARENTS= 60 MILLION

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GLBT ISSUES IN PSYCHOTHERAPY

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  1. GLBT ISSUES IN PSYCHOTHERAPY PETER C. RUSSELL, PH.D.

  2. PETER C. RUSSELL, PH.D. PCRUSSELL@UCSD.EDU CLINICAL PSYCHOLOGIST LIAISON, SCHOOL OF MEDICINE UCSD PSYCHOLOGICAL & COUNSELING SERVICES PETER C. RUSSELL, PH.D.

  3. HOW CAN YOU COMMUNICATE SAFETY TO CLIENTS ? 10% U.S. LGB= 30 MILLION PARENTS= 60 MILLION GRANDPARENTS= 60 MILLION SIBLINGS= 60-120 MILLION FRIENDS= 60 MILLION TOTAL= 270 MILLION PETER C. RUSSELL, PH.D.

  4. PETER C. RUSSELL, PH.D.

  5. PETER C. RUSSELL, PH.D.

  6. PETER C. RUSSELL, PH.D.

  7. PETER C. RUSSELL, PH.D.

  8. 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 PETER C. RUSSELL, PH.D.

  9. SEXUAL ORIENTATION • ONE’S SEXUAL, EMOTIONAL, SPIRITUAL, AND / OR AFFECTIONAL ORIENTATION TO MEMBERS OF THE OPPOSITE, SAME, OR BOTH GENDERS PETER C. RUSSELL, PH.D.

  10. SEXUAL ORIENTATION PETER C. RUSSELL, PH.D.

  11. MODELS OF SEXUAL ORIENTATION MONOSEXUALITY-BISEXUALITY (Zinik 1985, Rust, 1992) MONOSEXUALITY BISEXUALITY PETER C. RUSSELL, PH.D.

  12. 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 PETER C. RUSSELL, PH.D.

  13. 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 PETER C. RUSSELL, PH.D.

  14. 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 PETER C. RUSSELL, PH.D.

  15. 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 PETER C. RUSSELL, PH.D.

  16. 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 PETER C. RUSSELL, PH.D.

  17. 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 PETER C. RUSSELL, PH.D.

  18. HETEROSEXISM • AN UNCONSCIOUS BELIEF SYSTEM WHICH RECOGNIZES THE EXISTENCE OF ONLY HETERO- ORIENTATIONS • NON-CONSCIOUS BIGOTRY PETER C. RUSSELL, PH.D.

  19. 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 PETER C. RUSSELL, PH.D.

  20. 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 PETER C. RUSSELL, PH.D.

  21. DIFFICULTIES FOR GAY, LESBIAN, BISEXUAL AND TRANS ADOLESCENTS WHY IS IT SUCH A STRUGGLE FOR GLBT YOUTH TO DEVELOP THEIR IDENTITIES? PETER C. RUSSELL, PH.D.

  22. WHERE DO GLBTQ ADOLESCENTS FIND SUPPORT AVAILABLE? • FRIENDS • PARENTS • FAMILY / SIBLINGS • SCHOOL • CLERGY • ORGANIZED CLUBS • ATHLETICS PETER C. RUSSELL, PH.D.

  23. 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 PETER C. RUSSELL, PH.D.

  24. ISSUES FACING GLBT YOUTH 40% 40% SUFFER VIOLENCE DUE TO THEIR PERCEIVED OR ACTUAL GLB SEXUAL ORIENTATION (MARTIN & HETRICK, 1988) PETER C. RUSSELL, PH.D.

  25. ISSUES FACING GLBT YOUTH 25% 25% WILL BE THROWN OUT OF THEIR OWN HOMES UPON DISCLOSING A NON-HETERO IDENTITY TO PARENTS OR FAMILY (GLSEN) PETER C. RUSSELL, PH.D.

  26. ISSUES FACING GLBT YOUTH 25% 25%OF ALL HOMELESS YOUTH LEFT HOME OR WERE THROWN OUT DUE TO ISSUES OF SEXUAL ORIENTATION (GLSEN) PETER C. RUSSELL, PH.D.

  27. ISSUES FACING GLBT YOUTH 21% 21% ATTEMPT SUICIDE AT LEAST ONCE BEFORE AGE 20 (GLSEN) PETER C. RUSSELL, PH.D.

  28. ISSUES FACING GLBT YOUTH EVERY 35 MINUTES IN THE U.S., AN ADOLESCENT ATTEMPTS SUICIDE EVERY 35 MINUTES DUE TO SEXUAL ORIENTATION ISSUES (GLSEN) PETER C. RUSSELL, PH.D.

  29. ISSUES FACING GLBT YOUTH EVERY 5 HOURS & 48 MINUTES AN ADOLESCENT SUICIDES EVERY 5 HOURS AND 48 MINUTES (GLSEN) PETER C. RUSSELL, PH.D.

  30. ISSUES FACING GLBT YOUTH 28% 28% OF GAY YOUTH DROP OUT OF HIGH SCHOOL DUE TO DISCOMFORT IN THE SCHOOL ENVIRONMENT (GLSEN) PETER C. RUSSELL, PH.D.

  31. ISSUES FACING GLBT YOUTH 6 TIMES MORE LIKELY GLBT YOUTH ARE 6x MORE LIKELY TO DEVELOP DRUG AND ALCOHOL PROBLEMS THAN THEIR HETERO PEERS (GLSEN) PETER C. RUSSELL, PH.D.

  32. PSYCHOTHERAPY • 1973 THE AMERICAN PSYCHIATRIC (APA) AND PSYCHOLOGICAL ASSOCIATIONS (APA) STRIKE “HOMOSEXUALITY” FROM THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS [DSM] PETER C. RUSSELL, PH.D.

  33. 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 PETER C. RUSSELL, PH.D.

  34. 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 PETER C. RUSSELL, PH.D.

  35. 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 PETER C. RUSSELL, PH.D.

  36. 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 PETER C. RUSSELL, PH.D.

  37. AMERICAN PSYCHIATRIC ASSOCIATION 1998) REPARATIVE THERAPY IS DANGEROUSLY MISGUIDED: "THE POTENTIAL RISKS OF 'REPARATIVE THERAPY' ARE GREAT, INCLUDING DEPRESSION, ANXIETY AND SELF-DESTRUCTIVE BEHAVIOR, SINCE THE THERAPIST'S ALIGNMENT WITH SOCIETAL PREJUDICES AGAINST HOMOSEXUALITY MAY REINFORCE SELF-HATRED ALREADY EXPERIENCED BY THE PATIENT.” PETER C. RUSSELL, PH.D.

  38. 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? PETER C. RUSSELL, PH.D.

  39. • 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 PETER C. RUSSELL, PH.D.

  40. A MODEL OF IDENTITY DEVELOPMENT VIVIAN CASS (1979) PETER C. RUSSELL, PH.D.

  41. 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) MODEL OF GAY & LESBIAN IDENTITY DEVELOPMENT PETER C. RUSSELL, PH.D.

  42. 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 PETER C. RUSSELL, PH.D.

  43. 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 PETER C. RUSSELL, PH.D.

  44. II. IDENTITY COMPARISON• ALIENATION FROM WHAT HAS BEEN FAMILIAR • MAYBE I AM LESBIAN, GAY, OR BISEXUAL? • I’M ALL ALONE WITH THIS (CASS 1979) MODEL OF GAY & LESBIAN IDENTITY DEVELOPMENT PETER C. RUSSELL, PH.D.

  45. 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 PETER C. RUSSELL, PH.D.

  46. 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 PETER C. RUSSELL, PH.D.

  47. III. IDENTITY TOLERANCE• ACTIVELY SEEKS OUT OTHER LGBT PEOPLE AND ENCOUNTER POSITIVE SUPPORT • WHERE ARE OTHER LGBT PEOPLE? (CASS 1979) MODEL OF GAY & LESBIAN IDENTITY DEVELOPMENT PETER C. RUSSELL, PH.D.

  48. 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 PETER C. RUSSELL, PH.D.

  49. 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 PETER C. RUSSELL, PH.D.

  50. IV. IDENTITY ACCEPTANCE• PREFER CONTACT WITH LGBT PEOPLE OVER HETEROS• SELECTIVE COMING OUT • I AM LESBIAN, GAY, BISEXUAL, TRANS• I CAN COME OUT TOSOME PEOPLE (CASS 1979) MODEL OF GAY & LESBIAN IDENTITY DEVELOPMENT PETER C. RUSSELL, PH.D.

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