A survey of clinical psychologists on treating lesbian, gay, and bisexual clients.

Should the average psychologist receive specific training on lesbian, gay, and bisexual (LGB) concerns? On the basis of a random sample of practicing psychologists, LGB clients are present in most caseloads. Respondents rated the most important therapeutic issues with LGB clients and identified training that would improve their work with LGB clients (including the topics of coming out, estrangement from family, support system development, and internalized homophobia). In addition, participants reported on the types of training that they are getting (most frequently reading articles, supervision, and continuing education). The implications for training programs and private practitioners are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing Multiple Relationships Between Clients and Therapists in Lesbian, Gay, Bisexual, and Transgender Communities.

Therapists working in lesbian, gay, bisexual, and transgender (LGBT) communities are likely to experience the potential to engage in multiple relationships with their clients. Currently, the American Psychological Association's (2002) ethics code and the related literature base offer minimal direct guidance to therapists practicing in LGBT communities. In this article, the authors review current literature regarding multiple relationships in psychotherapy, considering how this literature addresses issues specific to practitioners working within LGBT communities, present a case study highlighting the negotiation of a multiple relationship between a client and therapist who both identify as lesbian, and offer recommendations for practitioners working within LGBT communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lesbian, gay, and bisexual victimization in the military: An unintended consequence of “Don't Ask, Don't Tell”?

The integration of lesbian, gay, and bisexual (LGB) individuals into the U.S. military is a long-standing and politically and socially divisive issue. Exclusionary and pseudo-inclusionary policies that restrict openly LGB individuals from military service are also of long duration. Yet LGB servicemembers have continued to serve covertly in the military for many decades. Moreover, political issues and social conventions associated with “Don't Ask, Don't Tell” (DADT) have diverted focus from imperative research issues, such as LGB servicemembers and incidents of victimization in the military. Research is reviewed to evaluate such victimization, which is conceptualized as resulting from a convergence of sexual stigma, conservative gender role beliefs, and sexual prejudice. DADT, in combination with overarching difficulties intrinsic to sexual orientation research, serves to augment LGB victimization and reduce victim reports and help seeking. Consequently, there is a deficient evidence base for assisting LGB servicemembers and for advancing research, prevention efforts, and policy changes. Implications of repealing DADT are discussed, as are future directions for LGB military research. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Competing selves: Negotiating the intersection of spiritual and sexual identities.

Psychotherapy has sometimes been seen as incongruent with religion and spirituality. This fact is even more pronounced when counseling lesbian, gay, and bisexual (LGB) clients, who feel as if their sexual orientation places them at odds with religious doctrine that is experienced as antigay. Postmodern theory provides a context for understanding socially constructed identities that may be in conflict with one another and may also provide some insight into how therapists may approach religious issues with LGB clients. The current study uses a mixed method design to investigate the relation between religious and sexuality variables in a sample of 422 LGB respondents. Quantitative results indicated that conservative religious beliefs were related to higher levels of shame, guilt, and internalized homophobia. Qualitative results appeared to highlight eight themes, the more dominant of which indicated that issues around sexual orientation were the catalyst for questioning or changing religious affiliation or beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist qualities preferred by sexual-minority individuals.

Psychotherapy research concerning lesbian, gay, and bisexual (LGB) individuals has focused on matching clients on gender and sexual orientation, yet has not considered how factors such as therapeutic skill, presenting problem, and cohort membership may influence preference for therapists. This study was designed to identify those therapist qualities that sexual-minority individuals prefer and to determine how the presenting problem influences therapist choice. Forty-two nonheterosexual adults between 18 and 29 years old ranked 63 therapist characteristics from "Extremely Uncharacteristic" to "Extremely Characteristic" when seeking treatment for a problem in which their sexual orientation was salient and one in which it was not. The analyses of both conditions yielded clusters of items reflecting therapist characteristics that participants considered unfavorable, neutral, beneficial, and essential. Participants valued therapists who had LGB-specific knowledge as well as general therapeutic skills, whereas they indicated that they would avoid therapists who held heterocentric views. Application of these findings to clinical practice and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internalized homophobia and adult attachment: Implications for clinical practice.

Two hundred eighty-six men and women who identified as lesbian, gay, or bisexual (LGB) were surveyed using measures of attachment, internalized homophobia, shame, and guilt. Results indicated that secure attachment was negatively correlated with internalized homophobia, shame, and guilt. Fearful and preoccupied attachments were positively correlated with these constructs, accounting for 36.9% of the variance in scores. Results are discussed in terms of the therapeutic relationship, with the therapist serving as a secure base for LGB clients working through issues of internalized homophobia and social isolation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lesbian, gay, and bisexual supervisees' experiences of LGB-affirmative and nonaffirmative supervision.

Lesbian, gay, and bisexual (LGB) supervisees were interviewed regarding their experiences of LGB-affirmative and nonaffirmative supervision. Supervisees were asked to describe one of each type of event (i.e., affirmative, nonaffirmative) from their past supervision. In LGB-affirmative supervision, all supervisees felt supported in their LGB-affirmative work with clients. Supervisees perceived that the affirming events also positively affected the supervision relationship, client outcomes, and themselves as supervisees. In LGB nonaffirming supervision, supervisees perceived supervisors to be biased or oppressive toward supervisees' clients or themselves on the basis of LGB concerns or identity. From supervisees' perspectives, the nonaffirming events negatively affected the supervision relationship, client outcomes, and supervisees. Implications for research and supervision are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coming to terms with coming out: Review and recommendations for family systems-focused research.

For lesbian, gay, and bisexual (LGB) adolescents and young adults, coming out to family members, especially parents, is a major psychological decision and hurdle due to both perceived fears and actual negative consequences. But beyond the literature on factors associated with the decision to come out and parents' initial reactions to the disclosure, empirical studies of what unfolds afterward, and how the family adjusts to the LGB adolescent's identity over time, are sparse and scattered. This article reviews and integrates findings from studies of the individual-, dyadic-, and family-level variables associated with positive outcomes, focusing particularly on relationship variables. Methodological concerns within this body of research are discussed, and research recommendations are offered. A preliminary working model of how families successfully come to terms with coming out is proposed to guide future research that will advance theory and clinical work with LGB youth and their families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lesbians, gay men, and their families. Some therapeutic issues

Although a body of scientific data about working with parents and families of gays and lesbians has not yet developed, there is a growing body of literature of an anecdotal and personal nature that has been cited. These works provide therapists with background information and clients needing assistance with guided reading. Therapists working with families and friends of gay men can find the experience rewarding and the therapeutic interventions effective. Much of the work is common sense, listening with the "third" ear for those underlying issues separate from the son's gayness that may affect the person's attitudes, feelings, and responses. Maintaining a professional demeanor while conveying a sense of caring and concern for the individuals is a key issue. As gay people become more visible in society and as the number of individuals coming out increases, there will be a need for more therapists who can assist families with their own coming out process. This article provides some basic guidelines and, as individual therapists gain more experience in this area, it will be important that others report those experiences, sharing them with the rest of the therapist community.     

Affirming Faith Experiences and Psychological Health for Caucasian Lesbian, Gay, and Bisexual Individuals.

Religious faith plays a central role in the lives of many people. Although studies and anecdotal literature have explored the conflict between sexual and religious identities, no research has investigated the role of faith group affirmation of a lesbian, gay, or bisexual (LGB) identity on the mental health of LGB members. This study compared 2 models of the relations between psychological health and current faith affirmation experiences, internalized homonegativity, and spirituality. Participants were 583 LGB individuals who identified themselves as currently affiliated with a faith group. Results indicated that the fully mediated model was a good fit and offered a more parsimonious explanation than the partially mediated model. Affirming faith experiences were related to psychological health through internalized homonegativity and spirituality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists' competence to treat lesbian, gay and bisexual clients: State of the field and strategies for improvement.

Recognizing research which suggests that many practicing psychologists enter the field without training or with inadequate training in the knowledge, skills, and awareness needed to treat lesbian, gay, and bisexual (LGB) clients, the authors in this Focus on Ethics provide suggestions for psychologists seeking competence with this population. In the lead article, Lyons fleshes out the contours of competent practice, presents the current state of psychologist competence, and calls for greater levels of competence. Next, Bieschke and Dendy respond by applying the Ethical Acculturation Model to describe the question of competence for those who may come from cultures not condoning of an LGB affirmative stance. Worthington provides hypotheses for the current rates of competence in the field and encourages the use of evidenced-based training and practice to increase competence. Finally, Georgemiller confirms the role of practicing psychologists who are heterosexual allies and identifies resources for gaining competence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sampling lesbian, gay, and bisexual populations.

Sampling has been the single most influential component of conducting research with lesbian, gay, and bisexual (LGB) populations. Poor sampling designs can result in biased results that will mislead other researchers, policymakers, and practitioners. Investigators wishing to study LGB populations must therefore devote significant energy and resources to choosing a sampling approach and executing the sampling plan. The authors describe probability and nonprobability sampling methods used in LGB populations and critically discuss the advantages and disadvantages of the sampling methods they review. The authors conclude that no single sampling methodology is correct or incorrect for use in LGB populations; rather, researchers must evaluate advantages and disadvantages of each sampling methodology in the context of the specific research question and the research design. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental Health of Lesbian, Gay, Bisexual, and Heterosexual Siblings: Effects of Gender, Sexual Orientation, and Family.

Self-identified lesbian, gay male, and bisexual (LGB) individuals were recruited via convenience sampling, and they in turn recruited their siblings (79% heterosexual, 19% LGB). The resulting sample of 533 heterosexual, 558 lesbian or gay male, and 163 bisexual participants was compared on mental health variables and their use of mental health services. Multilevel modeling analyses revealed that sexual orientation predicted suicidal ideation, suicide attempts, self-injurious behavior, use of psychotherapy, and use of psychiatric medications over and above the effects of family adjustment. Sexual orientation was unrelated to current psychological distress, psychiatric hospitalizations, and self-esteem. This is the 1st study to model family effects on the mental health of LGB participants and their siblings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

To accept a pilot? Addressing men's ambivalence and altering their expectancies about therapy.

When considering the challenges therapists encounter with their male clients, perhaps the most daunting tasks occur at the very beginning. Getting boys and men to avail themselves of psychological services is the first challenge. But when men do present, the second challenge is to get them to trust therapists sufficiently enough to share their issues and to form an effective working alliance. This article describes these gender-related challenges from male clients' point of view, and then elaborates upon effective techniques to help them engage in and benefit from psychotherapy. We suggest that good therapists for men, like good ship pilots, are informed and prepared. They learn the major cognitive and emotional issues they are likely to encounter with their male clients, and develop a variety of ways to help their male clients navigate the tricky psychological issues of their lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of physical touch in the "talking cure": A journey to the outskirts of psychotherapy.

The present literature review examines how physical touch has been used by therapists with their clients in traditional verbal psychotherapy. Attitudes and practices of therapists are presented in a historical context, starting with physicians' treatment of female hysteria in the 19th century, and concluding with current issues of debate. The use of touch in therapy has been highly controversial ever since Freud stated his principle of abstinence. This paper intends to give an overview of the various positions of influential therapists on the use of touch and their rationale for touching or not touching their clients, including the contextual factors that have shaped the use of touch over time. Furthermore, research findings pertinent to the use of touch in psychotherapy are included. The review concludes with practical recommendations concerning the use of touch in the contemporary therapeutic setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Internalized homophobia and relationship quality among lesbians, gay men, and bisexuals.

The authors examined the associations between internalized homophobia, outness, community connectedness, depressive symptoms, and relationship quality among a diverse community sample of 396 lesbian, gay, and bisexual (LGB) individuals. Structural equation models showed that internalized homophobia was associated with greater relationship problems both generally and among coupled participants independent of outness and community connectedness. Depressive symptoms mediated the association between internalized homophobia and relationship problems. This study improves present understandings of the association between internalized homophobia and relationship quality by distinguishing between the effects of the core construct of internalized homophobia and its correlates and outcomes. The findings are useful for counselors interested in interventions and treatment approaches to help LGB individuals cope with internalized homophobia and relationship problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A-B therapist perceptions and preferences for schizophrenic and psychoneurotic clients.

Administered an extended version of the a-b scale to 141 experienced, practicing psychotherapists. Ss also completed scales designed to assess therapist attitudes toward working with schizophrenic and psychoneurotic clients, personal liking for specific schizophrenic and psychoneutrotic clients, and orientation toward interpersonal relationships. Analysis of variance results revealed no evidence suggesting that a and b therapists differentially perceive or prefer schizophrenic or psychoneurotic clients. There was evidence suggesting that a therapists initially like both schizophrenic and psychoneurotic clients as individuals more than b therapists. By the time therapy had ended, these differences between a and b therapists tended to dissipate with schizophrenic clients. However, b therapists' personal liking of their psychoneurotic clients actually declined during therapy. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Victimization Over the Life Span: A Comparison of Lesbian, Gay, Bisexual, and Heterosexual Siblings.

Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Disclosure of sexual orientation and subsequent substance use and abuse among lesbian, gay, and bisexual youths: Critical role of disclosure reactions.

Research on whether disclosure of sexual orientation promotes lower substance use among lesbian, gay, and bisexual (LGB) individuals has been inconsistent. One reason for this may be that disclosure results in accepting and rejecting reactions. The current report longitudinally examines whether the types of reactions to disclosure are associated with substance use and abuse among 156 LGB youths (ages 14–21). Neither the number of disclosures nor the numbers of accepting or neutral disclosure reactions were associated with substance use or abuse. However, the number of rejecting reactions to disclosure was associated with current and subsequent alcohol, cigarette, and marijuana use, even after controlling for demographic factors, social desirability, and emotional distress. Further, accepting reactions were found to moderate or protect youths from the negative role of rejecting reactions on alcohol use, but not other substances. This research indicates that, rather than disclosure per se, it is the number of accepting and rejecting reactions in response to disclosure that are critical to understanding substance use among LGB youths. Further, the results suggest that to be maximally effective, substance use prevention and treatment efforts should address rejecting reactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)