Gay affirmative psychotherapy

Last updated February 09, 2024

Gay affirmative psychotherapy is a form of psychotherapy for non-heterosexual people, specifically gay and lesbian clients, which focuses on client comfort in working towards authenticity and self-acceptance regarding sexual orientation, and does not attempt to "change" them to heterosexual, or to "eliminate or diminish" same-sex "desires and behaviors". The American Psychological Association (APA) offers guidelines and materials for gay affirmative psychotherapy.^[1] Affirmative psychotherapy affirms that homosexuality or bisexuality is not a mental disorder, in accordance with global scientific consensus. In fact, embracing and affirming gay identity can be a key component to recovery from other mental illnesses or substance abuse.^[1] Clients whose religious beliefs are interpreted as teaching against homosexual behavior may require some other method of integration of their possibly conflicting religious and sexual selves.^[2]

Guidelines

For many years, psychiatry viewed homosexuality as a mental illness. Current guidelines instead encourage psychotherapists to assist patients in overcoming the stigma of homosexuality rather than try to change their sexual orientation.^[1]^[3]^[4]

Because some mental health professionals are unfamiliar with the social difficulties of the coming out process, particular to other factors such as age, race, ethnicity, or religious affiliation, they are encouraged by the APA to learn more about how gay, lesbian, and bisexual clients face discrimination in its various forms. Many LGBTQ people are rejected from their own families and form their own familial relationships and support systems that may also be unfamiliar to mental health professionals, who are encouraged to take into account the diversity of extended relationships in lieu of family.^[1] In gay affirmative psychotherapy, psychologists are encouraged to recognize how their attitudes and knowledge about homosexual and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated. Psychologists strive to understand the ways in which social stigmatization (i.e., prejudice, discrimination, and violence) poses risks to the mental health and well-being of homosexual and bisexual clients. Psychologists strive to understand how inaccurate or prejudicial views of homosexuality or bisexuality may affect the client's presentation in treatment and the therapeutic process.^[1]

Research

The term "gay affirmative therapy" was coined and defined by Alan K. Malyon in 1982 as therapy that challenges the pathological view of homosexuality and has the therapist develop knowledge on gay-specific issues to better treat gay clients.^[5] This was five years before ego-dystonic homosexuality was removed from the DSM. This model works to consider the effects of sexuality-based oppression and discrimination on gay individuals' and couples' mental health^[6]^[7] and affirm individuals in their sexuality-specific experiences.^[8]

Religious considerations

One of the emerging areas of research regarding gay affirmative psychotherapy is related to the process of assisting LGBTQ individuals from religious backgrounds feel comfortable with their sexual and gender orientation. Narrative analyses of clinicians' reports regarding gay affirmative psychotherapy suggest that the majority of conflicts discussed within the therapeutic context by gay men and their relatives from religious backgrounds are related to the interaction between family, self, and religion. Clinicians report that gay men and their families struggle more frequently with the institution, community, and practices of religion rather than directly with God. Chana Etengoff and Colette Daiute report in the Journal of Homosexuality that clinicians most frequently address these tensions by emphasizing the mediational strategies of increasing self-awareness, seeking secular support (e.g., PFLAG), and increasing positive communication between family members.^[9]

For some clients, acting on same-sex attraction may not be a fulfilling solution as it may conflict with their religious beliefs; licensed mental health providers may approach such a situation by neither rejecting nor promoting celibacy.^[10] Douglas Haldeman has argued that for individuals who seek therapy because of frustration surrounding "seemingly irreconcilable internal differences" between "their sexual and religious selves ... neither a gay-affirmative nor a conversion therapy approach [may be] indicated," and that "[just as] therapists in the religious world [should] refrain from pathologizing their LGB clients ... so, too, should gay-affirmative practitioners refrain from overtly or subtly devaluing those who espouse conservative religious identities."^[11] Data suggest that clients generally judge therapists who do not respect religiously-based identity outcomes to be unhelpful.^[12]

Youth and families

In recent years gay affirmative therapy has been adapted for youth populations who are struggling with their sexuality. Research has shown that sexual minority children and adolescents are more likely to develop depression, anxiety, substance use disorders, and attempt suicide.^[13] Affirmation of one's sexual orientation and experiences has shown to be effective in treating related mental health concerns [cite]. Cognitive Behavioral Therapy (CBT) has the most supportive evidence for treating general LGBTQ+ populations^[14] and has been extended to youth populations as well.^[15] It is currently considered by some psychologists as the best evidence-based practice for working with sexual minority youth.^[15]^[16]

There is currently little research on affirmative interventions for families,^[17] and most research focuses on lesbian, gay, and bisexual individuals becoming parents, with implications that transition to parenting training might be beneficial for sexual minority parents.^[17] Little research has been done on family therapy for sexual minority youth and family support.^[17]

German government action

In March 2008, the German federal government (CDU/SPD) summarized the professional consensus as indicating that homosexuality is not an illness, and that conversion therapy is dangerous and doesn't help homosexual people. Voluntary changes to sexual orientation are not an option, according to the administration's answer to parliamentary questioning, as these attempts may cause personal harm.^[18] The German government also made the point that Gay Affirmative Psychotherapy can help clients.^[18]

Literature

Adelman, M. (1990). Stigma, gay lifestyles, and adjustment to aging: A study of later-life gay men and lesbians. Journal of Homosexuality, 20(3-4), 7-32.
Allen, M., & Burrell, N. (1996). Comparing the impact of homosexual and heterosexual parents on children: Meta-analysis of existing research. Journal of Homosexuality, 32(2), 19-35.
Allison, K., Crawford, I., Echemendia, R., Robinson, L., Knepp, D. (1994). Human diversity and professional competence: Training in clinical and counseling psychology revisited. American Psychologist, 49, 792-796.
American Psychological Association. (1998). Appropriate therapeutic responses to sexual orientation in the proceedings of the American Psychological Association, Incorporated, for the legislative year 1997. American Psychologist, 53(8), 882-939.
Browning, C. (1987). Therapeutic issues and intervention strategies with young adult lesbian clients: A developmental approach. Journal of Homosexuality, 14(1/2), 45-52.
Buhrke, R. (1989). Female student perspectives on training in lesbian and gay issues. Counseling Psychologist, 17, 629-636.
Cabaj, R., & Klinger, R. (1996). Psychotherapeutic interventions with lesbian and gay couples. In R. Cabaj & T. Stein (Eds.), Textbook of homosexuality and mental health (pp. 485–502). Washington, DC: American Psychiatric Press.
Canadian Psychological Association. (1995). Canadian code of ethics for psychologists. [On-line]. Available: http://www.cycor.ca/Psych/ethics/html%5B%5D
Cornett, C. (1993). Affirmative Dynamic Psychotherapy With Gay Men. New York: Jason Aronson Press. ISBN 978-1-56821-001-8
Etengoff, Chana; Daiute, Colette (2015). "Clinicians' Perspective of the Relational Processes for Family and Individual Development During the Mediation of Religious and Sexual Identity Disclosure". Journal of Homosexuality. 62 (3): 394–426. doi:10.1080/00918369.2014.977115. PMID 25364980. S2CID 10971273.
Richard Isay, (1993). Schwul sein. Die psychologische Entwicklung des Homosexuellen. München: Piper. ISBN 3-492-11683-3 (Original 1989: Being homosexual. Gay men and their development. New York: Farrar, Straus, and Giroux.)
Journal of Gay & Lesbian Psychotherapy, Homosexuality and Psychoanalysis revisited, 2002, 6. ed., Nr. 1
Lebolt, J. (1999). Gay affirmative psychotherapy: A phenomenological study. Clinical Social Work, 27 (4), 355-370.
Pachankis, J. E., & Goldfried, M. R. (2004). Clinical issues in working with lesbian, gay, and bisexual clients. Psychotherapy: Theory, Research, Practice, and Training, 41, 227-246.
Udo Rauchfleisch, (2002). Gleich und doch anders: Psychotherapie und Beratung von Lesben, Schwulen, Bisexuellen und ihren Angehörigen. Stuttgart: Klett-Cotta. ISBN 3-608-94236-X
Kathleen Ritter and Anthony Terndrup, (2002). Handbook of Affirmative Psychotherapy with Lesbians and Gay Men. New York: Guilford. ISBN 1-57230-714-5

Related Research Articles

The National Association for Research & Therapy of Homosexuality (NARTH), also known as the NARTH Institute, is a US organization that promotes conversion therapy, a pseudoscientific practice used in attempts to change the sexual orientation of people with same-sex attraction. NARTH was founded in 1992 by Joseph Nicolosi, Benjamin Kaufman, and Charles Socarides. Its headquarters were in Encino, California, at its Thomas Aquinas Psychological Clinic. It has operated under the name Alliance for Therapeutic Choice and Scientific Integrity (ATCSI) since 2014. NARTH is not recognized by any major United States-based professional association.

The field of psychology has extensively studied homosexuality as a human sexual orientation. The American Psychiatric Association listed homosexuality in the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1952, but that classification came under scrutiny in research funded by the National Institute of Mental Health. That research and subsequent studies consistently failed to produce any empirical or scientific basis for regarding homosexuality as anything other than a natural and normal sexual orientation that is a healthy and positive expression of human sexuality. As a result of this scientific research, the American Psychiatric Association declassified homosexuality as a mental disorder in 1973. Upon a thorough review of the scientific data, the American Psychological Association followed in 1975 and also called on all mental health professionals to take the lead in "removing the stigma of mental illness that has long been associated" with homosexuality. In 1993, the National Association of Social Workers adopted the same position as the American Psychiatric Association and the American Psychological Association, in recognition of scientific evidence. The World Health Organization, which listed homosexuality in the ICD-9 in 1977, removed homosexuality from the ICD-10 which was endorsed by the 43rd World Health Assembly on 17 May 1990.

Sexual identity refers to one's self-perception in terms of romantic or sexual attraction towards others, though not mutually exclusive, and can be different to romantic identity. Sexual identity may also refer to sexual orientation identity, which is when people identify or dis-identify with a sexual orientation or choose not to identify with a sexual orientation. Sexual identity and sexual behavior are closely related to sexual orientation, but they are distinguished, with identity referring to an individual's conception of themselves, behavior referring to actual sexual acts performed by the individual, and sexual orientation referring to romantic or sexual attractions toward persons of the opposite sex or gender, the same sex or gender, to both sexes or more than one gender, or to no one.

Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

<span class="mw-page-title-main">Joseph Nicolosi</span> American clinical psychologist (1947–2017)

Joseph Nicolosi was an American clinical psychologist who advocated and practised "reparative therapy", a form of the pseudoscientific treatment of conversion therapy that he claimed could help people overcome or mitigate their homosexual desires and replace them with heterosexual ones. Nicolosi was a founder and president of the National Association for Research and Therapy of Homosexuality (NARTH). Medical institutions warn that conversion therapy is ineffective and may be harmful, and that there is no evidence that sexual orientation can be changed by such treatments.

Gender variance or gender nonconformity is behavior or gender expression by an individual that does not match masculine or feminine gender norms. A gender-nonconforming person may be variant in their gender identity, being transgender or non-binary, or they may be cisgender. In the case of transgender people, they may be perceived, or perceive themselves as, gender-nonconforming before transitioning, but might not be perceived as such after transitioning. Transgender adults who appear gender-nonconforming after transition are more likely to experience discrimination.

Homosexuality is a sexual attraction, romantic attraction, or sexual behavior between members of the same sex or gender. As a sexual orientation, homosexuality is "an enduring pattern of emotional, romantic, and/or sexual attractions" exclusively to people of the same sex or gender. It "also refers to a person's sense of identity based on those attractions, related behaviors, and membership in a community of others who share those attractions."

Ego-dystonic sexual orientation is a highly controversial mental health diagnosis that was included in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) from 1980 to 1987 and in the World Health Organization's (WHO) International Classification of Diseases (ICD) from 1990 to 2019. Individuals could be diagnosed with ego-dystonic sexual orientation if their sexual orientation or attractions were at odds with their idealized self-image, causing anxiety and a desire to change their orientation or become more comfortable with it. It describes not innate sexual orientation itself, but a conflict between the sexual orientation a person wishes to have and their actual sexual orientation.

<span class="mw-page-title-main">Charles Silverstein</span> American LGBTQ activist (1935–2023)

Charles Silverstein was an American writer, therapist, and LGBT rights advocate. He was best known for his presentation as a graduate student before the American Psychiatric Association in 1973 that led to the removal of homosexuality as a mental illness from the organization's Diagnostic and Statistical Manual. He was also the founding editor-in-chief of the Journal of Homosexuality.

<span class="mw-page-title-main">History of psychotherapy</span>

Although modern, scientific psychology is often dated from the 1879 opening of the first psychological clinic by Wilhelm Wundt, attempts to create methods for assessing and treating mental distress existed long before. The earliest recorded approaches were a combination of religious, magical and/or medical perspectives. Early examples of such psychological thinkers included Patañjali, Padmasambhava, Rhazes, Avicenna and Rumi.

Sexual Identity Therapy (SIT) is a framework to "aid mental health practitioners in helping people arrive at a healthy and personally acceptable resolution of sexual identity and value conflicts." It was invented by Warren Throckmorton and Mark Yarhouse, professors at small conservative evangelical colleges. It has been endorsed by former American Psychological Association president Nick Cummings, psychiatrist Robert Spitzer, and the provost of Wheaton College, Stanton Jones. Sexual identity therapy puts the emphasis on how the client wants to live, identifies the core beliefs and helps the client live according to those beliefs. The creators state that their recommendations "are not sexual reorientation therapy protocols in disguise," but that they "help clients pursue lives they value." They say clients "have high levels of satisfaction with this approach". It is presented as an alternative to both sexual orientation change efforts and gay affirmative psychotherapy.

Jack Drescher is an American psychiatrist and psychoanalyst known for his work on sexual orientation and gender identity.

Sexual fluidity is one or more changes in sexuality or sexual identity. Sexual orientation is stable and unchanging for majority of people, but some research indicates that some people may experience change in their sexual orientation, and this is slightly more likely for women than for men. There is no scientific evidence that sexual orientation can be changed through psychotherapy. Sexual identity can change throughout an individual's life, and does not have to align with biological sex, sexual behavior, or actual sexual orientation.

Arlene Istar Lev is a North American clinical social worker, family therapist, and educator. She is an independent scholar, who has lectured internationally on topics related to sexual orientation and gender identity, sexuality, and LGBTQ families.

LGBT psychology is a field of psychology of surrounding the lives of LGBTQ+ individuals, in the particular the diverse range of psychological perspectives and experiences of these individuals. It covers different aspects such as identity development including the coming out process, parenting and family practices and support for LGBTQ+ individuals, as well as issues of prejudice and discrimination involving the LGBT community.

Beverly Greene is a professor in the Department of Psychology at St. John's University. She is a clinical psychologist known for her work on sexism, racism, and analyzing the intersectionality of social identities. As a specialist in the psychology of women and of gender and racial issues in the practice of psychotherapy, Greene has also created many public health frameworks for understanding mental health in marginalized communities. She is the author of close to 100 psychological literature publications. Greene is involved with the Association for Women in Psychology and the Society for the Psychology of Women. She is one of sixteen women to have received the Distinguished Publication Award (DPA) from the Association for Women in Psychology in 2008.

John E. Pachankis is an American clinical psychologist. He is the Susan Dwight Bliss Professor at the Yale School of Public Health. His research has examined the nature of stigma and its impact on mental health and social functioning. He specifically studies the psychological experiences of LGBT individuals, including processes of identity formation and identity concealment; the cognitive, emotional, and behavioral consequences of stigma-based rejection and exclusion; and affirmative mental health treatments for LGBT populations.

LGBT trauma is the distress an individual experiences due to being a lesbian, gay, bisexual, trans, queer person or from possessing another minoritized sexual or gender identity. This distress can be harmful to the individual and predispose them to trauma- and stressor-related disorders.

Many health organizations around the world have denounced and criticized sexual orientation and gender identity change efforts. National health organizations in the United States have announced that there has been no scientific demonstration of conversion therapy's efficacy in the last forty years. They find that conversion therapy is ineffective, risky and can be harmful. Anecdotal claims of cures are counterbalanced by assertions of harm, and the American Psychiatric Association, for example, cautions ethical practitioners under the Hippocratic oath to do no harm and to refrain from attempts at conversion therapy.

Winn Kelly Brooks was an American researcher and scholar in the field of minority stress theory. She is recognized as a pioneer of the concept of minority stress in sexual minority populations. Brooks completed a Doctorate in Social Work (DSW) and Social Welfare at University of California-Berkeley and published Minority Stress and Lesbian Women in 1981.

References

1 2 3 4 5 American Psychological Association. (2011). Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. Accessed March 7, 2022.
↑ Haldeman, Douglas (2004). "When Sexual and Religious Orientation Collide:Considerations in Working with Conflicted Same-Sex Attracted Male Clients". The Counseling Psychologist. 32 (5): 691–715. doi:10.1177/0011000004267560. S2CID 145278059.
↑ Australian Psychological Society. (2014). Ethical guidelines for psychological practice with lesbian, gay, and bisexual clients.
↑ Meg-John Barker. (2019). Good Practice across the Counselling Professions 001: Gender, sexual, and relationship diversity. British Association for Counselling and Psychotherapy.
↑ Malyon, Alan K. (1982). "Psychotherapeutic implications of internalized homophobia in gay men". Journal of Homosexuality. 7 (2–3): 59–69. doi:10.1300/J082v07n02_08. PMID 7346549 – via EBSCO.
↑ Harrison, Nigel (2000). "Gay affirmative therapy: a critical analysis of the literature". British Journal of Guidance & Counselling. 28: 37–53. doi:10.1080/030698800109600. S2CID 144277256 – via EBSCO.
↑ Meyer, Ilhan (2003). "Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence". Psychological Bulletin. 129 (5): 674–697. doi:10.1037/0033-2909.129.5.674. PMC 2072932 . PMID 12956539.
↑ Langdridge, Darren (October 21, 2008). "Gay Affirmative Therapy: A Theoretical Framework and Defence". Journal of Gay & Lesbian Psychotherapy. 11 (1–2): 27–43. doi:10.1300/J236v11n01_03. S2CID 144382313.
↑ Etengoff, Chana; Daiute, Colette (2015). "Clinicians' Perspective of the Relational Processes for Family and Individual Development During the Mediation of Religious and Sexual Identity Disclosure". Journal of Homosexuality. 62 (3): 394–426. doi:10.1080/00918369.2014.977115. PMID 25364980. S2CID 10971273.
↑ Appropriate Therapeutic Responses to Sexual Orientation
↑ Haldeman, Douglas (2004). "When Sexual and Religious Orientation Collide:Considerations in Working with Conflicted Same-Sex Attracted Male Clients". The Counseling Psychologist. 32 (5): 691–715. doi:10.1177/0011000004267560. S2CID 145278059.
↑ Throckmorton, Warren; Welton (Winter 2005). "Counseling practices as they relate to ratings of helpfulness by consumers of sexual reorientation therapy" (PDF). Journal of Psychology and Christianity. 24 (4): 332–42. Archived from the original (PDF) on 2008-10-01.
↑ Meyer, Ilhan (2003). "Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence". Psychological Bulletin. 129 (5): 674–697. doi:10.1037/0033-2909.129.5.674. PMC 2072932 . PMID 12956539.
↑ Iwamasa, Gayle (2019). Culturally responsive cognitive behavior therapy: Practice and supervision., 2nd ed. American Psychological Association. pp. 287–314. ISBN 978-1433830167.
1 2 Craig, Shelley (December 22, 2012). "Gay Affirmative Cognitive Behavioral Therapy for Sexual Minority Youth: A Clinical Adaptation". Clinical Social Work Journal. 41 (3): 258–266. doi:10.1007/s10615-012-0427-9. S2CID 144141802.
↑ Safren, Steven (2001). "Cognitive-behavioral therapy with lesbian, gay, and bisexual youth". Cognitive and Behavioral Practice. 8 (3): 215–223. doi:10.1016/S1077-7229(01)80056-0.
1 2 3 Pachankis, John (April 2019). Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities. Oxford University Press. pp. 115–145. ISBN 9780190669300.
1 2 Bundestag: Answer of German government