In the course of our clinical practice, it is not unusual to work with clients who are lesbian, gay, or bisexual (LGB). Indeed it has been found that LGB individuals are more likely to make use of psychotherapy than are heterosexuals (Bieschke, McClanahan, Tozer, Grzegorek, & Park, 2000). This is also true of same-sex couples, in that approximately one-half of lesbian couples and close to one-third of same-gender male couples indicate that they have sought professional help for relationship issues (R.-J. Green, 2000).
The reason for this greater use of therapeutic services comes from the fact that sexual minorities not only have to deal with the same issues confronting heterosexual individuals and couples, but are additionally confronted with life stressors associated with their being LGB in our society. To make matters worse, LGB clients have a history of being seen by therapists who acknowledge that they do not feel totally prepared to work with gay men and lesbians (Doherty & Simmons, 1996; Garnets, Hancock, Cochran, Goodchilds, & Peplau, 1991).
Why is this so? The unfortunate fact of the matter is that mainstream psychology has traditionally ignored the clinical and research work that has been done with sexual minorities--much to the detriment of the field in general and practicing therapists in particular (Goldfried, 2001). The relevant writings on LGB issues that have remained virtually invisible in the mainstream literature includes clinical and research work on development; aging; teenage suicide; substance abuse; victimization and abuse; couple relationships; and family issues. For example, much has been written in the mainstream literature about the ways that adolescents struggle to form their identity, but ignored are those unique development tasks faced by LGB teenagers in forming their own unique identity.
This tendency to be unaware of important issues facing LGB individuals is precisely why the AFFIRM network has come into being in psychology. Recognizing the very important role that family plays in the lives of lesbian, gay, bisexual, and transgender (LGBT) individuals, a number of psychologists have formed AFFIRM: Psychologists Affirming their Lesbian, Gay, Bisexual, and Transgender Family. AFFIRM was established not only to provide open support for family members, but also to support clinical and research work on LGBT issues within psychology. Thanks to the Internet and e-mail, well over 750 psychologists having GLB family members have joined AFFIRM.
It is difficult to imagine a more visible current social issue than LGBT rights. The issues range from same-sex marriage to the ordination of LGBT clergy, from same-sex adoption to “don’t ask, don’t tell.” Regardless of the outcome of the social debates and proposed legislation currently affecting LGBT individuals, one thing is clear—LGBT individuals are no longer a hidden minority. From television characters to politicians, from family members to neighbors, more and more LGBT individuals are making themselves visible.
It is not surprising that with this increased visibility comes the increased likelihood that we as therapists will continue to encounter LGBT individuals who seek our professional help. Sexual minorities present with the usual mental health concerns in addition to some unique concerns, such as victimization, internalized homophobia, family rejection, identity development, coming out, stress related to legal and financial constraints in their lives--just to name a few.
Some professionals may suggest that no special knowledge is necessary to work with an LGBT client, that an intelligent, compassionate stance is sufficient. Unfortunately, this is not so. It is easy to erroneously conclude that a gay man who dreads going to work on Monday dislikes his job, when he might actually feel apprehensive about answering questions about how he spent the weekend.
Surveys have indicated that large numbers of LGBT individuals have been adversely affected by their therapy experiences (Garnets et al., 1991). Given the lack of exposure to LGB issues in graduate school, we may not feel totally adequate in working with LGBT clients. Recent surveys of clinical and counseling psychology students suggest that the students we train do not feel prepared to address the unique concerns with which LGBT individuals present (Anhalt, Morris, Scotti, & Cohen 2003; Murphy, Rawlings, & Howe, 2002; Phillips & Fischer, 1998).
Graduate students have been so concerned about the lack of LGBT-related coverage in their coursework that they submitted a memo on behalf of the APA Graduate Student organization (APAGS) to the Committee on Accreditation (CoA), urging that the CoA more carefully monitor the inclusion of LGBT-related content in graduate coursework as part of the diversity requirement.
It would indeed be unfortunate if our profession remained under-prepared to work with a group of individuals who seek our services in great numbers. Given our field’s historically less-than-helpful treatment of LGBT individuals, the continued lack of preparation in working with LGBT clients is especially discouraging. Recognizing the promise that our profession possesses for improving the lives of LGBT individuals through LGBT-affirmative treatment, the ARCUS Foundation National LGBT Fund has provided funding for AFFIRM to promote greater inclusion of readings on LGBT issues in graduate psychology curriculum. Working together with the APA Society for the Psychological Study of LGB Issues (Division 44), AFFIRM has put together a carefully selected list of readings on LGB issues and sent them to Directors of Clinical Training asking them to distribute it to their faculty. The topics covered include child/development, couples/family, ethics, psychopathology, and therapy.
In order to make these references available to an even larger audience—especially practicing therapists-- AFFIRM has also posted them on its Web site, together with Abstracts for each. I invite you to visit the AFFIRM Web site at: www.sunysb.edu/affirm. Go to “Announcements” for further information on the project, and then click on “Bibliographies.” To facilitate ease of use, a PDF can be obtained for each reading through PsycINFO or by contacting the author. If that doesn’t work, you can obtain a copy by emailing marvin.goldfried@sunysb.edu.
Author Note
Correspondence concerning this article should be addressed to Marvin R. Goldfried, Department of Psychology, Stony Brook University, Stony Brook, New York, 11794-2500. Electronic mail may be sent to marvin.goldfried@sunysb.edu.
References
Anhalt, K., Morris, T.L., Scotti, J.R., and Cohen, S.H. (2003). Student perspectives on training in gay, lesbian, and bisexual issues: A survey of behavioral clinical psychology programs. Cognitive and Behavioral Practice, 10, 255-263.
Bieschke, K. J., McClanahan, M., Tozer, E., Grzegorek, J. L, & Park, J. (2000). Programmatic research on the treatment of lesbian, gay, and bisexual clients: The past, the present, and the course of the future. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, and bisexual clients (pp.207-223). Washington, DC: American Psychological Association.
Doherty, W. J., & Simmons, D. S. (1996). Clinical practice patterns of marriage and family therapists: A national survey of therapists and their clients. Journal of Marital & Family Therapy, 22, 9-25.
Garnets, L., Hancock, K. A., Cochran, S. D., Goodchilds, J., & Peplau, L. A. (1991). Issues in psychotherapy with lesbians an gay men: A survey of psychologists. American Psychologist, 46, 964-972.
Goldfried, M. R. (2001). Integrating gay, lesbian, an bisexual issues into mainstream psychology. American Psychologist, 56, 977-988.
Green, R.-J. (2000). Lesbians, gays, and family psychology: Resources for teaching and practice. In B. Green, & G. C. Croom (Eds.), Education, research, and practice in lesbian, gay bisexual, and transgendered psychology: A resource manual (pp. 207-225). Thousand Oaks, CA: Sage.
Murphy, J.A., Rawlings, E.I., & Howe, S.R. (2002). A Survey of Clinical Psychologists on Treating Lesbian, Gay, and Bisexual Clients. Professional Psychology: Research and Practice, 33, 183-189.
Phillips, J. C., & Fischer, A. R. (1998). Graduate students’ training experiences with lesbian, gay, and bisexual issues. Counseling Psychologist, 26, 712–734.
