Gay affirmative psychotherapy

Gay affirmative psychotherapy is a form of psychotherapy for non-heterosexuals, 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 states that homosexuality or bisexuality is not a mental illness, 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] 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 gays and lesbians 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] 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.[3]

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.[4] This was 5 years before homosexuality was removed from the DSM in 1987. This model works to consider the effects of sexuality-based oppression and discrimination on gay individuals and couples mental health[5][6] and affirm the individual in their sexuality-specific experiences.[7]  

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.[8]

Gay Affirmative Therapy for 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.[9] 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[10] and has been extended to youth populations as well.[11] It is currently considered by some psychologists as the best evidence-based practice for working with sexual minority youth.[11][12]

There is currently little research on affirmative interventions for families,[13] 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.[13] Little research has been done on family therapy for sexual minority youth and family support.[13]

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.[14] The German government also made the point that Gay Affirmative Psychotherapy can help clients.[14]

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

References
  1. APA:Guidelines for Psychotherapy with Lesbian, Gay, & Bisexual Clients
  2. 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.
  3. Appropriate Therapeutic Responses to Sexual Orientation
  4. 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.
  5. 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.
  6. Meyer, Ilhan (2003). "Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence". American Psychological Association. 129 (5): 674–697. doi:10.1037/0033-2909.129.5.674. PMC 2072932. PMID 12956539.
  7. Langdridge, Darren (October 21, 2008). "Gay Affirmative Therapy: A Theoretical Framework and Defence". Journal of Gay and Lesbian Psychotherapy. 11 (1–2): 27–43. doi:10.1300/J236v11n01_03. S2CID 144382313.
  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.
  9. Meyer, Ilhan (2003). "Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence". American Psychological Association. 129 (5): 674–697. doi:10.1037/0033-2909.129.5.674. PMC 2072932. PMID 12956539.
  10. Iwamasa, Gayle (2019). Culturally responsive cognitive behavior therapy: Practice and supervision., 2nd ed. American Psychological Association. pp. 287–314. ISBN 978-1433830167.
  11. 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.
  12. 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.
  13. Pachankis, John (April 2019). Handbook of Evidence-Based Mental Health Practice with Sexual and Gender Minorities. Oxford University Press. pp. 115–145. ISBN 9780190669300.
  14. Bundestag: Answer of German government
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