Family therapist comfort with and willingness to discuss client sexuality

Limited empirical information exists on whether or not marriage and family therapists are having sexuality-related discussions with their clients. When helping professionals ignore client sexuality, the potential for unintended negative outcomes increases. The researchers surveyed 175 clinical members of the American Association for Marriage and Family Therapy to assess how their clinical training and education, their perceived sexual knowledge, and their comfort with sexual material influenced their willingness to engage in sexuality-related discussions with their clients. The results indicate that sexuality education and supervision experiences are the cornerstone for a therapist's base level of comfort. It is through sexuality education and supervision that sex knowledge is acquired and comfort levels are increased. Once comfort with sexual discussions increases, then therapists are more likely to engage in sexuality discussions with their clients.     

Boundary Issues in Gay and Lesbian Psychotherapy Relationships

Abstract

Gay and lesbian psychotherapists face unique challenges when working with clients who also identify as gay or lesbian. Of particular importance are the roles professional boundaries play in working with sexual minorities. For example, clinicians must decide whether it is in the client's best interests to know the therapist is gay. Issues of contact outside of the therapy hour also become important, particularly when the therapist lives in a small community, or otherwise risks the possibility of seeing the client in the community. This chapter addresses some of these issues, and poses options for therapists on how to minimize professional boundary or ethical violations.     

Coming Out in a School Setting

Abstract

The present study was conducted to learn more about the experiences of gay men and lesbians in educational settings, particularly about experiences relevant to disclosure of their sexual orientation. One hundred six gay men and 156 lesbian women responded to an anonymous questionnaire dealing with how their sexual orientation had affected their experiences in school.

As students, very few respondents had chosen to disclose their sexual orientation to principals, teachers, counselors, or friends. Reasons cited for nondisclosure included fear of the consequences and not wanting others to know. The majority of those who did disclose their sexual orientation received positive feedback for doing so, but respondents reported both positive and negative consequences of coming out. Gay men were aware of their sexual orientation at an earlier age than lesbians and were somewhat more likely to recommend disclosure to principals and teachers. Females were more likely to disclose only to females, whereas males were likely to come out to both males and females. Generally, the similarities between males and females were greater than the differences, with both groups being cautious about coming out in the school setting.     

Coming out of the Therapy Closet: Women’s Disclosure of Same-sex Attraction in Counselling

“Coming out” is a process that same-sex attracted people undergo if they choose to acknowledge it to others. Minimal research exists examining the coming-out experience for same-sex attracted women in counselling settings. This qualitative study addressed the gaps in existing research by exploring counsellors’ perceptions of factors influencing same-sex attracted female clients to disclose their sexual orientation to a counsellor. Semi-structured interviews were conducted with 10 counsellors from diverse clinical backgrounds. In their view, the main factors influencing disclosure were the perceived lesbian, gay, bisexual, and queer (LGBQ) friendliness of a service or counsellor; the presence of LGBQ symbols within services; using gender-neutral language; and the level of a client’s self-acceptance of their sexual orientation. These findings suggest that the utilisation of culturally affirming models by counsellors working with same-sex attracted female clients can create a safe environment for disclosure of sexual orientation.     

THERAPIST AND CLIENT BEHAVIORS IN THE FIRST INTERVIEW: EFFECGTS ON SESSION IMPACT AND TREATMENT DURATION

The first-session behaviors of therapists and clients in 38 cases were observationally codes and their relations to client ratings of session impact and treatment duration were examined. Results indicated that few first-session global types of behaviors of participants affect treatment durations. Clients may suspend judgement about continuing in therapy untill after they have attended more than one session, regardless of the first inverview's impact. Thus, the first interview may be less crucial than traditionally asserted. It also appears that first-session behaviors of therapists and clients that are associated with greater impact may vary as a function of client type, that is individuals as opposed to couples and families.     

HIV and family therapists' duty to warn: a legal and ethical analysis

In the absence of definitive legal precedents, family therapists must decide whether to warn sexual partners of HIV-positive clients when clients themselves refuse to do so. Deciding whether to break confidentiality reaises both legal and ethical issues. Legally, the Tarasoff ruling requires therapists to warn potential victims of illegal dangers posed by clients but does not require therapists to warn potential victims of dangers posed by their clients' legally permissible actions. unless the behavior of the seropositive client is proscribed by state law, warning the clients' partners does not fall within the scope of the Tarasoff ruling. Ethically, therapists must negotiate and adhere to a disclosure policy that balances considerations of respecting autonomy, maintaining integrity (avoiding fraud and betrayal), benefiting clients, and fostering responsibility. Some therapeutic and ethical aspects of these considerations are discussed.     

Behind Closed Doors: An Exploration of Kinky Sexual Behaviors in Urban Lesbian and Bisexual Women

This study of 347 urban, self-identified lesbian (n = 289) and bisexual (n = 58) women examined women's engaging in 4 kinky sexual behaviors: bondage/domination, sadomasochism, photo/video exhibitionism, and asphyxiation/breath play. A cross-sectional, brief-intercept survey was administered at 2 New York City gay, lesbian, and bisexual community events. Over 40% reported engaging in at least 1 of these behaviors, and 25% reported engaging in multiple behaviors. Bisexual women were more likely to have engaged in any kinky sexual behavior and photo/video exhibitionism. White women were more likely than women of color to have engaged in bondage/domination. Compared to older women, younger women were more likely to have engaged in photo/video exhibitionism and asphyxiation/breath play. Participants who were younger when they came out to others, and younger at their same-sex sexual debut, were more likely to have engaged in any and each of the behaviors compared to women who were older at those developmental events.     

An Investigation of the Incidence of Client-Perpetrated Sexual Violence Against Male Sex Workers

ABSTRACT

This article discusses exploratory research investigating the incidence and context of client-perpetrated sexual violence against male sex workers. Four different methods (Web-based surveys, tick-box questionnaires, telephone, and face-to-face interviews) were employed in this study of 50 male escorts. The qualitative data were analyzed using an adapted form of grounded theory. It was found that client-perpetrated sexual violence within male sex work appears to be uncommon. However, when sexual violence did occur the cause was a disagreement over barebacking. Escorts’ explanations for the low level of sexual violence within this sector included (1) that gay men were non-confrontational, (2) their clients led clandestine lifestyles avoiding undue attention, and (3) comparatively, female sex workers were perceived to be more vulnerable resulting in the higher level of sexual violence within the female sex work industry.     

Sexual Compulsivity and Sexual Behaviors Among Gay and Bisexual Men and Lesbian and Bisexual Women

Within the existing body of research, the information pertaining to sexual compulsivity (SC) among women, both homo- and heterosexual, remains rather limited in comparison to men. The aim of this study was to assess the prevalence of SC in a community sample of gay and bisexual men and lesbian and bisexual women and to identify differences in sexual practices based on classification as sexually compulsive within gender. Supporting previous research, the findings indicated that gay and bisexual men were significantly higher in SC when compared to lesbian and bisexual women. Similarly, sexually compulsive gay and bisexual men were more likely to report drug use with sex than their non-sexually compulsive peers, suggesting that “party n' play” may play a larger role for men with SC. In addition, the findings demonstrated empirical support for the proposition that lesbian and bisexual women with symptoms of SC were more likely to engage in specialized sexual behaviors in comparison to their non-sexually compulsive peers. These data suggest that SC manifests differently in gay, lesbian, and bisexual men and women.     

To Refer or Not to Refer: Exploring Family Therapists' Beliefs and Practices Related to the Referral of Lesbian,Gay, and Bisexual Clients

This study explored how negative beliefs toward lesbian, gay, and bisexual (LGB) individuals and LGB clinical competence influenced family therapists' beliefs and practices regarding referring based on the sexual orientation of the client. The sample consisted of 741 experienced clinicians. The results of this study indicated that the majority of the participants believe it is ethical to refer LGB clients; however, most had never made such a referral. Furthermore, participants who had referred based solely on the client's sexual orientation reported higher levels of negative beliefs toward LGB individuals and lower levels of LGB clinical competence. Finally, negative beliefs toward LGB persons not only predicted the practice of referring, but also the belief that it is ethical to refer an LGB client.     

The role of sexual behavior in the identification process of gay and bisexual males

This study examined the role of same‐sex sexual behavior in the identification and coming‐out process among three cohorts of gay and bisexual males. The sequence through which the males identified their same‐sex attractions was coded as either sex‐centered (labeling of sexual identity after first same‐sex sexual encounter) or identity‐centered (labeling of sexual identity before engaging in sex with males). The project tested whether developmental sequence was a significant predictor of later adjustment to sexual identity and relationship involvement. Findings demonstrate that the proportion of sex‐centered males decreased as a function of age cohort. Moreover, sex‐centered males reported higher levels of homophobia toward other males, more lifetime sexual partners, and more heterosexual sexual and romantic relationships. Thus, the route males take to identify and label their sexual identity is a good predictor of future adjustment and relationship involvement.     

Negative attitudes,nonverbal behavior and self-fulfilling prophecy in simulated therapy interviews

This research investigated if interpersonal expectancies in a psychotherapeutic context were mediated through nonverbal behavior. Beginning (male) therapists served as interviewers and interacted with (male) subjects who were introduced as clients (who were treated for psychological problems) or normal students. It was hypothesized that the therapists would have a more negative attitude toward the supposed clients than toward the nonclients and show more arm position symmetry and less forward lean toward the supposed clients. The interviewees were predicted to show more ah-filled pauses, speech disturbances, and less looking at the interviewers in the client condition than in the nonclient condition. The results demonstrated that therapists had more negative expectancies toward supposed clients than toward nonclients. Support was shown for the hypothesis that more arm position symmetry would be shown in the client condition than in the nonclient condition. The results also indicated that supposed clients used more ah-filled pauses and speech disturbances than nonclients. The therapists used this information when they attributed more discomfort to the supposed clients. It is suggested that the findings of this study have implications for understanding the process of self-fulfilling prophecy in a therapeutic context.     

Older Lesbians and Gays Accessing Health and Aged-Care Services

Abstract

The present paper examines older lesbian and gay people's experiences of and expectations for the delivery of health and aged-care services. In-depth narrative interviews were conducted with older gays and lesbians in the Blue Mountains, west of Sydney (NSW, Australia). Data were analysed by identifying evaluative statements within specific narratives and grouping these statements into themes. Participants reflected on the meaning of their sexual identity and how they would like it to be acknowledged when in contact with health and aged-care service providers. In addition to direct discrimination, participants reported a more indirect form of discrimination in providers’ assumption of heterosexuality among clients and their failure to provide lesbian- or gay friendly services. The findings highlight the need for health and aged-care services to better understand and acknowledge older gay and lesbian people's sexual identities to enable improved access to services in the future.     

Sexual behavior of resident street prostitutes with their clients in Camden,New Jersey

This paper describes a prospective study of the sexual behaviors of 20 resident street prostitutes and their clients. Prostitutes were long‐term residents of and practiced street prostitution in their community. They worked full‐time and reported averages of four clients per workday, four to five workdays per week, in an eight‐year career. Sexual behaviors with clients on five to eight workdays were recorded over a seven‐month period. Forty‐nine percent of contacts were with repeat clients. A regular client was defined by prostitutes as one who visited at least once a week. The results of the present study indicate that long‐term sexual relationships exist between some clients and prostitutes. Typically, a regular client had one to three sexual encounters per week with the prostitute, spent several hours with her at a motel (or one of their homes), and was more likely (than the occasional client) to engage in vaginal intercourse. Reported condom use was in the range of 39 to 74 percent.     

When therapists do not want their clients to be homosexual: a response to Rosik's article

This commentary is a response to Rosik's "Motivational, Ethical, and Epistemological Foundations in the Treatment of Unwanted Homoerotic Attraction" (this issue). Such treatment raises complex questions that cannot be resolved by focusing on the therapist's conservative versus liberal values. Most such clients are deeply ambivalent about their homosexual attractions. The degree to which their homosexuality is "unwanted" is highly variable among them and sometimes within them over time. Clients who are exclusively homosexual are very unlikely to be able to change their sexual attractions, whereas some clients who are bisexual may be more able to "manage" their homoerotic attractions (acting only on their heterosexual feelings). Marriage and family therapists should be able to support a client along whatever sexual orientation path the client ultimately takes, and the client's sense of integrity and interpersonal relatedness are the most important goals of all.     

Counselor Trainees' Assessment and Diagnosis of Lesbian Clients with Dysthymic Disorder

SUMMARY

Graduate-level counselor trainees completed an Assessment and Diagnostic Inventory consisting of clinical vignettes and a series of questions pertaining to conceptualization of client problem, diagnosis, and assessment of overall level of psychopathology.We hypothesized that participants would assign different diagnoses to clients with lesbian versus heterosexual sexual orientation. Participants responded to vignettes in which clients were identified as either a lesbian or a heterosexual female, with all other content identical. Participants were significantly more likely to perceive lesbian clients' problems to be related to sexual orientation for the vignette corresponding to dysthymic disorder. However, they were not more likely to assign personality disorder diagnoses, nor did they attribute a greater degree of psychopathology to lesbian clients with dysthymic disorder.     

Male Clients of Male Escorts: Satisfaction,Sexual Behavior,and Demographic Characteristics

Few studies have examined male clients who pay for sex with male escorts. In 2012, clients (n = 495) completed an online survey about their most recent hire. Most clients were White/Caucasian (87.7%), HIV negative (89.5%), employed full time (71.1%), single (58.6%), with a mean age of 54. Three-quarters of clients were gay identified, 18% bisexual, and 4% heterosexual. The median rate paid to escorts was $250 per hour with a modal appointment time of 1 to 2 hours (41.6%). Oral sex was common (80% gave, 69% received), 30% reported anal insertive sex, and 34% reported anal receptive sex. In total, few (12%) reported unprotected anal sex. Satisfaction with encounters was high. Receptive unprotected anal intercourse was associated with greater satisfaction in bivariate analyses but not in multivariable analyses. In a multivariable model, having receptive anal sex (whether protected or not) and rating the financial cost of the encounter as “worth it” were significantly associated with greater satisfaction. This study contributes to a scarce literature regarding clients of male sex workers and, in particular, provides information on the characteristics of men hiring men for sexual services, behavioral event-level data about their encounters, and analysis of factors directly associated with client satisfaction.