Staying put in the Closet: Examining Clinical Practice and Countertransference Issues in Work with Gay Men Married to Heterosexual Women

Gay men married to heterosexual women seek psychotherapy for numerous reasons, not only to find a way out of their marriages. Therapists must identify their countertransference reactions to avoid pushing the patient either to commit to his marriage or leave it. The patient’s underlying problems should be addressed before the patient can explore the fate of his marriage. Therapists also need to be understanding of the patient’s attachment to his wife. In addition, therapists must be aware of the societal implications of homophobia on gay patients. This article discusses motivations for heterosexual marriage among gay men, examines two clinical cases, and addresses practice and countertransference issues. A version of this article was presented at the tenth national conference of the National Membership Committee on Psychoanalysis in Clinical Social Work on March 10, 2007.     

Psychological Adaptation and Adjustment to Acquired Immune Deficiency Syndrome

Early reports of the psychological ramifications of acquired immune deficiency syndrome (AIDS) emerged shortly after the first incidence of the isease was officially reported in this country in 1981. These preliminary reports were based on clinical observations and anecdotal information which showed that the psychological reactions of AIDS patients were similar to those stages of death and dying described by Kubler-Ross (1969) although they appeared to be intensified and compounded by other issues related to the stigmatized status of most carriers of this disease. Two specific models of the staging of these psychological reactions are outlined. The psychological problems most commonly requiring therapeutic intervention are discussed with attention paid to the importance of distinguishing between those whose etiology is functional versus organic. The suspected pathogenesis, symptomatology and progression of the most common form of organic neurological disorder associated with AIDS, AIDS dementia complex, is summarized. Finally, a model of integrated treatment for the psychological aspects of adaptation to AIDS is described.     

Paradoxes of Sexuality,Gay Identity,and the Closet

In this project, I illustrate how eight premises of sexuality, gay identity, and the closet contribute to the existence of paradox, an interactional situation constituted by contradiction. I first outline the following premises: gay identity is (1) inextricably tied to the metaphor of the closet; coming out is necessary when gay identity (2) is invisible; the closet draws meaning (3) only in relation to heteronormative contexts; gay identity, as a (4) stigmatized identity, makes coming out a (5) potentially dangerous act; coming out is conceived of as a (6) necessary and important, (7) discrete and linear, (8) inescapable and ever‐present process. I then use autoethnography to describe and analyze the lived experience of paradox in terms of these premises. I conclude by formulating ways a gay person can negotiate paradox in, and by way of, interaction.     

The Utility of Social Class,Race, and Gender in Clinical Practice: A Case Study Involving Intraracial Dyads

This article focuses on clinical work involving a male Black practitioner and a male Black client in which issues of social class, race, and gender were prominent in the treatment process. Three questions raised by the client early in the therapeutic encounter informed assessment, treatment, and the clinician's countertransference. Tenets from self-psychology, relational theory, intersubjectivity, and sociocultural factors relative to Black men are used to ground the discussion. Finally, the article illustrates why intraracial therapy should be understood in the context of the delivery of culturally competent services, highlighting how the intersection of a client's psychological issues, social class, race, and gender can emerge as functional features in psychotherapeutic work.     

Sexual Dysfunction,Paraphilias and their Relationship to Childhood Abuse in Men who have Sex with Men

ABSTRACT

This study aimed to examine 1) the occurrence of sexual dysfunctions and paraphilias and 2) the relationship between childhood abuse and current sexual disorders in a MSM sample. Participants were MSM in the Midwest who completed baseline surveys prior to attending a sexual health seminar. Most men reported a sexual dysfunction or paraphilia. Thirty-nine percent of the sample reported childhood abuse. Results indicated childhood abuse was associated with a significant increased risk of male erectile disorder (OR = 1.83) and secondary sexual dysfunction (OR = 2.01). The intent of the study was to generate hypotheses to guide future research efforts.     

大学生职业道德教育途径探讨

近年来,在我国高等教育大众化的推动下,高校招生扩大,大学生就业难的问题非常突出,而大学生在就业过程中严重存在一些普遍性的职业道德素质问题:诚实守信素质缺失,吃苦耐劳素质的欠缺,责任意识缺乏等。随着社会分工的精细化和专业化,市场竞争激烈化,社会对从业人员的职业道德素质要求越来越高。服务社会的需要,高校应重视对大学生职业道德教育,积极探索大学生职业道德教育的有效途径。     

Fame,Social Media Use,and Ethics

This essay addresses two journalists' very public criticism of a blog that chronicles a woman's fight with cancer. I examine the role of fame in this controversy. Are the expectations for maintaining “privacy” actually stricter for people who are not famous? How do shifting boundaries between private and public (exacerbated by social media, which allow anybody to have a “public” persona) and shifting understandings of what constitutes “fame” affect the traditional understandings of what is appropriate to share?     

Sexuality in Marriage,Dating, and Other Relationships: A Decade Review

In this article, we review the major research advances made during the 1990s in the study of sexuality in marriage and other close relationships. More specifically, we provide a critical review of the empirical findings from the last decade on such sexual phenomena as sexual behavior, sexual satisfaction, and sexual attitudes within the context of marriage, dating, and other committed relationships. After highlighting the major theoretical and methodological advances of the 1990s, we focus on the research literatures of: (1) frequency and correlates of sexual activity in marriage; (2) sexual satisfaction, including its association with general relationship satisfaction; (3) sexuality in gay and lesbian committed relationships; (4) trends in sexual behavior and attitudes in dating relationships; and (5) the role of sexuality in dating relationships. We also incorporate brief reviews of the past decade's research on sexual assault and coercion in marriage and dating and on extramarital sex. We end our decade review with recommendations for the study of sexuality into the next decade.     

The Relationship of Practice Beliefs and Practice Behaviors among Social Workers with Lesbian and Gay Clients

This study explores the levels of beliefs about practice and practice behaviors with lesbian and gay clients among social work practitioners in a medical setting. The Gay Affirmative Practice scale was utilized to measure the levels of gay affirmative practice beliefs and practice behaviors among the sample surveyed. The relationship of practice beliefs and practice behaviors is explored and reveals that practice beliefs are significant to practice behaviors with lesbian and gay individuals. The results identify variables that contribute to practice beliefs and practice behaviors.     

New Institutionalism and Sexuality at Work in Local Government

Recent statutory and policy changes have raised the profile of lesbian, gay and bisexual equalities initiatives in the local government arena. These initiatives are increasingly developed and delivered via inter‐agency partnerships. This article applies concepts from the sociological branch of new institutionalism to the field of sexualities equalities partnership work in local government, drawing on findings from a large empirical project. Notions of norms, ritual, templates and isomorphism all have purchase in this sensitive, value‐laden field, providing insight into the organizational dynamics associated with inter‐agency and partnership working. The article introduces the notion of institutional hybridization as a means of understanding the collaborative, and sometimes conflicting, processes associated with governance in the field of sexualities equalities work.     

Factors Influencing the Sexual Relationships of Lesbians and Gay Men

ABSTRACT

This study examined the rewards and costs that lesbians and gay men experience in their sexual relationships. Participants were 23 lesbians and 15 gay men who completed questionnaires and participated in a semi-structured interview. Frequently identified sexual rewards included emotional and physical intimacy, feeling accepted and supported, communication, and a positive view of self. Sexual costs included feeling vulnerable and negative social and cultural attitudes toward same-sex relationships. Sexual rewards and costs tended to cluster into three main categories: relationship factors, sexual factors, and factors related to being a sexual minority. The participants' responses illustrate the limitations of applying conventional (biomedical) models of sexual response to men as well as to women. Moreover, they strengthen calls for theories of sexual functioning that are based on diverse experiences and that consider sociocultural, political, economic, relational, psychological, and medical factors.     

Experience of Older Gay and Bisexual Men Living with HIV/AIDS

Although HIV/AIDS definitely impacts gay and bisexual men of all ages, the impact on people in their later years has not been actively investigated. This exploratory study obtained detailed narratives from 14 adults between the ages of 51-72, all of whom were infected with HIV. Ten of the participants were potentially infected through male to male sexual contact. The subjects reported living with HIV for substantial periods with an average of 13 years of life since diagnosis, estimating a duration of HIV seropositivity from 1-20 years. Most had significant health problems, which may be related to aging, in addition to a number of HIV-related symptoms. They expressed community identification as people living with HIV; some were highly identified as gay men, while other were closeted or in denial regarding their same-sex activity. Half felt to some extent bisexual, and described relationships with wives or other women. Although many participants maintained active social lives, others expressed feelings of loneliness and isolation. This group was minimally active sexually and several of the participants expressed reservations about safer sex, especially condom usage. A strong theme was the sense of having lived a full life, which may help the individual cope with his diagnosis. The findings suggest the need to examine the diversity among older gay and bisexual men living with HIV, how these experiences vary by race and ethnicity, and identification of issues related to prevention and services.     

Parents’ awareness of lesbian,gay, and bisexual youths’ sexual orientation

This study used a sample of 293 lesbian, gay, and bisexual youth to examine factors that differentiated youth whose parents knew of their sexual orientation from youth whose parents did not know. Earlier awareness and disclosure of same‐gender attractions, greater childhood gender atypicality, and less internalized homophobia were characteristic of youth whose parents were aware of youths’ sexual orientation. Youth with aware parents reported more past verbal victimization on the basis of sexual orientation from parents, yet more current family support and less fear of future parental victimization on the basis of their sexual orientation.     

Conducting Research with Lesbian,Gay, and Bisexual Populations: Navigating Research Ethics Board Reviews

The acceleration of research with lesbian, gay, and bisexual (LGB) populations amid existing sexual prejudice and advancing human rights leads to sometime conflicting stances between researchers and ethics boards over acceptable methodological practices. Ethics boards, charged with ensuring the safety of research participants, may engage in ostensibly protective stances regarding potential risks and informed consent that are unwittingly founded upon negative stereotypes of LGB populations. We examine four case studies that demonstrate divergent stances between researchers and ethics boards, researchers’ responses to ethics reviews and their resolution. Based on these cases, we describe themes and strategies for researchers working with LGB populations in responsibly navigating ethics board concerns.     

Psychological Distress in Older Portuguese Gay and Bisexual Men: The Mediating Role of LGBT Community Connectedness

Abstract

Objectives: Examining Psychological Distress (PD) among older Portuguese gay and bisexual men (GBM), and the mediator role of LGBT community connectedness (LGBTCC) of minority stress variables on PD. Methods: We performed a mediation analysis with LGBTCC as mediator between minority stress variables and PD with a sample of 110 elderly GBM. Results: We found moderate PD levels; LGBTCC was a significant mediator between concealment of sexual orientation and PD, but not between internalized stigma and expectations of rejection and PD. Conclusions: More attention is needed to Older Portuguese GBM’s mental health. LGBTCC is an important ameliorating factor for older GBM.     

Passionate Gods and Desiring Women: Jeanette Winterson, Faith, and Sexuality

Throughout her literary works, Jeanette Winterson describes sexual passion in the language and with the understanding of a parallel and informing spiritual faith and compassion. Winterson's narratives of romantic love and sexual passion seek in a different form the experience of perfect union with another demonstrated in the ecstatic practices of charismatic Christianity. From her first book, Oranges Are Not the Only Fruit (1985), to her most recent fictions, Winterson has consistently drawn on Biblical language and religious experience to produce her own exalted discourse of passion. In drawing on Biblical language to express erotic passion, Winterson resists the popular cultural image of perfect rapprochement, the merging of self and other typically ascribed to the lesbian couple. Rather, she emphasizes the challenge of union in love, using the language of faith to indicate the elusive qualities of passionate connection. The language she borrows from her Pentecostal childhood allows her to describe a kind of charismatic experience of meeting between self and lover while recognizing the essential difference between partners, the foreignness of the beloved.     

Attachment Style,Rules Regarding Sex,and Couple Satisfaction: A Study of Gay Male Couples

This article explores the characteristics of open and closed relationships in 170 gay men according to their levels of satisfaction, their attachment styles, and the rules of having sex outside their relationships for open couples. We found no significant difference between open or closed relationships in levels of satisfaction or attachment styles. However, we found that gay men in open relationships who have explicit rules about having sex with other men are significantly more satisfied that those gay men with no rules. A content analysis of the rules is presented and implications for therapy are drawn from the findings.