Cross Cultural Perspectives in Treating the Gay Male Trauma Survivor

Summary

In recent years, there has been an increased emphasis on cultural considerations in psychotherapeutic treatment. Sound psychotherapy is ideally culturally sensitive and concerned with the context within which the client developed and exists. At the same time it is often difficult for many clinicians to navigate the cultural within the psychological framework. When both patient and clinician share more than one language in common, there are a variety of subtle issues that surface. In psychotherapy, “coordinate bilinguals,” those who learn their languages separately, during different developmental stages and contexts, tend to have greater access to their emotional experiences within their first language. When the client presents with a sexual trauma history, the language spoken during the abuse will also have an effect on the language used in the psychotherapy. The case history of Lucio, a Latino gay male, is discussed in terms of the cultural and psychological elements of his treatment by a bilingual North American therapist. This therapist's psychotherapeutic conceptualizations and treatment approaches are examined and reviewed in a written dialogue/ discussion with a Latino psychologist.     

Beyond “Dry Drunkenness”: Facilitating Second Stage Recovery Using Wilber's “Spectrum of Consciousness” Developmental Model

ABSTRACT

The usefulness of Wilber's “Spectrum of Consciousness” developmental model in the treatment of substance abuse is demonstrated by a case study that illustrates how underlying emotional pain and intimacy issues can be worked through in the counselling process with a client during the second stage of recovery from addiction. Wilber's model allows for narcissistic, critical self, social, identity, intimacy, existential, and psycho-spiritual issues to be integrated into the counselling process for long-term recovery. This model provides social workers and addictions counselors with a useful map in embracing client recovery.     

Integrating self-care into clinical practice with trauma clients

ABSTRACT

Self-care is recognized as an important aspect of social work practice. Beginning in educational settings, developing social workers are encouraged to learn about and practice self-care. However, self-care is typically promoted through strategies and approaches outside of the practice context. Social workers are oftentimes encouraged to use individualized self-care plans, which often feature a variety of relaxation and secondary techniques; focus on self-awareness and self-reflection; and have proper use of supervision. Although these strategies are invaluable, they do little to directly benefit the social worker during direct practice or while in session with a client which is a time period when clinicians are particularly vulnerable to distress or burnout. The importance of real-time self-care strategies is particularly critical for clinicians, especially those who engage in trauma work, given the sensitivity of topics that clients may have endured or benefit from assistance in processing. Further, little information has been published on the use of self-care techniques during a session with a client or in a clinical context. The purpose of the present paper is to discuss self-care strategies that can be useful both outside of and within a clinical setting and present a model of such strategies that focus on integrating self-care in clinical practice particularly for those engaging in trauma work. The paper will conclude by discussing the relevancy of the developed model in practice.     

Supervisors’ Perception of Vicarious Trauma and Growth in Australian Refugee Trauma Counsellors

ABSTRACT

Vicarious trauma is a well-accepted phenomenon supported by more than 20 years of research, yet the body of research on the positive impact, known as vicarious post-traumatic growth, is relatively small. Based on a metasynthesis of qualitative peer-reviewed vicarious trauma studies, Cohen and Collens propose a model of the co-occurrence of vicarious trauma and vicarious post-traumatic growth. This model was examined through a qualitative study involving 11 interviews with supervisors of refugee trauma counsellors working in Forum of Australian Services for Survivors of Torture and Trauma (FASSTT) member agencies. This research project both reviewed the model from the perspective of experienced supervisors and illuminated what occurred within the supervision process to manage vicarious trauma and encourage vicarious post-traumatic growth. While the research project affirmed aspects of the model, the failure of the model to consider socio-political factors limited its applicability to FASSTT agencies.

IMPLICATIONS

• FASSTT clinical supervisors engage in supervision in a manner that may assist counsellors to process how their clients’ trauma disclosures impact on their levels of stress and change their perception of self, their role, and their worldview.

• Including recognition of the influence of the socio-political context of refugee trauma and trauma recovery may be an important additional component of supervision practice.

     

Vicarious resilience from attachment trauma: reflections of long-term therapy with marginalized young people

The concept of vicarious resilience captures the therapist's emotional growth occurring as a direct result of therapeutic engagement with traumatized clients. Three chronological case scenarios are presented for exploration of vicarious resilience in relation to attachment trauma. The purpose is to increase awareness and appreciation of the positive functions it serves for client mentalization, therapist skill and resilience factors for both parties. The reflective methodology considers the intrapsychic worlds of the client and the therapist and details how the therapist comes to experience the client's distressing projections. The potential for vicarious resilience begins from the outset of the therapist's actions of containment upon these projections. Advancing early ideas, it is advocated that vicarious resilience requires the therapist to have both the capacity and willingness to maintain a constant reflective stance.     

A Two-Level Community Intervention Model for Homeless Mothers with Mental Health or Substance Abuse Disorders

ABSTRACT

This paper describes a two-tiered community intervention model in response to a call from the Center for Mental Health Services for the development of best-practice strategies for homeless mothers with mental health and/or substance use disorders and their children. This model incorporates best practice principles gained from previous research projects pitched at the system and client levels. The model has been conceptualized, presented, and funded by CMHS and is currently being implemented in a local community. This model is unique in that it develops an intervention that addresses both levels of service delivery (i.e., system and client) in a single project. Blending systems integration/wraparound service philosophy and consumer-driven/strength-based development approaches provides a model that encompasses interventions at the individual client level via supported case management, and improved coordination and collaboration at the service system level. While this model was developed for a specific community population, the approach is general inits applicability to other areas of practice.     

Partners in the Spiritual Dance: Learning Clients’ Steps While Minding All Our Toes

We present four case illustrations highlighting the complex interplay of therapists’ and clients’ spirituality in therapy. Complexity, in these cases, results from (a) degrees of similarity and difference, both real and perceived, between clients’ and therapists’ spiritual beliefs and practices; (b) degrees of spiritual disclosure; (c) characteristics of the therapeutic relationship; and (d) geographic and cultural influences. Practicing therapists and therapist training programs can benefit from addressing how therapist and client spirituality intersect and influence therapy, how both similarity and difference present obstacles and opportunities, and how ambiguity and assumptions can contribute to misunderstandings. We believe that both the therapist’s and the client’s spiritualities are key influences in therapy that can contribute to the frustration, and the growth, of clients and therapists alike.     

Asking About Sexual Orientation During Assessment for Drug and Alcohol Concerns: A Pilot Study

ABSTRACT

An assessment tool was designed to assist service providers in identifying lesbian, gay and bisexual (LGB) clients who present for assistance related to substance use concerns. Items were designed to facilitate self-disclosure of the individual's sexual orientation and identify concerns of LGB clients that will be relevant to treatment planning for substance use concerns. Therapists in general assessment and LGB-specialized services of a large treatment agency were trained to use the tool. This paper presents client and therapist comments made during the pilot study regarding the use and value of the assessment tool.     

Eye Movement Desensitization and Reprocessing in the Treatment of Traumatized Gay Men

Summary

Gay men suffering from traumatic experiences can benefit from Eye Movement Desensitization and Reprocessing treatment (EMDR). In the past decade the theory and practice of EMDR has expanded to address acute and chronic childhood and adult traumas, substance misuse or abuse, identity issues including shame and self-esteem, and health issues. Through a process of accelerated information processing, traumatic memories are desensitized and reprocessed, resulting in less distress for the client in the present and future. EMDR can also be useful for developing internal resources and for exploration of relevant themes for the client. Further attention is needed in exploring the use of EMDR for gay men traumatized by hate crimes, sexual issues resulting from traumatic experiences, and internalized homophobia.     

Phenomenology and intersubjectivity: considerations for webcam-facilitated psychotherapy

ABSTRACT

The clearest distinction between webcam-facilitated versus face-to-face psychotherapy is the available sensorial information. The following questions guide this discussion: 1. How do our senses inform the psychotherapeutic process? 2. What are the implications for the therapeutic process when sensory information is different than during face-to-face therapy? This examination of the role of the senses in the creation of knowledge is grounded in phenomenology. Individual unity of consciousness and reciprocal understanding are applied to literature on webcam-facilitated therapy. An amalgam clinical example illustrates these phenomenological concepts and role of intersubjectivity. The core issues are involvement of sensory processes in the process of psychotherapy and co-construction of knowledge. By accepting the limitations of therapist knowledge, the client is encouraged to articulate and develop their own knowledge, and make conscious their unconscious. It is not necessary for therapist and client to share a physical space for co-creation of knowledge necessary for client transformation.     

Lesbian Therapists and Lesbian Clients

Abstract

The authors, on the basis of their own experience, explore issues specific to therapists working openly as lesbians with lesbian clients. Their discussion covers the structure of a private practice, the therapeutic relationship between lesbian therapist and lesbian client, and personal challenges for the lesbian therapist. Questions are raised and direction given with the aim of facilitating congruence among the therapist's personal capacities, the therapeutic setting, and the psychological intention of the therapeutic work. The authors note the therapist's need to tolerate the exposure of her personal life and the pressure toward fusion that are both entailed in work with lesbian clients, and they suggest that these special challenges, when the lesbian therapist's engagement with them is conscious, offer rich material that can deepen the therapeutic relationship and the therapeutic work.     

Two accounts of the management of racial different in psychotherapy

Abstract

In this paper, the authors present material from their clinical work, in which racial difference impinges directly on the psychotherapeutic encounter. They examine the primitive origins of racism from a psychoanalytic view point and discuss their management of related issues within the framework of psychoanalytic psychotherapy.

Part of a session from a psychotherapy group is described by Sue Davison, in which one member is excluded as part of a dramatisation entered into by all the group members for defensive purposes. The therapist, by calling attention to the painful reality which was banished from awareness, enabled the group members to recover their capacity to think, rather than re-enact the trauma.

The case study by Fakhry Davids describes work with a woman whose struggle in life is against a racist, intolerant mother. This mother is projected onto her black therapist, and a session is described in which the dynamics of this projection begin to be unravelled. Her therapist is experienced as an intolerant, oppressive mother to whom the patient's own hatred and intolerance has become attached, and the patient is enabled to take back some of these projections. The defences she uses illustrate a common way in which so-called “liberals” disown their hidden racism.     

A Client Perspective on Therapist Self-Disclosure

Abstract

Options of “coming out” in differing therapeutic modalities are considered. Modalities considered include traditional psychotherapy, alternative therapies, and managed care systems. Therapist disclosure situations are discussed from the viewpoint of both client and practitioner. Vignettes describing therapy experiences of adult lesbian and gay clients in a variety of clinical settings are presented. Clinical issues pertaining to therapist disclosure of sexual orientation receive consideration in terms of client self-determination as well as in terms of the options or limitations imposed by different modalities. Distinctions are drawn between disclosure in predominately lesbian and gay practice settings and disclosure in predominately heterosexual settings.     

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.     

Woman Abuse and Conjoint Therapy: Therapists' Experiences of Engagement

ABSTRACT

Treatment approaches with couples in which woman abuse is a factor have been the subject of much attention and concern in the therapeutic community. We used focus groups to examine therapists' experiences of what they see as impeding or facilitating their ability to engage therapeutically with heterosexual couples when a man has used violence. Results were coded along four categories: contextual issues, the person of the therapist, client characteristics, and strategies for enhancing engagement. Results point to the difficulties therapist participants experienced engaging with males who have been violent with their partner. Strategies which therapists used to enhance engagement are illuminated. We discuss differences between the experiences of male and female therapists, and implications for clinical work and future research.     

The Oral History Rating Scale–Revised: Preliminary Evaluation of a Clinician-Rated Measure of Divorce Potential

ABSTRACT

This study was a preliminary psychometric investigation of the Oral History Rating Scale–Revised (OHRS–R), a therapist-rated measure of married couples' divorce potential based a 90-min oral history interview. Findings suggest the OHRS–R shows promise as a clinical tool. Therapist and observing raters' total OHRS–R scores demonstrated high interrater reliability and discriminated from client reports of psychological functioning (Outcome Questionnaire-45.2) and marital satisfaction (Revised Dyadic Adjustment Scale). Therapist OHRS–R ratings showed evidence of construct validity. Convergence between therapist OHRS–R ratings and a client-reported measure of divorce risk (Marital Status Inventory) was relatively low. Longitudinal research is needed to confirm predictive validity.     

Dangerous Liaisons: The Time Is Out of Joint

ABSTRACT

Anne is an older woman, with a history of severe, complex trauma, including abandonment and multiple rounds of sexual abuse, which started in her early childhood and was followed by sexual exploitation in a previous experience of therapy. In this article I discuss her treatment with me in the context of the #MeToo movement and the rest of the current troubling sociopolitical constellation. I argue that when tanks crash into our bedrooms and transform them into battlefields, seismic psychic change occurs: catastrophic or healing or both. I also contemplate the nature of the psychoanalytic contract between patient and therapist, as well as the limits of the psychoanalytic endeavor in the face of massive social and historical trauma, “when the time is out of joint” (Shakespeare, “Hamlet”).     

Strategies of Stigma Resistance Among Canadian Gay-Identified Sex Workers

Abstract

The purpose of the current study was to explore how sex workers (specifically, gay-identified Canadian men working primarily, though not exclusively, as independent escorts) combat the pervasive negativity that surrounds their profession. Semi-structured interviews were conducted with 9 men, a majority of whom were targeted through escort review boards. Interviews were transcribed verbatim and analysed for themes of “stigma resistance.” Four themes were identified: (1) escorting is volitional (i.e., one isn't forced to work as an escort, rather it is a choice one makes); (2) escorting is a profession (i.e., the client is a customer and the escort a service provider); (3) the escort is in control during client/escort interchanges; and (4) escorting is distinct from, and better than, street prostitution. Directions for future research and limitations of the current study are outlined.     

Staying with it: A case study

Abstract

This is a case study which illustrates some of the conflicts and dilemmas facing local authority social workers in child protection. The worker had to learn to understand and deal with his feelings about a client, who was at different times unable to communicate verbally, sexually procative and seductive, hostile and aggressive. For the client there was a gradual shift from acting out her fears and fantasies about men, to being able to verbalise and trust the worker.

The worker moves towards an understanding of the client's problems and also of his own difficulties in dealing with the case. He believes that his personal involvement was of value to the client.