From Bars to Grindr to Fatherhood: Clinical Work With Gay Men

From Bars to Grindr to Fatherhood: Clinical Work With Gay Men Jay Robertson-Howell, Psy.D., MSSW California State University San Marcos The 4 th National Psychotherapy with Men Conference Participants will be able to: Identify three reasons that gay men might seek mental health services Identify three societal issues that impact the

psychological well-being of gay men Identify the underlying emotion impacting the gay males psychological functioning Identify three strategies in developing an affirmative therapeutic approach in our work with gay men Health Disparitie s Mental

Health Disparities Coming Out Clinical Issues HIV/AIDS Substance Abuse

Relationship Issues Mental Health Disparities Gay and bisexual men showed higher prevalence of depression, panic attacks and psychological distress than heterosexual men (Cochran et al., 2003). According to Remafedi et al. (1998), young gay and bisexual men may be 7x more likely to attempt suicide

than young heterosexual men. Although gay men are more likely than their heterosexual counterparts to seek help for emotional distress, approximately 1/3 of gay men reported negative or mixed reactions from mental health professionals (King et al., 2003). Mental Health Disparities Gay men exhibited lower self-esteem if they believed that appearance, weight, and muscularity were

important to others (Fish, 2006). Kaminski et al. found that gay men also believed that increased muscularity would offer protection from physical attack (2005). Disclosure of ones identity to others is usually associated with better mental health (Morris et al., 2001), but other factors need to be considered during the coming out process. Health Disparities

Gay men, as well as anyone who has receptive anal sex, are at higher risk for anal cancer due to an increased risk of becoming infected with human papillomavirus (HPV) with gay and bisexual men estimated to have 1 17x more likely chance to develop anal cancer than heterosexual men(McRee, et al., 2010, Tider et al., 2005). Some disparities, such as HIV and other sexually transmitted infections, are associated with the sexual practices of men who have sex with men (MSM) (Wolitski, et al., 2008, p. 23). Gay men may experience violence based on their sexual

minority status and/or within an intimate relationship (Herek, 2009 and Houston, et. al., 2007). Substance Abuse Controversy related to the rate of alcohol use historically reported to be 3x the general population Bars as social gathering places, accessibility of alcohol, and cultural norms of alcohol use Alcohol use as a coping strategy for discrimination

Recent studies show that gay men use substances, including alcohol and illicit drugs at a higher rate than the general population not just in large communities like NY, San Francisco or Los Angeles (Ostrow and Stall, 2008) Gay men and lesbians were more likely than heterosexuals to have used recreational drugs (King, et al., 2003). Use of poppers appears to be a gay male phenomenon (Fish, 2006). So health disparities appear to be the result of:

DISCRIMINATION HOMOPHOBIA HETEROSEXISM STIGMA and a culture that idolizes MASCULINITY Not to dismiss biological and genetic factors Historical Persecution The Holocaust and the The Stonewall Riots Mental Health Disorder until 1974 Reparative Therapy still promoted as a cure

Same-sex sexual activity criminalized in 14 states until 2003 Lawrence v. Texas Same-sex marriage and adoption by same-sex couples still illegal in many jurisdictions Examples of Privilege Being able to marry the person you love in all 50 states and having that marriage recognized federally

Not having the need to come out Knowing that I wont be fired from my job based on my sexuality Having the security that my children will not be taking away from me based on my sexuality Having the freedom to talk about LGBT issues without being accused of forcing a homosexual agenda on others Not having economic, emotional, physical, or psychological consequences if family and friends find out about my sexuality List based on Peggy McIntosh's article on white

privilege Minority Stress Premise that gay people in a heterosexist society are subjected to chronic stress related to their stigmatization (Meyer, 1995) Minority stress can be experienced in the form of ongoing hassles (such as hearing antigay jokes) and more serious negative events (such as loss of employment, housing, custody or children, and physical and sexual

assault) (DiPlacido, 1998) Microaggressions The everyday encounters of discrimination that people of various marginalized groups experience throughout their lives (Sue et al. 2007) Brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that

communicate hostile, derogatory, or negative slights and insults toward members of oppressed groups (Nadal, 2008, p. 23) The Intersection between sexuality and masculinity Living in a culture that worships masculine power Being a gay man in a hyper masculine world Being a gay man in a heterosexual society Results in:

Living outside the BOX SHAME To be gay in an uncompromisingly straight world is to struggle to find love and, once found, to hold on to it. We are men in a world where men are emotionally disabled by our masculine cultural ideals (Downs, 2012, p. 62) Downs 3-Stages

Overwhelmed by shame Compensating for shame Cultivating authenticity Stage 1: Overwhelmed by shame Overwhelmed with being gay in a society that promotes masculine power Coping equals avoidance Engaging in any behavior that works to

lessen the feeling of shame Avoidance Strategies Suicide LGBT youth are 2-3 times more likely to attempt suicide (Garofalo, et al., 1999) Substance Abuse Anonymous Sex Grindr and other sites Denying sexuality

Hyper sexuality with women Getting married and starting families Bisexuality Anti-gay activities Stage 2: Compensating for Shame or the Best Little Boy in the World syndrome Best Little Boy in the World Ongoing search for validation Stage 1 validation equals hiding sexuality Stage 2 validation equals proving worth and

deserving of love Hunger for validation and hypersensitivity to invalidation Inauthentic validation satiates briefly Anonymous sex, promotions at work, body image and muscularity Stage 3: Cultivating Authenticity Rediscovering the essence of self and the

deconstruction of life built on shame Decreased visibility in gay community Movement towards distress in an effort to overcome avoidant behavior Reclaiming life that might be marked by ambiguity Aligns with Casss synthesis stage http:// www.youtube.com/watch?v=R4PV4Vyluc8#t

=10 Identity Development Foreclosure v. acceptance An unfulfilled life v. a fulfilled life A conflict in values Intersection between multiple identities Sexuality Masculinity Race, ethnicity and national origin Age

Ability Socioeconomic status Affirmative Therapy Clark (2009) suggested that therapists help LGBT clients establish a support system of other LGBT individuals, help LGBT clients understand how oppression has affected them, help desensitize the shame and guilt associated with homosexual thoughts, behaviors, and feelings, and allow for clients

expression of anger at being oppressed. Davies (1996 ) suggested that therapists amplify Rogers core provision of unconditional positive regard in working with LGBT clients. Affirmative Therapy Internalized homophobia a target for therapeutic intervention Explores the effects of anti-homosexual prejudice on the presenting complaint and

therapeutic process Foster the development of all aspects of an LGB clients identity and the enhancement of an LGB individuals experiences. Acceptance and Commitment Therapy Work in assisting client to understand the different emotional experiences he might be having and ways in which he engages in avoidance strategies

Identify and work with values Establish a plan of committed action that moves client forward in living an authentic and fulfilling life Case Example Older than average student presenting with depression seen for 10 sessions over the course of a semester Existential outlook which led to a negative

self-concept Inability to solve lifes problems Strong comparison to peers should be in a different place Search for validation in an effort to minimize the effects of shame What can we do as clinicians? Ongoing education related to LGBT issues Developing competency

Knowledge, skills, and attitudes A therapeutic space that reflects inclusiveness Safe Zone Pamphlets reflecting same-sex couples Develop a therapeutic alliance that values diversity Be familiar with APA Guidelines for

Psychological Practice with Lesbian, Gay & Bisexual Clients Questions Jay Robertson-Howell, Psy.D., MSSW California State University San Marcos Student Health and Counseling Services [email protected] 760-750-4974 References Clark, D. (2009). Loving Someone Gay. Maple Shade, NJ: Lethe Press.

Cochran, S. D., Mays, V. M. and Sullivan, J. G. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 1: 53-61. Davies, D. (1996). Towards a model of gay affirmative therapy. In D. Davies & C. Neal (Eds.), Pink Therapy: A Guide for Counselors and Therapists Working with Lesbian, Gay, and Bisexual Clients. Buckingham, England: Open University Press. Fish, J. ( 2006). Heterosexism in Health and Social Care. NY: Palgrave Macmillan. Garofalo, R., Wolf, R.C., Wissow, L.S., et al. (1999). Sexual orientation and risk of suicide attempts among a representative sample of youth. Archives of Pediatric and Adolescent Medicine, (153(5), 487-493. Herek, G.M. (2009). Hate crimes and stigma-related experiences among sexual minority

adults in the United States: Prevalence estimates from a national probability sample. Journal of Interpersonal Violence, 24(1), 5474. Houston, E., & McKirman, D.J. (2007). Intimate partner abuse among gay and bisexual men: Risk correlates and health outcomes. Journal of Urban Health, 84(5), 681690. Kaminski, P. L., Chapman, B. J., Haynes, S. D. And Own, L. (2005) Body image, eating behaviors and attitudes toward exercise among gay and straight men. Eating Behaviors, 6, 3: 179-187. References King, M., McKeown, E., Warner, J., Ramsay, A., Johnson, K., Cort, C., Wright, L. et al. (2003). Mental health and quality of life of gay men and lesbians in England and Wales: Controlled, cross-sectional

study. British Journal of Psychiatry, 183, 6: 552-558. McRee, A. L., Reiter, P. L., Chantala, K., et al. (2010). Does framing human papillomavirus vaccine as preventing cancer in men increase vaccine acceptability? Cancer Epidemiology Biomarkers and Prevention, 19(9), 1937. Morris, J., Waldo, C. R. and Rothblum, E. D. (2001). A model of predictors and outcomes of outness among lesbian and bisexual women. American Journal of Orthopsychiatry, 71, 1: 61-71. Morrow, SL. (2000). First do no harm: therapist issues in psychotherapy wit lesbian, gay, and bisexual clients. In RM Perez, KA DeBord, & KJ Bieschke (Eds.), Handbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual Clients (pp. 137-156). Washington, DC: American Psychological Association. Ostrow, D.G., & Stall, R. (2008). Alcohol, tobacco, and drug use among gay and bisexual men.

In Wolitski, R. J., Stall, R., & Valdiserri, R. O., (Ed.) Unequal opportunity: Health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press Remafedi, G., French, S., Story, M., Resnick, M. D. and Blum, R. (1998). The relationship between suicide risk and sexual orientation: Results of a population-based study. American Journal of Public Health, 88, 1: 57-60. Tider, D.S., Parsons, J.T., & Bimbi, D.S. (2005). Knowledge of human papillomavirus and effects on sexual behavior of gay/bisexual men: A brief report. International Journal of STD & AIDS, 16, 707 708.