Monthly Archives: September 2013

First Alumni Event

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Meeting Again: the First Pink Therapy Alumni Event

If sexuality is one of the ways we feel most alive in the world, I have felt this in abundance during the privilege of a long Pink Therapy training.  To my delight, it turns out that other participants on PT courses felt this way too.  So, when Dominic suggested we have a quarterly Alumni event for anyone who’d done one of the substantial trainings, I was more than happy to host the first one.

It felt a bit like turning up at a party where you know you’re not going to know anyone, but willing to reach out and hoping it will be good.  I had brought a case-presentation (always take something to a party!) and the others were happy to spend time focusing on my couple-case of two women in their sixties who’d been wondering whether to split up.  Lots of learning, lots of self-reflection and lots of intelligent, generous contributions from those present.  There are not many places, even with good supervision, where I can guarantee the quality of thoughtfulness and openness.  Pink Therapy events continue not to fail me.

After the case discussion, we just talked.  We talked about our professional and personal selves; about ‘homonormativity’ (the experience many of us had had of not-quite-meeting-the-requirements of gay and lesbian social groups); we talked of our work with hetero clients and whether we challenge them enough, and we talked of the significance of a clients’ choice to work with us.  We also mused on whether there is unconscious homoeroticism amongst heterosexuals in gyms and spas, disguised by competitiveness and envy.  That makes it sound too heavy – we also enjoyed laughing at ourselves and our guesswork.

The magic of Pink Therapy events is finding there’s always more to learn.  I used the acronym LOL and not everyone knew what that meant (Late-Onset-Lesbian), and someone used the term ‘the creative void’ about those times in life when you’ve let go of something, but haven’t found a new way yet.  We thought a bit about the changes in legislation over our life-times and appreciated – and even envied – those who had been in the fight for basic gay rights back in the 1960s and 70s.  And most of all we talked about how sexuality isn’t something that can or should be categorized by words or experience, but a lifelong way of becoming ourselves.

We look forward to the next event, scheduled for Saturday 14 December 2013 at 2 pm.  The following two dates are 15 March and 21 June 2014.   These events are open to anyone who has completed a Pink Therapy Diploma, Certificate or Essentials course.  And only £10.00.

Contact: Chris Kell (chriskell37@gmail.com

Male body dysmorphia: a force for evil in the gay community

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“Sorry”, my boyfriend at the time was looking down apologetically; “For what?” I said, a little concerned. He gripped about a half-inch of tan skin on his stomach and said “I had takeaway pizza twice last week… I’m not in my best shape”. I looked at the skin he was gripping, stuck between sympathy and envy.

Muscle Body Dysmorphia – also known as The Adonis Complex or ‘Bigorexia’ – is an illness on the rise. There exist no firm numbers of who might be affected, but cases of men who suffer from body dysmorphia – or a warped perception of their physical self – have increased steadily over the last 20 or so years.

Our current understanding of the Complex is that there are men who see a distorted version of themselves in the mirror. What they see, when we see a potentially very attractive man, is a pale, flabby gremlin. They often have conscious if illogical or uncritical understandings of their condition, such as: potential mates prefer substantial muscle (found to be untrue), they are in competition with their peers or they are addressing childhood memories of being labelled ‘fat’ or ‘overly thin’. Or they have no opinion whatsoever on very extreme behaviour

This does not just affect gay men – straight men, out to assert masculinity against the tides of butch feminism, metrosexuality and overt criticism of ‘male-ness’, have been found to have deep-seated anxieties relating to their physical appearance.

But in the gay community a shoring up of insecurities e.g. family, friends and romantic, can be very toxic when we add body anxieties. Gay men are notoriously critical, or ‘bitchy’, about each other; and the club scene asks, in exchange for inclusion, subscription to certain norms. Two of these ‘norms’: drug use and bareback sex, have been well covered in recent times. But little has been said on the subjective field of physical appeal, although this might be the most tangible on any night out in in Soho, London, or Canal Street in Manchester.

It is why the ‘Adonis Complex’ is an appropriate term for muscle dysmorphia in gay men. In the place of divinity, many men idolise male celebrities or porn stars. Gays are well-recognised niche group for marketers to target – most often (if I little lacking in creativity) with homoeroticism. In these images there is no ambiguity about the ‘ideal’ male body.

These ‘relationships’, I would argue, are important – they are channels through which to celebrate and normalise MSM sexuality. But they foster a dark by-product: physical elitism, which is reenforced by popular images of skin-tight (or absent) clothing, unrealistic muscles and rare beauty.

It makes sense that gay men would be obsessive about their body with this images as a dominent feed between gay men and gay-targeted media. Especially for men who participate in ‘mainstream’ gay cultures, such as the club scene. The ultimate standard for the male body has been set by these media. So it is not hard to see why many men, fearing irrelevance if they become old or overweight, can become ‘over concerned’ (to warily use that word) with their physical appearance. This, again, is true in the straight world as in the gay one.

But in the gay world the catalyst – the male form – is everywhere. In our media, in the clubs, on the streets and in our bedrooms (which is, for the most part, lovely). Gay men are presented with the omnipresent male form in any gay niche group (by definition). Even in drag acts, much of the humour comes from the ungainly and overt masculinity of the performers. We have a common ‘currency’ in the male body – we all have one, and we all to one extent or the other desire one romantically and possibly sexually.

This omnipresence compounds our doubt and anxiety. We have no refuge within popular culture nor within groups of gay men. The nature of this is a cycle: as we try and convince others that we belong to this elite standard, we fuel anxieties in others (“Am I as attractive as he is?), as well as our own (“Does he agree with me? Does he appreciate how often I go to the gym?”).

All this is to say that pockets of gay men experience body dysmorphic disorder as a mainstream cultural presence, not an undercurrent. Stereotypes of gay men – which are, effectively, generalisations taken after a superficial glance – often cite vanity, obsessive attention to physical appearance, and obnoxious neurotic behaviours: “do I look fat? I feel fat” “My hair is so awful today” “don’t take a photo of me, I look disgusting!”. These behaviours do not tell us some gay men are arrogant, vain and in need of reassurance, but that they obsess over fine and often insignificant aspects of their looks. And for no other reward other than to wake up tomorrow and repeat.

Obviously: this is the opinion of gay man who has never lived a straight life, nor been exposed to the cultural stimuli of straight men. From this side of divide, however, the pressure to look good seems stronger among gay men then our heterosexual counterparts.

Either way, the pressure is there, and it is toxic. And if it exists among heterosexual men then: what’s good for the goose is good for the gander (without specifying which is which). Professional, personal and romantic lives are affected by a desperation to ‘look good’, without respecting the subjectivity of looking good or the part personality and mentality have to play in attraction. The internal menace of body dysmorphia is an ongoing concern, and one with far-reaching consequences. There may be no absolute solution – but understanding is the key to progress.

Jack Flanagan

Communicating with gay clients with mental health needs: how psychologists’ personal characteristics can get in the way

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At a time when Lesbian and Gay (LG) equality rights are still being debated by the United Kingdom (UK) Parliament and by several religious organisations, worldwide attitudes towards same-sex relationships remain controversial and ambivalent (Pew Research Centre, 2013). Previous research has identified the existence of such ambivalent attitudes amongst the general population (Herek, 2009; Herek, Gillis & Cogan, 2009), in particular when unconscious (implicit) attitudes are measured and do not always match people’s self-reported (explicit) attitudes (Banse, Seise & Zerbes, 2001; Nosek & Banaji, 2009; Ranganath & Nosek, 2007; Steffens & Jonas, 2010). Equally, attitudes in psychologists seem to follow similar trends (Boysen & Vogel, 2008; Boysen, 2009) where explicit attitudes tend to be positive while implicit attitudes tend to be ambivalent or negative. Such discrepancy between explicit and implicit attitudes can cause internal conflicts in people between their thoughts about, and their behaviour towards, LG people. This can make people come across as ambivalent, distant, and negative (Gawronski & Strack, 2004; 2012) when interacting with LG people. 

Research has found evidence that psychologists and psychologists-in-training can show such ambivalence to LG people too (Finkel et al., 2003; O’Brien, 2003; Scher, 2009), including anxiety and avoidance (Gelso et al., 1995), and emotional and social distance (Barrett & McWhirter, 2002; Jones, 2000). Equally, vulnerable clients belonging to minority groups may often be at the centre of unintended discrimination, through ambivalent behaviours, when professionals’ attitudes about clients’ identity are negative or biased. Studies also revealed that psychologists would show less concern for gay clients when their attitudes towards LG people were more negative (Clarke, 2010), consider LG clients riskier and more likely ‘to harm other people’ (Bowers et al., 2005), propose more controlling interventions with gay clients (O’Brien, 2003), be less willing to work with gay clients in therapy (Barrett et al., 2002), regard LG identity as more pathological, and support the use of therapy to change a client’s sexual orientation (Kilgore et al., 2005). 

These findings are particularly relevant for clinical psychologists who increasingly may have to see in clinic LG people with psychological and social needs, and to offer them support through direct and indirect clinical work, consultancy and training, supervision and research, and academia-related activities (British Psychological Society, 2006; 2012). Psychologists’ attitudes about clients are then particularly relevant to clinical communication. This is due to the recognition of the potential bio-psycho-social impact that discrimination and prejudice can have on people belonging to minority groups (Meyer, 2003; Davies, 2012). Nonetheless, communication and attitudinal research is a recent emerging phenomena among healthcare professionals (Steffens, 2005; Steffens & Jonas, 2010), remains scarce and is further needed at the centre of clinical psychology practice.

The current research investigated communication patterns on a sample of UK clinical psychologists-in-training toward simulated ‘gay clients’ (professional actors), and how participants’ demographic characteristics and attitudes towards LG people may be related to their behaviour in session with a ‘gay client’ either with depression or with anxiety. The study also looked at changes in clinical communication over time, so each 10-minute ‘session’ was video-recorded to be analysed with two communication measures. ‘Gay clients’ also provided their satisfaction score at the end of each session for each psychologist. Results suggested that the current sample of psychologists-in-training show discrepancy between positive self-reported (explicit) attitudes and slightly negative and ambiguous unconscious (implicit) attitudes towards LG people. The attitudes of the current sample were equivalent to those found in earlier studies (i.e. Boysen et al., 2008; Banse et al., 2001) thus showing a prevalence of unconscious social prejudice and distance towards sexual diversity. These attitudes did not change after six months of clinical training and placement experience. 

Furthermore, clinical communication scores revealed that participants interacted professionally with ‘gay clients’ but showed less empathy and interest in client’s concerns and worries. ‘Clients’ also felt overall dissatisfied with their sessions and did not feel a connection with their ‘psychologist’. In particular, psychologists who had more avoidant characteristics had more difficulty in communicating with ‘clients with depression’, did not explore clients’ feelings as often, and gave ‘clients’ less opportunities to speak about their worries. Whenever clients gave hints to the psychologist that they wanted to talk about their concerns, most of the time these were not noted or followed-up by the psychologist.  ‘Clients with depression’ felt less satisfied with their session than ‘clients with anxiety’ and findings were similar after six months of clinical training and placement. However, after six months of training, psychologists’ communication scores improved slightly and ‘clients with depression’ felt slightly more satisfied with their session.

These findings are important since previous research has found that practitioners often struggle more when working with clients with depression (e.g. Gonzalez et al., 2013; Annen et al., 2012; Lyons & Janca, 2009). These clients are often perceived as unmotivated and disengaged, and consultations are more difficult to conduct. However, most of the time clients with depression are unsure if they can trust their therapists with their problems and just want to be asked the right questions. When applying such results to LG clients, a study by Newman and colleagues (2010) uncovered that gay men with depression often withheld information about their worries and concerns until they feel that their therapists are trustworthy, ethical, encouraging, knowledgeable, supportive and, most of all, are open and clear. These are important areas to highlight, due to the dual stigmatisation that gay men may face when also diagnosed with a mental illness. 

Quality of life, therapeutic outcome and client satisfaction can be greatly improved when there is tailored client participation and decision-making and good clinician communication skills (Vogel, Leonhart & Helmes, 2009). So there is an urgency to ensure that psychologists are trained to provide therapy in a safe and affirmative environment with the right communication skills, even if at first they may feel deskilled to working with LG people. There is also a need for psychologists to revisit their assumptions of sexual orientation through specific sexual diversity training, to prevent cultural and personal bias from transpiring to the therapeutic relationship. In particular, future research could explore the impact of such training on attitudes and clinical communication with gay clients with depression when comparing to heterosexual clients with depression to evaluate if there is any difference in the interaction.

 References

Annen, S., Roser, P., & Brune, M. (2012). Nonverbal Behavior During Clinical Interviews: Similarities and Dissimilarities Among Schizophrenia, Mania, and Depression. Journal of Nervous & Mental Disease, 200(1): 26-32.

Banse, R., Seise, J., & Zerbes, N. (2001). Implicit attitudes toward homosexuality: reliability, validity and controllability of the IAT. Zeitschrift fur Experimentelle Psychologie, 48(2): 145-160.

Barrett, K. A., & McWhirter, B. T. (2002). Counselor trainees’ perceptions of clients based on client sexual orientation. Counselor Education & Supervision, 41: 219-232.

Bowers, A. M. V., & Bieschke, K. J. (2005). Psychologists’ clinical evaluations and attitudes: an examination of the influence of gender and sexual orientation. Professional Psychology: Research and Practice, 36(1): 97-103.

Boysen, G. A. (2009). A Review of Experimental Studies of Explicit and Implicit Bias Among Counselors. Journal of Multicultural Counseling and Development, 37: 240-249.

Boysen, G. A. & Vogel, D. L. (2008). The relationship between level of training, implicit bias, and multicultural competency among counselor trainees. Training and Education in Professional Psychology, 2(2): 103-110.

British Psychological Society (BPS) (2006). Core competencies – clinical psychology – a guide. Leicester, UK: BPS.

British Psychological Society (BPS) (2012). Guidelines and literature review for psychologists working therapeutically with sexual and gender minority clients. Leicester: British Psychological Society.

Clarke, C. P. (2010). Exploring the relationship between heterosexual therapists’ attitudes toward gay men, their self-reported multicultural counseling competency, and their initial clinical judgments. Dissertation Abstracts International, 70, 12-B, PsycINFO, EBSCOhost [accessed 25 September 2012]

Davies, D. (2012). Sexual orientation. In C. Feltham & I. Horton (eds) The Sage handbook of counselling and psychotherapy, 3rd edition, pp. 44-48. London: Sage Publications.

Finkel, M. J., Storaasli, R. D., Bandele, A., & Schaefer, V. (2003). Diversity training in graduate school: an exploratory evaluation of the Safe Zone Project. Professional Psychology: Research and Practice, 34(5): 555-561.

Gawronski, B., & Strack, F. (2004). On the propositional nature of cognitive consistency: Dissonance changes explicit but not implicit attitudes. Journal of Experimental Social Psychology, 40, 535–542.

Gawronski, B., & Strack, F. (Eds.). (2012). Cognitive consistency: A fundamental principle in social cognition. New York: Guilford Press

Gelso, C. J., Fassinger, R. E., Gomez, M. J., & Latts, M. G. (1995). Countertransference reactions to lesbian clients: the role of homophobia, counsellor gender, and countertransference management. Journal of Counseling Psychology, 42: 356-364.

Gonzalez, A. V., Siegel, J. T., Alvaro, E. M., & O’Brien, E. K. (2013). The Effect of depression on physician–patient communication among Hispanic end-stage renal disease patients. Journal of Health Communication: International Perspectives, Feb 14. DOI:10.1080/10810730.2012.727962

Herek, G. M. (2009). Understanding sexual stigma and sexual prejudice in the United States: a conceptual framework. In D. Hope (Ed.), Contemporary perspectives on lesbian, gay and bisexual identities: the 54th Nebraska Symposium on Motivation (pp.65-111). New York: Springer.

Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56: 32-43.

Jones, L. S. (2000). Attitudes of psychologists and psychologists-in-training to homosexual women and men: an Australian study. Journal of Homosexuality, 39(2): 113-132.

Kilgore, H., Sideman, L., Amin, K., Baca, L., & Bohanske, B. (2005). Psychologists’ attitudes and Therapeutic approaches toward gay, lesbian, and bisexual issues continue to improve: an Update. Psychotherapy: Theory, Research, Practice, Training, 42(3): 395-400.

Lyons, Z., & Janca, A. (2009). Diagnosis of male depression – does general practitioner gender play a part?. Australian Family Physician, 38(9), 743-746. 

Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129: 674-697.

Newman, C., Kippax, S., Mao, L., Saltman, D., & Kidd, M. (2010). Roles ascribed to general practitioners by gay men with depression. Australian Family Physician, 39(9), 667-671. 

Nosek, B. A., & Banaji, M. R. (2009). Implicit attitudes. In P. Wilken, T. Bayne, & A. Cleeremans (Eds.), Oxford Companion to Consciousness (pp. 84-85). Oxford, UK: Oxford University Press.

O’Brien, K. (2003). Patient sexual orientation and clinical intervention: A study of psychoanalytic psychologists’ biases and countertransference enactments with the gay male patient. Dissertation Abstracts International, 63, 7-B, PsycINFO, EBSCOhost [accessed 25 September 2012].

Pew Research Centre (2013). The global divide on homosexuality: greater acceptance in more secular and affluent countries. Available online from: http://www.pewglobal.org/2013/06/04/the-global-divide-on-homosexuality/ [accessed 6th June 2013].

Ranganath, K. A., & Nosek, B. A. (2007). Implicit attitudes. In R. Baumeister & K. Vohs (Eds.), Encyclopedia of Social Psychology (pp.464-466). Thousand Oaks, CA: SAGE.

Scher, L. J. (2009). Beyond acceptance: An evaluation of the safe zone project in a clinical psychology doctoral program. Dissertation Abstracts International, 69, 10-B, PsycINFO, EBSCOhost [accessed 25 September 2012]

Steffens, M. (2005). Implicit and explicit attitudes towards lesbians and gay men. Journal of Homosexuality, 49(2): 39-66.

Steffens, M. C., & Jonas, K. J. (2010). Implicit attitude measures. Journal of Psychology, 218(1): 1-3.

Vogel, B., Leonhart, R., & Helmes, A. (2009). Communication matters: The impact of communication and participation in decision making on breast cancer patients’ depression and quality of life. Patient Education & Counseling, 77(3), 391-397. doi:10.1016/j.pec.2009.09.005

Miguel Montenegro
Trainee Clinical Psychologist, University of Liverpool

September 2013

How we got shortlisted for the National Diversity Awards

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The first step in our nomination for the National Diversity Awards was when Andrea Roth who translated two of our recent papers into her native German as part of our Translations Project submitted our name.  Andrea joined our team of volunteer translators a couple of years ago and we’re now covering almost all the major languages of the world. Her nomination was completely unsolicited and unexpected.

We then ran a small social media campaign asking for support of the nomination and the next we heard was we were asked to submit to the judges some background on the organisation and what we do.  The text below is what we sent in.

National Diversity Awards 2013 Nomination

Pink Therapy is the largest independent therapy organisation to provide information and therapeutic support to the LGBTIQ+ communities. We see our role as not to duplicate direct service provision through the voluntary sector in offer centre based counselling, but rather to provide a wider framework, training counsellors and therapists of all sexualities and genders to better understand LGBTIQ+ communities, and to contribute to the debate about service provision and commenting on issues of concern for our communities from a sex-positive perspective.  Our website and social media work are important points of contact with the LGBTIQ+ communities.

We look beyond the more regular LGBT sector and take a wider view of gender and sexual diversity, providing therapy and training around other disenfranchised and marginalised groups including Asexuality, BDSM/Kink, Intersex and those in consensually non monogamous relationships of all sexualities and genders.  We’ve provided a support group for asylum seekers and refugees and offered training for therapists on this issue too.

Funding and Staffing
Our work is largely done by the goodwill of a couple of part time volunteers/interns and the work of our Founder and Director, Dominic Davies. We receive no grants or external funding and is funded from the small profit on course training fees and client fees from Dominic’s private practice.

Services to the Communities
Our website contains a fairly extensive knowledge base of websites and self help books which can help people who can’t afford therapy or where clients in therapy can engage in bibliotherapy to augment and enhance the therapeutic process.

Our Directory of Pink Therapists offers a national online database of therapists of all gender and sexualities who offer non-pathologising therapy.  We hope to expand this to include complementary therapists who understand some of the specific challenges of LGBTIQ+ health issues

Pink Therapy’s founder and director has gathered a team of highly skilled Clinical Associates who contribute to raising the standards of therapy available to the LGBTIQ+ communities through offering consultation and clinical supervision of other therapists as well as contributing to our world renowned and highly respected extensive training programme. Our clinical associates have generally all contributed to the field through publishing, speaking at conferences and are recognised in their own professional fields as leading the development of raising the quality of services to the LGBTIQ+ communities

International Development
We were invited to become members of International Lesbian and Gay Association.  We’re also members of the World Association for Sexual Health and World Professional Association for Transgender Health.

We’re very committed to working internationally to help the mental health   of LGBTIQ+ overseas through training therapists and psychologists.  In the past two years our Director has visited Colombia Dublin and Malta and will be visiting Hungary and Brazil in the next two months.

For the past four years we have fundraised and run a week long International Summer School with therapists coming from  Benin (West Africa) Brazil x2, Columbia, Croatia, Eire x3, Denmark x2, England x4, Finland, France, Hungary, Italy x3, Northern Ireland x2 Poland x2, Portugal, Scotland x2,  Serbia x2, Singapore x3, Spain x2, Turkey, USA x2.  One each course we offer a bursary to a trans* counsellor and have been very active in supporting trans* people.

With help from a team of volunteers have translated some of our recent publications into a range of languages.  Now covering about 80% of the world.

We are active in social media and print media, responding to requests from journalists and editors and recognise our wider experience and expertise.  We recently appointed an intern Press office who’s written about some of our achievements on our Press Release page We’re on Facebook with almost 1200 likes. We’re on Twitter with 1500 followers. LinkedIN 1,146 connections and recently began this blog.

We then heard we were shortlisted from over 4k applicants to be one of three LGBT community organisations up for an award.  Amazing!

We were asked to submit a short 60 second video on why we should win (click link or see below)

Pamela Gawler-Wright and I will attend the awards ceremony and find out how we did on 20 September.  We’ve never been externally recognised by anyone before like this and so it’s exciting to have even got this far!

Wish us luck!

Dominic Davies
Director