If I had a dollar for every time I’ve heard a clinician tell me they treat all their gay and straight couples ‘the same’ I’d be a rich man. Although it’s totally true that same-sex couples bring many of the same issues to their therapist’s offices, working with gender and sexually diverse individuals in relationships is anything but the same as working with their heteronormative counterparts.
If I had a dollar for every time I’ve heard a clinician tell me they treat all their gay and straight couples ‘the same’ I’d be a rich man. Although it’s totally true that same-sex couples bring many of the same issues to their therapist’s offices, working with gender and sexually diverse individuals in relationships is anything but the same as working with their heteronormative counterparts.
Consider for a moment if your heterosexual clients had to come out? And then had to come out about their relationship to friends and family but not at work because the bank manager one of them works for is openly homophobic and so to protect her prospects of promotion she airbrushes her partner out of life at work, a situation that leaves her partner feeling abandoned, ignored and undervalued. Worse, this airbrushing is traumatic because the couple has had Christmas separately for the last 12 years because the other partner’s mother does not recognise her ‘friend’ as her partner. They cry on the phone each Christmas because the ‘festive’ season has come to symbolise separation, longing and lack of recognition.
It should be obvious that additional considerations need to be factored into the therapist’s work with these sorts of clients but the trouble is it's information that’s not easily obtained. Very little education about working with gender and sexually diverse (GSD) individuals, let alone their relationships, is provided to clinicians either at an undergraduate clinical education or professional development level. It’s a real pity because as a result, many therapists are missing important things about their GSD couples that might be standing in the way of optimal treatment.
Cultural, social, institutional and interpersonal factors coalesce around GSD relationships affecting the interpersonal and intrapsychic experiences of the individuals (and it is sometimes more than just two people) in these relationships. When therapists appreciate these factors and when these factors inform their assessments and interventions they quickly know that working with GSD is anything but the same as working with heteronormative couples. While the differences can range from stark to subtle, without a doubt working with GSD couples requires additional knowledge, cultural awareness and skills to do effective work.
A course for Gottman clinicians
At the end of September 2016, I had the pleasure of co-presenting a workshop with John Flanagan from Relationships Institute Australasia titled “Let’s Talk Gender and Sexually Diverse Couples” with 12 highly engaged, curious and mostly Gottman trained clinicians.
As one participant rightly pointed out, courses like this are good because ‘we don’t know what we don’t know’ and it was in this spirit that we ran the one-day pilot workshop as a way of offering extra insights and increased awareness about issues GSD couples face. We know there are knowledge gaps and way too little education in this area and so we wanted to fill the gap, at least a little. We designed the program to integrate Gottman theory and interventions with additional information about GSD couples. To be honest, fitting such complexity into a day was difficult and we had to focus on broad areas including:
♣ Developmental issues with GSD clients and how they impact relationship dynamics
♣ Internalised homophobia and its effects on relationship expectations
♣ Coming out stories, shame and hiding and its impact on intimacy
♣ Assessment considerations when working with GSD clients
♣ Alternative relationship configurations beyond the couple dyad
We then applied some of this thinking to the Sound Relationship House and looked at the way some Gottman interventions might play out when working with these issues in GSD relationships. For examples, expressions of fondness and admiration can be difficult for some male couples because the two men might share a history of hiding feelings from other men growing up to either avoid being found out as gay prior to being out or, alternatively, because culturally and socially such expressions could lead to risk of excommunication, persecution, assault, or worse.
Developing a safe therapeutic alliance
Working with GSD couples requires an additional set of rapport building skills, specific assessment considerations and, perhaps most importantly, confidence to explore the couple’s personal histories with care and thoughtfulness (but also authority) that facilitates the building of a strong therapeutic alliance. It’s important to remember that, perhaps more than many types of clients, GSD couples are vigilant for safety in a therapeutic relationship and that safety comes when the therapists know something of the client’s world and, knows the right questions to ask to understand that world.
One thing we do know is that GSD couples are very likely to ‘sanitise’ and hold back aspects of their relationship if they detect that a therapist is not familiar with or attuned to aspects of the culture, ideas, realities and values of GSD relationships. If a therapist, for example, does not understand that non-monogamous relationships are common and not necessarily destructive for many gay men then prizing monogamy or believing its absence is fundamental to the couples’ relationship problems will quickly feel like the therapist is not ‘getting’ the couple and they’re likely to disappear from the therapist’s consulting room.
Tuning into the impact of being ‘other’
Recently, I had a new Lesbian couple in their 50s start with me and as I follow the Gottman approach carefully I explained about the individual sessions will be the time when I hope to gain an understanding of their individual coming out stories as well as the coming out story about the relationship to friends, family and ex-lovers. The couple told me that having heard this in our first assessment session they went away quite excited. Despite having had individual therapy several times in their lives, they were thrilled that I had indicated that I would devote specific time to exploring the individual's coming out narratives. They said this immediately made them feel they were in the right place as their stories had never been focused on in this way.
When two people bring an experience of being ‘other’ to a relationship it’s my experience that it always has an impact on the relationship itself. Not knowing the additional material means therapist run the risk of interpreting the couple's experience through the lens of heteronormative values and perspectives and not knowing what we don’t know mean something important could be missed, or worse, something harmful could occur.
It’s important to hold an appreciation that being an ‘outsider’ exposed to institutionalised and other forms of exclusion (let’s not talk about marriage equality in Australia, it’s way too depressing) takes its toll on GSD individuals and couples. There is a significant body of evidence pointing to the deleterious mental and physical health effects of stigma, minority stress and acts of micro-aggression; the common, frequent verbal and behavioural acts that sometimes unintentionally or seemingly benign but that act to communicate hostility or are derogatory about marginalised groups that undermine credibility and equality. Examples might include misgendering a transgender person, linking homosexuality with paraphilias or stories being told where straight men eroticise lesbian sex. Researchers have directly linked homo-negative micro-aggressions with PTSD symptoms in several studies. (Robinson and Ruybin, 2016).
Internalised negativity
It’s also important to appreciate those concepts like internalised homophobia, where GSD couples (and individuals) incorporate negative societal, cultural and faith-based messages into the way the individuals in a couple view themselves. Internalised homophobia can include concepts like ‘gay men’s relationships don’t last because they’re primarily based on sex’ or ‘children are harmed by being raised by same-sex couples’ (when the fact of the matter is that research indicates kids do slightly better). The effects are toxic to individual’s sense of self and can get in the way of relationship success.
Not always same-same
Of course, it is important to realize that this is not every gay person’s experience of growing up and increasingly young gay individuals are growing up in accepting and open environments but the therapist doesn’t know if he or she does not know how to make the right sort of inquiry when assessing the couple.
The reality is you are likely to be working with GSD couples given they make up 1% of all couples in the 2011 census. Between 1996 and 2011 the number tripled and when the latest census data is made available, these numbers are set to be very much higher. It’s good to make a commitment not to treat all couples the same and to improve our skill and knowledge rather than turn away from the issue. We were thrilled with the positive feedback we received about the workshop and plan to iteratively improve the workshop going forward so if you are working with GSD couples you might like to consider doing one of the courses when it comes to a city near you.
Brad McLean is a psychotherapist and Gottman Level 3 trained couples’ therapist specializing in relationship therapy and individual psychotherapy with gender and sexually diverse clients. He also provides individual consultations to therapists working with GSD couples who feel they might benefit from specialised clinical skills and knowledge of GSD issues. He can be contacted at [email protected].