Tailoring Therapy for Gender and Sexual Minority Clients

Clients with minority identities related to their sexual orientation or gender seek therapy for a variety of concerns, and many therapists use the evidence-based approaches they are most comfortable with to respond to the presenting symptoms. The impact of possessing a stigmatized identity, encountering discrimination, or witnessing political debates regarding one’s belonging in society lead to vulnerabilities and challenges that set these clients apart. Some of the most researched difficulties experienced by gender and sexual minorities that traditional treatment packages may not respond to are internalized stigma, rejection sensitivity, and shame.

When Our Worst Thoughts are About Ourselves

Internalized stigma (i.e., internalized homophobia, biphobia, or transphobia) refers to those attitudes or stereotypes about a minority group present in our culture that might be internalized and believed by an individual. These sorts of thoughts can be painful, from assertions that attraction to the same sex is a result of sexual abuse as a child (a theory that might be repeatedly asserted by family or religious leaders), to ideas about what the future holds (“I’ll never be respected in my field”, “Real relationships don’t exist for people like me”, or “My parents will never love me again”).

Tips for addressing internalized homophobia:

Don’t argue with the fears – a client can get caught in a cycle of attempting to convince ourselves of which fears are true or not. Mindfulness techniques can help the therapist and client to observe when those thoughts arise, how they affect the client, and to notice those moments when the client might decide to engage with the world differently.
Defusion exercises can be helpful – fusion refers to the way that our thoughts, in that echo chamber between our ears, can seem completely true. Those same thoughts might feel lighter in the course of a day when a client is able to notice how the believability rises and falls, or old habits of responding to those thoughts.

Armor Up: Avoiding Rejection and Intimacy

Growing up, many GSM individuals have experienced rejection – and not just rejection, but rejection from parents, siblings, and those who knew them and had appeared to love them most! Learning to be less guarded emotionally, to engage vulnerably and authentically in relationships after such experiences of rejection, is one of the most difficult tasks for GSM clients to overcome, in my clinical experience – particularly if one’s parents do not allow for reestablishing a relationship after adjusting to a child coming out.

Tips for building client capacity for vulnerability and intimacy:

Drawing attention to the relationship in the room – for many clients, it is easy to discount a therapist’s warmth as part of their job, or service in response to payment. Slow down, be mindful, and guide a client to notice the feel in the room with therapist.
A warm relationship including disclosure – while associated with better therapeutic relationships for all clients, a relationship that emphasizes the client’s genuine care for the client and authentic responses to events in the client’s life are particularly important.
Encouraging risks outside of therapy – tracking and sharing experiences of behaving in a more vulnerable or authentic way, particularly when the risk of rejection feels possible, can both build confidence and reduce fear of being fully seen by others.

When You Can’t Seem to Love Yourself

Shame is a complicated emotion, and tends to involve barriers to notice or let in warmth from others, a harsh and judgmental attitude toward yourself, and a feeling of isolating difference from other people. According to some experts, like Paul Gilbert, this is an emotion with evolutionary roots tied to being a social animal. We want to feel safe in our group, as it’s a dangerous world to go alone. Shame also may have different origins for GSM people. One recent study of cisgender men’s experiences found that while heterosexual men have a variety of people, places, and situations that come up when reporting early shame memories, gay men overwhelmingly report experiences of feeling shamed by their fathers. In this study, caregiver shame was more associated with depressive symptoms.

Use compassion training skills to address shame:

Compassion for others – at times the most accessible way to notice how a lack of safety or of shaming environments affects a GSM client is to encourage exploring how those around them are affected. Caring for others warms the heart to care for ourselves.
Compassion from others – as described above, guardedness to the emotional responses of others can become habit for many GSM people. In CFT, practicing guided visualization exercises that involve receiving warmth from a loving, ideal figure is sometimes required as a precursor to feeling safe receiving it from the therapist or others in the client’s life.
Compassion toward ourselves – in the face of bias, relationship challenges, or navigating politically charged environments, GSM clients benefit from the reminder to slow down and notice those parts in need of care. To work effectively, one must be able to both generate and receive compassion, so this is often the most difficult step for clients (or clinicians).

If you are a therapist wanting to learn more about responding to these common processes in psychotherapy, you can read more about these approaches here, or attend an upcoming workshop on this topic at Portland Psychotherapy.

Matthew D. Skinta, Ph.D., ABPP, is a board-certified clinical psychologist and a trainer of acceptance & commitment therapy and functional analytic psychotherapy. He directs Palo Alto University’s Sexual & Gender Identities Clinic, and is passionate about increasing the application of evidence-based care to work with GSM clients.

Resources for self- and other-care in difficult times

Many of us have been impacted by the election results.  Whether you are feeling shock, fear, anger, sadness, confusion, disbelief, or excitement, joy, satisfaction or hope, you are likely not alone.

If you have been struggling, some of these resources might be helpful (thanks to Jennifer Villatte for sharing this list).  I prefaced each with a quote that spoke to me.  I also noticed the urge to provide a more in depth review of each, but eventually decided to practice self-care by calling it good.  I hope you find something you might be seeking.

Resources for Self-Care in the Face of Social Injustice and Marginalization

“When we hold space for other people, we open our hearts, offer unconditional support, and let go of judgement and control.”
What It Really Means to Hold Space for Someone, by Heather Plett
http://upliftconnect.com/hold-space/

“Have you showered in the past day? If not, take a shower right now.”
4 Self-Care Resources for Days When the World is Terrible, by Miriam Zoila Perez
https://www.colorlines.com/articles/4-self-care-resources-days-when-world-terrible

“Oppression is far more effective when the oppressed are also mentally drained and physically ill, so our physical and mental wellness is, in itself, a personal counter-attack on oppression.”
3 Ways to Prioritize Self-Care While Resisting Dehumanization: Because #BlackWellnessMatters, by Akilah S. Richards
http://everydayfeminism.com/2015/07/self-care-resisting-dehumanization/

“There are things you can do for yourself right now to get prepared for the next four (to eight) years.”
What to Do If You’re Trans and Live in America Now, by Jessica Lachenal
http://www.themarysue.com/trans-in-america-2016/

“Anger used as a catalyst for social transformation can go a long way.”
Transforming Anger into Building Solidarity, by Beth Berila
http://www.contemplativepracticesforantioppressionpedagogy.com/blog/transforming-anger-into-building-solidarity-by-beth-berila-phd

“Sometimes saying no is a radical act of self-care that’s as vital to our struggles as the marches, teach-ins, and walk-outs in which we participate.”
5 Self-Care Tips for Activists – ‘Cause Being Woke Shouldn’t Mean Your Spirit’s Broke, by Kim Tran
http://everydayfeminism.com/2016/04/self-care-for-woke-folks/

“The antidote for exhaustion isn’t rest.  It is wholeheartedness.”
What’s Missing When We Talk About Self-Care, by Carmenleah Ascencio
https://www.youtube.com/watch?v=4eX5Wjm4FrE

Resources for Engaging in Difficult Conversations and Being an Ally

“I’m more interested in helping them change their oppressive behavior than publicly shaming them for it.”
Calling In: A Quick Guide on When and How, by Sian Ferguson
http://everydayfeminism.com/2015/01/guide-to-calling-in/

“Comfort IN, dump OUT.”
How not to say the wrong thing – The “Ring Theory” of Comfort, by Susan Silk & Barry Goldman
http://articles.latimes.com/2013/apr/07/opinion/la-oe-0407-silk-ring-theory-20130407

13. Recognize That Yes, You’re Going to Do it Wrong and 14. Apologize Without Caveats”
30 Ways to Be a Better Ally, by Jamie Utt
http://everydayfeminism.com/2014/01/30-ways-to-be-a-better-ally-in-2014/

“We Center The Voice and Leadership of the Survivor and Oppressed Communities.”
Being An Ally/Building Solidarity, by Southerners On New Ground (S.O.N.G.)
http://southernersonnewground.org/wp-content/uploads/2012/12/SONG-Being-An-Ally-Building-Solidarity.pdf

“Create and Share Art, Support People with Disabilities”
26 Ways to Be in the Struggle Beyond the Streets, by Anderson, Barett, Dixon, Garrido, Kane, Nancherla, Narichania, Narasimham, Rabiyah and Richart
https://issuu.com/nlc.sf.2014/docs/beyondthestreets_final

To those who feel afraid or hurt after the election

For many of us, these are frightening and uncertain times. We at Portland Psychotherapy want to make a declaration of support to the millions of people around the nation and here in Portland that have been targeted, oppressed, attacked, or silenced and to those who feel fearful of what may come.  Portland Psychotherapy does not endorse discrimination in any form and is invested in ensuring the safety of all members of our community.

If you feel marginalized, oppressed, angered, hurt, afraid, ashamed, or stigmatized, we want you to know you are welcome here.  You are all part of the community we love and serve. This is a safe place for you to speak and to be heard. We value you.

The Staff of Portland Psychotherapy

The 5-Minute Guide to ACT: A Visual ACT Elevator Pitch

The 5-Minute Guide to ACT: A Visual ACT Elevator Pitch

The challenge of explaining ACT

As an ACT trainer, one of the most challenging things for me is when someone who isn’t familiar with ACT says “What’s this whole ACT thing about?” Let’s just say my ACT elevator pitch needs some work! It’s tricky to try to describe something that is supposed to be an experiential therapy. And then there is the whole conundrum of trying to use language to explain a theory that holds that language is at the heart of the problem. But I find that “you just have to experience it” is the trainer equivalent to “because I said so” and is equally unsatisfying (and also not very helpful). So this week I was thrilled when I got another tool in my “what is ACT” arsenal thanks to ACBS member Dov Ben-Yaacov and the 5-minute Guide to ACT Pictogram he created.

The 5-Minute Guide to ACT Pictogram (click on picture to download)

This isn’t something I would necessarily share with clients. However, I do think this simple, yet surprisingly comprehensive pictogram could be very helpful in orienting students and those learning ACT to the general gestalt of how ACT, RFT, and Functional Contextualism fit together.

Another example of the generosity in the ACBS community

One of the things I most love about the Contextual Behavioral Science community is how incredibly generous the community is. I can’t imagine how much time it took Dov to create this. And then he just went ahead and posted it for anyone to use it for free. So it’s with much gratitude to Dov Ben-Yaacov that I pass this along to you. Please use it as it is helpful and also continue to credit Dov Ben-Yaacov as you do so. 

Jenna LeJeune, Ph.D

Author: Jenna LeJeune, Ph.D

Jenna is a clinical psychologist who specializes in working with people who struggle with relationship and intimacy difficulties and with those who have a trauma history. Her research focuses on developing compassion-based interventions targeting stigma, shame, and chronic self-criticism.

Portland Psychotherapy’s Clinical-Research Social Business Model Published in APA Journal – Psychology Research and Practice

Portland Psychotherapy’s Clinical-Research Social Business Model Published in APA Journal – Psychology Research and Practice

Many of those reading this blog probably already know that that in addition to providing science-based mental health services, Portland Psychotherapy is also a productive independent research center.

How we fund our research

What many of you may not know is how we go about funding that research. To our knowledge, we are the only organization of its kind to have set up a private mental health clinic and research center based on social business concepts in which the profits from the money-generating activities of the organization go back to serving the greater good (in this case, scientific research) rather than be used as profits for shareholders.

What we discuss in the article

We are very excited that the APA journal Psychology Research and Practice just published our article that outlines our model, which we call the clinical-research social business model. Among some of the things addressed in the article include:

  • An outline of our clinical-research social business model that is based on social enterprise concepts
  • How we overcame the barriers to conducting research outside of academia, including how we created an independent IRB and how to address infrastructure limitations such as assistants and access to journal articles
  • Benefits of conducting research outside of traditional academic settings
  • How we have shifted the contingencies around money in our model and structure our model such that intrinsic rewards such as mastery, autonomy, and purpose can serve as powerful motivators that advance more communal and creative goals.
  • Ideas about how our model might be applicable to other settings.

One thing we are very aware of at our center is that all our work depends upon a supportive community. If you are reading this, it is likely that YOU are a part of that community and we thank you for that. If you are interested in reading more about our model, how it came to be, and what your support of us has helped make happen, you can read the a pre-print of the article here.

Jenna LeJeune, Ph.D

Author: Jenna LeJeune, Ph.D

Jenna is a clinical psychologist who specializes in working with people who struggle with relationship and intimacy difficulties and with those who have a trauma history. Her research focuses on developing compassion-based interventions targeting stigma, shame, and chronic self-criticism.

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