Using ACT to target internalized homophobia and self-stigma

Using ACT to target internalized homophobia and self-stigma

Many of our clients struggle with shame and stigma. Despite its prevalence in the therapy room, there are few clinical interventions that specifically target self stigma,  defined here as “negative thoughts and feelings (e.g., shame, negative self-evaluative thoughts, fear) that emerge from identification with a stigmatized group” (p. 48, Luoma, O’Hair, Kohlenberg, Hayes, & Fletcher, 2010). This is an issue that we at Portland Psychotherapy are exploring, both in our clinical work and in the research we are conducting. We currently have several research projects underway, looking at various aspects of stigma and shame, how they impact functioning, and ways to target stigma and shame inside and outside the therapy office.

For these reasons, I was very interested in a recent article in Cognitive and Behavioral Practice by Yadavaia & Hayestitled “Acceptance and Commitment Therapy for Self-Stigma Around Sexual Orientation: A Multiple Baseline Evaluation.”  In the article, the authors report on the effectiveness of a brief (6-10 session) ACT intervention for self stigma in those who experience same sex attraction– sometimes referred to as internalized homophobia. While the ACT intervention in the study was individualized to each participant, similar to standard clinical practice, all 6 of the basic ACT processes were covered and expert ratings of treatment integrity were high.

The study found that participants evidenced positive changes on a variety of factors including self stigma/internalized homophobia, depression, anxiety, quality of life, perceived social support, and overall psychological flexibility. What I found to be most significant was that while participants reported a decrease in the believability of same-sex thoughts, the frequency of those thoughts did not change. This finding is consistent with previous studies using ACT to target other psychological difficulties (e.g. Bach & Hayes, 2002) and appears to support an ACT-consistent mechanism of change. In ACT, it is the workability of a thought in terms of valued action, rather than the form of the thought that is targeted. As such, we would expect, and this study did indeed find, that the frequency or even the form, of particular thoughts would not necessarily change significantly, but rather that change is found in the function that thought serves. It other words, after the intervention, participants continued to still have the same same-sex thoughts, but they were much less troubled by the thought.

Previous studies have supported the use ACT to target other forms of self-stigma, including those who struggle with substance use problems (Luoma, Kohlenberg, Hayes, Bunting, & Rye, 2008) and obesity (Lillis, Hayes, & Bunting, 2009). Although power was limited because of the small sample size  (n=5), the pattern of findings in this study were consistent with previous findings and suggests that ACT may be an effective intervention for individuals who struggle with self-stigma related to sexual attraction and sexual orientation.

Why Google+ is Good for Therapists: Respect for Diversity

Why Google+ is Good for Therapists: Respect for Diversity

“Don’t be evil”—Google motto

I just created my new Google+ account yesterday and I’m very pleased. No, it’s not because it’s the latest and greatest social networking tool (though, those circles are pretty cool). And no, it’s not because finally, after holding out from joining Facebook for all these years, my friends and family will finally get off my back about needing to move into the 21st century. Nope. Those things are fine but, what I’m really impressed by though was what I found as I was going through the process of creating my account. Specifically, under the “gender” box you could choose from an option of “male,” “female,” and “other.” Wow! Now that’s not just “not being evil,” (Google’s motto) — that’s pretty darn enlightened! Yes, of course I’d like to see them use a fill-in-the-blank format so people who identify as something other than “male” or “female” don’t have to identify as “other”, but it’s a great start. This is a great example of how something as small as demographic questions can reflect our values. We have come a long way in terms of inclusivity and awareness of the rich diversity of our world when a Fortune 500 company like Google makes a statement like this.

It also got me thinking about ways that we here at Portland Psychotherapy can further advocate for our clinic’s core value to support diversity and inclusivity and to make quality, evidence-based mental health services available to all member of our community. I came across this brochure published by the Gay and Lesbian Medical Association that offers some great suggestions to help make your practice more inclusive and affirmative. I also found this sample of a “culturally competent intake form” from the King County Public Health Department that includes ways to structure your intake forms around issues of relationships and sexuality that are most inclusive.

Ways to Improve Inclusivity in Your Therapy Practice

Here are a few other suggestions of things you might want to consider to make your practice more welcoming to all:

  • Use fill-in-the-blank spaces rather than check boxes on intake forms for categories like “gender,” “sexual orientation,” “relationship status,” and “ethnicity”.
  • If you ask about religion on your forms, be sure to also include an option for “atheist” as a viable choice.
  • If you have brochures or magazines in your waiting room, consider whether or not they represent a diverse range of experiences and lifestyles (e.g. Do you only have “Parenting” magazine in your waiting room or do you also have “The Advocate”?)
  • If it seems clinically appropriate, ask clients which pronoun (e.g., he, she, it, they) they would like to be referred by.
  • When talking about sexual or relationship partners, be cautious about assumptions about gender, legal status (i.e. married versus partnered), monogamy, sexual orientation, etc. Using the term “partner or partners” may be more inclusive than “spouse” for example.

So, take a cue from Google+ and maybe revisit your office forms and practices to see if there are ways in which you could create a more welcoming and inclusive environment for all those you serve. I know we’re going to be revisiting that issue here at the clinic as well.

UPCOMING TRAINING EVENTS

How to be Experiential in Acceptance and Commitment Therapy

Jason Luoma, Ph.D.
April 23, 2021 from 12-1pm

Acceptance and commitment therapy (ACT) is, at its core, an experiential treatment, but is frequently delivered in a non-experiential way. Experiential learning involves going beyond verbal discussion, insight, and explanations of experience. But how do we do this in ACT and how do we know when we are spending too much time engaged in non-experiential modes of learning? This workshop will outline a simple model you can use to identify when you are in less or more experiential modes during therapy and easy methods to switch to more experiential modes. You will then have a chance to practice it in breakout groups and get feedback. Read More.


Ethical & Legal Considerations in Psychedelic Integration Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 7, 2021 from 12-2pm

This workshop is based on extensive research and writing we have conducted into the legal and ethical issues of working with psychedelics in the current regulatory climate, as well as clinical practice doing harm reduction and integration therapy with psychedelics. It is informed by consultation with multiple experts on harm reduction, as well as attorneys knowledgeable about criminal and civil matters relating to drug use and professional practice. We will share with you all we know so that you can be more informed in the decisions you are making in your practice and be better able to decide whether to jump into this kind of work if you are considering it. Read More.


Case Conceptualization in Acceptance and Commitment Therapy

Jason Luoma, Ph.D. and Brian Pilecki, Ph.D.
May 21, 2021 from 12-2pm

This workshop provides a chance to learn concrete methods for conceptualizing cases from the perspective of Acceptance and Commitment Therapy. Formulating a useful case conceptualization is a foundational clinical skill that is essential in delivering effective treatment, and one that can be often overlooked in the process of working with clients. Participants will learn several formats for doing formal case conceptualization outside of session as a means to further develop knowledge and skill with ACT theory, as well as to learn a means to enhance treatment planning. The importance of ongoing case conceptualization throughout a course of treatment will be emphasized, as well as common pitfalls in conceptualizing client problems. Participants will also have a chance to practice newly learned skills with a case in breakout groups. Read More.


ACT Precision Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Help You be Focused and Strategic in Your Interventions

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
June 18, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop focuses on helping you use ACT theory & in-session clinical markers to make more precise and strategic interventions. The main goal of this workshop is to help you become more adept at identifying in-session client behaviors that are indicators for particular ACT processes that are likely to be most relevant. The workshop uses a process we call ACT Circuit Training, which involves intensive analysis of a video of an ACT session and intentional practice in conceptualizing client behavior and generating possible ACT responses, followed by discussion and feedback. Read More.


ACT Agility Training: In-Session Case Conceptualization in Acceptance and Commitment Therapy to Increase Flexible Responding

Jason Luoma, Ph.D. and Jenna LeJeune, Ph.D
July 16, 2021 from 12-2pm

This workshop provides a chance to learn and practice in-session, in-the-moment case conceptualization of cases from the perspective of Acceptance and Commitment Therapy. This workshop is intended to help therapists be more flexible and nimble in their use of ACT processes, strengthening their ability to fluidly shift as needed between processes within sessions. Therapist learning ACT often develop tunnel vision, focusing too much on particular processes or responding rigidly when more flexibility is needed. Read More.


Therapy and Research in Psychedelic Science (TRIPS) Seminar Series

Second Friday of each month from 12:00 PM – 1:00 PM (PT)

TRIPS is an online seminar series that hosts speakers discussing science-informed presentations and discussions about psychedelics to educate healthcare professionals. This series was created to guide healthcare providers and students preparing to be professionals towards the most relevant, pragmatic, and essential information about psychedelic-assisted therapy, changing legal statuses, and harm reduction approaches in order to better serve clients and communities. This seminar series is a fundraiser for our clinical trial of MDMA-assisted psychotherapy for social anxiety disorder that Portland Psychotherapy investigators are preparing for and starting in the Fall of 2021. All proceeds after presenter remuneration will go to fund this clinical trial. Read more.

April 9th, 2021 – Ketamine 101: An Introduction to Ketamine-Assisted Psychotherapy with Gregory Wells, Ph.D.
May 14th, 2021  Research on MDMA and Psychedelic-Assisted Therapy: An Overview of the Evidence for Clinicians with Jason Luoma, Ph.D.
June 11th, 2021 Becoming a Psychedelic-Informed Therapist: Toward Developing Your Own Practice with Nathan Gates, M.A., LCPC