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

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.

December 11th, 2020 – Ethical and Legal Considerations in Providing Psychedelic Integration Therapy with Brian Pilecki, Ph.D. & Jason Luoma, Ph.D.
January 8th, 2021 – What’s it Like to Trip? The Patient Experience in Psychedelic-Assisted Therapy with Brian Pilecki, Ph.D.
February 12th, 2021 – 5-MEO-DMT with Rafael Lancelotta, M.S.
March 12th, 2021 – What does Psilocybin-Assisted Therapy for Depression Look Like? A Clinical Case Presentation based on a Recent Clinical Trial from Johns Hopkins with Alan K. Davis, Ph.D.
April 9th, 2021 – 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.