Janna L. Horowitz:
This book is a must-have for practitioners serving the needs of lesbian and gay clients! It is more than a sourcebook, as the title implies; it is a handbook. Each chapter is filled with concrete suggestions on how to work clinically with certain problems and populations. All of the chapters are in depth, comprehensive and relatively jargon-free even though they rest on scientific foundation. Instead of merely describing an issue, this book offers specific interventions to be used in the course of treatment. It leaves the reader with a treasure chest full of valuable clinical jewels to be integrated into treatment with lesbian and gay clients. All of the chapters are pertinent and interesting. Below I will discuss only a few:
Chapter 2, “What About My Needs? Working with Lesbian Partners of Childhood Sexual Abuse Survivors” is excellent. In this article, Miriam Smolover, MFCC and licensed therapist addresses a population whose needs are largely invalidated by society. Smolover describes how these women often have a tremendous desire to make it all better, a so-called savior mentality. There are many complications and consequences of having this dynamic in any relationship, where the savior assumes the role of protector through fusion and isolation. Smolover, in discussing the needs of the survivor's partner, also covers the needs of the survivor. She states that the survivor's recovery involves a process of gaining a new perspective on personal boundaries and limits and, as with any new skill, may go to extremes before finding a comfortable middle ground. The survivor's partner is caught in this process of constantly changing rules until the survivor is settled, which may take years. Smolover also addresses the partner's difficulty with talking about the abuse, problems with sexuality and reenactment of the abuse, and the problems that arise when the partner was initially unaware of the abuse and finds herself embroiled in her partner's painful healing process. Other issues that are addressed include but are not limited to family issues for both the survivor and her partner, parenting issues, and suicidality.
The main point of this article is that the lesbian partner, while trying to help her survivor partner work through her pain, must ultimately attend to her own needs, priorities, and mental health. At the end of the chapter, Smolover offers 15 concrete suggestions that the lesbian partners of childhood sexual abuse survivors have found useful in focusing on themselves, some of which include the following: 1. Know that your needs are valid; 2. Ask yourself what you would be focusing on if you were not in this relationship; 5. Ask yourself what would happen if you did not fill her need(s) for yourself and her. Does not abandoning her mean abandoning yourself? The list goes on and appears useful for lesbian as well as gay male or heterosexual couples. This chapter is so full of useful information, perspectives, and suggestions, that a simple review cannot do it justice.
Chapter 4, “Living in an Era of Multiple Loss and Trauma: Understanding Global Loss in the Gay Community” provides a wonderfully useful conceptualization of the impact of the AIDS pandemic on gay male mental health. Mark Marion, MFCC, explains how the multiple losses experienced by many gay men makes sustaining a quality of life challenging when more losses are certainly expected. Marion distinguishes between single multiple loss (tragic car accident) and progressive multiple loss, which involves continual and accumulative loss. He notes that in progressive loss, as with AIDS, the task of grieving the deceased is constantly being interrupted and altered by yet another loss (p. 63). Marion also describes the impact of trauma on loss, and how trauma challenges one's primary assumptions as proposed by Janoff-Bulman: 1. The self is worthy. 2. The world is benevolent. 3. Life has meaning. Marion writes that secondary assumptions that trauma violates are: 1. There is a relationship between a person and what happens to him or her; that is, good things happen to good people. 2. We can control what happens to us through our behavior. 3. Events are orderly and understandable. 4. People are basically good and kind. Marion describes how the global trauma and multiple progressive loss in the gay community as a result of AIDS impacts the mental health of gay men. The violation of basic life assumptions is an assault on the client's core beliefs and psychological foundation. Many men come to avoid intimacy because they fear that loss of the partner is inevitable; they vacillate between feeling numb from the pain of loss and feeling overwhelmed by grief; they exhibit anxiety, depression, survival guilt, psychological fatigue, and they link sex with death.
Marion does an excellent job of laying out these issues in a clear framework for the mental health professional to be able to sort them out. He makes astute distinctions between single and multiple loss, single-event and progressive loss, and trauma and global loss. He examines the multi-layered, aggregate effects of loss from AIDS, so the reader absolutely understands how the impact of this pandemic differs from other losses which clients face. The main difference is that the losses continue to intrude on a person's life, so the grief is cyclical instead of a linear progression. Marion includes a Global Loss Model that is helpful for conceptualizing the grief cycle. At the conclusion of the article, he provides suggestions for adaptation that include recommitment and attachment in the context of the global loss. This article is comprehensive, incredibly helpful, and an absolute must read.
Chapter 8, “Working with Parents of Gay and Lesbian Children,” is by Loris L. Wells-Lurie, LCSW, mother of a lesbian daughter and gay son. Well-Lurie states that the process of coming out for children parallels the parents' coming out process in many ways, such as selective disclosure, acceptance, and assimilation. Well-Lurie cautions that a therapist working with parents of lesbian/gay/bisexual children should not overemphasize the normality of homosexuality. She writes that she addresses educating parents, and adds, though parents clearly need to have the realities of homosexuality normalized, they also need and require validation of their own feelings… find a balance between educating about homosexuality, and allowing for the expression of the full range of their feelings (p. 163). Well-Lurie also points out to parents that the problem is not our gay children. The problem is with our misinformed and homophobic culture (p. 165). She posits that ways of helping parents with the coming out process is to educate them about religion and historical and medical perspectives on homosexuality. Most importantly, parents need to get support for themselves through a variety of avenues, notably PFLAG (Parents and Friends of Lesbians and Gays). The inclusion of this chapter is one of the reasons that this book is a special contribution to the clinician's collection. Most books or resources on lesbian and gay psychology ignore the parents' needs and focus solely on the child's coming out process. The combination of both found in this chapter is appreciated.
Chapter 11, “Lesbian Grief and Loss Issues in the Coming Out Process” by Carol A. Thompson, MFT, focuses on women's issues as they confront society's valuing of a heterosexual lifestyle and the grieving they experience from the loss of those rites and privileges. She points out that many women are raised to believe that they will one day marry and have a family, and these ideas come into conflict with the emerging lesbian identity. Thompson proposes a 5-Stage model of loss: Stage one is to accept the reality of the loss of heterosexual identity and its privileges; stage two is to acknowledge specifics of the loss and look for ways to fit in; stage three is to feel the pain of the loss and to grieve; stage four is to adjust to life as a lesbian; and stage five is to integrate lesbian life into the lesbian community and broader society. This stage model is a bold conceptualization of a realistic process for many women, even though its emphasis on heterosexuality may seem politically incorrect. Thompson takes her clinical experience to a theoretical level in a very well written and affirming article. She calls on therapists to examine their own homophobia and social and political views, and to deal with their own loss issues. Additionally, therapists should have resources and referrals ready for their clients.
Additional chapters in Gay and Lesbian Mental Health cover the following topics: narcissism and egocentricity in gay men, which presents clinical issues and concern over bias; suicidality, in which it is discussed that 42% of lesbian/gay/bisexual adolescents had attempted suicide at least once; autonomy and intimacy in lesbian and gay relationships, in which the clinician is guided to balance these two competing needs; lesbian parenting issues, such as legality and conflicts over fatherhood; identity issues for Gay Latino men, which examines cultural factors; religious conflicts and options, aging, and eating disorders.
Overall, Gay and Lesbian Mental Health is an interesting, comprehensive, and incredibly helpful sourcebook and handbook for any clinician working with lesbian and gay clients. Its concrete suggestions and dynamic conceptualizations of clinical issues are specific enough to speak directly to interventions for gay and lesbian clients, yet many are broad enough to be used with heterosexual clients as well. It tackles difficult issues in well-written and accessible language. I absolutely recommend this book.
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