First Thoughts
Gay Affirmative Therapy is a product of our
time. It is a description of practices which arises out of the
context of a dominant culture in society which attempts to regulate
and specify according to normative notions of gender and sexuality.
It arises out of a discourse of power which asks questions about
how operations of power have been and are carried out. The more
local domains of psychology and therapy can boast a history of
subjugation and oppression in the treatment of lesbians, gay men
and bisexuals.
Our premise in this paper is that gay affirmative
therapy is an indication of a discourse in transition - both within
and without of psychology and psychotherapy - and that we should
be looking to how gay affirmative practices might be thought
of within a practice of critical therapy. Critical Therapy
encourages an idea of a constantly evolving relationship between
theory and practice and which recognises the influences on our
thinking of different contexts such as race, culture, class, gender
and sexuality.
Practice Context
The ideas we are presenting in this paper
are significantly influenced by our experience in setting up and
running a counselling and psychotherapy practice for lesbians,
gay men and bisexuals in London. Our clients approach us assuming
or knowing that all the therapists in the practice are lesbian,
gay or bisexual. We work with individuals, couples and families
- only a small proportion of whom specifically seek consultations
because they are uncomfortable about being gay.
Theoretical Context
We are particularly interested in Social Constructionist and Systemic theories as described by Cronen & Pearce (1980, 1989, 1994), Gergen et al (1992), Shotter et al (1989), Cecchin et al (1993), White (1989, 1991) in which
- Social context is foregrounded
over a notion of an individual's internal world. There is a shift
from "knowledge" to ethics.
- Human beings are seen
as meaning-generating.
- There is a concern
with the relationship between meanings and actions and the social
contexts within which these arise.
- Meaning depends on
context. We act out of and into contexts.
- Identity is continually
being co-constructed in different contexts.
- Language is seen as
expressing and constructing our experience. We make sense
of our experience through the descriptions available to us.
- Therapy is a context
for the collaborative deconstructing and co-creating of meaning.
"Descriptions and explanations of the
world are themselves forms of social action and have consequences.
Different descriptions and explanations have different consequences."
(Gergen 1985)
Theories as Stories
The Virtual Library of Queer Stories has neither
been fully read nor yet written. Let alone acted on. Our stories,
as lesbians and as gay men, as bisexuals and as third gendered
people, have barely started to be told or lived. What we work
with in "therapy" is, by and large, a set of stories
which we call "theories" which come out of stables rarely
frequented by queers except in role as "patients". Gay
affirmative therapists see themselves more as "impatients",
expecting change: change in the valuing and presence of stories
which are not usually found on the shelves of therapeutic or societal
discourse; change in the attitude to therapeutic/psychological
"knowledge".
Most psychological theories have, in the modernist
past of scientific "realities", subscribed to an idea
of revealing the truth of about a subject, uncovering "knowledge"
from which general principles could be deduced and applied to
the world at large. Psychotherapy has, and in many instances,
still does, participate in this discourse of finding out what
is "really" going on with a client. Our attitude to
"knowledge" and "truth" is changing. We are
beginning to appreciate how subjective "the facts" usually
are. What we take to be the case is the consequence of the ways
we have available to make sense of the world.
Foucault (1976 ) said "The history of
sexuality must first be written from the view point of a history
of discourses." Stories about sexuality are best understood
as arising out of socio-historical contexts. Sexuality is a concept
which, therefore, has shifting meanings. Given its centrality
in our culture, the descriptions we are invited to take on and
expected to perform about our sexuality or an aspect of our identity,
say a lot about who we are and our adequacy in the world. Those
stories act as ways of defining and regulating social behaviour
often, for example, by disqualifying different practices. Pathologising
is one form of disqualifying.
Power, gender and sexuality are interrelated
discourses. It is not surprising, therefore, that ethical questions
have arisen for counsellors and psychotherapists concerned with
the practices of power both within therapeutic practice and in
society at large. We feel it is important to be mindful of the
interplay between the power relations in society and those practised
in therapy. The question of Gay Affirmative Therapy seems to arise
out of this concern which calls into question dominant stories
about sexuality, the performance of gender, the individual and
therapy.
Thinking about Gay Affirmative Therapy: Language and Practice.
The term "Gay Affirmative Therapy"
has tended to come from a North American person-centred discourse.
Davies (1995) suggests that the word "gay", has most
often been used in "gay affirmative therapy" as a generic
reference to gay men, bisexuals and lesbians and that the gay
affirmative therapist "affirms a lesbian or gay identity
as a positive thing, without necessarily pushing anyone towards
it."
As well as recognising gay affirmative therapy which has some usefulness as a description of a problem in the therapeutic discourse and may propose some ways forward, there are certain questions which arise for practitioners from different psychological discourses.
1) For some therapists there might be an idea implicit in the notion of affirmative therapy which can sometimes sound as if what is being affirmed is intrinsic to the person, fixed and an essential part of their "being", who they really are. The Oxford English Dictionary gives several meanings of affirmative: agreement, favouring, approving and asserting that a thing is so. We would tend to regard a person's identity as fluid and co-constructed. Otherwise we might participate in specifying and categorising sexuality further.
2) The therapist is seen as having the authority to recognise and validate the experiences of their client. We feel this raises an important question about the understanding of the relationship between client and therapist. It might create an idea that the therapist is in a better position to empower or affirm the client's experience than the client (Amundson, Stewart & Valentine 1993). We suggest that a description of co-constructive practice may well fit better for many therapists and, in turn, may shift some of the power dynamics with which they feel to be incoherent with their ideology.
3) It seems that the word "affirmation" is being used in the context of this conference to describe an attitude of the therapist supported by therapeutic actions. What kinds of beliefs are behind this attitude? Is it always best to be affirmative of a person's self description? When might the origins and consequences or context of this description need exploring further?
4) It does not necessarily take account of
creating and developing meaning, for example, about "becoming"
gay or lesbian. (Foucault 1981)
The Role of Language in Therapy
The activities we participate in as lesbians
and gay men are constantly evolving and the accounts for these
activities often taken longer to emerge in language than they
do in practice. As they begin to appear in language, we wrestle
with the meaning of activities - new and old - and look at them
through mainly negative lenses which we have inherited and which
were invented by non-participants. How helpful then are the concepts
of healthy and unhealthy? Under which column do we put sadomasochism
currently?
In addition to any negative ideas which lesbians
or gay men may have adopted, we find many people have also been
recruited into a language of pathology way before they get to
therapy. In fact, we find many clients feel it is expected of
them to be able to explain their problems in problem-saturated,
psychotechnical terms. " I am a co-dependent", "We
have communication problems", "I come from a dysfunctional
family". Inevitably, there is an undermining content to the
description. Maybe it would be interesting to ask "If you
had never come across psychology theories before, how do you think
you would be describing your concerns to me?" or "How
would you have described yourself/ behaviours before you came
across that phrase?" It is likely that many people would
still feel negatively about themselves. It seems that the language
associated with therapy has been appropriated by members of the
public to bring forth negative descriptions of themselves, emphasising
their inabilities. (Those trained in counselling and therapy,
in our experience, are often the most affected by this negative
accounting). While admitting to what is problematic may be helpful
and agentive(ref/explan) action, for many people, "therapy"
has become associated with producing negative explanations and
descriptions of the self and relationships.
From Fixed Descriptions to Emergent Abilities
Given the impossibility of neutrality for therapist and client (1), how can we ensure that we create the conditions for both to explore meanings and ideas behind clients' and our own experiences so we can free themselves of stories which act as constraints and develop accounts which allow for other possibilities and create stories of ability?
One option is to work with the client to deconstruct
their negative accounts and ideas (White, M. 1991), looking at
how these ideas have come about and how they work for or against
the client and in which contexts. The following examples are not
taken from any specific clients but the patterns of description
are familiar.
Case Example 1
Client - I don't feel comfortable about the kind of sex I'm into.
Therapist - How come?
Client - It's just not normal.
Therapist - What gives you the idea it's not normal?
Client - Well, I've only ever met three others who, um, like, er, the kind of thing I like.
Therapist - How many people would you have to come across before you did think it was normal?
Client - Er, um, maybe fifteen. Ten?
Therapist - Fifteen to ten. How long has it taken to meet these three?
Client - Two years, bit less.
Therapist - Three in two years. That's another six to eight years of feeling abnormal. I wonder if, for a moment, you imagine that there is a discussion group running for people who practise the same things you do. There's about fifteen people present - all discussing what they like, have tried etc. How do you think that would affect your sense of not having normal sexual practices?
Client - I dunno. I think it would be a bit of a laugh. We could swap tips!
Therapist - How do you think you might be feeling if you thought your behaviour was closer to normal?
Client - Well, I wouldn't want it to be too normal. Could be a bit boring. I like the idea of there being lots and lots of others though.
Therapist - Could you get too comfortable with your SM practices?
Client - I don't think so. Maybe.
Case Example 2
Client - I am such a depressed and needy person.
Therapist - What gives you that idea?
Client - Oh, I've been feeling very down.
Therapist - About what?
Client - I think I'm worried about John finding out what I'm really like.
Therapist - How does he see you at the moment?
Client - He thinks I'm a happy and independent person.
Therapist - How do you think he gets that idea?
Client - I am happy when I'm with him.
Therapist - Only when you are with him?
Client - No. In fact, I've been happy a lot over the last few weeks.
Therapist - So, do you think he sees you as happy and independent because he is ignorant of the depressed parts of you? Or do you feel you have been acting happier and more independent than you have felt yourself to be?
Client - Well, he doesn't know me that well yet. (Pause) But I think I probably am happier than I realise and I forget that I am quite independent now. Because John has only come out quite recently, I can see how far I have come myself from the days when I was dealing with being gay and was so down.
Therapist - What difference do you think it makes to you when you think of yourself either as the depressed and needy person or as a happier and quite independent person?
Client - I tend to look on the bleak side of things.
Therapist - What? When you you think of yourself as depressed and needy? Or when you think of yourself as happy and independent?
Client - Hmm. Both. When I am feeling happier too.
Therapist - How do you think looking on the bleak side of things works for you or against you?
Client - I think I can't always see when things are going right. I just always assume the worst - in case I get disappointed. I can't bear disappointment.
Therapist - What do you mean by "disappointment"?
Client - Taking a fall, getting hurt. (Pause) But I guess getting hurt is just part of life really, isn't it.
Therapist - So, what difference do you think it would make, if any, if you thought of yourself as happier and quite independent?
Client - Hmm. I think I'd be less afraid of
being hurt. And maybe, people wouldn't think they could mess me around as much.
Here the therapist is asking questions for
the client to explore their own thinking. The clients start with
a negative and fixed description of themselves or their practices
and throughout the conversation they deconstruct this initial
description, opening up space to for other descriptions and allow
for other meanings to emerge. By taking an irreverent attitude
(Cecchin et al 1993) to one's own and the client's descriptions
of depression or of SM and by exercising a curiosity about the
client's ideas, one can explore with the client how they think
the different descriptions may act to constrain or liberate.
Critical Therapy: thinking about the Relationship between Theory and Practice
Critical therapy is useful to us in thinking
about the thinking that shapes our practices in therapeutic contexts.
It invites and encourages account-ability - how we account for
our actions as therapists, how our accounts influence in turn
what we notice and treat as meaningful, what we include and exclude.
Weingarten (1992) proposes that it is important for a therapist
that "he or she is constantly selecting aspects of the conversation
to amplify or diminish..... that this process of selection is
guided by a number of variables including the therapists experiences
gained by virtue of being located in a particular racial, gendered
and class position in the wider socio-political context within
which therapy takes place."
Leppington (1991) proposes a way of thinking
about practice by looking at the reflexive and recursive relationship
between our epistemology (ways of thinking about what we think
we know), theory, method and data (what we learn/ feedback).
This diagram demonstrates a relationship between
these components which allows for change at any level, at any
point in the therapeutic process. Each level acts as a context
for the other.
Fig. 1 (Leppington 1991)
The level of methodology is influenced by
our epistemology (our entire ways of seeing the world) to which
we bring all kinds of stories and ideas from cultural, family
and personal contexts. These influence our choice of theoretical
approach which, in turn, influences what we do in the therapy
in the way of techniques. Our technique will bring forth one kind
of story or data rather than another.
To avoid confirming one's own basic premises
or "becoming attached to one's own story", Leppington
proposes taking an ironic stance in relation to the conversations
which come about between therapist and client - we would call
this critical positioning - in which one is
Evolving Thoughts.......
One of the problems then, with affirming a
lesbian or gay identity or any aspect of identity for that matter,
is that identity can be described as a fluid and emergent thing.
Davies (1995) describes gay identity as being "a set of cultural
beliefs, values and support networks which contribute to the modern
lesbian or gay man." Perhaps the notion of gay identity and
culture throws up further questions for the postmodern lesbian
or gay man and it certainly raises questions for the postmodern
lesbian, gay, bisexual and other concerned therapists who have
rejected an idea of "true", fixed identity.
How do we as therapists create and use an
awareness of the commonalities of lesbian and/or gay and/or bisexual
experience while, at the same time, create the conditions to explore
the meaning of descriptions which we might otherwise take for
granted and create new accounts of what it means to be lesbian
or gay?
Are gay affirmative practices something discreet
which people can add on? Or do we need to develop a practice
at a higher level which has built into it an invitation to think
about ideologies and theories, which provides a way of speaking
about therapeutic practices that can account for power, take account
of power and recognise how power operates in the contexts of not
only sexuality but also other arenas for oppression such as gender,
race, class and ability?
It is our hope that, as lesbian, gay and bisexual
and third gendered therapists, we will value and develop our ability
to be curious about the influence of ideology on practice and
co-create with clients and colleagues the ability to both participate
in a discourse, be reflexive about our place in it and decide
how we want to continue to participate in the future.
(1) Neutrality is generally a modernist concept based on the idea that there is such a thing as scientific objectivity (Bateson 1980). Systemic therapy suggests that all theories have a subjective context and that it is impossible for a therapist to free themselves of personal values (Weingarten 1992). The aim of a postmodernist therapist might be to practice self reflexivity (Hoffman 1990) and treat psychological theories as different narratives that may privilege certain ideas over others. (White 1991)
Amundson, J., Stewart, K. & Valentine, L. (1993) Temptations of Power and Certainty. Journal of Marital & Family Therapy 1993 Vol.19.2
Anderson, H. & Goolishian, H. (1988) Human Systems as Linguistic Systems: preliminary and evolving ideas about the implications for clinical theory. Family Process 27:4
Anderson, H. & Goolishian, H. (1993) The Client is the Expert: a Not-Knowing Approach to Therapy. Therapy as Social Construction. Eds. Mcnamee, S. & Gergen, K. Sage. UK
Bateson, G. (1973) Steps to an Ecology of Mind. Palladin, London.
Cecchin, G., Lane G., Ray W. (1993) From Strategising toNon-Intervention: Towards Irreverance in Systemic Practice. Journal of Marital & Family Therapy. 17.1
Cronen, V. & Pearce, W.B. (1980) Communication, Action and Meaning: The Creation of Social Realities. Praeger, New York
Epston, D. & White, M. (1992) Experience, Contradiction, Narrative and Imagination: Selected Writings of Epston and White. Dulwich Centre Publications. Australia.
Foucault, M. (1976) The History of Sexuality: An Introduction. Peregrine (reprint) 1984. UK
Foucault, M. (1981) Friendship as Lifestyle: An Interview. Gay Infromation. Vol.7 Spring 1981 (4)
Gergen, K. (1985) The Social Constructionist Movement in Modern Psychology. American Psychologist 40 pp 226-275
Gergen, K. & McNamee, S. (Eds.) (1993) Therapy as Social Construction. Sage. UK
Leppington, R. (1991) From Constructivism to Social Constructionism and Doing Critical Therapy. Human Systems: Journal of Systemic Consultation and Management. Vol.2.2
Pearce, W. B. (1989) Communication and the Human Condition. Southern Illinois University Press
Pearce, W. B. (1992) A Camper's Guide to Social Constructionisms.Human Systems: Journal of Systemic Consultation and Management. Vol.3 & 4.2
Pearce, W. B. (1994) Interpersonal Communication, Making Social Worlds. Harper Collins College Publishers. New York
Shotter, J. & Gergen K. (Eds.) (1989) Texts of Identity. Sage. London
Tomm, K. (1987-88) Interventive Interviewing: Part I: Strategizing as a Fourth Guideline for the Therapist. Family Process. 26: 3-13;
Tomm, K. (1987) Interventive Interviewing: Part II: Reflexive Questioning as a Means to Enable Self-Healing.. Family Process. 26: 167-183
Tomm, K. (1988) Interventive Interviewing: Part III: Intending to ask Lineal, Circular, Strategic or Reflexive Questions? Family Process. 27: 1-15
Weingarten, K. (1992) A Consideration of Intimate and Non-Intimate Interactions in Therapy. Family Process
White, M. (1988) Externalising the Problem. Dulwich Centre Newsletter
White, M. (1991) Deconstruction and
Therapy in Experience, Contradiction, Narrative and
Imagination: Selected Papers
of David Epston and Michael White
1989 - 1991. Ed. Epston, D. & White, M. Dulwich Centre
Publications. South Australia
Further Reading
Bannet E. Tavor (1993) Postcultural Theory: Critical Theory after the Marxist Paradigm. Macmillan
Carl, D. (1990) Counselling Same Sex Couples. Norton, London
Fuss, D. Ed.(1991) Inside/Out Lesbian Theories, Gay Theories. Routledge, New York
Hoffman, L.(1989) From System to Discourse. Human Systems: Journal of Systemic Consultation and Management. Vol.1
Hoffman, L.(1990) Constructing Realities: An Art of Lenses. Family Process 29; 1-12.
Kitzinger, C. (1989) The Social Construction of Lesbianism. Sage
Kvale S. (ed.) (1992) Psychology and Postmodernism. Sage.
Rosenau, P.M. (1992) Post-Modernism and the Social Sciences. Princeton Paperbacks.
Sarup M., (1993) An Introductory Guide to Poststructuralism and Postmodernism. Second Edition. Harvester Wheatsheaf.
Stacey, K. (1993) Exploring Stories
of Lesbian Experience in Therapy: Implications for Therapists in a Postmodern World.
Dulwich Centre Newsletter 1993 No.2 Adelaide