Book Review
Psychotherapy 
Handbook of Affirmative Psychotherapy With Lesbians and Gay Men Kathleen Y Ritter, Anthony I Terndrup. New York, London: The Guilford Press; 2002. 493 p. CAN$84.75
Reviewer
rating*: Excellent
Review by: Peter Moore, MD, FRCPC
Collingwood, Ontario
Despite opposition that is often hateful, and sometimes murderous, gays and lesbians are inching their way toward greater social acceptance. Still, they push against continued resistance. Recently, Canadian Anglicans decided that they could not endorse same-sex relationships, and lamentably, Albertan and American conservatives continue their jeremiad that same-sex anything rips at the roots of society. We live in a heterosexual world jealous of its privilege but nervous about its safety.
Safety, both of body and spirit, is of course an ongoing concern for lesbians and gays, all of whom will at some time have known violence, either physical or, more likely, emotional—for example, the violence of being repeatedly scorned. Affirmation is precious for them, and this admirable text offers a fine guide for therapists who want to learn affirming approaches and gain the understanding needed to help lessen the negativity that has surrounded same-sex issues.
Not surprisingly, lesbians and gays use mental health services more than do heterosexuals, and most therapists, knowingly or not, have met them. Whether socially withdrawn, suspicious, insecure, or self-hating, lesbians and gays harbour the traits of the persecuted. In the first of the 4 large sections of this book, “Social, Developmental and Political Foundations,” the authors outline the persecutory nature of heterosexist stereotypes and how they contribute to debilitating stress, the self-hatred of internalized homophobia, and the emotional stuntedness of “passing” as heterosexual. We read about how society forms its judgments regarding what is “normal” and what is not and about how those deemed abnormal are open to discrimination socially, in employment, in housing, and in parental rights.
Indeed, the right to selfhood is a given for most people but is an enviable luxury to girls or boys struggling to belong in a world where they know they don’t fit in. Selfhood, for them, is a patchy business, and they lack the stable sense of self on which mental health is founded. For the sissy boy or the tomboy girl, disapproval waits around many corners. They learn they must be something other than what they are. Thus, as elaborated in the book’s second section, they construct an identity that falters toward a poor semblance of adequacy, an identity that, for sexual- minority adolescents dealing with their burgeoning sexuality, turns out to be a flimsy affair. They shamble along with a self that hides, or masquerades, or gets lost in drunkenness and drugs. If we learn of these kids dropping out of school, selling themselves for sex, getting sexually transmitted diseases, or attempting suicide, we can infer some basic causes of their later battle for respect, both in their own eyes and in the world’s.
Not, one must thankfully say, that there aren’t young gays and lesbians these days making very healthy adjustments. Among their less healthy counterparts, however, many have survived by adopting cumbrous defences—the idealization of the perfect body, leading to compulsive exercise; the denial that masks their age-old rage; the excessive use of alcohol, especially among lesbians; the devaluing need to please, among gay men, that even results in submission to unprotected anal penetration (“barebacking”)—all of which may not only try the patience but also rouse indignation in the therapist. Affirmative practice demands, however, that one’s own values and feelings be set aside. The best possible care calls for objectively informed approaches based on therapists’ searching appraisal of their own biases, on diagnostic expertise (Are we dealing, for example, with paranoia or with a reasonable response to recurrent stigmatization?) and on familiarity with the developmental trajectory leading to the patient’s current adjustment. In the book’s third section, these issues are fleshed out, leading to considerations of same-sex relationships in minority populations; of career struggles; of the fact of, and reasons for, lesbians’ and gay men’s more frequent use of health services, compared with heterosexuals; and, finally, of the role of religion, either helpful or harmful, in patients’ lives.
The book’s fourth and final section addresses families—families of origin, the 2-person family a same-sex couple creates, and families in which one parent, or both, is lesbian or gay. Affirmative practice is put to the test here, for many therapists may still expect a family to be a mom, dad, and kids, generation after generation. Families who share these therapists’ expectations may reject their lesbian or gay offspring, often for fear of being “outed” themselves to extended family, friends, or neighbours, and therapists may be torn between identifying with the parents while trying to help the patient. Couple families, same-sex or opposite-sex, have much in common, for all people bring their own background and their own backlog of behaviours out of which a couplehood will be built, for better or worse. Money and sex, as for all couples, will be the commonest causes of concern, although more and more often among gay couples, and especially among lesbian couples, children are a cause of concern as well. Whether from a prior heterosexual union or from a biological and (or) adoptive initiative, studies show that, if raised with love and authenticity, these children’s adjustment will be no different from that of children from a male-female union. If the various concerns arising from these nontraditional social constructions are viewed by therapists from a multilevel, multicausal perspective, they will bring the best orientation for affirmative practice.
This book is clearly written and attractively and helpfully laid out. It offers a copious appendix of resources— publications, legal advocacy, and health services—followed by 63 pages of references. It is well worth the price. At a time when expressing prejudice against minorities is unacceptable, it is still acceptable to insult, harass, and exclude the same-sex minority. Thoughtful study of this book will reward readers with an excellent education in working with lesbians and gay men to achieve a position for them in society that is no longer debilitating but healthful, respected, and possibly, esteemed.
*Reviewer
Rating Scale/ Échelle d’évaluation du réviseur
Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé
|
