Collaborative Therapy

Collaborative Therapy

John Stafford

Brandman University

Abstract

Postmodern therapy gave rise to new and innovative theories and approaches to working with clients experiencing a variety of problems. A vital aspect of the postmodern movement is the divergence from traditional methods of how the therapist and client interact sessions. Collaborative therapy is one example of how the postmodern movement has taken an innovative approach to using a conversational technique that allows both the client and therapist to work together in a collaborative process without the traditional diagnosis and hierarchical methods.

Keywords:  Postmodern Therapy, Collaborative Therapy, Psychology, Family Therapy, Individual Therapy, Couples Therapy

Collaborative Therapy

Postmodern therapies are considered a new generation of psychotherapy that started development in the latter part of the twentieth century and spawned from the belief that alternative methods to psychotherapeutic practices could challenge historically sustained premises of existing therapeutic process[s] (Lebow, 2008). The practitioners and theorists of this movement chose not to focus on a single model but instead introduced numerous theories including, collaborative, discursive, conversational, narrative,  and social-constructionist, to name a few (Lebow, 2008). Collaborative therapy, which this paper focuses on, is an approach designed to create a process where the therapist and client establish a collaborative, shared experience where both parties explore the client’s story and learn as that story progresses. To do this, the postmodern approaches needed to create a paradigm shift from some of the traditional practices like providing a diagnosis, the therapist and client not being viewed as equals, and adding an emphasis that the therapist must learn the client’s language (Bardin, 2018).

The views of postmodern therapy approaches assert that the client is the expert on his or her own life story and truths. There is also a belief that individuals communicate and share knowledge and experiences through forms of attitude, language, the tone of voice, bodily expressions, and even the words chosen during conversation (Anderson, & Gehart, 2006). The construction of language, both spoken and unspoken, is a representation of how the individual interprets and constructs his or her world and expresses or communicates those experiences to others. According to Anderson & Gehart (2006) “Knowledge is not an individual activity or passive process: knowledge cannot be sent to or received by another (p.9). What this means is that what people create through the use of language is a multifaceted collaboration of events and experiences curated through a social construct that is fluid and always changing (Anderson & Gerhart, 2006).

Collaboration serves as a primary practice of different therapeutic approaches for working with clients (Sutherland, & Strong, 2011). People are not passive transmitters or receivers of information, nor does the individual process information in an identical manner as another. Even if two people with the same upbringing, career path, and social environment who experience the same event, they will both have a different truth (Hansen, 2006). The reason individuals interpret similar experiences differently is due to variations, both major and minor, are their respective social constructs and ability to construct and understand the world around them (Hansen, 2006; Anderson, & Gehart, 2006). Because of this, social constructionists view therapeutic collaboration as a process involving mutual coordination, sharing, and the construction of meaning (Sutherland, & Strong, 2011). Language, as referenced above is not simply the language one uses in the cultural construct. Instead, it is a primary method that people use when constructing and making sense of their world and truth. Language gains meaning and value because of its meaning or roots when used to transmit information about one's life experiences (Bardin, 2018).

Additionally, when we look at the therapeutic process, notable differences emerge. In traditional or commonly used therapeutic approaches like Cognitive Behavioral, Dialectical, Solution-Focused, or Acceptance and Commitment therapies, the therapist is notably in control of the therapeutic session. Barring the most crucial aspect that of creating the therapeutic alliance, the therapist takes the role of inquisitor asking questions, providing a diagnosis, and helping the client explore his or her presenting problem before developing a treatment plan designed to improve the client’s ability to come to their conclusions and resolutions. In contrast, the collaborative approach might appear as if the client and therapist are engaged in a casual conversation. But a closer look reveals that the therapist acts as a guest in the client’s story and aims at focusing on the uniqueness of the client as an individual, ignoring similarities, and centers of the client's unique experience[s] by asking pertinent questions and talking about things within the client’s context (Bardin, 2018).

Effective counseling has a general purpose of enhancing the well-being of an individual client, a couple, or a family unit. No matter the theoretical perspective used, the general process includes forging a solid therapeutic alliance in which the client[s] are free to express their problems [story] in a safe environment where they feel the receiving party [the therapist] is genuinely attuned, attentive, and empathetic. In collaborative therapy, the therapist and client engage in a conversational approach to articulate and align with one another on shared goals (Horvath & Symonds, 1991: Hubble, Miller, & Duncan, 1999). Adherently, this conversational process is not without particular difficulties. Cultural differences introduce variations in verbal and non-verbal language, and generational or gender differences may complicate the conversational method. The therapist needs to consider and compensate for any perceived complications that make the collaborative process more difficult for the client by learning the client’s preferred way of verbal and non-verbal language and helping construct the conversational direction.

Collaborative Family Therapy

Family therapy introduces additional complexities into a therapeutic situation because the therapist is not focusing on a single person. He or she is balancing the individual personalities and difficulties that impact the entire family unit. Hoffman (2003) eloquently states “An autonomous system is any composite unity formed of elements that may or may not themselves be autopoietic” (p.18). Similar to a computer network, if a single node within the network fails to operate to specification, the remaining nodes become taxed with the additional workload to keep the network functioning. If multiple nodes experience system malfunctions, the network becomes bottlenecked, data transmission slows or becomes corrupted, and data gets lost in confusion. The failure results in what is called a network-wide failure. Families operate on the same premise. For the family to function effectively, all family members need to communicate and work together. The commonality is open lines of communication and shared operational structure or goals. However, humans cannot alter those shared regularities at whim because the autonomy of social and biological systems cannot be erased and reformatted as in a computer network (Hoffman, 2003). A primary difference is that a failed node can easily be replaced without disrupting the computer network, whereas a family member cannot. If a family member gets dysfunctional or removed the family structure changes entirely, and damage to the family is imminent. However, similar to the computer network, the loss or alterations may only be temporary if proper maintenance is initiated. Similarly, in both cases, the restoration of communication becomes the primary emphasis.

Collaborative family therapy approaches family dysfunction from a communicative perspective. It views the family structure from a systemic framework that focuses on human determination and reciprocality that impacts human behaviors. At the core of this perspective is how the family communicates with each member and as a whole unit (Tuerk, McCart, & Henggeler, 2012). Families experiencing difficulties usually prolong the issues by trying, generally without success, to deal with the underlying problems on their own. Problem children might sometimes get labeled as going through a phase or are just bad seeds that should be sent to boarding schools or to live with relatives. Problems within the marital dyad can result from issues ranging from financial matters to infidelity, or even just a feeling that the spark in the relationship has died. The common thread in many of these issues is the lack of active collaboration within the family. In the nuclear family, many of these issues got ignored because the family presentation was an essential aspect of societal expectation. In modern society, technology has added additional complications to familial communication because the art of talking face-to-face is slowly becoming obsolete. Collaborative therapists aim, in some ways, to reintroduce family members by helping them share their own stories and truths (Tuerk, McCart, & Henggeler, 2012). The therapist is a guest in the family story that can walk with the family and each family member as they collaborate on the issues, thoughts, and feelings that impact the individuals and the family as a whole. By doing this, the family members learn valuable collaborative skills that enable them to understand one another from a different perspective.

The Family in Trouble

The vignette presents a family in severe distress and dysfunction. Juliet is troubled by her past abusive marriage that resulted in addiction issues and the loss of custody of her child. She is overcompensating for these haunting experiences by overindulging her two children. Romeo is troubled by the fact that Juliette is overindulging the children and feels neglected. He is frustrated and hurt by what he perceives as Juliet favoring the children over him and views divorce as the only way to resolve the issue. Both parents have an unhealthy desire to be central in the children’s lives, and the possibility of divorce will lead to a bitter custody battle for the children. The marital issues have overflowed into the entire family dynamic. The daughter, Elizabeth has become withdrawn from the family, and her grades in school are negatively affected. Of more significant concern is the son, Ceasar who has grown angry at his parents and has made threats of harm towards others as a way of getting his parents attention. Current attempts at couples therapy appear to produce little to no resolution in the presenting issues.

Conceptualization

There are severe failures in the family resulting from the lack of communication skills and understanding where each family member is emotionally and mentally. Juliet is experiencing difficulties coping with the loss of her first child, her addiction, and abandonment issues. Romeo is feeling ignored and irrelevant in Juliet’s life in comparison to the children. He feels abandoned in his own home and believes that the love between them has died, or possibly never existed. The children think they are the subjects of a tug-of-war between the parents and suffer the adverse effects of the hostility and turmoil the parents believe they have been successfully hiding from them. Elizabeth, most likely the timider of the two children resorts to alienating herself from the issues and has lost the ability or desire to focus on her scholastic activities. Caesar, naturally the stronger of the two has taken a path of being angry at the situation and is lashing out at his parents and, more concerning appears to start harboring dangerous thoughts towards others. Although it is difficult to tell if his threats are real or just a ploy to get his back at his parents, the severity of his threats requires immediate action.

How it Came to Be

A common denominator in this family’s problems is the lack of proper communication and the ongoing individual stories that keep the issues active. It is apparent that neither of the parents is collaborating with or hearing each other's truths behind their feelings and actions. In turn, the children mostly left to interpret the uncomfortable and tumultuous atmosphere in the household are left to make their assumptions, thereby creating their realities. At the forefront of all of the issues are the issues Juliet holds from her past and how they influence her relationship with the children and Romeo. Additionally, Romeo’s inability to put Juliet’s past into context and work with Juliet to find a happy middle-ground are compounding the problems and ultimately affecting the children and their ability to be active participants in a harmonious family unit.

Can it be Fixed

It is too early to say the problems will resolve, nor would I assume that the family will remain together. The outcome will result from how the family, in particular, the parents, decide what direction is best for them at the end of therapy. Either way, there are stories to be told and heard from each family member that becomes a journey of exploration, learning, and understanding. The ride starts by helping the family understand that they are not talking with one another, but instead of one another. When people talk to one another, the meaning lost, emotions miscommunicated, needs are unspoken, stories left unrevealed. If Romeo and Juliet learn how to speak with one another, to hear each other's stories, and understand the language, each other is using to communicate, their ability to work together as a couple improves. Harmony improves as the family begins to understand the language, both verbal and non-verbal, that each person is expressing. Their stories start to unfold and realign to bring the family together.

However, there is another side to how the problems may cease to exist. IN learning to talk with and hear one another. To understand each other’s stories and language, the potential of realizing there is no ability to reestablish the family as it once was. Separation or divorce could be the eminent solution. In this case, the family, using what they have learned, will start to spin new stories and collaborate to find a suitable and amicable dissolution of the current family structure and provide a positive experience for the couple and the children. In either outcome, the family has a tremendous task ahead of them.

Family Goals

The first goal is to establish effective communication strategies that allow each member of the family to collaborate on restoring homeostasis to the family unit. We start by exploring communication and a collaborative effort that creates acceptance through the use of language, learning to understand the differences in individual perceptions, evaluating the strengths and weaknesses of each member, and what each member needs from the family unit to feel accepted, loved, and understood.

The second goal would be to enhance the first goal by learning how each family member’s reality differs based on their perceptions of the situation and how their language is either hampering or helping the condition exist. Learning how to collaboratively communicate how each member of the family perceives issues and how it affects their individual feelings is a primary consideration. Initially, the family members will exhibit apprehension to express their opinions, but being able to explore those apprehensions in session will enable them to gain comfort in communicating them at home. If open discussion appears too difficult, possibly asking each member to journal their thoughts to share in session could be a starting point.

The third goal is to remove blame, guilt, and anger. The family needs to learn that there is no singular truth involved and that each family member holds a different perception of reality. A family is a socially constructed unit impacted by numerous factors. Similar to a planet being hit by a meteor shower, every single impact leaves a distinct mark. To paraphrase Hansen (2006), singular truths are not revealed by the passive or disinterested investigation of a phenomenon, but are in-fact, discovered by attentive observation with the observers providing meaning.

The Therapist Role

As mentioned earlier in this paper, the postmodern theory asserts that the client is the ultimate expert of his or her own life. Understanding this allows the therapist to take the role of a guest in the client’s journey or story as they collaborate to seek new meanings and creating an environment for change. Because the therapist is a guest in the story, he or she should take the not knowing position. The not knowing stance places the therapist as a blank slate that is open, and willing to learn the nuances of the client and their story. As the story starts, the therapist and client begin to discover one another’s internal voice, or language and build a rapport of understanding and communication. The therapist should also employ the technique of circular questioning and reframing as he or she walks the path of the client’s story to reveal hidden nuances and meanings behind the client’s perceptions of his or her truth.

Conclusion

The conclusion to this story is not one of simplicity. Some complexities affect every aspect of the family’s existence. Each member has individual perceptions of truth and reality that once explored, reveal a family in severe dysfunction. Also, there is no reliable method of predicting how the family’s story will unfold. The therapist must rely on his or her ability to join the family in a journey of exploration and learning through collaboration, and understanding individual perceptions. Teaching the family how to interpret the language each member uses, how they perceive events and issues, and how to collaborate with one another to openly express their feelings and thoughts, instead of talking at one another, will give the family a substantial advantage in either resolving their issues, or finding an amicable way of dissolution. Collaborative therapy provides these unique tools in a method that differs from conventional treatments that view the client as sick, or that focuses on a single presenting problem. Collaborative therapy teaches the skills of honestly expressing and hearing every aspect of what another person is relaying because it shows people that there is no absolute truth and that everyone’s story is a learned journey.

 References

Anderson, H., & Gehart, D. R. (2006). Collaborative therapy in action: Bridging the gap between theory and practice. London: Routledge.

Bardin, G. (2018, October 31). Postmodern Therapy. Lecture presented at PSYU 556 in Brandman University, Palm Desert.

Hansen, J. T. (2006). Counseling Theories Within a Postmodernist Epistemology: New Roles for Theories in Counseling Practice. Journal of Counseling & Development,84(3), 291-297. doi:10.1002/j.1556-6678.2006.tb00408.x

Hoffman, L. (2003). Exchanging voices: A collaborative approach to family therapy. London: Karnac.

Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy: A meta-analysis. Journal of Counseling Psychology,38(2), 139-149. doi:10.1037//0022-0167.38.2.139

Hubble, M., Duncan, B., & Miller, S. (1999). The Heart and Soul of Change. American Psychology Association.

Lebow, J. L. (2008). Twenty-first century psychotherapies: Contemporary approaches to theory and practice. Hoboken, NJ: Wiley.

Sutherland, O., & Strong, T. (2010). Therapeutic collaboration: A conversation analysis of constructionist therapy. Journal of Family Therapy,33(3), 256-278. doi:10.1111/j.1467-6427.2010.00500.x

Tuerk, E. H., Mccart, M. R., & Henggeler, S. W. (2012). Collaboration in Family Therapy. Journal of Clinical Psychology,68(2), 168-178. doi:10.1002/jclp.21833

.

LGBTQ Couples Therapy: The Additional Problems Therapists Encounter

LGBTQ Couples Therapy: The Additional Problems Therapists Encounter

John R. Stafford

Brandman University

Abstract

Couples therapy provides unique situations for any therapist. Each couple has a different dynamic, interpersonal relationship, and individual personality traits that either exacerbate or alleviate the daily stressors that a couple experiences. However, other couples encounter more than the every-day nuances of negotiating a healthy relationship. LGBTQ couples face the same issues like any other couple, but their societal status produces additional stressors that many other couples may never encounter.

Keywords:  LGBTQ, LGBTQ Couples Therapy, Couples Therapy

LGBTQ Couples Therapy: The Additional Problems Therapists Encounter

One of the most significant societal expectations is that we, as humans, mature and find someone to couple with and start a family. From a young age, children are molded by experience and natural instinct to seek a mate. Once a suitable mate is found, the couple begins to blend their individual lives into what they hope will be a cohesive family unit. It sounds easy, but combining two different entities is not as easy as it may seem. Moreso than not couples, both new and seasoned find internal and external forces introduce speedbumps into the relationship. Whether it be the simple act of moving in together and merging belongings, the birth of a child, or the death of a family member, each new experience is bound to result in some level of relational change.

Issues for LGBTQ Couples

Outside of the nuclear family model, which most couples and family therapy techniques developed, there are alternative family models that do not adhere to the baseline assumptions at the root of family and couples therapy (Sue, & Sue, 2016). For decades, LGBTQ couples hid, and continue to conceal their relationships from society. Many same-sex couples derived elaborate stories that resulted in the creation of a false relationship portrayed to friends, family, co-workers and the general public. Additionally, the experiences LGBTQ people experience in day-to-day life may introduce personal psychological issues that result in relationship problems. Mental stress related to abuse, alienation from family and friends, job discrimination, denial of essential services, and even exposure to medical conditions like HIV/AIDS create unique issues that get introduced to the relationship dynamic.

Relationship Facades

It was not uncommon for two men or women engaged in an intimate relationship to form a façade of being roommates when moving in with one another. They would set up two separate bedrooms to serve as an indicator to family and friends that they were in fact, just friends sharing a living space (Niolon, 2011). The fake family status created by gay and lesbian couples is only one detrimental aspect placing additional pressures on LGBT households. Societal acceptance of gay and lesbian people, in general, adds stress to the individuals in a relationship because he or she may experience issues of violence, prejudice, and discrimination in the workplace, or in obtaining essential services (Kessler, & Yalom, 1996).

Gay and lesbian individuals may also have problems stemming from their family of origin that carry over into their relationship (Sue, & Sue, 2016). He or she may have experienced abuse, both physical and psychological, or abandonment from parents and other family members (Kessler, & Yalom, 1996). Some LGBTQ men and women may not have experienced any of these issues at all. Individuals who came out to friends and family and received full acceptance will not have an understanding of a partner’s fears of being outed. Additionally, an individual employed in an environment that promotes equality may equally find it hard to understand why a partner in a more conservative work environment does not invite him or her to company parties or events in fear of being discovered (Kessler, & Yalom, 1996; Sue, & Sue, 2016).

Marriage Equality

Over the decades, LGBTQ people have received more recognition in society. Countries around the world have enacted laws protecting LGBTQ people from discrimination in the workplace, housing, and access to essential programs. Many nations have adopted laws recognizing same-sex unions, while others have made advancements in legalizing marriage equality. Although these improvements indicate a changing landscape for LGBTQ people, they do not suggest that societal acceptance is advancing in the same strides. While it may be legal for a gay or lesbian couple to marry, many may not because of issues related to acceptance of family or societal concerns. An excellent example of these matters in America is the growing movement to legally discriminate against LGBTQ couples based on a religious objection, also known as the First Amendment Defense Act (H.R. 2802, 114^th Cong., 2015).

Raising Children

Raising children is considered by society to be a marker of adulthood and a successful relationship. However, for the LGBTQ couple, this widely accepted marker of success poses unique problems. Studies evaluating the academic performance, cognitive and social development,  psychological health, and early substance abuse and sexual activity of children raised in same-sex households indicate no variation when compared to children raised in different-sex households (Crowl, Ahn, & Baker, 2008; Manning, Fettro, & Lamidi, 2014). In one study at the University of California-San Francisco, Gartrell, & Boss (2010) concluded that adolescent sons and daughters of lesbian parents rated higher in academic, social, and total competence, and lower in social problems, aggressive and externalizing problems, and rule-breaking than their age-matched peers.

Although these studies provide supporting evidence for the stability of children raised in same-sex households, they also offer indicators that children can be negatively affected by socioeconomic circumstances, lack of opportunity and support for same-sex parents (Crowl, Ahn, & Baker, 2008; Gartrell, & Boss, 2010). In addition to the stressors related to parenting, the lack of opportunity and support, and other socioeconomic issues, same-sex parents and their children also face problems related to discrimination in school administrations, teasing from peers, and alienation from specific social activities (Manning, Fettro, & Lamidi, 2014).

Extended Family Issues

The extended family of LGBTQ couples may pose additional stressors in the relationship. These problems could be related to alienation of one or both of the partners from their family of origin or from hiding the relationship from family and friends. Another factor for extended family issues is the circle of friends one or both of the partners may have. Because many LGBTQ couples are alienated or estranged from the family of origin, friends of one or both partners become surrogate family members in which they can share experiences like holidays and other relationship milestones. While friends do sometimes make acceptable surrogates for the family of origin, they are not without pitfalls.

Every couple is destined to contend with death in the extended family. As the couple matures, family members age and eventually die. With the introduction of HIV/AIDS in 1981. The LGBTQ community landscape changed. People were dying at wholesale rates (U.S. Department of Health & Human Services, n.d.). A friend someone saw at a party a couple of weeks previously was now dead. Although treatment had advanced and improved the lifecycles of those infected, the rate of death in the LGBTQ community remains high. For couples who are extended family consists of friends, the grief of loss may be more of a typical occurrence than those in close contact with their families of origin (Kessler, & Yalom, 1996).

HIV, Intimacy, and Relationships

One of the leading issues in relationships is intimacy. Couples experience a myriad of problems including loss of sexual desires, sexual dysfunction due to injury or other causes, and daily issues that restrict quality alone time for the couple. LGBTQ couples experience these same problems, however, many couples today face another challenge with intimacy. With the widespread epidemic of HIV in the LGBTQ community, it is not uncommon for one or both partners in a relationship to be HIV positive. Advancements in HIV treatments have enhanced and expanded the life expectancy of those infected with HIV, and studies indicate that more people with HIV are 50 years old and growing (Psaros, Barinas, Robbins, Bedoya, Safren, & Park, 2012).

Although medical advancements have improved the quality of life for HIV patients, difficulties arise in couples where one partner is HIV positive, and the other is not. The HIV negative partner may express concerns about accidentally forgetting to use protection in the heat-of-the-moment, or in some cases may express a desire to become HIV positive as to avoid having to be concerned about using protection. Both of these situations present emotional concerns for both partners because the HIV positive partner may be overly worried about his partner’s health, or may feel regret and distress that his partner may wish to contract HIV to remove a barrier between them (Rhodes, & Cusick, 2000). Additionally, the HIV negative partner may push harder on issues like creating wills and making funeral preparations earlier than other couples or attempting to increase the number of experiences the couple shares out of fear the HIV positive partner may die prematurely (AIDSmap, n.d.).

Roles and Role-Models

Roles and role-models for same-sex relationships present unique problems. Society places role expectations on people based on an archaic belief that women are nurturers and child bearers and men are hunters and protectors. This view instills into society a biased view of masculinity and femininity as it relates to gender orientation. Gay and lesbian children raised with these biased opinions may experience difficulties in their relationship. However, using these assumptions, therapists can understand, and help clients understand psychological feminity and masculinity roles within each other ( American Association for Marriage and Family Therapy, n.d.).

Consequently, society emphasizes the nuclear family concept. This outdated notion maintains that a proper family unit is most likely a white, opposite-sex couple with two children, a husband that works and provides for the family, and a stay-at-home mother responsible for maintaining the household and family. This ideal, to this day, dominates mainstream entertainment outlets and marketing channels, leaving same-sex couples little to model their family structure. Additionally, because same-sex relationships remained mostly hidden in society, many young same-sex partners lack not only societal but also personal role models (Kessler, 1996).

Therepeutic Implications

 Couples present to therapy for a wide variety of concerns that range from learning how to negotiate arguments to dealing with infidelity. The crucial function of the therapist, while varied by the dominant theory applied, is to be a facilitator to help the couple resolve dysfunction within the relationship. Although most people seek couples therapy to address dysfunction and improve the quality of their relationship, others may enter treatment to help end the relationship in an amicable manner (Gurman, 2008). No matter the presenting problem, the therapist is placed in a position that demands specific attributes. First, the couple may present a problem that reminds the therapist of his or her own experiences. In this situation, the therapist must be aware of counter-transference. While many therapists find it inappropriate to share personal experiences, others may find it beneficial to divulge just enough to help the couple understand that he or she is capable of relating to their problem (Gurman, 2008). Therapists may also become exposed to situations that conflict with personal values, which place implications of ethical interactions with the client if the therapist is not able to see past his or her own biases (Sue, & Sue, 2016).

Working with LGBTQ Couples

Most therapists will find that working with same-sex couples is similar, if not identical, to working with couples of the opposite sex. Many of the presenting issues will be the same, and the treatment paths will be the same. However, there are also issues that same-sex couples will encounter that differ from opposite-sex couples and others that are unique to same-sex couples. One of the problems related to working with same-sex couples is the bias related to studies of gay and lesbians in couples therapy. In a compelling article in the Journal of Family Therapy, Ussher (1991) argued that couples therapy, at the time, was widely unavailable due to a lack of referrals and that therapists were ill-equipped both psychologically and by lack of understanding the dynamics of same-sex couples to provide adequate treatment. Acknowledging this pitfall also provided compelling arguments “that established forms of intervention are effective with gay clients, provided that the specific needs and problems of the gay and lesbian community are addressed by the therapist” (Ussher, 1991 p.1).

Therapeutic Techniques

As referenced earlier, most standard therapeutic techniques used with opposite-sex couples will work equally as well with same-sex couples. The issues that a same-sex couple will present for treatment are most likely to be the same as those of any other couple, and the process of treating the presenting problem the same as well (Ussher, 1991). Accounting for issues considered unique to same-sex couples, the therapist may use Structural Couples Therapy or Cognitive Behavioral Couples Therapy, or a combination of these or other therapeutic models he or she is most comfortable with.

Structural Couples Therapy

Structural Couples Therapy (SCT) is a product of Structural Family Therapy developed by Salvador Minuchin. SCT focuses on systemic issues in a relationship based on the assumption that each member of the family plays a role in the family system and subsystem (Gurman, 2008). Using SCT, clinicians can assess the family system, subsystem[s], and external contexts that impact same-sex couples (DeDiego, 2016). For example, a gay couple preparing to start a family may experience difficulties based on the lack of traditional “mother and father roles.” Under SCT, the clinician addresses issues of hierarchy and power boundaries by refocusing family roles beyond the traditional gender roles (DeDiego, 2016).

Cognitive Behavioral Couples Therapy

Cognitive Behavioral Couples Therapy (CBCT) focuses on educating clients on the biological and psychological processes in the relationship, and how couple interactions become ineffective (Hubbard, 2016). Using this baseline, clinicians can work with couples to assess how their interactional patterns interfere with the relationship and provide opportunities to practice troubled areas like communication and challenge disruptive thoughts and behaviors that are causing relationship dysfunction (Gurman, 2008; Hubbard, 2016). CBCT can be helpful when working with LGBTQ couples where one partner’s low self-esteem or self-worth are causing dysfunction in the relationship by enhancing the couple’s ability to communicate more efficiently while challenging the feelings of the individual. For example, a couple presenting about constant arguments in the household. During the assessment, the clinician discovers that one partner has low self-esteem because his family of origin degraded him and eventually alienated him for coming out. Using CBCT, the clinician can address the communication problems while at the same time, challenging the feelings of low self-esteem of the partner.  This process not only helps the individual begin to change how he sees himself but also helps the other partner understand how these feelings can cause problems.

Conclusion

Clinicians working with couples are sure to experience a myriad of issues that are as unique as each couple, as well as presenting problems that share a commonality. No matter how many clients a clinician has worked with, knowing exactly how to contend with the next client has an air of uncertainty. Although traditional opposite-sex couples share some commonalities, this is never something that can be assumed. Besides the conventional nuclear family couple, some couples do not fit this mold, and who present issues that may be outside the usual box. Same-sex couples for example not only share the standard problems like any other couple, but also experiences that add a new layer of complications to a relationship. For clinicians to work efficiently with same-sex couples, he or she needs to be aware of not only personal biases that could interfere with the clinician-cleint relationship but also aware of the unique issues that LGBTQ peope experience in life and bring into the relationship.

References

AIDSmap. (n.d.). HIV & sex - Relationships with an HIV-negative partner. Retrieved October 10, 2017, from http://www.aidsmap.com/Relationships-with-an-HIV-negative-partner/page/1637216/

American Association for Marriage and Family Therapy. (n.d.). Therapeutic Issues for Same-sex Couples. Retrieved October 10, 2017, from https://www.aamft.org/iMIS15/AAMFT/Content/Consumer_Updates/Therapeutic_Issues_for_Same-sex_Couples.aspx

Crowl, A., Ahn, S., & Baker, J. (2008). A Meta-Analysis of Developmental Outcomes for Children of Same-Sex and Heterosexual Parents. Journal of GLBT Family Studies,4(3), 385-407. doi:10.1080/15504280802177615

DeDiego, A. C. (2016, September 28). A systemic perspective for working with same-sex parents. Retrieved October 10, 2017, from https://ct.counseling.org/2016/09/systemic-perspective-working-sex-parents/

Garanzini, S., Yee, A., Gottman, J., Gottman, J., Cole, C., Preciado, M., & Jascula, C. (2017). Results of Gottman Method Couples Therapy with Gay and Lesbian Couples. Journal of Marital and Family Therapy,43(4), 674-684. doi:10.1111/jmft.12276

Gartrell, N., & Boss, H. (2010). US National Longitudinal Lesbian Family Study: Psychological Adjustment of 17-Year-Old Adolescents. Pediatrics,126(1), 28-36. Retrieved October 10, 2017, from http://pediatrics.aappublications.org/content/126/1/28

Gurman, A. S. (2008). Clinical handbook of couple therapy(4th ed.). New York: Guilford Press.

Hubbard, B. (2016). CBT for Couples Marital Therapy. Retrieved October 12, 2017, from http://cognitive-behavior-therapy.com/relationship-couples-marital-therapy/

KESSLER, H., & YALOM, I. D. (1996). Treating couples. San Francisco: Jossey-Bass.

Manning, W. D., Fettro, M. N., & Lamidi, E. (2014). Child Well-Being in Same-Sex Parent Families: Review of Research Prepared for American Sociological Association Amicus Brief. Population Research and Policy Review,33(4), 485-502. doi:10.1007/s11113-014-9329-6

Niolon, R. (2011, August 02). Issues for Same-Sex Couples | PsychPage. Retrieved October 10, 2017, from http://www.psychpage.com/family/library/gay-lesbian.html

Psaros, C., Barinas, J., Robbins, G. K., Bedoya, C. A., Safren, S. A., & Park, E. R. (2012). Intimacy and Sexual Decision Making: Exploring the Perspective of HIV Positive Women Over 50. AIDS Patient Care STDS,26(12), 755-760. doi:10.1089/apc.2012.0256

H.R. 2802, 114th Cong., Www.congress.gov (2015) (enacted).

Rhodes, T., & Cusick, L. (2000). Love and intimacy in relationship risk management: HIV positive people and their sexual partners. Sociology of Health & Illness,22(1), 1-26. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.00189/pdf

Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: theory and practice(7th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

U.S. Department of Health & Human Services. (n.d.). A Timeline of HIV and AIDS. Retrieved October 10, 2017, from https://www.hiv.gov/hiv-basics/overview/history/hiv-and-aids-timeline

Ussher, J. M. (1991). Family and couples therapy with gay and lesbian clients: acknowledging the forgotten minority. Journal of Family Therapy,13(2), 131-148. Retrieved from http://onlinelibrary.wiley.com/doi/10.1046/j..1991.00418.x/pdf