Psychological theories for counseling LGB individuals and social integration

Unnatural sexual orientation is not an independent, standalone issue for those professing inclination towards same sex individuals for their sexual needs. Such individuals invariably face difficulties, humiliation, and consternation in many other areas of their lives, thereby being isolated, stigmatized, and finding it difficult to lead normative, meaningful life. In recent times, there are concerted efforts to address their concerns through various empirical psychological theories, tools, and practices to give more meaning to their individuality. Assimilation of such persons into the mainstream is sought through a change in the perspective of both, the LGB individuals as well as the society (mainly those who are closest to them, often meaning family members, colleagues, and even friends). Various theories view the problems faced by LGB individuals from different perspectives and a theory or a combination of theories may be applied to counsel the individual and help them integrate into the society. The theories considered in the present work are Gestalt, Person Centered, Reality Therapy, and Cognitive Behavioral Therapy.

Sexuality Theory

Biology explains sexual needs in animals and humans through the concept of sexual impulse. The impulse is compared to hunger and the desire to take nourishment. Scientists make use of the term 'libido' to convey sexual expression that corresponds to hunger. Popular belief assumes vastly different ideas with regard to sexual impulse's quality and nature. It is believed not to be present at all in childhood years and to develop during and in relation to puberty or physical maturation. Sexual impulse is believed to express itself in compelling attractions exerted on one sex by the other. Lastly, the goal of sexual impulse is believed to be sexual union (or actions that would result in it) (Freud, 1910).

The popular sexual impulse theory corresponds to the poetical myth of division of an individual into two parts -- female and male -- who then strive to reunite via love. Thus, it is astonishing to see males who view males, not females, as a sexual object (and similarly, females who are sexually attracted to females and not males). Such individuals are termed inverts or contrary sexuals; they constitute the realities of inversion and are in significant numbers. Their precise ascertainment, however, is fraught with difficulties (Freud, 1910).

The behavior of inverts varies in many different ways; (a) these individuals can be utterly inverted, that is, the sexual object for them is invariably from the same gender as themselves. No individual of the opposite gender can ever stir sexual longing in them; rather, they may be indifferent to members of the opposite gender, or may even be repulsive to thoughts of such union by them. As males, they cannot, perform the natural act of sexual union owing to repugnance, or they may not find any pleasure in it; (b) some contrary sexuals are also amphigenously inverted. In other words, their object of sexual attraction might indifferently belong to same/opposite gender. There is no characteristic of exclusiveness in inversion; (c) they may be inverted on occasion; that is, in specific situations, of which the main situation is unavailability of their regular sexual object and imitation, inverts can take another individual of their own gender as their sexual object for sexually gratifying themselves (Freud, 1910).

Inverted individuals also demonstrate various behaviors in judging their sexual impulse's peculiarities. Some individuals regard their inversion as natural, similar to the way the normal view their libido; thus, they firmly demand equal rights as normal individuals. However, there are others who strive against this inverted nature and view a morbid urge in it. Other variations are in relation to time. Inversion characteristics of a person might date back to their oldest memories, or may become evident to the individual at a specific period prior to or following puberty. The character may sustain all through their life's course, or may (occasionally) ebb or represent one of the episodes occurring on the way to normal sexual development. Occasional fluctuations between inverted and normal objects have been noted, as well. Of specific interest are instances wherein the libido undergoes a change, assuming inversion following a heartbreaking experience with the person's normal object of sexual impulse (Freud, 1910).

Relatively fewer research works are found on LGB (lesbian, gay, bisexual) individuals hailing from ethnic/racial minorities, but the literature so far suggests that these individuals experience numerous life and minority stressors, which include the stigma connected with their homosexuality, discrimination and bias linked to their ethnicity/race, and rejection by members of their ethnic/cultural group. Very few researches deal with childhood abuse in non-White LGBs. Balsam and Morris conducted a large-scale, nationwide survey in 2003, whose findings indicated higher childhood sexual and physical abuse rates on non-White bisexual females and lesbians than in White bisexual females and lesbians. Likewise, two research works on bisexual and gay males reported higher incidence of sexual abuse in childhood among Latino and African-American males than in White males (Feldman & Meyer, 2007). Non-White LGB individuals may suffer heightened risk in comparison to their White counterparts, as well as in comparison to heterosexuals from their ethnic group. For instance, Balsam and colleagues (2004) reported that homosexual Native Americans were more likely to suffer physical abuse in their childhood than heterosexual indigenous individuals. Further, Brown (2008) observes that even in households where no explicit abuse occurs, general negative remarks regarding homosexuality may be reported as traumatic experiences by kids who turn homosexual in their adulthood. Hence, in view of the subjective character of emotional abuse experiences, it is likely that homosexual adults may possess lower thresholds for emotional abuse perceptions as they are especially sensitized to this kind of attitude among members of their family (Balsam, Lehavot, Beadnell, & Circo, 2010)

Person Centered Theory

The initial focus of this perspective was on clients being in control of their treatment, resulting in development of a better grasp of self, enhanced self-concepts, and self-exploration among them. Subsequently, emphasis shifted to reference frame of client and the main conditions essential to effective therapy; e.g., ensuring that the therapist displays empathy and is non-judgmental.

Influence of humanistic perspective on client-centered therapy: The humanistic perspective has significantly influenced client-centered therapy. Client-centered therapists regard clients as trustworthy, capable persons, and concentrate on clients' capability of effecting changes by themselves.

Actualization: Individuals tend to strive towards attaining self-actualization, which denotes comprehensive development of an individual. Actualization takes place all through their lives, as he/she endeavors towards self-realization, fulfillment, and intrinsic goals, involving self-regulation and independence (Seligman, 2006).

Conditions of worth: These denote derogatory, negative messages from key figures in a person's life, impacting how he/she reacts to and acts in specific situations. In other words, they govern how important individuals in his/her life molded the self-concept of a person. A person tends to have low self-image if conditions of worth are forced on him/her. Moreover, a person's self-image may also be adversely affected upon exposure to dominating or overprotective environments.

The fully functioning person: Represents a person whose emotional health is perfect (Seligman, 2006). Normally, such individuals will be amenable to experience, trust themselves as well as others, and have purpose and meaning in their lives. One key aim of client-centered therapy is working towards making the client "fully functional." "

Phenomenological approach: This approach deals with every person's unique view of their own world. Individuals view and experience their own world differently, and react in distinct ways. Client-centered therapy concentrates on the client's personal experience informing the way the therapy will work.

Psychologist Carl Rogers developed the client-centered perspective, approaching therapy from a humanistic standpoint. In humanistic psychology, individuals are considered as independent and competent; the theory believes people can recognize their potential, resolve personal difficulties by themselves, and positively transform their lives (Seligman, 2006). On the whole, client-centered therapy constitutes a positive, non-directive therapy whose focus is on the ability of client to alter their lives, while striving to attain self-actualization (Person centered Therapy, n.d.).

Reality therapy

American psychologist and psychiatrist, William Glasser developed Reality Therapy during the mid-1960s. Its theory, methods, and broader applications are still evolving. It represents a therapeutic technique that teaches individuals to grasp the needs which have evolved through human evolution and that guide the whole of mankind; to meet these needs by making better choices; to take charge of one's life; and to cultivate the strength required for coping with life issues and stresses (EART, n.d.).

Reality therapy, as a corrective tool, is empowering as well as challenging, as it places emphasis on a person's ability to, and responsibility for, change; its theory opposes client 'excuses.' The focus of reality therapy's underlying theory -- choice theory -- is on existing relationships; this implies that the therapy de-emphasizes prior experiences; therefore, interventions are able to remain solution-focused and brief. Reality therapists offer a challenging, yet non-judgmental and helpful, environment, urging clients to understand that it is possible to bring about change, which, however, will need active client involvement. The aim of reality therapists is maintaining an optimistic and non-critical frame, and employing the micro-skills of warmth, humor, and counseling, for communicating to clients that they care, and are interested in what the client has to say. The idea that mental illness refers to 'denying reality' is inherent in this therapeutic approach. Historically, professionals have frequently utilized mental health services for suppressing dissent (e.g., Soviet Psychiatry); a disagreement with regard to facets of mankind's socially developed reality is the basis of all societal development. In the words of George Bernard Shaw: "The reasonable man adapts himself to the world; the unreasonable man persists in trying to adapt the world to himself." Hence, in his view, all development is dependent on those who are unreasonable. Social deviance cannot be considered 'irrational' by itself, and choice theory's criticism of psychoanalytic disagreement with traditional morality (Glasser, 1975) overlooks the patriarchal and exceedingly repressive nature of sexual and social relationships of the late nineteenth to early twentieth century (Stack, n.d.).

Bisexual and gay Latino males in the U.S., as members of both ethnic and sexual minority groups, are attacked by no less than three socially unfair forces -- racial discrimination, homophobia, and poverty -- preventing them from properly participating in the homosexual community and family life, and limiting their educational/professional prospects. Their exceedingly stigmatized social condition predicts a broad array of health issues; however, much is still unknown about the mental or physical health of bisexual and gay Latino males in the U.S. Since this group is characterized by some of the highest national rates of sexual risk-taking, HIV seroconversion and seroprevalence, rare empirical research on this social group have been performed in the HIV prevention context (Diaz, Ayala, Bein, Henne, & Marin, 2001).

Cognitive Behavioral Therapy (CBT)

CBT represents a talking therapy, which can aid individuals suffering from a wide array of mental health-related issues. CBT is grounded on the assumption that individuals' thoughts can impact their feelings and behaviors. When mentally distressed, individuals think differently with regard to themselves and all that is happening with them. Their thoughts may turn extreme and adverse, and may aggravate the individual's negative feelings. Their resultant behavior may prolong their distress. Cognitive behavioral therapists assist clients with recognizing and altering their extreme thoughts and negative behavior. The consequence, is, often, a significant improvement in an individual's life and how he/she feels. CBT is based on principles and concepts derived from human behavioral and emotional models of psychology. They include an extensive range of therapeutic strategies for emotional ailments, across a continuum ranging from self-help content to structured individual therapy.

CBT is a key psychotherapeutic orientation (Roth & Fonagy, 2005), and constitutes an exclusive psychological intervention category, as it draws from behavioral and cognitive psychological theories of human behavior, including, for example, theories of abnormal and normal development, and of psychopathology and emotion. Behavior therapy, one of the initial CBT psychotherapies, is founded on the clinical implementation of thoroughly researched behavioral models, like learning theory (wherein operant and classical conditioning have primary roles). The initial behavioral models were not direct in their analysis of cognitive process' and cognition's role in the growth/maintenance of emotional ailments. Cognitive therapy's basis is the clinical implementation of widespread and more recent studies into the dominant influence of cognition in emotional disorder development (Grazebrook & Garland, 2005).

Therapists require accessible data in connection with how, specifically, to ascertain the effect of antigay persecution on their gay clients, as well as how to adapt and employ current therapeutic models for reducing these effects The prejudice and hostility encountered by gay men because of stigmatization jeopardizes their mental well-being further. Among representative samples of members of this group, perceived societal stigma, and reported prejudice and violence incidents are noted to be linked to suicidality and other mental health issues. Therefore, it is imperative for social workers who support gay males to evaluate and manage the psychological repercussions of stigma (LaSala, 2006).

Male homosexuals strive against the basic stigma of their homosexuality and the correlation of this with masculine identity. Pachankis addresses the significance of the gender-nonconformity stigma in development and masculine identity in his 2009 essay. Fortunately, masculine identity and socialization are, of late, getting the attention deserved by them in the literature of male psychology (Szymanski & Carr, 2008). These issues' role is complicated, particularly for gender-conforming men, and for gender-non-conformists as well. Despite Pachankis's focus being gender-non-conformity among gay males, Felix conformed to his gender, and yet strove with the crossroads of gay identity and masculinity. In his interest and actions, he was gender-conformist and identified strongly with the male role. Additionally, he did not report any inconvenience or shame with behaviors that were of a gender-non-conforming nature. A major share of his anxiety and stress, however, arose from the gay stigma and the discrepancy between conventional 'masculinity' definitions and male homosexuality (Mankowski, 2000).

Pachankis (2007) performed extensive research about stigma's effect on LGB clients' psychology. His works highlight stigma's adverse influence and its pivotal role in people striving to hide their homosexuality. Comprehending these factors will be able to guide therapists' conceptualization of their clients' individual assumptions and patterns of behavior. Felix's, as referred in the case study, (refer to the case study) worry over keeping his homosexuality hidden stemmed from his anxiety regarding the discrepancy between his masculinity and his highly masculine profession. During the research conducted by Bedoya & Safren (2009), they stated that it was important to keep Felix's homosexuality a secret as he feared for the impact it would have on his family. However, this same fear made him come out to his family and the therapeutic work done by the researchers and Felix helped him to accept his identity and also helped his family to accept his sexual identity. The stigma associated with his homosexuality resulted in his decision to conceal it, as a function of its incompatibility with the career and masculine identity chosen by him. Felix handled minority stress by keeping his homosexuality hidden, constantly using his impression management techniques, and having negative expectations in regard to the consequence of revealing his sexual orientation. Psychotherapy typically teaches clients self-awareness, while endeavoring to offer them strategies for integrating their cognitions and emotions into one framework and living with increased authenticity and freedom. CBT can specifically achieve this by its capacity of, firstly, freeing clients from restrictive behaviors and cognitions, and secondly, of adding concrete skills and tools to the repertoire of clients for accomplishing personally-centered life goals. Furthermore, in case of Felix, the eventual outcome was in relation to Felix -- his inspiration, integrity, and strengths helped determine the positive result; his integrity aided him in striving for improved authenticity (GLASSGOLD, 2009). Furthermore, other theories mentioned above also apply like in sexuality theory, Freud states that the inverted are amphigenious so their sexual object may be different or same to the other sex. It also states that the inverted have a manifold behavior regarding their judgment about peculiarities of their sexual activity. Gestalt theory also applies to the case as it states that a person experiences his surroundings through contact without which he or she does not connect or form their identities. That connection is psychological, social and biological through which the needs of the person are met and he identifies with things that nourishes him and rejects what harms him. Felix formed his identity and he mentioned ethnicity and sexual orientation as important aspects of his life. The person centered theory focuses on the self-exploration, self-understanding and self-improved concepts that helps the client to positively change their lives and realize their potential. Felix accepted himself and after therapy, his family accepted him too despite the important elements that were essential for Felix's family like masculinity and Latino identity. Reality theory also applies to the case as it talks about empowering and confrontation and understanding the needs that the person has developed by taking control of their lives. Felix struggled despite being gender conforming and the stress he went through was due to the stigma around him regarding gay men, but after the acceptance by himself and his family, he carried no stigma.

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