Working With Gay Male Clients
For individuals in the U.S. & U.S. territories
In Working With Gay Male Clients, Douglas C. Haldeman demonstrates his eclectic, relationship-focused approach to therapy with gay men. In working with clients from this population, therapists must be aware of what it means to be part of a stigmatized sexual minority group.
In this session, Dr. Haldeman works with a young man who, although he does socialize with other gay men, does not feel entirely comfortable identifying with gay culture. Dr. Haldeman listens to and discusses the client's experiences compassionately, and then helps him to see that there is no single correct way to express one's sexual orientation.
Focusing on this young man's history of trauma, his beliefs and self-concept as a gay man, and his vision of his future together form the basis for developing a treatment strategy.
Working with gay men of course bears some similarity to working with heterosexual men. Issues of control, competence, emotional repression, financial success, and physical stamina may be included in the clinical concerns of all men, regardless of sexual orientation. It should also be noted that many of the concerns that gay men bring to therapy will have nothing to do with their sexual orientation.
Differences in working with gay men generally derive from the internalization of factors related to stigmatized status in society, including family, work, and religious affiliation. Therapists working with gay men are encouraged to consider the psychological effects of living in a world where the client is taught that he is less "masculine" than non-gay men, that his primary relationships are of lesser value than those of heterosexual men, and where he may have suffered abuse, harassment, or discrimination as the effect of a prejudiced family, church, or social world.
Successful work with gay male clients depends upon attention to two kinds of factors: those internal and external to the gay man's life.
Internal factors are connected to his sense of identity—both as a gay man and as a man in a heterocentric world. How he feels about himself as a gay man is a result of the interaction between significant social influences (history of trauma, overt or insidious; family receptivity; strength of peer group; connection—or lack thereof—to the gay community) and his own unique personality. Who he is as a man among other men and women is another aspect to be considered, given the "de-masculinizing" influence of living in a society with varying degrees of sexual prejudice.
External factors are exemplified by relationship stability (family of origin and family of choice, including primary and social relationships), and work and work–life balance concerns. Gay men fall on a wide spectrum of response to the traumatic effects of sexual prejudice of all forms. The therapist needs to understand where the gay male client is on this spectrum and develop appropriate therapeutic strategies.
Keeping these concepts in mind, the therapist may employ any number of modalities, from behavioral to psychoanalytic. Dr. Haldeman's personal orientation is eclectic and person-centered in nature, starting with a careful assessment of the man's psychosocial development and background.
Unlike working with heterosexual men, it is useful to understand something of the gay man's coming-out journey. Whatever traumatic events, either overt or insidious, the client has experienced should be considered, especially if they carry a lasting effect on his life.
In addition to these internal issues, it is important to understand the reality of the life the client lives: his family and emotional life, friends, and work.
Finally, conceptualizing and committing to his personal and professional goals and vision of the future complete the therapeutic process. It may sound much like standard therapy with all men, but it is important not to overgeneralize: The therapist working with gay men, whether he himself is gay or not, is encouraged to remember that he is working with someone who has been made to feel badly about who he is by virtue of living in a homonegative culture.
It is also essential to remember that all gay men are unique individuals and the covariance of a variety of potentially stigmatizing factors will influence their presentation in therapy.
Generational factors and age, for example, determine many aspects of gay male identity. Older gay men, who came out in the Stonewall era, will have a far different view of cultural prejudice than a young gay man of the present era, especially if he comes from a progressive geographic area.
Gay men of color may face the effects of dual-minority status, in which they feel a sense of alienation from their communities of color (due to being gay) and the gay community itself (due to being a person of color).
Lower socioeconomic status gay men face challenges in what is typically thought of as a gay community comprised of relatively financially secure individuals.
Gay men living with disabilities may experience the greatest challenges of all in finding a home among other gay men.
The intersection of these and other variables creates endless sources of individuality for all gay men.
Douglas C. Haldeman, PhD, is a counseling psychologist, lecturer, consultant, and author who focuses on the GLBT (gay, lesbian, bisexual and transgender) community. Although he primarily works with this community in his therapy practice, he also specializes in relationship counseling with both heterosexual and gay/lesbian couples and is a nationally known expert on men's issues.
Dr. Haldeman serves on the Board of the APA Insurance Trust, the Board for the Advancement of Psychology in the Public Interest, and is the Diversity Officer of the Washington State Psychological Association.
Dr. Haldeman is a past member of APA's Board of Directors, and is the recipient of the Outstanding Achievement Award from the Committee on Lesbian, Gay and Bisexual Concerns (2002), an APA Presidential Citation (2005), and the John D. Black Award for excellence in Practice from the Society of Counseling Psychology (2007).
He comments frequently in the media on a variety of issues related to professional psychology and social policy, and has published numerous articles and book chapters on the ethical and competent treatment of lesbian, gay, and bisexual clients in psychotherapy.
Dr. Haldeman lives and practices in Seattle, Washington.
- American Psychological Association. (2009). Report of the APA task force on appropriate therapeutic responses to sexual orientation. Retrieved January 8, 2010 from www.apa.org/pi/lgbt/resources/therapeutic-response.pdf
- American Psychological Association. (2000). Guidelines for psychotherapy with lesbian, gay and bisexual clients. American Psychologist, 55(12), 1440–1451.
- Dworkin, S. H. (1992). Some ethical considerations when counseling gay, lesbian, and bisexual clients. In S. Dworkin & F. Gutierrez (Eds.), Counseling gay men and lesbians: Journey to the end of the rainbow (pp. 325–334). Alexandria, VA: American Association for Counseling and Development.
- Fassinger, R. E., & Arseneau, J. R. (2007). "I'd rather get wet than be under that umbrella": Differentiating the experiences and identities of lesbian, gay, bisexual, and transgender people. In K. J. Bieschke, R. M. Perez, & K. A. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual, and transgender clients (2nd ed.; pp. 19–49). Washington, DC: American Psychological Association.
- Greene, B. (1997). Ethnic minority lesbians and gay men: Mental health and treatment issues. In B. Greene (Ed.), Psychological perspectives on lesbian and gay issues: Vol. 3. Ethnic and cultural diversity among lesbians and gay men (pp. 216–239). Thousand Oaks, CA: Sage Publications.
- Haldeman, D. (2010). Reflections of a gay male psychotherapist. Professional Psychology: Theory, Research and Practice.
- Haldeman, D. (2007). The village people: Identity and development in the gay male community. In K. Bieschke, R. Perez & K. DeBord (Eds.), Handbook of counseling and psychotherapy with lesbian, gay, bisexual and transgender clients (2nd ed.; pp. 71–90). Washington, DC: American Psychological Association.
- Haldeman, D. (2004). When sexual and religious orientation collide: Considerations for psychotherapy with conflicted gay men. The Counseling Psychologist, 32(5), 691–715.
- Haldeman, D. (2001). Counseling gay and bisexual men. In G. Brooks & G. Good (Eds.), A new handbook for counseling men (pp. 796–815). San Francisco, CA: Jossey-Bass.
- Herek, G. M., & Garnets, L. D. (2007). Sexual orientation and mental health. Annual Review of Clinical Psychology, 3, 353–375.
- Kiselica, M., Mule, M., & Haldeman, D. (2007). Finding inner peace in a homophobic world: Counseling gay boys and boys who are questioning their sexual identity. In M. Kiselica (Ed.), Counseling troubled boys: A guidebook for professionals. New York, NY: Routledge.
- Meyer, I. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
- Patterson, C. J. (2000). Family relationships of lesbians and gay men. Journal of Marriage and the Family, 62, 1052–1069.
- Ritter, K. Y., & Terndrup, A. I. (2002). Handbook of affirmative psychotherapy with lesbians and gay man. New York, NY: Guilford Press.
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