LGBT Treatment Suggestions

I have a plan to watch the psychotherapy video shown in class week again and again, it was that good!  Why?  Because one psychotherapist noted that LGBT clients seek out therapy more than heterosexuals and because 95% of therapists will have at least one LGBT client.

Several elements to the videos were helpful.  First, it is important to understand the concept of internalized homophobia and the continuum from awareness about one's orientation leading to integration.  This continuum has four general categories.

1. Integration = sexual orientation is fully realized

2. Acceptance = some acceptance of sexual orientation

3. Awareness = some awareness of sexual orientation

4. Little or no awareness of sexual orientation

To help LGBT clients, it is vital to understand where the client is on the continuum.  When the gay client  is fully integrated in his identity, then a treatment plan can be developed as usual because their orientation is not causing them distress. However, the LGBT client with little or no awareness about their orientation, their distress may be complicated or generated in a small degree by their lack of awareness. The video provides a great example of helping a client move along the continuum towards integration.  The therapist finds just the right balance between being directive and empathetic. 

The video was equally helpful in demonstrating the coming out process. The therapist uses the continuum to show how the client has changed so wouldn't it make sense for family members to change just as he did?  This is a excellent example of hypothesis testing, a great therapeutic concept for all types of sexual orientation.

Another important point made is that societal stigma should not be overpathologized or underdiagnosed when dealing with LGBT clients.  This is equally important when treating same-sex couples who may differ in where they are in the coming out process.

This blog is just some of the highlights from the video, it was that jam-packed with helpful information.  With the news of another tragic transexual suicide this week, this information takes an even more importance.

 Mr. Grey and Ms. Steele, did you know there's more variations?

With the major motion picture release of Fifty Shades of Grey, millions of Americans now know about BDSM, one of 500 paraphilias. Count me as one of those who really did not know much about BDSM. Thanks to a great presentation by Lauren, Victoria and Emily, I now know about the other 499.  Could I have gone the rest of my life without knowing about Emetophilia?   Yes!   But thankfully, because of this knowledge, if I ever were to have a client who finds vomit arousing, I could possibly refrain from looking shocked and dismayed and treat the client with the respect that they deserve.

What a daunting project to tackle but with humor and clear organization, this team did a great treatment video and wikipage.  The cartoons provided comic relief and helped me not to"yuck someone's yum."  Focusing on the big eight paraphilias and providing the DSM 5 definitions gave this topic much needed structure.  I especially enjoyed the italicized summaries of the research reports.  Kudos on the treatment video, especially to Victoria as Shawn who kept calling his partner, "Court", short for Courtney which is such an accurate depiction!

A race car analogy is useful to describe where I was before this presentation.  I was going about 25 miles per hour.  But this project got me going 25 to 100 mph.  Talk about acceleration!  But instead of crashing into a client with an unexpected paraphilia, this presentation will keep me on track to treat everyone with dignity and acceptance.

Sex and Medical Conditions

Since this topic was my group's presentation, I am more than a little familiar with the material.  But what I think is an overriding theme is people in these situations (cardiac challenges, spinal cord injuries and intellectual disabilities) and people, even without these challenges, all could be helped by sex education.  Imagine a sex ed class where the myth of asexuality is shattered once and for all?

A recent article in the New York Times highlighted a sex education program started by Julie Metzger. Like a stand-up comedienne, she presents anatomy to intercourse topics to an audience of mothers and daughters or fathers and sons.   Participating teen ask questions about sex by writing them on index cards which she reads and answers accurately but humorously. Metzger says this helps parents hear what teens are wondering about and opens the door for parents and kids to talk regularly about sex. Metzger, a nurse, was motivated to start this program because she noticed that kids either learn about sex in dry health classes for 10 weeks or maybe a 10 minute conversation with a parent.  Why not get parent and kid together and make it fun?

Make no mistake, teens attending Metzger's classes do not want to go initially. But in the end,  everyone gives the program high ratings.  The article describes Metzger's attempts to reach out to more culturally diverse demographics. Others wonder how transgendered teens could benefit from this program.  Here's my question: does Metzger include questions about sex and disabilities? One can only hope. In the meantime, she deserves credit and accolades for tackling sex education with humor and creativity.

Reflections on FOD

My heart went to the couples who suffer so much when dealing with vaginismus. I am so glad for this presentation because sadly before this, I potentially would have been one of those who would give the terrible advice: "Have a glass of wine and forget about it."

Because of this presentation, I now know there are sex therapists and even clinics that help women train their vaginas not to have "panic attacks." What I found interesting is this condition is a great illustration regarding the female desire, arousal, orgasm process because of the complex interplay of biopsychosocial factors.  So with vaginimus, the desire is there, the arousal may or may not be there but physically the walls tighten to prevent penetration. Possibly this physical reaction may be rooted in some part in anxiety.   It's easy to imagine the shame and guilt that would prevent a couple from seeking help.

All this complex interplay involved in female orgasm process is an argument against the female version of Viagra. So one pill is going to help?  Sorry drug companies, this presentation in HDF 505 shows Pfizer and the like should look elsewhere to make a profit.