Introduction to Special Issue.

Counselors Be Aware: Clients Come in Every Size, Shape, Color, and Sexual Orientation

SARI H. DWORKIN and FERNANDO GUTIERREZ

In order to guarantee that each individual is free to pursue his/her potential, each member of AACD is charged to (a) engage in ongoing examination of his/her own attitudes, feelings, stereotypic views, perceptions and behaviors that might have prejudicial or limiting impact on women, ethnic, minorities, elderly persons, gay/lesbian persons and persons with handicapping conditions; (b) contribute to an increased sensitivity on the part of other individuals, groups or institutions to the barriers to opportunity imposed by discrimination; (c) advocate equal rights for all individuals through concerted personal, professional and political activity. (Position paper of the Human Rights Committee of the American Association for Counseling and Development, 1987, p.1)

ounselors do not work within a vacuum. They are part and parcel of the society within which they live. Coun-

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beliefs, and values of the time period and the culture surrounding them. These attitudes, beliefs, and values are carried into the counseling session and affect the definition, assessment, and treatment of the problem presented.

Gay, lesbian, and bisexual clients are also part and parcel of the society within which they live. They are recipients of the attitudes, beliefs, and values of their time period and culture, but they are also creators of culture (Gutierrez, 1987).

There are many definitions of culture. Gutierrez (1985, 1987) pointed out that one definition of culture that is particularly relevant from a counselor's perspective is the psychological definition of culture. In 1934, K. Young defined culture as:

These folkways, these continuous methods of handling problems and social situations... the whole mass of learned behavior or patterns of any group as they are received from a previous group or generation and as they are passed on to other groups or to the next generation. (Kroeber & Kluckhohn, 1952, p. 106)

This transmitted content and these patterns of ideas influence behavior, from the way we dress or eat to the way we perceive ourselves, the way we communicate, and the way we form our values (Elam, 1968). Thus, the problems of gay, lesbian, and bisexual clients sometimes overlap with those of heterosexuals but often they differ. The methods of handling these problems and social situations will also overlap sometimes and differ at other times.

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As counselors, we assist clients in handling problems and social situations. In order to counsel gay, lesbian, and bisexual clients, counselors must become familiar with the culture of their clients and the "folkways" that are pertinent to these people's lives, from the client's perspective, so that "these continuous methods of handling problems" that they learn in the counseling session are culturally relevant. Just as a counselor would not always use the same method to treat Anglos as to treat Blacks, a counselor cannot always use the same methods that work in a heterosexual context to counsel clients living and existing within a gay, lesbian, or bisexual context. These coping skills are not often transferable from one cultural group to another.

Because we do not know the process by which sexual orientation develops, we cope by using methods that are familiar, though not always relevant. In the past, when we did not understand something, we labeled it as a sin or an illness. It used to be considered heresy to promote the idea that the world was round. More recently, in the 1950s, the immoral stigma of alcoholism was removed by the World Health Organization (Royce, 1981) by its declaration of alcoholism as an illness, based on the fact that science has provided us with better information with which to assess this phenomenon.

In this context it would be useful to examine the historical perspective of the treatment of sexual orientation by our society.

HISTORICAL BACKGROUND

In Europe as early as the mid-1800s there was a push for less negative attitudes toward homosexuality (Alexander, 1986). Karl Heinrich Ulrichs attempted to coin a more positive term for homosexual people. He called gay people urnings, which was an allusion to the god Uranus. He considered gay people to be a third sex and that their sexual orientation was inborn. The physician who first used the term homosexual, Karoly Maria Benkert, argued for an end to discrimination against gay people. In Germany and England there was an abundance of literature published on homosexuality, such as Havelock Ellis's Studies in the Psychology of Sex in 1896, Richard von KraftEbbing's Psychopathia Sexualis in 1894, and Edward Carpenter's Homogenic Love in 1894 (cited in Alexander, 1986). Unfortunately, the repression of the 1930s put an end to this movement toward more positive attitudes.

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Historically, in this country the climate for gay people has been one of heavy repression (Klein, 1986), which has kept gay people an invisible minority. "Society's views of homosexuals are a reflection of two important realities: One is that homosexuality is deeply stigmatized in our society. The other is that homosexuals are largely invisible to society, so that the stigmatization goes mostly unchallenged" (Martin, 1982, p. 341). The stigmatization is institutionalized in our laws, churches, and until very recently within the helping profes-

sions.

The parent of the helping professions-psychiatry-has viewed homosexuality as a mental illness and therefore homosexuals as sick (Herron, Kinter, Sollinger, & Trubowitz, 1985; Klein, 1986). Gay people have been viewed as arrested in development and their relationships have been seen as immature (Cartrell, 1984; Herron et al., 1985). Treatment, both psychoanalytic and behavioral (Davison & Wilson, 1973; Herron et al., 1985), typically involved the attempt to cure homosexuals and to change them into heterosexuals. Behavioral therapy went as far as using aversive therapy in the attempt to reduce or eliminate homosexual behavior.

The question of whether or not homosexuality per se was pathological needed to be investigated. Beginning with Dr. Hooker (1957), this type of research continued through the 1960s and 1970s, with studies comparing homosexuals and heterosexuals on personality tests (16PF, MMPI, adjective checklists, projective tests) and psychiatric interviews (for a complete review, see Meredith & Riester, 1980). While the studies did find differences between heterosexual and homosexual people (e.g., in one study, on a neuroticism scale male homosexuals were found to be higher on tender-mindedness, submissiveness, and anxiety and lower on depression than male heterosexuals, while in another study, low feminine lesbians were found to have higher self-acceptance than a comparison group of low feminine heterosexuals), there was no support for homosexuality as inherently pathological. As might be expected, those homosexual people who had legal difficulties and/or who were psychiatric patients showed pathological traits. Some homosexuals were well adjusted and some were not.

On the basis of the mounting evidence that homosexuality in and of itself was not pathological, many different groups (Herek, 1984; Klein, 1986) lobbied the American Psychiatric Association, and in 1973 the Association declassified homosexuality as a mental illness except for those who were in conflict with their orientation. The revised edition of the DSM III just removed ego-dystonic homosexuality from the diag-

noses.

As we stated earlier, we do not currently understand the phenomenon of sexual orientation. What we do know is that persons with diverse sexual orientations exist and that the existence of this diversity is not pathological.

Our goal as counselors is to assist all people with their growth and development. It is not our job, however, to define the goals of that growth and development for the client. The goals must come from the clients themselves. Counselors must then be aware of the attitudes, beliefs, and information that they bring into the counseling session so that these do not interfere with the process.

ATTITUDES OF HELPING PROFESSIONALS AND TRAINEES Immediately following the declassification of homosexuality as a mental illness, therapists were expected to shift their own

Introduction to Special Issue

attitudes and behaviors from a sickness model to a model whereby gay people would be helped to self-actualize as gay people (Graham, Rawlings, Halpern, & Hermes, 1983). For the most part the only experience these therapists had with understanding gay life-styles had come from their interactions with their gay and lesbian clients (Martin, 1982). Since gay people have typically been invisible (even more so in the past), it is reasonable to assume that the attitudes and beliefs held by these therapists and clients were stereotypic ones. Actually, early studies of therapists' attitudes toward gay and lesbian people showed that most professionals did not view homosexuality in and of itself as pathological, but, in spite of this, they rated heterosexual clients as healthier than gay clients and felt inadequate in their store of information regarding gay and lesbian life-styles (Davison & Wilson, 1973; Garfinkle & Morin, 1978; Meredith & Riester, 1980).

Therapists typically receive the most intensive part of their training in graduate school, and if graduate programs do not address gay, lesbian, and bisexual issues, most therapists will probably be inadequate in this area. A survey of graduate counseling students in 1977 (Thompson & Fishburn, 1977) found that these students were well informed about homosexuality and rejected the myths but were confused about the etiology of homosexuality and felt inadequately trained to deal with this population. Some current studies of counseling trainees reveal little progress in this area (Buhrke, 1987; Glenn & Russel, 1986; McDermott & Stadler, 1988). Students exhibit negative attitudes toward gay people and heterosexist bias. They feel that training in this area is nonexistent to inadequate. A disturbing study of therapists with varying levels of training and experience showed that, despite inadequate training and lack of information about gay and lesbian people, therapists are providing services to this population (Graham et al., 1983).

REASON FOR THIS SPECIAL ISSUE Many, if not most, therapists are willing to treat gay, lesbian, and bisexual clients (although this has not been empirically tested) despite the fact that they feel inadequately trained and lacking in knowledge about gay, lesbian, and bisexual lifestyles. This is in direct violation of the Ethical Standards of the American Association for Counseling and Development (March 1988). One method of gaining knowledge is through professional journals.

The Journal of Counseling and Development offers special indepth issues on relevant topics that have been neglected within training programs or that are new, innovative, or in need of updating. This journal has never had a special feature dealing with gay, lesbian, and bisexual issues in counseling before now. Information on this topic is not enough. Homosexuality has been perceived so negatively throughout history by both the lay and therapeutic communities that there is a need not only to teach but also to research, develop, and practice models that are gay, lesbian, and bisexual affirmative. John Gonsiorek (1985) defines gay/lesbian affirmative models as follows:

... are relevant to the life experience of gay men and lesbians ... function over a full range of psychological adjustment and ... speak to the concerns and clinical issues of well though poorly functioning gay men and lesbians. (p. 6)

This special issue is a blend of research, theory, and practical applications for counselors and counselor trainees attempting to be knowledgeable and affirmative when working with their

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