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Bisexuality in the therapy room: identity


Bisexuality in the therapy room: identity & experience Emily Hodgkinson PhD, Dip POP, UKCP – PowerPoint PPT presentation

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Title: Bisexuality in the therapy room: identity

Bisexuality in the therapy room identity
Emily Hodgkinson PhD, Dip POP,
Why focus on bisexuality?
  • Publication of Pink Therapy, 1996
  • People who have relationships with both sexes
    may have been counted within research into
    homosexuality or excluded from the data. We
    believe it is important to conduct research into
    bisexual psychology to see how it compares with
    lesbian and gay psychologies. In the absence of
    such evidence, we are assuming that the
    psychology of bisexuals is not very different to
    that of lesbians and gay men. (Davies Neal)
  • .

  • Post-1990 Bisexual communities voices begun to
    be heard (books, internet, lobbying L/G community
  • Specific, separate research into bisexuality
  • Bisexual psychologies are substantially different
    to lesbian and gay psychologies
  • Confirms anecdotal evidence.

Emerging research Bi people have significantly
worse mental health than lesbian, gay or straight
people anxiety, depression, suicidality,
self-harm. Why?
Mental health recent research
  • Bisexuals have higher levels of certain mental
    health problems than straight, lesbian or gay
  • Anxiety, depression, self-harm, suicidality,
    negative affect.
  • Why?
  • 1 Page, 2007 in Firestein (ed), Becoming Visible
    2Bi report, 3Dodge Sandfort, 2007 in Firestein

What is bisexuality?
Part 1
  • If a client tells you they are bisexual, what
    does this tell you about them?

Im bisexual
Beliefs about sexual orientation
  • There are 3 categories straight, gay bisexual.
  • You have to choose between men and women.
  • There are many genders.
  • Sexual attraction is on a spectrum between male
    and female.
  • We all have a core sexuality that were trying to
  • Were all born bisexual.

Conflicting models of (beliefs about) sexual
  • Essentialism vs. Constructionism vs. ....???
  • Foucault sexual orientation is a relatively
    recent product of Western culture.
  • Could say bisexuality is a biphobic concept? (for
  • Intersections with gender culture bisexuality
    is culture-specific and dependent on binary model
    of gender.
  • pansexuality, genderqueer, etc
  • Identity, behaviour attraction how public
    society deals with the contradictions.

Clinical implications
  • Clients already have models, conscious or not,
    which may not be congruent with experience.
  • E.g. One must have a sexual orientation
  • You have to choose
  • Dissonance between model and experience leads to
    inner conflict.
  • Experience and model interact in feedback loop,
    to modulate awareness identity
  • Bi identity development happens at the meeting
    point between experience and model.

Its doing my head in, mate!
Identity development L/G-centric models
Part 2
  • Several stages from confusion/denial towards
  • Identity confusion a common early stage,
    implicitly pathologised and to be resolved.
  • Assume fixed stable identity or identity
    maintenance as desired outcome.
  • E.g. Here a woman feels a sense of settling down
    that is similar to finishing adolescence. She
    often develops a chosen family of accepting
    friends often an ongoing committed relationship
    is formed. (Lewis 1984)

Bisexual development My home is not a place
but a process
  • A constant interaction between changing flow of
    experience and different models communities.
  • Does not necessarily have a desired end-point.
  • Experience is not necessarily constant over time
    social or relationship context. Identity not
    maintained or supported by choice of partner or
  • Intersectionality bisexuality is
    culture-specific and dependent on binary model of
    gender, e.g. pansexuality, genderqueer, etc.

Identity development a B/T-centric model (Meyer1)
  • Identity formation is culturally specific to
    Western industrial society. Bi-genderist. One
    must have an identity often difficult or
    impossible for bisexuals.
  • Sexual identity as a never-ending process of
    co-creation between self and society.
  • E.g. woman in same sex relationship attended
    lesbian events. Now with male partner, so her
    social identity changes.
  • E.g. Poly life constant shifts in social
  • 1 Meyer, in Alexander Yescavage (eds),
    Bisexuality Transgenderism Intersexions of the
    Others, 2003.

Oppression marginalisaton inner and outer
Part 3
  • Key themes
  • Stereotyping
  • Invisibility
  • Biphobia, homophobia
  • Hetero- and mono-normativity
  • And the effects of all this on
  • Mental health
  • Relationships
  • Living in society

Invisibility (is hard to spot)
  • How?
  • Not noticing/not seeing
  • Tacking onto LGBT (e.g. no Bi-specific services)
  • It doesnt exist/ Just a phase
  • Seeing sexual orientation defined by current
  • Straight or gay?
  • Where?
  • In mainstream AND LGBT communities
  • Research, books, media
  • Social intercourse (e.g. womens social group)
  • Gender-based social structures (e.g. speed dating)

Mental health recent research
  • Bisexuals have higher levels of certain mental
    health problems than straight, lesbian or gay
  • Anxiety, depression, self-harm, suicidality,
    negative affect
  • Most studies bi identity one study bi
    behaviour 3
  • Bi womens problems more serious overall1
  • Bi mens sexual identity issues more serious1
  • 1 Page, 2007 in Firestein (ed), 2Becoming
    Visible Bi report, 3Dodge Sandfort, 2007 in
    Firestein (ed).

Mental health possible answers
  • Greater adversity, less support acceptance from
    family friends, less likely to be out
  • Higher substance use
  • Theory of dual oppression
  • 1 study bi men worse mental health than gay men
    while bi women lesbians had similar levels3
  • 1 study found bi females and Trans people had
    higher levels of mental health than bi males. 4
  • Invisibility greater experience of not fitting
    societys models?
  • 4 Mathy et al, 2003, in Alexander Yescavage

Relationships sexual health
  • Invisibility whoever youre with relationship
    determines your social world
  • Hetero- and mono-normativity, e.g. assuming
    orientation towards one gender, e.g. biases
    towards monogamy but which do you prefer?, etc
  • Finding relationships creating relationship
    family structures
  • Coming out as bi to a non-bi partner ( issues
    for non-bi partner)
  • Homophobia biphobia in same and other-sex
  • MSM often less acess to safer sex education

Society community
  • In the mainstream
  • less likely to be out
  • less support acceptance
  • The B in LGBT
  • Same problems. B is tacked on but marginalised
  • The Bi scene
  • Often small, hard to access
  • White, educated, online
  • Relatively Trans-friendly

Therapeutic models reflexive practice
Part 4
  • Outline
  • Setting context of therapy
  • Your therapy paradigm
  • Your personal model of sexual orientation
  • What clients want and get - from therapists
    counsellors study

Reflecting on your therapeutic paradigm
  • Identify elements of your therapeutic paradigm
    that relate bisexual experience, identity
    identity development.
  • Can you describe a possible model of
    bisexuality implied by your paradigm?
  • Identify its strengths possible limitations.

Reflexive practice your personal model of sexual
  • What is your personal model of sexual
  • What kind of bisexual lifestyle or model of
    identity could you most easily empathise with?
  • What about a bisexual clients beliefs, lifestyle
    or experience would you find most hard to
    empathise with or threatens your identity? Why?
  • What worldview or personal history/experience is
    challenged in you?

What Bi clients want from therapists ( what they
  • Raising Bi issues in therapy/counselling
  • 20 sought help for bi issues, 1/3 for other
    reasons but bi issues came up
  • 20 never/rarely disclose to clinician
  • Bi as stress 40 some 33 difficult or hardest
  • Clinicians less helpful than for L/G issues
  • 1 From Page, 2007 in Firestein (ed) study of bi
    clients seeking MH services

Main problems in therapy
  • Invalidation, invalidation, invalidation
  • Saying bisexuality does not exist
  • Seeing as part of pathology
  • Refusing to engage unless they choose men or
  • Assuming bisexuality connected to clinical goals
    when it isnt
  • Recommend improvement by limiting interest to one
    or other sex.
  • Attempting conversion to straight, lesbian or

Common stereotypes held by clinicians
  • Indecisive
  • Current relationship true orientation
  • Its a phase or in transition
  • Accept gay but not bi
  • Dysfunctional
  • Manifestation of problem your with men
  • One experience doesnt make you bi

Top Bi needs in therapy
  • Validation, validation, validation!
  • See Bisexuality as healthy
  • Knowledge
  • Skill in helping with bi issues
  • Apply skills to supporting positive bi identity
  • Proactively intervene to support bi issues

Knowledge wishlist
  • Variability of sexual attraction relationships
  • Validate non-monogamous relationships as real
  • Aware of het/L/G cultural bias bi stereotypes
  • Appropriate language
  • Understand difficulty in finding relationships

Skills attitudes wishlist
  • Acceptance, understanding, support,non-judgmental,
    confidence in clients healthy development
  • Recognise challenge homo- and bi-phobic
    thinking proactively
  • Provide information resources proactively
  • Advocate with colleagues society
  • Frame that assumes clients have been impacted by
    homo- and bi-phobia
  • Sensitive to how clients may have internalised
    cultural bias