Despite a quality service offered by many counsellors and psychotherapists, two main findings from Cordelia Galgut’s research into the experiences of lesbians in therapy give cause for concern
A while ago, I completed my DPhil research based on interviews with 24 lesbian women about their experiences of counselling and psychotherapy. They were an experienced group of clients, who had seen 104 practitioners between them, for longer- and shorter-term therapy – 14 had seen 4 or more therapists. Of the 104 therapists seen, 77 were women, approximately half of whom were heterosexual. Of the 27 male therapists seen, the vast majority were heterosexual.
Reasons for the investigation
Since my MA research1 had highlighted worrying degrees of pathologising of, and prejudice towards, lesbians, amongst a large and experienced sample of qualified counsellors and psychotherapists, I was keen to explore lesbians’ experiences in therapy. Although it is hard to prove a relationship between practice and attitudes (Ajzen and Fishbein2), it is reasonable to assume that the presence of negative attitudes towards lesbians in the psyche of practitioners might adversely affect a lesbian client’s successful progress through therapy.
Furthermore, there was evidence in other literature that the services offered to lesbians are not always as beneficial as they should be (Young3, Annesley4). Also, as Golding5 states, ‘there is a paucity of research into the needs and experiences of lesbians, gay men and bisexuals who are involved in mental health services’.
I was, therefore, keen to increase the amount of research done in this area, not least of all because there is little research done in the UK on lesbians’ experiences of mental health services, and precious little in the field of counselling and psychotherapy.
Conducting the research
I decided to use a qualitative research method. Since the whole focus of qualitative research is on the examination of personal experience (Annesley4), this research method was compelling to me for this topic. Moreover, since I wanted to allow concepts to emerge from my data, which would in turn generate working hypotheses rather than invariable empirical facts (Henwood and Pidgeon6), a qualitative research method that would allow for this seemed most appropriate.
I was also keen to reflect upon and listen to my own feelings as part of the research process. This was, undeniably, a personal process for me and therefore my own particular perspective as a lesbian, feminist woman might well have influenced data outcomes.
Although I promised them anonymity, being interviewed could still feel risky for the 24 courageous women who came forward. But, for this kind of research, the sample was pleasingly large. However, I was disappointed that only one woman was black and none was Asian, despite making enormous efforts to generate a more representative sample of lesbian women.
I conducted semi-structured interviews over a period of a year. The areas I covered in the interview spanned general questions about the interviewees’ experiences of counselling and psychotherapy, and more detailed ones about process. I then transcribed the tapes onto templates, though I had taken care to allow the interview to flow, in the hope that the richest data possible would emerge from this process. Through the process of transcribing the tapes, themes started to emerge from the women’s words, from which I did summaries. Finally, diagrammatic representations were done of these themes, which, in turn, I used to write up the results.
Two major themes
I will focus here on just two of the major themes of the study, ones that are, in my opinion, of greatest interest, and that raise a number of issues for us to consider in relation to our lesbian clients.
1. Explicitness in the counselling relationship
[‘A matter that becomes clear ceases to concern us.’] (Nietzche7)
The major theme that emerged from my research, raised by all 24 women, was the particular need for explicitness from therapists and openness in specific areas. Thirty-two sub-themes emerged from this major theme, some of which I will focus on here. Overall, the need for therapist self-disclosure was cited by 92 per cent. Concerning self-disclosure generally, one participant explained: ‘It was disclosures that bonded me to my therapist and they just seemed appropriate.’
In particular, though, the need for practitioners to disclose their sexuality was stressed (83 per cent). Reasons given for this were, for example, ‘It would feel as though she was retaining a power and I wouldn’t like that,’ or ‘She refused to tell me and I just didn’t want to work with her. It matters to me that they’ll disclose this about themselves.’
Eighty-three per cent of the sample also highlighted the extreme importance of heterosexual therapists’ willingness to initiate and be open about lesbianism and related issues – the tenor of which was that the more relaxed the therapist is able to be about talking about lesbianism and related issues, the better it is for the lesbian client. One interviewee said that the therapist’s explicitness had made it ‘possible for conversations to be completely open, so I could bring into it anything I wanted’.
Another participant spoke about her therapist having encouraged her to ‘speak the unspeakable’ by suggesting she had erotic feelings for her. That had, in turn, facilitated a deeper disclosure by the client, which had been very useful for her.
Another woman said of her male, heterosexual therapist, ‘I think he said something about girlfriend before ever I did. I don’t know if I’d ever use ‘girlfriend’ as a word, but the fact [was] that he dared speak it!’ By doing this, she continued, the therapist ‘gives me permission to speak what I daren’t speak, and that’s a way in which he has helped me and continues to help me process stuff around sexuality’.
As part of this willingness to be open about lesbianism, 29 per cent of the sample also stressed the importance of therapists being prepared to say they don’t know. For example, one participant said that, specifically stating that they don’t know much about lesbian lifestyle and culture, and also being prepared to say they don’t know what it feels like to be a lesbian in this world, would be useful.
Seventy-one per cent of the sample also stressed the need for heterosexual therapists to directly disclose positive attitudes to lesbians, and 50 per cent particularly stated the importance of being affirmed by their therapist as a lesbian. This affirmation could take various forms. Clearly stating a positive attitude was considered very helpful, along with, for example, in the case of heterosexual therapists, ‘recognising that sexuality might be an issue between us that needs talking about’.
Seven of the women saw parallels between therapists referring to their (the client’s) partner in a relaxed and comfortable way and the embodiment of positive attitudes in those therapists. One participant said of her heterosexual therapist, ‘He refers to X a lot. He shows he accepts my relationship by aligning himself to X, he’s always referred to her without question.’
A theme also emerged which reiterated the above, by citing the problems, for the participants, of a lack of explicitness in the counselling relationship. The problems of lack of explicitness from heterosexual therapists were cited by 79 per cent of the women. Seventy-one per cent wanted their therapist to be more explicit about sexuality issues, and specifically, less scared of raising issues, less careful and less self-conscious.
For example, one woman said that a successful outcome for her in therapy would have been ‘if the therapist had said, “Wow, what’s it like knowing I don’t have sex with women and maybe you’re feeling you can’t talk to me” – that kind of thing and nobody’s done that. That would have helped. It may not have meant I could do it, but I could have had a good old rant at the fact that they were less than perfect for me, and that would have been helpful.’
Another comment was made about therapist reticence in relation to sex, which the participant saw as specifically related to the therapist’s uneasiness about her (the client’s) sexuality. She said, ‘It’s interesting cos I make hints about certain anxieties in relation to our relationship or whatever, about sex. I’ll hint at matters, and what I notice is that he doesn’t pick up on these things as much as other stuff. I think it’s because it’s charged territory and he’s got to be careful that he may be seen as prejudiced or whatever, so he’ll tend to be careful rather than wade in.’
The difficulties of being explicit with heterosexual counsellors were also very much at the forefront of these women’s thoughts. Sixty-seven per cent highlighted this. Within this, the biggest area of concern, mentioned by 46 per cent, concerned revealing their sexuality. For example, comments were made such as, ‘I came out straight away and had no reaction from her. Nothing would have told me if she was supportive of it, or whatever.’
Another woman said, about revealing her sexuality, ‘Being explicit might lead to the taking apart of my whole lesbian identity. I might have to defend it.’
The net result of the above is that 92 per cent of the women in my sample have a preference for lesbian therapists, for reasons such as, ‘You can’t talk about sex with a heterosexual therapist, you can with a good lesbian therapist.’ Or: ‘I do not believe that a heterosexual woman can understand the dynamics of lesbian relationships. I feel very strongly about this. I think that being a lesbian takes you into a different psychological space, takes you into a completely different society, cultural space as well. It’s completely vital as a lesbian that my therapist is a lesbian – to work with a heterosexual woman or man would seem like giving myself a hard time.’
Furthermore, another woman said, ‘I needed someone I knew would be on my side and that my lesbianism wouldn’t be made an issue of unless I wanted it to be.’ Also, ‘It’s about having that understanding and that knowledge,’ and ‘Initially, getting into it was much easier, knowing I wasn’t going to have to explain and justify and account for myself as a lesbian.’
Interestingly, though, and, in one sense contradicting the above, 58 per cent of the interviewees spoke of difficult areas with lesbian counsellors/psychotherapists. The biggest area of concern, expressed by 42 per cent, regarded feeling the need to be politically correct, with a lesbian therapist, which the women experienced as a constraint. One example given was, ‘It was not very helpful. I ended up feeling censored. I couldn’t say how I felt in case she disapproved of me.’ Also, ‘She made all kinds of assumptions about me, because I was a lesbian, that might have fitted into her political world, and there’s a danger there, too. There’s a difference between us, too, it’s not helpful not to acknowledge that. There’d be ways in which the mutual understanding was her understanding of her own situation.’
So, a lesbian therapist is preferred, though with the proviso that it be easily possible to address the issue of feeling the need to be politically correct with a lesbian counsellor, within the counselling relationship.
2. Heterosexual therapists’ problem with lesbians
[‘Prejudice is never easy unless it can pass itself off as reason.’] (Hazlitt8)
The second, very marked, major theme to emerge from my data concerned heterosexual therapists’ lack of awareness and understanding of, pathologising of, and indications of, a problem with lesbians.
Within this major theme, 96 per cent of my sample spoke of heterosexual therapists’ lack of awareness of and understanding of lesbian lifestyle and culture. Comments were made such as, ‘I almost felt that her (the therapist’s) questions became abusive, because she didn’t have the faintest idea about lesbian sexuality.’ Another interviewee said, ‘I don’t know if she’d ever worked with lesbians before. She should have had that knowledge and awareness and she didn’t have it. It was a major thing and it would have spared me an awful lot of discomfort. It definitely hindered my progress.’
Another concern within this theme, which is particularly worrying, in my opinion, was heterosexual therapists’ pathologising or indicating a problem with lesbians, raised by 71 per cent. A surprising 58 per cent of the participants said they had been pathologised by their therapist. For example, one woman said that her psychotherapist, ‘had had a compassion for me, in that I was sexually immature and could evolve into a heterosexual’. Another woman said that she had felt heavily judged by her therapist when the therapist had said, ‘You’ll get over it,’ referring to her lesbianism.
On the subject of experiencing therapists who had a problem with lesbians, comments were made such as, ‘People give themselves away all the time, body language, obvious discomfort in the way they’re talking or a complete inability to bring the subject up at all.’
Another interviewee said, ‘When I finally did come out, she blushed and I knew something like that would happen. I knew she was uncomfortable with it, not only in what she said, but in her manner. She led very quickly to a structure model, tried to keep open body language, but couldn’t manage it. She was unnerved.’
Conclusions
[‘In human intercourse, the tragedy begins not when there is misunderstanding about words, but when silence is misunderstood.’] (Thoreau9)
So, on the basis of these results, what should we conclude? I had not expected the degree of need for explicitness in the counselling relationship, between lesbian client and practitioner, that was expressed. I had predicted that a certain amount would be necessary, perhaps in key areas, but the level of concern amongst my sample was a surprise. During the research process, I was also doing a good deal of face-to-face work and found myself reflecting quite considerably on this issue of explicitness. My practice started to change as I discovered that my findings, when put into practice, did seem to reap rewards, across client groups, although the needs of these groups did appear to differ, in some significant ways.
Clearly, a lesbian client, because she has a sexuality that is not likely to have the kind of approval within society as does her heterosexual equivalent, will bring with her, into the counselling relationship, a concern, at the very least, and an uncertainty about her therapist’s attitudes to her as a lesbian. A heterosexual client does not have to deal with this – though there may be other issues he or she might worry about disclosing. The sexuality issue is an added problem for the lesbian. Though it is not likely to be an issue or problem for her personally, the fact that it could be for her therapist creates a problem. The data shows that there is a relationship between how comfortable therapists show themselves to be about lesbianism and the extent to which the lesbian herself feels comfortable within the therapeutic relationship. Since it can be hard for a lesbian client to feel comfortable enough to reveal her sexuality, it is vital that the heterosexual therapist reveals his or hers, since it is with heterosexual therapists that the problems are greatest for lesbian clients. If this knowledge is withheld, it can be very problematic for the lesbian client, and she cannot know her therapist’s sexuality for certain unless it is clearly stated. There is, it could be argued, nothing lost if the therapist reveals this information at the onset with all clients. To some, it will be irrelevant, to others of vital importance.
The area of pathologising by the practitioner and indications of there being a problem with lesbians and lesbianism is clearly of great concern to the lesbian client. Where her therapist espoused pathologising attitudes, this seriously affected a successful outcome for her, as did a therapist having a problem with her as a lesbian. The question arises, why have as many as 58 per cent of this sample experienced pathologising attitudes from their therapists, and what can be done about it?
The need for therapists to be in touch with their own thoughts and feelings about their own sexuality is of paramount importance, in their approach to their lesbian client’s sexuality. If therapists espouse negative attitudes towards these clients and are uncomfortable about affirming them as lesbians, it is perhaps inappropriate for them to be working with this client group. The data from my research clearly indicates that the participants do consider that there is a relationship between therapists’ attitudes, namely adopting positive ones, and a successful outcome for them, in therapy, despite the received wisdom that ‘I can still work with lesbian clients if I don’t agree with lesbianism, because I can separate my attitudes from my attitude to my client,’ which is still quite prevalent, within the counselling and psychotherapy world.
Overall, then, my research data points to key areas that we can address as therapists, in order to offer this client group a better service. The women participants speak out loudly and clearly, pointing the way forward for us. The task is now ours, to take heed and improve what we can improve, in order to make therapy for lesbians the beneficial process it should and can be.
References
1. Galgut C. A fair deal for lesbians in therapy – an ethical issue? Counselling. 1999; 10(4):285.
2. Ajzen I, Fishbein K. Understanding attitudes and predicting social behaviour. Englewood Cliffs: Prentice-Hall; 1980.
3. Young V. The equality complex: lesbians in therapy, a guide to anti-oppressive practice. London: Cassell; 1995.
4. Annesley P. Dykes and psychs: lesbians’ experiences and evaluations of clinical psychology services. (Unpublished PhD) University of Surrey; 1995.
5. Golding J. Without prejudice: Mind lesbian, gay and bisexual mental health awareness research. London: Mind; 1997.
6. Henwood KL, Pidgeon NF. Qualitative research and psychological theorising. British Journal of Psychology. 1992; 83:97-111.
7. Nietzche F. (1886) Beyond good and evil. tr. Kaufman W. 1980.
8. Hazlitt W. (1839) On Prejudice, sketches and essays.
9. Thoreau, HD. (1849
