Pride and Prejudice with Gay and Lesbian Individuals more

UNDERSTANDING GENDER AND CULTURE IN THE HELPING PROCESS Practitioners' Narratives from Global Perspectives CLAIRE LOW RABIN, EDITOR Tel Aviv University, Israel THOMSON WADSWORTH AUSTRALIA • CANADA • MEXICO • SINGAPORE • SPAIN • UNITED KINGDOM • UNITED STATES PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS Combining Narrative and Expressive Practices ELEANOR PARDESS ISRAEL OVERVIEW This chapter explores many unique issues and challenges in helping gay, les- bian, and bisexual clients develop a positive identity in a society in which prej- udice and discrimination are prevalent. A narrative approach within a postmodern framework gives us a new perspective on homophobia and het- erosexism and sheds new light on the complexities of identity development and the "coming-out" process as rewriting of one's story and a continuous conversation with oneself and others. Because the definitions and acceptability of same-sex love differ across cultures and are constantly changing, under- standing the sociocultural context is imperative. When helpers deny the culture-specific experiences in the lives of lesbian and gay clients, bias is likely to pervade the helping encounter. Combining the expressive arts with narrative therapy can open new possibilities for practitioners. By rendering the invisible visible, opening lines of communication, and transcending culture barriers, art is a valuable resource. It can be a form of "giving voice" and of protest against dominant oppressive discourses. A detailed case study will illustrate how narrative practices integrated with the expressive arts may provide support and vali- dation as well as strengthen the capacity of the individual to resist the detri- mental effects of negative labeling and pathologizing discourses. Finally, based on studies surveyed in this chapter, a table has been prepared that lists 109 110 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES guidelines for those affirmative practices that can provide support for identity development and biased practices where helping can harm. INTRODUCTION Three decades have passed since the decision to remove homosexuality from the American Psychiatric Association's (APA) list of mental disorders. However, despite the changing social atmosphere in many countries around the world, prejudice continues to be widespread (Haldeman, 1994; Herek, 1995; Perez, DeBord, & Bieschke, 2000). Help providers need to be aware of social stigma- tization (i.e., prejudice, cUscrimination, and even violence) and the risks it poses to the mental health and well-being of lesbian and gay clients. Prejudice and stigmatization have various manifestations, including homophobia, internalized homophobia, and heterosexism. Homophobia Merriam-Webster's Collegiate Dictionary (10th ed., 1993), defines homopho- bia as the "irrational fear of, aversion to, or discrimination against homosex- uality or homosexuals." Its manifestations range from social avoidance to verbal abuse to civil, military, and religious discrimination, to physical violence (Isay, 1989). From a postmodern perspective, understanding the social context of homo- phobia is crucial. Homophobia thrives in societies that are intolerant of diver- sity. Although the use of the term phobia may imply a personal problem of an individual (who, according to psychoanalytic formulations, is threatened by his or her homosexual impulses), homophobia is located in the sociocultural con- text and supported by dominant social discourses. Antigay attitudes and deni- grating messages about homosexuals and bisexuals are socially construed, and discrimination is institutionalized in many aspects of society—legal, military, and so on (DePoy & Noble, 1992). Numerous and complex social factors contribute to homophobia. Intolerance and prejudice toward the "other" is one factor (Cain, 1991). Another source of homophobia in many cultures seems to be religious traditions that oppose homosexuality (e.g., Christianity, Judaism, and Islam). In recent years, certain "progressive" branches of Protestantism and Judaism have increasingly accepted homosexuality. However, in most religious settings, homosexuality may still be considered a sin. The psychiatric and early psychoanalytic models of homosexuality as a disorder perhaps were meant to "liberate" homosexuality from its status as a sin, yet in doing so they created new pathologizing discourses as an illness or a sign of arrested developmental disorder. These discourses dominated the mental health field for most of the last century (Bieschke, McClanahan, Tozer, Grzegorek, & Park, 2000). Antigay prejudices are not limited to any specific educational, cultural, or social group. They exist across religions, professions, environments, and ages. However, recent studies have shown that levels of tolerance toward homosexuality CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 111 are affected by demographics and direct familiarity with people with gay and lesbian sexual orientations as well as by personality traits and interpersonal issues. People with low education levels; traditional, religious, and conservative values; and sexual identity conflicts tend to be more homophobic than their edu- cated, nonreligious, progressive, and sexually confident counterparts (Greene & Herek, 1994). Internalized Homophobia Internalized homophobia means the rejection, condemnation, or even hatred of one's own homosexuality (Gonsiorek, 1991). Because of the pervasiveness of homophobia in our culture, we are exposed from the earliest age to a constant stream of messages that denigrate homosexuality and homosexuals. For exam- ple, "faggot" or "fairy" are names used by children in elementary school to insult a classmate. There are many myths regarding homosexuality. For many people, these myths and negative messages become internalized as "truths" about "the way things really are." The fact that the messages are culturally con- structed becomes invisible as in the case of gender stereotypes—girls are sup- posed to "be sweet and demure," boys "aggressive and competitive." In many ways, internalized homophobia is similar to the self-hatred based on the inter- nalization of gender stereotypes. Those who do not meet the standards may develop gender-related stress and a lowered self-esteem as a result. Internalizing racism can have similar effects on one's self-esteem. When one fives with rejec- tion day after day, and society discounts one's value constantly, it is difficult to maintain perspective and realize that the problem is others' perceptions, not one's own. Heterosexism Heterosexism is "a belief system that values heterosexuality as superior to [and] more 'natural' than homosexuality" (Morrin, 1977). In contrast to homo- phobia, the manifestations of heterosexism are more subtle and difficult to detect (Van Vorris & Wagner, 2002). As Berkman and Zinberg (1997, p. 320) noted, "Heterosexism permeates the culture in which social institutions and social work practice are built." Society sends a clear message: "Be like every- one else!" "One heterosexist assumption is that people assume everyone is het- erosexual until proved otherwise" (Berkman & Zinberg, 1997, p. 320). Different theories exist as to homosexuality and its etiology. Some models stress biology as the primary factor; others stress the role of environment. These models, seen in a postmodern framework as shifting perspectives, can shape one's attitudes and behavior. The evidence from research on etiology is still inconclusive and points to a dynamic interaction between biology and environment. Because each individual develops his or her private theory of the causes of homosexuality, it is important to listen carefully in order to learn about these personal meanings and explore their implications in an open-minded approach. 112 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES UNDERSTANDING IDENTITY DEVELOPMENT AND ITS SOCIAL CONTEXT Identity does not develop in a vacuum but in a specific social context. Developing a strong sense of identity in a heterosexist society means being able to resist neg- ative labeling and stigmatrzation. Identity development and coming out is a pro- longed process in which people rewrite the stories they have about themselves (Cass, 1984; Troiden, 1989). In general, the development of gay identity involves for the gay world three major stages: (1) corning out to oneself, (2) coming out in the gay world, and (3) coming out in the straight world {straight, in this case, being the gay term for heterosexual) (Plummer, 1981). Plummer notes that the first stage of iden- tification is often the hardest because it usually has to be done alone and with- out support. This step involves confronting insidious messages that homosexuality is rare, a sickness or maladjustment, or just abnormal. Cass (1979) describes the complexities of coping with prejudice and devel- oping a sense of pride. It is interesting to note that identity pride, according to her theoretical model, is the stage in which the individual, having accepted his or her identity, is able to establish connections with the gay community. Living "in the closet" means being cut off from important sources of support (Falco, 1991). Gaining access to homosexual role models can counterbalance the negative messages and serve to dispel many myths and preconceptions about homosexual people and behavior. Pride in this stage marks the beginning of gay acculturation. The term pride seems to express a protest against dominant shame-inducing discourses. Pride can be considered a counter-narrative. Counternarratives are stories that people tell and live that offer resistance, either explicitly or implic- itly, to dominant cultural narratives (Andrews, 2002). In supporting a developing sense of pride, the gay community can function as a source of support to buffer stress and provide often sorely needed valida- tion. Support networks of close and accepting friends, called "families of choice," are part of this process about which helpers need to be aware. The coming-out process can be a totally different experience in different cultures, as we shall see in the following parts of the chapter. Choosing to live as a gay man or lesbian can mean, especially for those who live in a culture that is totally unaccepting of homosexuality, a cutoff from one's roots— from one's friends and other support systems—as well as leaving behind an important part of one's identity—values, beliefs, identification, and a sense of belonging (Dworkin, 1996). In many ways, this is like a process of immi- gration in which multiple losses are inherent as well as a painful transfor- mation of identity. The cutoff from important parts of one's identity may leave the individual with a sense of uprootedness and alienation. The individual may be left "storyless" or with huge gaps and missing pieces in his or her life story. CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 113 PREJUDICE IN THE HELPING ENCOUNTER Many social workers and mental health providers are ignorant of the societal heterosexism and homophobia and of the way it may impact their practices (Ben-Ari, 2001; DeCrescenzo, 1984; O'Dell, 2000; Morrin, 1988; Van Vorris & Wagner, 2002) as well as the impact it has on the way that the client tells (or does not tell) his story. In spite of a trend toward increasing acceptance, homo- phobic attitudes still exist among social workers, counselors, and psychologists (Berkman & Zingberg, 1997; DeCrescenzo, 1984; Garnets, Hancock, Cochran, Godchilds, & Peplau, 1991; Gelso, Fassinger, Gomez, &c Latts, 1995; Morrow, 1996; Wisniewski & Toomey, 1987). For example, clients turn for help for a variety of reasons that may have little to do with their sexual orientation. However, a helper may automatically attribute a client's problems to his or her sexual orientation without evidence that this is so (Garnets et al, 1991). The helper's narrative may be imposed on the client in so many ways. For example, a helper who is trained according to traditional psychoanalytic models may search for evidence to support these models, regarding homosexuality as a sign of arrested development because of unresolved oedipal conflicts. A 26-year-old, talking about his attraction to men, was encouraged to date women in order to get over his fear of women. The helper insisted on working through possible dif- ficulties in his relationship with his mother, assuming that she was dominant and engulfing. This led the client to think that something was deeply wrong with him. There have been reports of reorientation therapy, although such practices are considered unethical (Haldeman, 1994). "Corrective therapy" that is aimed at changing sexual orientation can be seen as another form of cultural domi- nation in a heterosexist and homophobic society—that is, getting people to return to the mainstream. Clients who are uncertain about their sexual orientation may seek help to resolve their concerns. A helper may adopt three different approaches. One, called a "must" approach, is to push the client into defining himself or corning out before being ready to do so. The second, a "must not" approach, can entail trying to discourage the client from adopting a gay or lesbian identity. This can be done in many subtle ways. The third approach is a "can" approach that enables the client to find his or her own way (Hanley-Hackenbruck, 1988). The difficulty in achieving the last includes the fact that heterosexism pervades the language, theories, and psychotherapeutic interventions of psychology (Bieschke et al, 2000; Van Vorris & Wagner, 2002). One manifestation of heterosexism is approaching the helping process with a "sexual orientation-blind" perspec- tive. This means ignoring the culturally unique experiences of the lesbian, gay, and bisexual population. Like a colorblind approach, this may be a strategy for avoiding a pathologizing stance by stressing the universal components of human experience. However, when helpers deny the culture-specific experiences in the fives of lesbian, gay, and bisexual people, heterosexist bias is also likely to per- vade that work in a manner that is unhelpful to clients (Garnets et al., 1991; Roth, 1989). 114 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES A helper may fail to "recognize that a client's psychological symptoms or distress can be influenced by multiple social stresses as well as the client's own negative attitudes or ideas about homosexuality" (Perez et al., 2000). Talking openly about one's homosexuality can play an important role in changing attitudes. However, it is also important to keep in mind the cultural context and remember that disclosure does not always pave the way to a change of attitudes or a better understanding of what it means to be gay. In some cul- tural contexts disclosure may actually be too dangerous. A helper, lacking a broader perspective on sociocultural factors or awareness of the discrimination, may push the client into premature disclosure and in some cases even endanger him in doing so. Such an approach conveys an implicitly negative message to those choosing not to disclose—"Something is wrong with you"—and locates once again the problem within the individual rather than recognizing its loca- tion in the social context. Actual threats may be implied (losing friends and family members; and, in some cases, losing a job or even facing physical danger). The helper, coming from a different or perhaps more liberal background and lacking social awareness, may be unaware of these possible threats. PRIDE AND PREJUDICE IN ISRAEL: THE SOCIAL CONTEXT Having understood how important it is to understand the social context, let us turn to understanding the Israeli sociocultural context: Ga'avah (pride in Hebrew) is the word associated in Israel with gay community activities, cultural events, and the gay rights movement. The adoption of British mandatory law that banned sodomy was changed in Israel only in 1988. Certain legal changes have been achieved since. For example, an explicit law since 1992 has forbid dis- crimination because of sexual orientation. The social climate seems indeed to be changing rapidly and is more accepting of homosexuality than it was a decade ago. The visibility of homosexuals and lesbians has greatly increased, as manifested in openly gay parades, numerous publications in the media, regular "pride pages" in the newspaper, gay bars, theater, and other social activities, mainly in urban centers such as Tel Aviv (Sumakei-Fink &c Press, 1999). Well-known artists, authors, actors, and singers have openly come out, talking in public of their personal experiences. A member of the Knesset (the Israeli parliament) gave a famous speech on his own experiences as a homo- sexual and as a leading officer in the army. Despite the changing climate, many people fear the consequences of coming out and still live behind locked doors in fear of their secret being exposed, paying a heavy price of isolation. Lack of social recognition and legitimacy by Israeli society has also a direct impact on the interaction of couples (Mizrachi, 1990; Rabin, 1991). Religious influences, the coexistence of two legal systems—the one secular and the other religious— and the great value placed on the traditional family have contributed to con- flicting trends in the acceptability of same-sex love (Walzer, 2000). Israel is a multicultural society, a mosaic of people from many diverse backgrounds, bringing with them a wide spectrum of traditions, values, beliefs, and customs. There are great cultural differences in terms of the acceptability CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 115 of homosexuality in different parts of Israeli society. The "ancient old" in Israel lives side-by-side with the ultramodern in many respects. Coming out is there- fore a totally different experience in different populations as well as in differ- ent age groups because of the rapid changes in the social atmosphere. The challenge of achieving identity integration and making room for diversity in one's identity as discussed above and the danger of throwing away the baby with the bath water and relmquishing one's roots in order to adopt a gay identity is def- initely a problem for those who are trying to reconcile or negotiate conflicting identities. "Keshet Ga'avah" ("The Spectrum of Pride"), the 17th World Conference of GLBT (Gay, Lesbian, Bisexual, and Transgender) Jews held in Israel, chose "Reclaiming Roots, Rites, and Roles" as the central theme of the 2002 conference—focusing on "reclaiming cultural heritage, spirituality, roots and a rightful place within wider Jewish communities around the world" (quo- tation from conference brochure). This is an interesting example of a commu- nity program that promotes the goal of identity synthesis as mentioned above and makes room for diversity. Stress (and internalized homophobia) may be especially pronounced for those who are living in intolerant environments—for example, the ultraortho- dox, Arab Israelis, or, in some cases, those immigrants coming from Arab coun- tries (where homosexuals are actively persecuted and subjects of severe violence). Recent immigrants from the former Soviet Union have also been reported to hold antigay attitudes as reflected in Russian media. Individuals from these commu- nities may face exacerbated stress, stigmatization, and discrimination from multiple sources and at the same time are less able to access and receive appro- priate help. The following vignettes illustrate the importance of understanding the social context: A Muslim Arab with a steady relationship with a Jew, the two living together for years, could not stand being touched by his partner during the muezzin's' calls to prayer from the mosque nearby. A 14-year-old boy from an ultraorthodox religious background used to walk around with a botde of water because he was so afraid that if he had "bad thoughts" being around other guys, "tongues of fire would shoot out of hell" as his rabbi had told him. A 15-year-old boy from an oriental background, after being discovered with a boyfriend, was taken to many traditional healers, one of whom put a dead dove on his belly. Another told him to pray, and a third told him to drink his own urine. This boy developed severe self-destructive behavior. His parents refused to allow him to consult with a helper. THE CONTRIBUTION OF THE NARRATIVE APPROACH IN CHALLENGING HOMOPHOBIA The narrative tradition suggests that the stories we tell ourselves not only speak of the lives we live but also "author" them. Stories are not mirrors of reality; they constitute a map and shape our lives over time. Narrative therapy focuses on the "reauthoring" of one's story, deconstructing the "text" of a problem, and 116 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES questioning the "taken for granted truths" (Freedman & Combs, 1996; White &C Epston, 1990). Questioning the taken-for-granted truths and deconstructing practices can help in identifying and challenging dominant subjugating dis- courses. This can support the deconstruction of myths about homosexuality as well as assist in combating heterosexism and internalized homophobia. Externalizing practices can provide additional support in combating fear, shame, and guilt as illustrated in the case study. The way people narrate their experi- ences is influenced by their individual histories and cultural discourses. We can also focus on the way in which clients' stories are constrained by dominant nar- ratives such as patriarchal or oppressive stories. People's stories are often constrained by finding themselves living out a story into which they have been recruited (Parry & Doan, 1994). For a woman who loves women, being recruited into a cultural story according to which she is expected to marry and raise children with a husband may lead her into hiding her feelings and needs and thus paying a high sense of isolation and alienation from her true self. Narrative therapy can strengthen the individual's capacity to resist negative labeling as well as resist being recruited into stories told by others as to what it means to be a "real man" or "real woman" or what it takes to make a "real family." This means discovering one's own voice and not accepting others' descriptions of one's life. Narrative therapy can help both helpers and clients shift from seeing prob- lems as internal to seeing them as constructed within the social and cultural con- text and shaped through use of language. Clients' narratives are influenced by the way in which their cultures view homosexuality (Herdt, 1997). The construction and possible deconstruction of narratives about same-sex love involve complex dynamics that are associated with factors such as cultural values regarding gender roles and religious and procreative beliefs. The degree of individual and family acculturation and the personal and cultural history of discrimination or oppression are also important. All of these factors have been found to have a sig- nificant impact on identity integration and psychological and social functioning. "Dominant culture takes up most of the space and pushes to the edges those experiences that He outside its normalized standards and values" (Zimmerman & Dickinson, 1996). In order to free oneself from the influence of the problem, one has to "challenge" the dominant meaning that is experienced as oppressive. This challenge is a form of therapeutic protest. Therefore, instead of seeing homosexuality as "the problem," one can realize how myths and misperceptions are "the problems." This is only one example of multiple stories that can be reauthored through the helping encounter. The therapeutic dialogue can promote identity development and synthesis by a flexible use of deconstructive ques- tioning, opening space for exploring one's "landscape of identity" (Bruner, 1989; Freedman & Combs, 1996). This can mean exploring the personal mean- ing of issues such as the role of gender, sexual orientation, and culture in one's life story. Through the narrative lens it becomes possible to appreciate some of the richness and complexity of human experience. The "not knowing" stance is particularly important in setting aside precon- ceptions and truly listening, placing the client as the expert on his or her life. Such CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 117 an approach can be highly effective in combating prejudice. Because narrative ther- apy stresses multiple viewpoints and alternating perspectives, it is especially help- ful in paving the way for the acceptance of diversity within oneself and in society. COMBINING EXPRESSIVE ARTS WITH NARRATIVE THERAPY Combining the expressive arts with narrative therapy using visual arts, music, bibliotherapy, and poetry can open new possibilities of telling and retelling one's story and having it authenticated. The use of nonverbal means comple- ments the narrative therapy and its focus on the spoken language. Paintings can also help tell stories. This is true of other forms of art. Art provides rich oppor- tunities to explore the different sides of one's story, making room for diversity (including gender and culture-related issues) and thus promoting identity devel- opment and synthesis. Within a narrative approach, the following practices are supported by cre- ative art: 1. Externalizing. Artwork naturally supports externalizing practices in nar- rative therapy. By getting in touch with one's feelings (such as shame or guilt) and expressing them in a tangible concrete form (through paintings, sculp- ture, photography, etc.), one can establish some distance and regain a sense of perspective and control. 2. Thickening the plot. Art can be utilized to help clients make the stories they are authoring "thicker" and more multistranded. During the creative process, the artwork can be revisited and reworked, thereby adding new dimensions to the reauthoring conversations, promoting identity develop- ment, and thickening the plot of preferred emerging stories. 3. Making room for diversity and multiple viewpoints. Art can help people recognize the multiple nature of themselves and the world—and to view it as a source of enrichment not to be resisted. 4. Transcending barriers. The language of symbols and metaphors creates a universal language that transcends culture and gender barriers, adding new dimensions and depth to one's narrative. 5. Unique outcomes. Art as a stimulating and challenging activity helps people connect with the transcendent and growth aspects of their stories, thus pro- moting a sense of mastery and competence. Gay culture in general can play an important role in the process of individual identity construction. Art makes visible the invisible (Riley, 2001). Given the ^visibility of many facets of the gay experience, this is a valuable resource. Visual arts, films, theater, and literature offer rich opportunities for the expres- sion of voices outside dominating discourses. Art can serve as a form of "giving voice" as well as a protest against dom- inant discourses. Through nonverbal means and the elaboration of metaphors within a narrative approach, a client can be helped to find a channel for voic- ing experiences beyond words. Art can serve as a bridge for communicating with oneself and others, as will be illustrated in the following case study. 118 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES "I JUST CAN'T THINK STRAIGHT": REAUTHORING CONVERSATIONS WITH DAPHNE* Daphne, aged 28, came for help because she was feel- ing depressed and "on the edge" and was having end- less fights with her parents. She was still living at home and working as a waitress, although she had graduated law school with high grades. She felt deeply- frustrated and angry, didn't quite know what to do with her future, and had a difficult time with job interviews, being rejected time and again. "I just can't think straight," she said. During the first session, Daphne, dark-skinned with short hair and sporty clothes on a petite body and looking younger than her age, was edgy and defensive. She was the eldest of three daughters. Her sister, two years younger, was about to get married. Daphne was extremely angry with her parents for praising her sister's fiance all the time and for spending so much time and money on preparations for the wedding. Daphne herself had an open and steady relation- ship with her girlfriend and was considering leaving home but was confined by limited finances. On the surface, it seemed that her parents had accepted her love for women after more than 10 years of struggling with her over the issue. However, on weekends and holidays, her sister's fiance was welcomed warmly, whereas Daphne's partner of 3 years had never been invited. Daphne expressed her indignation at the deep respect her parents had for every "piece of nonsense" her future brother-in-law said around the table. "It's just because he's a man," she said bitterly. "Well, at last they have found the son they wanted so much," she remarked in another session. The arguments around the table had escalated into shouting, with Daphne leaving the house and slamming the door. Daphne was most sensitive to every slightest facial response on my part. It was clear that she wanted me to justify her indignation at her parents' conduct. When I hesitated in answering her demands, she was fuming in obvious anger. She was almost about to *The client's name and identifying information have been changed to protect her confidentiality. walk out of my room, too, and slam the door behind her. My reflection on how she felt misunderstood only made her angrier. However, she stayed on in silent and sulking protest, totally withdrawn and dif- ficult to reach. Instances such as this of intense anger" at my failure to express empathy recurred time after time. In the second session, when she asked to take off her shoes to feel more comfortable, she threw at me "Next time my shirt!" Each of my reactions was scru- tinized and often met with contempt. I often felt stereotyped and accused of being outdated and of not being able to understand. I really was having a diffi- cult time understanding. The chasm between us seemed unbridgeable. At that time, I was quite exasperated, often embar- rassed, and at a loss as to how to reach her. I found myself identifying with her parents and flunking of the difficult time they were going through. As far as I knew, or chose to assume, they had accepted Daphne's love of women, acknowledged the relationship with her girlfriend, and were trying hard to placate her. So why was she making such a fuss and unable to under- stand their difficulties? It was much easier then to be empathetic with her parents' distress than with her. It took me time to realize how vulnerable, exposed, and threatened Daphne felt. I had not really understood the impact of the long-standing rejection that Daphne had suffered in her family and social context. She had been talking about being treated unfairly and had spoken of what she called "the dark years" in her adolescence, but I hadn't asked her about those years. I had assumed mistakenly that she was out and in the open and felt comfortable with her identity and life choices. Awareness on my part of the negative labeling seemed to enable the story of those "dark years" to be told. I will focus in the following paragraphs on those related to the complexities of the identity development and coming-out process. The Pain of Rejection Daphne had intense love affairs beginning at age 13 but had struggled with defining herself as a lesbian. The derogatory voices and names she heard at school regarding what it meant to be a "homo" contributed to a deep sense of shame. She lived a split life in con- stant fear of being found out, hiding love letters and other proof of her love. Her world seemed to collapse CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 119 when, at age 16, her parents discovered the nature of her relationship with her close girl friend and forbade the two to have any further contact. Her mother responded with a deep depression. She refused to speak to her. "How could you do this to us?" Daphne remembers her saying through tears. Her father was outwardly angry and on several occasions even vio- lent. The parents began blaming each other, and it seemed that the whole family was falling apart. Memories about that period were traumatic, and amnesia and dissociation were dominant. All that she could remember is that she wanted to die. Prior Experience in Obtaining Help When she was 16, Daphne's parents took her to a helper, hoping that therapy would put her on the right track. The helper did not collaborate with her parents' wish to "convert" Daphne into loving boys. However, as far as Daphne could remember, the helper ignored the deep love and painful longings that Daphne expressed for her girlfriend, whom she deeply missed at the time. Daphne did not feel comfortable enough to admit she was secretly meeting her partner. When the helper met the deeply worried parents, she told them that Daphne was going through a period of confusion. "This is something she will outgrow," they were told. This is exactly what the parents wanted to hear. They were still waiting 5 years later, urging Daphne to try to date boys. Feeling a Misfit Daphne herself, before going into therapy, had been quite sure of her sexual orientation yet convinced that this was a sign of being a "defect," a misfit—indeed, abnormal. She was thoroughly confused. The helper's attitude planted self-doubt and caused her to try dating boys, although she was totally disinterested. She kept meeting her friend in secret, feeling extremely guilty and a disgrace to her family. She tried to com- pensate by being an excellent student at school and bringing home high grades. It was only after 3 years of constant struggle with her parents and periods in which her mother didn't talk to her that her parents finally gave up talking about her dating boys. It felt to her that they gave up on her totally. In any case, they stopped talking about her personal life altogether. She was then in the army and living away from home, which enabled her to gain some distance and restore some self-esteem. She finished the officer's course with excellent results and upon leaving the army registered for law school. In the years that followed, she continued to expe- rience shame and guilt, living a closeted life. She was successful in her university studies, yet the only real sense of security and of being her true self was achieved when she was with her girlfriend (a new and strong relationship that had developed in university). In therapy she now talked about how she could never fit in. In her words, "I am not a real woman, not a real man, not really anything, not belonging anywhere." Combating Shame and Guilt During the period of talking about her parent's rejec- tion and its devastating impact on her life, Daphne shared a recent nightmare. In her dream, she was seated at the end of a long table, being pointed at by blaming fingers and facing the severe faces of her par- ents, sisters, and brother together with teachers from school, all of them calling her names and shouting accusations of being an unfaithful and ungrateful daughter. She was speechless, trying to but unable to utter a word. She woke up in a deep sweat. In the session, we were able to explore the multi- layered meanings of the dream. Now she became more prepared to face the shame and guilt and iden- tify the internalized homophobia. Externalizing con- versations together with deconstructing questioning (Freedman & Combs, 1996) helped her face the shame and guilt that had joined together in silencing her and constricting her steps. Shame coupled with guilt had coerced her into hiding away for so many years. In one of our sessions, Daphne brought a newspa- per clipping with a picture of a woman whose mouth and face are covered with a kind of polythene stifling her (see Figure 7.1). On the image are written quota- tions from Sefer Hanashim, the Jewish orthodox reli- gious rules. Sefer Hanashim is Hebrew for "The Women's Book." "Written of course by men," as Daphne said. "What does this story tell you?" I then asked. She talked about the suppression of the voice of the woman in the picture. While telling the story, she looked closer at the picture and saw actually that the woman herself was stifling her voice with her own hands, holding up the cover. This shed new light and (continued) 120 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES FIGURE 7.1 | Art as "giving voice." Images can evoke powerful feelings that help people tell their own stories. This silenced outcry represented for Daphne the story of oppression of women. It also represents how oppressive rules are adopted and internalized. FIGURE 7.2 | Identity development is an ongoing dialogue with oneself and others. Gender and culture are interwoven in this dialogue. Through this painting, Daphne was able to talk about the "crippled" and distorted conversations she had been having with others, leaving her with a painful feeling of being labeled and misunderstood. s Dialogue, Hanna Silberstein, 2000. Used with permission. Sefer Hanashim ("The Book of Women"), Nechama Golan, 2001. Used with permission. led Daphne to reauthor her own story. The story now became a story of internalized oppression, with the woman adopting the men's rules and point of view and committing herself to silence. "I have been gag- ging myself as well," she said. "Gagging herself" became a central metaphor in the therapy. Exploring Unique Outcomes In spite of tremendous pressures, Daphne had been able to develop a meaningful and strong bond with the woman she deeply loved. Understanding what had helped her keep up this resistance had an empowering effect, shedding new light on the interactions with significant others and enabling her to draw on resources she was not aware of. She now realized how shame and guilt were interfering with the way she presented herself during job interviews. Soon afterward, she started working as a lawyer for a small law firm. Her success in finding a job appeared to be related to her growing confidence and ability to assert herself. Capitalizing on unique out- comes related to her assertiveness at work helped "thicken the plot" (White & Epston, 1990) of the new story being authored—of her being a survivor and not a victim. Daphne was indeed highly resource- ful: The success at work added to her redefining of herself and the restorying of her life. Harnessing Creative Processes Reflecting on a painting (Dialogue) by Israeli artist Hanna Silberstein (Figure 7.2) Daphne spoke of the "crippled" conversations she had been having in her family. "So much to be said, so much turmoil going on in the mind, and such a little mouth." Speaking of the left figure in the painting, she said, "She looks so mis- erable. She has been marked like they label cows." This led to exploring what it meant for her to be labeled as a woman in her upbringing. She had expe- rienced such great difficulty in explaining herself in CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 121 FIGURE 7.3 | Challenging dominant discourses. Creative approaches can challenge dominant discourses such as the heterosexism reflected in messages that it is unnatural for a woman to love a woman—"What next? A woman with a goat?" My Love, Hanna Silberstein, 2002. Used with permission. the face of ignorance. Responding to another sketch (Figure 7.3) by the same artist, she quoted from Ellen Degeneres's show: "There is this huge debate about same-sex marriage. People say, "Marriage is a union between a man and a woman. A woman marrying a woman! What next? A woman with a goat?" Well, these people scare me—and they think we are weird." The gentle tenderness, humor, and playfulness conveyed in the drawing helped Daphne cope with the messages of illegitimacy she had been receiving. Deconstructive questioning and working through these issues enabled her to identify the great difficulty she was having in conversing with others and to see these difficulties as located in the mes- sages she had received instead of resulting from her own "defect." This facilitated the reauthoring of her own story: She had formerly thought of herself as crippled and speechless in the conversations with others. This version gave way to considering herself as being able to speak up for herself even in the most embarrassing situations. In her own words, "My mouth now opens quite easily sometimes to my surprise. I can be called 'a big mouth' but that will not silence me." With my encouragement, Daphne went back to painting, a hobby she had neglected. This followed the sessions in which she had discussed the way shame had silenced her. She had talked of her difficulties in expressing herself and articulating her feelings. Using nonverbal means of communication, she was able to explore new territories. She could express experiences for which she had no words. She brought with her to the sessions some of her paintings such as one sketch of a nude woman sitting before a mirror. She was carefully watching my reac- tions: Could she speak openly about her sexuality in the room? Would there be enough space in the room? Would she meet rejection? acceptance? empathy? Reflecting on the meanings of the painting, she was able to explore what it meant for her to be exposed with no clothes on, getting to know herself through looking at the mirror. For years she hadn't dared look at herself. "I just hate myself." Tears poured out as she gave voice to the deep sense of hurt and self-hatred. "My defenses are like this tissue paper," she said through her tears. Expressing these feelings led to exploring what it meant for her to be a woman, feeling she had disappointed her parents and the deep sense of inferiority and shame. Lesbian community theater in Israel was another source of validating support for Daphne, helping her give voice to what she had not even dared to admit to herself. Daphne's artwork was also a way of helping me understand her and helping her understand her- self. In her paintings, she began using a wide spectrum of colors she had never touched before. She felt she could eventually show her true colors and feel good about having such a rich spectrum of shades in her world instead of the black and white monochromatic worldview she held beforehand. The wide spectrum of colors on the pride flag found its way to her art- work. She explored the meaning of tolerating diver- sity and making room for different colors. The colors were there in her work, and she could see them and take pride in the way they were composed together, side by side, each maintaining its individual identity without mixing with the others. Daphne resonated deeply with a drawing of a "queer" zebra hidden away within its own body, all closed up in itself. She called the drawing "Feeling So Embarrassed." Daphne, as part of her reflecting and telling her story through the zebra, found great fun in drawing queer zebras in different positions. We talked about striped zebras being so different and set apart from the family of horses. Throughout history, (continued) 122 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES FIGURE 7.4 | Making room for diversity and paving the way to a "shaky sense of pride." Daphne understood the sense of "being different," of feeling awkward, and of "walking on shells" shown in this painting. Still, she was able to show her true colors (which corresponded to the striped colors of the gay pride flag). The painting is multilayered, as are our stories. nniKr L'.i.jiffii1 iff rlTwlilrT.rr u\ v » * we -•"'^ H.,. ■ ,^ ..... Diversity, Hanna Silberstein, 2000. Used with permission. attempts to tame zebras to behave like horses have been in vain. A zebra will not be harnessed. "Can this zebra learn to love herself?" Daphne asked. Celebrating Pride for the First Time Daphne had never been to a gay party or even to a gay bar. Her girlfriend had tried for years to persuade her to go out together with her. However, she was too apprehensive about whom she could meet there. Going for the first time to a lesbian community party was for her a triumph in overcoming the shame—the paralyz- ing and overriding force that had been controlling her. It took her four weeks to actually gather the courage to show up at a party. She was able to share her relief and joy: "Such a small step, but a huge leap for me." She had such a good time! It was an enlightening feel- ing to discover that she was able to feel free to dance with her partner and even kiss her in front of the huge mirror in the room, gradually letting the feelings of stiffness and self-consciousness dissolve and giving way to "just being myself." The shaky sense of pride was also expressed through Silberstein's painting of a sort of "strange creature" as Daphne said, so used to feeling awkward and different, but now showing its true colors for the first time (see Figure 7.4). Telling the story from the point of view of the figure in the draw- ing helped her tell her own story. Exploring Landscapes of Identity and Creating New Roadmaps Narrative questioning and deconstructing assisted Daphne in exploring her "landscape of identity" (Bruner, 1989). The roadmaps she had received from her parents and society had not helped her find her true self in the landscape of her life. These maps were unsuitable and inapplicable. Same-sex love was not on these maps. She had found paths that did not appear on the roadmaps she was given. Deciphering the keys for those maps was a metaphor elaborated. The keys to these roadmaps, which had been passed on from former generations, included rigid traditional definitions about masculinity and femininity, defini- tions of what it means to be a woman, to be a man, as well as the definitions of success. Daphne's mother was from an eastern background. Coming from a highly patriarchal background, she had found it almost impossible to conceive how a woman would give up the idea of getting married. She could not imagine how Daphne could ever possibly be happy or lead a satisfying life as a lesbian. Outright displays of anger by a woman were also unacceptable in her upbringing. Daphne's father had a western European upbringing. Although he was not orthodox himself, he took pride in his grandfather being a well-known rabbi. Same-sex love had definitely not been on his roadmap of life either. He placed great value on career development and achievement. Daphne was proud of him and adopted his high standards and the great value he had placed on perseverance and excellence. By being a lawyer, Daphne was considered a suc- cess and her parents were proud of her. However, being a successful woman meant for both of them, especially for Daphne's mother, getting married and raising children with a husband. Daphne at first had accepted her parents' roadmaps as "essential truths" about life. However, the definitions on the key of these roadmaps were too narrow for her and did not fit into her vision of her reality. According to these, she was indeed a misfit, as well as a troublemaker, caus- ing disgrace to her family. Now she began to con- sider the possibility that it was not she who did not fit in. The definitions just did not fit her reality. She faced the challenge of creating a new roadmap with a key of her own definitions, finding the freedom to define her- self instead of accepting the way others defined her. CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 123 Redefining the Meaning of "I Just Cannot Think Straight" "I just cannot think straight," Daphne had said, refer- ring to her inability to think clearly when overwhelmed with anger. We redefined this to mean that she was still trying to think as a "straight" person. Acknowledging her right to "stop thinking straight" and to think out things her way was an important step in therapy. She could see how she had been able to resist being recruited into the script prescribed to her. She no longer saw herself unquestionably as the problem. We were also able to explore her difficulty with expressing anger—rooted in the messages she had received from early childhood about anger. In her social context, anger was considered unfeminine. Understanding the social context of these messages was important. She had internalized the ideas about anger and had great difficulty in accepting her own anger. Furthermore, being defined as crazy every time she was angry colluded with her deep conviction that something was wrong with her and that she was indeed abnormal. Helping her validate her anger had direct implications on being able to cope with conflict at work and in the family. Helping Her Parents Understand Daphne was now able to talk with her parents about the issues they had been avoiding. She was less threat- ened and prepared to accept that they would not be able to understand without her explaining herself. This replaced her former conviction that her parents, or at least her mother, should have been able to under- stand her without her having to explain herself. Her youngest sister helped her bridge the gap between herself and her parents. In one instance, her sister had talked to her father (and later with her grandparents) about the Nazi persecution of homo- sexuals. The way she put it, in light of the shared plight of Jews and homosexuals, discriminating against Daphne because of her love of women was actually continuing the Nazi persecution. Furthermore, their "conspiracy of silence" was just like the silence about the suffering in the Holocaust. Her father was left speechless after the sister's strong words. The parents, who in the course of the ongoing con- versations between themselves, with Daphne and others, had already gone through many transforma- tions, made it quite clear that her partner was most welcome to come over on Fridays and, indeed, she became an integral part of the family. Coping with Racism, Sexism, and Heterosexism Daphne was threatened by certain interactions and "putdowns" both in the office and in court. Coping as the only woman in a predominantly male surround- ing stirred a range of feelings. She almost quit the job after an incident in which she felt deeply insulted. Externalizing the shame and reaction of insult helped her gain distance from the strong emotions that took control over her. These had in the past caused her to react in an impulsive and defensive manner instead of asserting herself. In understanding her reactions and overreactions, it was important to work through addi- tional issues, exploring the effects of racism and sexism, among others. Proud to Be Myself Together with increasing self-acceptance, Daphne was now able to openly talk with her parents, confront the putdowns at work, and stand her ground. She felt able to take on new challenges and cope assertively. Liberated from the powerful grip of shame and guilt and free of the constraints of labeling, she was now open to explore new horizons, committed to fmding and refinding new ways to be herself. In her words, "I am proud to be myself. I am proud of the road I have navigated, of being able to make my choices and be true to myself in spite of tremendous pressures." PERSONAL REFLECTIONS The courage and determination demonstrated by Daphne in navigating her own road, her ability to find her own voice, and her resistance to being recruited into someone else's story was and still is a source of inspiration for me. This led me to explore different sides of my own story, to face challenges, and to ask myself questions I had not faced before. Through sharing her pain, as well as the stories of pain and struggles of others, I have become deeply committed to 124 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES hearing the silenced outcry and closeted stories of those who have been oppressed and forced into hiding their true self. Through the years of my clinical practice, I have also become more painfully aware of my own biases. I was trained as a clinical psychologist in the early 1980s. Homosexuality, as we were taught then, was conceptualized as a sign of arrested psychosexual development and unresolved conflicts. I had a lot to unlearn. My clients, as well as some dear friends of mine, helped me in this process, showing me how to listen carefully and let each individual find his or her own way. Issues of gender and culture were definitely neglected in my train- ing at the time, which emphasized the universality of human experience and the intrapsychic world of the client (then called patient—and yet another example of the language that reflects and shapes our discourses). The narrative approach of "not knowing" and placing the client as the expert on his or her life has, in my experience, an empowering effect and can help bridge differences, whether due to culture, gender, or sexual orientation (or all of them together). By not knowing and by acknowledging the differences as well as the misunderstandings in the therapeutic encounter, we are able to encourage the client to find new ways to translate him- or herself. This, in turn, can be of value in other encounters in his or her life. The expressive arts are a natural adjunct to this approach of reauthoring conversations. Apart from my private practice as a psychotherapist, I work with groups of traumatized new immigrants to Israel (as a volunteer for Selah, the Israel Crisis Management Center). Incorporating the expressive arts within a nar- rative framework in a group setting allows the bearing of witness and telling of testimony in new ways. It builds bridges across language and culture barriers. Introducing the expressive arts into my practice has been a challenging, stimu- lating, and highly rewarding experience. CONCLUSION In spite of increasing acceptance and changing definitions of same-sex love, prej- udice still pervades the helping encounter in many ways. Table 7.1 lists not only those affirmative practices discussed in this chapter that can provide support for identity development but also those biased practices that can do more harm than good. Some of these points have been covered by the research reported by Garnets et al. (1991). Helpers need to be aware of how their attitudes and knowledge can affect the helping process. This table can be used as a checklist for exarriining one's own practice. Combining expressive arts with a narrative approach opens up new possi- bilities for helping gay and lesbian individuals cope with stigma and negative labeling as well as expanding the reflecting space for exploring one's identity and accepting diversity. A flexible use of diverse therapeutic strategies can support the deconstruc- tion of oppressive dominant discourses and help the client overcome the debil- itating effects of shame, fear, or guilt. Training to become one's own "spokesman" and learning to mobilize internal resources (such as one's creativity) and external TABLE 7.1 CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 125 BIASED VERSUS AFFIRMING PRACTICES A helper can harm when he or she: A helper can support when he or she: believes homosexuality to be a form of psychopathology, developmental arrest, or other psychological disorder denies or ignores the impact of social prejudice and discrimination on the client's attitudes and self conceptions focuses on sexual orientation as a therapeutic issue even when that is not relevant to the reason of referral attempts to discourage a client from having or adopting a lesbian or gay orientation views gay or lesbian identity merely in terms of sexuality and sexual behavior fails to recognize the changing attitudes, defini- tions, and understanding about same-sex love fails to recognize multiple stresses because of the synergistic effects of heterosexism, racism, and sexism lacks knowledge of gay and lesbian issues and is unaware of the interplay of issues concerning his or her own gender, culture, and sexual orientation, and their impact on the helping process. understands that homosexuality, in and of itself, is neither a form of psychopathology nor evidence of developmental arrest acknowledges social prejudice and discrimination and its possible impact on the client's attitudes and identity sees sexual orientation as one facet of the client's identity among others and not in itself as a problem to be adressed in therapy supports and validates the development of a positive gay male or lesbian identity and provides space for the questioning client to explore issues concerning his or her identity has a broad perspective on gay identity, acknowledging the diversity and multifaceted nature of homosexual and lesbian experience is aware of the rapid changes in definitions and understandings about same-sex love is aware of cultural variations in the acceptability and understanding of homosexuality and keeps in perspective issues concerning culture, ethnicity, gender, and sexual orientation strives to increase knowledge and awareness through continuing education and is prepared to examine the impact of his or her own issues of gender, culture, and sexual orientation on the helping process. resources (such as siblings, friends, and the gay community) can be of help during the coming-out process. Gay art and culture is another resource that enables the expression and authentication of voices outside the dominant social discourse. Narrative practices can also be employed in support groups (Behan, 2002) as well as in training programs for help providers. New ways are yet to be found for increasing the intercultural awareness and sensitivity of helpers of gay male and lesbian issues and of incorporating these in training programs. Narrative approaches combined with creative activity can offer new opportunities for both helpers and clients to reflect on the stories we were told and those we tell our- selves—-about being a woman or a man, about being gay, lesbian, bisexual, or heterosexual in our society. 126 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES KEY CONCEPTS • homophobia • internalized homophobia • heterosexism • sexual orientation-blind perspective • pathologizing discourses • counternarrative » gay affirmative practices • externalizing shame • coming out and identity QUESTIONS FOR REFLECTION 1. What experiences have shaped your ideas about same-sex love? 2. What messages were conveyed in your upbringing about being a woman? a man? 3. What messages were conveyed about women loving women? Men loving men? 4. What were the words used for same-sex love? 5. Have the attitudes where you live changed over the years? How? Have your ideas changed? 6. How comfortable do you feel talking about men loving men? Women loving women? 7. What does prejudice mean to you? What does pride mean to you? Have you encountered incidents of prejudice, bias, or discrimination? 8. Have you ever felt different? Pressured to be like everyone else? Blamed for not conforming? How did you cope with this? What enabled you to handle the pressure? With whose support? EXERCISE This is an exercise that gives a chance to experience some of the expressive work described in this chapter. Look through the illustrations in this chapter. Chose the one that talks to you and look at it for a few more moments. Think about why you chose this illustration—what about your own life attracted you to it? What do you see in it? What associations does it bring up? Now think about one of your own clients. Which picture do you think your client would choose? Why do you think your client might be attracted to that picture? What might that picture say about his or her own life? If you feel comfortable doing this, copy these illustrations and show them to your client. See if your client indeed chooses the one you thought that he or she would and ask why they chose it. If you feel comfortable, share your own choice for them, and both of you can discuss overlap or differences about what you see in the picture. CHAPTER 7: PRIDE AND PREJUDICE WITH GAY AND LESBIAN INDIVIDUALS 127 References Andrews, M. (2002). Introduction— Counter-narratives and the power to oppose. Narrative Inquiry, 12(1), 1-6. Behan, C. (2002). Linking lives around shared themes: Narrative group therapy with gay men. In D. Denborough (Ed.), Queer counselling and narrative practice. Adelaide, Australia: Dulwich Center Publications. Ben-Ari, A. T. (2001). Homosexuality and heterosexism: Views from academics in the helping professions. British Journal of Social Work, 31,119-131. Berkman, C. S., & Zinberg, G. (1997). Homophobia and heterosexism in social workers. Social Work, 42, 319-332. Bieschke, K. J., McClanahan, M., Tozer, E., Grzegorek, J. L., & Park, J. (2000). Programmatic research on the treatment of lesbian, gay, and bisexual clients: The past, the present, and the course for the future. In R. M. Perez, K. A. DeBord, & K. J. Bieschke (Eds.), Handbook of coun- seling and therapy with lesbian, gay, and bisexual clients (pp. 309-336). Washington, DC: American Psychological Association. Bruner, J. (1989). Actual minds, possible worlds. Cambridge, MA: Harvard University Press. Cain, R. (1991). Stigma management and gay identity development. Social Work, 3 6, 67-73. Cass, V. C. (1979). Homosexual identity formation: A theoretical model. Journal of Homosexuality, 4, 219-235. Cass, V. (1984). Homosexual identity: A concept in need of definition. Journal of Homosexuality, 9(2-3), 105-126. DeCrescenzo, T. (1984). Homophobia: A study of the attitudes of mental health pro- fessionals toward homosexuality. Journal of Social Work and Human Sexuality, 2, 115-136. DePoy, E., & Noble, S. (1992). The struc- ture of lesbian relationships in response to oppression. Affilia, 7, 49-64. Dworkin, S. (1996). From personal ther- apy to professional life: Observations of a Jewish, bisexual lesbian therapist and aca- demic. Women and Therapy, 18(2), 37-46. Falco, K. L. (1991). Psychotherapy with Lesbians. Journal of Social Issues, 34(3), 84-100 Freedman, J., & Combs, G. (1996). Narrative therapy: The social construc- tion of preferred realities. New York: Norton. Garnets, L., Hancock, K. A., Cochran, S. D., Godchilds, J., & Peplau, L. A. (1991). Issues in psychotherapy with les- bians and gay men: A survey of psycholo- gists. American Psychologist, 46, 964-972. Gelso, C. J., Fassinger, R., Gomez, M. J., & Latts, M. G. (1995). Countertransference reactions to lesbian clients: The role of homophobia, counselor gender and coun- tertransference management. Journal of Counseling Psychology, 42, 356-364. Gonsiorek, J. C. (1991). The empirical basis for the demise of the illness model of homosexuality. In J. C. Gonsiorek & J. D. Weinrich (Eds.), Homosexuality: Research implications for public policy (pp. 115-136). Thousand Oaks, CA: Sage. Greene, B., & Herek, G. M. (Eds.). (1994). Lesbian and gay psychology: Theory, research, and clinical applications. Thousand Oaks, CA: Sage. Haldeman, D. C. (1994). The practice and ethics of sexual orientation conversion therapy. Journal of Consulting Clinical Psychology, 62, 221-227. Hanley-Hackenbruck, P. (1988). "Coming out" and psychotherapy. Psychiatric Annals, 18(1), 29-32. Herdt, G. (1997). Same sex different cul- tures: Exploring gay and lesbian lives. Boulder, CO: Westview Press. Herek, G. (1995). Psychological hetero- sexism in the United States. In A. D'Augelli & C. Patterson (Eds.), Lesbian, gay, and 128 PART II: GENDER, CULTURE, AND STRESS: MULTILEVEL HELPING PROCESSES bisexual identities over the lifespan: Psychological perspectives. New York: Oxford University Press. Isay, R. (1989). Being homosexual: Gay men and their development. New York: Avon Books. Logan, B. (2002). Weaving new stories over the phone: A narrative approach to a gay switchboard. In D. Denborough (Ed.), Queer counselling and narrative practice. Adelaide, Australia: Dulwich Center Publications. Mizrachi, S. (1990). Same sex couples: Coping with stigma. M.A. thesis, Department of Social Work, Tel Aviv University. Morrin, S. F. (1977). Heterosexual bias in psychological research on lesbianism and male homosexuality. American Psychologist, 32, 629-637. Morrow, D. (1996). Heterosexism: Hidden discrimination in social work education. Journal of Gay and Lesbian Social Services, 5(4), 1-16. O'Dell, S. (2000). Psychotherapy with gay and lesbian families: Opportunities for cul- tural inclusion and clinical challenge. Clinical Social Work Journal, 2S(2), 171-182. Perez, R. M., DeBord, K. A., 8c Bieschke, K. J. (Eds.). (2000). Handbook of coun- seling and therapy with lesbian, gay, and bisexual clients. Washington, DC: Amer- ican Psychological Association. Parry, A., 8c Doan, R. E. (1994). Story re- visions: Narrative therapy in the postmod- ern world. New York: Guilford Press. Plummer, K. (1981). Going gay: Identity, life-cycles and life-styles in the male gay world. In J. Hart 8c D. Richardson (Eds.), The theory and practice of homosexuality (pp. 93-160). London: Routledge & Kegan Paul. Rabin, C. (1991). The cultural context in treating a lesbian couple: An Israeli expe- rience. Journal of Strategic and Systematic Therapies, 11(4), 42-58. Riley, S. (2001). Group process made vis- ible. Philadelphia: Taylor & Francis. Roth, S. (1989). Psychotherapy with les- bian couples: Individual issues, female socialization, and the social context. In M. McGoldrick, C. Anderson, & F. Walsh (Eds.), Women in families: A framework for family therapy. New York: Norton. Sumakei-Fink, A., 8c Press, J. (1999). Independence park: The lives of gay men in Israel. Palo Alto, CA: Stanford University Press. Troiden, R. R. (1989). The formation of homosexual identities. Journal of Homosexuality, 17, 43-73. Van Vorris, R., & Wagner, M. (2002). Among the missing: Content on lesbian and gay people in social work journals. Social Work, 47(4), 345-355. Walzer, L. (2000). Between Sodom and Eden: A gay journey through today's changing Israel. New York: Columbia University Press. . White, M., 8c Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton. Wisniewski, J. J., 8c Toomey, B. G. (1987). Are social workers homophobic? Social Work, 32, 454-455. Zimmerman, J. L., 8c Dickerson, V. C. (1996). If problems talked: Narrative ther- apy in action. New York: Guilford Press.