Couples Exploring Non-Monogamy: Guidelines for Therapists

A population that is potentially challenging for couple and family therapists to work with is that of couples who want to explore non-monogamy. For many therapists, non-monogamy challenges personal values and beliefs, and there is little in the literature to support therapists in achieving cultural competency in this area. B

Based on a review of Western clinical literature over the past 20 years, and on the author's clinical experience, the author provides therapists with guidelines to use with couples who want to explore the possibility of becoming non-monogamous. 

The guidelines include: 

1. Educate oneself about non-monogamy, 
2. Identify one's own values and beliefs related to non-monogamy, 
3. Work with the couple's definition of non-monogamy, 
4. Be aware that partners may have varying concerns about non-monogamy, 
5. Address infidelity if present, 
6. Avoid assumptions about the ways non-monogamy will impact the relationship; and 
7. Recognize that opening a relationship is an ongoing process.

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By:  Bairstow A1.

• 1 Widener University , Toronto , Ontario , Canada.
• J Sex Marital Ther. 2016 Mar 30:0. 

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The Impact of Key HIV Intervention Components as Predictors of Sexual Barrier Use: The Zambia Partner Project

Behavioral interventions have utilized a variety of strategies and components to reduce HIV risk. This article describes the partner intervention, a couple-based group HIV risk reduction intervention implemented in 6 urban community health clinics in Lusaka, Zambia, and examines the components of the intervention and their relationship with condom use. 

Couple members completed assessments on condom use, acceptability, willingness to use condoms, communication, intimate partner violence (IPV), self-efficacy, and HIV information at baseline and 6 months' follow-up. This study examined the relative impact of elements of the intervention as predictors of condom use. Changes in acceptability had the greatest overall influence on condom use, followed by social support, relationship consensus, and willingness to use condoms. Changes in self-efficacy, IPV, negotiation, and information had no influence. 

Results support the use of multidimensional approaches in behavioral interventions and highlight the importance of identifying critical elements of interventions to maximize risk reduction outcomes.

…Changes in acceptability had the greatest overall influence on sexual barrier use, followed by social support, relationship consensus, and willingness to use sexual barriers. Self-efficacy was associated with the use of sexual barriers, but increased self-efficacy did not contribute to increased barrier use in multivariable analysis. Finally, negotiation, IPV, and information had no apparent influence on sexual barrier use.

Study results provide further support for the predictive relationship between acceptability and self-reported willingness to use barriers and sexual barrier use, in line with earlier findings by this team using individual rather than dyadic analyses.²⁸ One of the key elements of CB therapy is the premise that attitudes influence behavior, for example, acceptability of condoms will predict their use. In this study, acceptability may have been increased by CB strategies designed to promote positive attitudes and reduce negative opinions regarding condom use. Condoms are highly effective in the prevention of HIV transmission, but their impact as a prevention strategy has been limited by low acceptability and inconsistent use. Meta-analyses of positive prevention studies in developing countries have reported that interventions targeting HIV sero-positive individuals are successful in increasing condom use, in both seroconcordant and discordant relationships.²⁹ Recent studies, for example, microbicides and preexposure prophylaxis (PrEP), have highlighted the importance of assessing the acceptability of prevention strategies as a predictor of uptake. In fact, low product acceptability may be the Achilles' heel of HIV prevention. Enhancement of product acceptability is likely a critical intervention element and has important implications for the uptake of existing prevention strategies as well as new strategies such as PrEP.

Social support and relationship consensus also played a key role in the uptake of sexual barrier products. In psychotherapy, the group format is often used to increase the overall impact of the intervention by providing a variety of viewpoints on interpersonal issues, but the group format may also increase the perception of the availability of supportive like-minded peers. In addition, the supportive nature of the group format may be more comfortable for members of collective communities and cultures, although results of previous research regarding the impact of the group format on condom use are mixed.² Although no interaction was discovered, future studies should continue to explore the association between social support and relationship consensus. Both the elements of social support and the focus on achieving consensus appear to be critical intervention elements…

Full article at:  http://goo.gl/u4pTRv

By:  Ndashi Chitalu, MD,1 Mirriam Mumbi, CNM,1 Ryan Cook, BA,2 Stephen M. Weiss, PhD, MPH,2 and Deborah Jones, PhD2

¹Department of Pediatrics, University Teaching Hospital, University of Zambia School of Medicine, Lusaka, Zambia

²Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA

Corresponding Author: Deborah Jones, Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave, Suite 404A, Miami, FL 33136, USA, Email: ude.imaim.dem@senojd

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Sexual Orientation Change Efforts Through Psychotherapy for LGBQ Individuals Affiliated with the Church of Jesus Christ of Latter-Day Saints

This study reports the results of a comprehensive online survey of 1,612 current or former members of the Church of Jesus Christ of Latter-day Saints, many of whom engaged in psychotherapy to cope with (i.e., understand, accept, or change) their same-sex attractions. 

Data obtained from written and quantitative responses showed that therapy was initiated over a very wide age range and continued for many years. However, counseling was largely ineffective; less than 4% reported any modification of core same-sex erotic attraction. Moreover, 42% reported that their change-oriented therapy was not at all effective, and 37% found it to be moderately to severely harmful. In contrast, affirming psychotherapeutic strategies were often found to be beneficial in reducing depression, increasing self-esteem, and improving family and other relationships. 

Results suggest that the very low likelihood of a modification of sexual orientation and the ambiguous nature of any such change should be important considerations for highly religious sexual minority individuals considering reorientation therapy.

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By:  Kate Bradshaw^a, John P. Dehlin^b, Katherine A. Crowell^c, Renee V. Galliher^b & William S. Bradshaw^d*

^a English Department, Dartmouth College, Hanover, New Hampshire, USA

^b Department of Psychology, Utah State University, Logan, Utah, USA

^c Department of Psychology, Pacific Lutheran University, Tacoma, Washington, USA

^d Department of Microbiology and Molecular Biology, Brigham Young University, Provo, Utah, USA

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Toward Formulating Evidence-Based Principles of LGB-Affirmative Psychotherapy

In this commentary, we review eight potential LGB-affirmative psychotherapy principles for improving minority stress coping among sexual minority clients. We illustrate these principles with examples from both Mandel’s (2014) treatment approach and our clinical research team’s recent attempt to create and test the efficacy of a treatment employing these principles in an ongoing randomized controlled trial. These principles are grounded in empirical research regarding the mechanisms through which minority stress compromises the mental health of sexual minority individuals and are supported by clinical expert consensus. 

The specific principles that we review include: 

1. normalizing the mental health impact of minority stress, 
2. facilitating emotion awareness, regulation, and acceptance, 
3. decreasing avoidance, 
4. restructuring minority stress cognitions, 
5. empowering sexual minority clients to communicate assertively, 
6. validating sexual minority individuals’ unique strengths, 
7. building supportive relationships, and 
8. affirming healthy, rewarding expressions of sexuality. 

We believe that Mandel’s skillful approach to helping her hybrid client Adam cope with minority stressors, such as internalized homophobia, and associated mental health problems such as substance abuse and depression, to form a healthy identity as a gay man represents an exemplary demonstration of these principles in action.

Full article at:   http://goo.gl/lsi8SL

By:  Rachel A. Proujanskya and John E. Pachankisb,c,d

¹Yeshiva University

²Yale School of Public Health

^cCorrespondence regarding this article should be addressed to John Pachankis, Laboratory for Epidemiology and Public Health, Room 316, 60 College St., New Haven, CT 06510 ; Email: ude.elay@siknahcap.nhoj

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When Psychotherapy Is Indefinite & There Is No Final Outcome: Case Study of a Community Mental Health Clinic

Little is known about long-term patients for whom there is no anticipated endpoint to treatment. In this qualitative case study, we used a focus group methodology to understand how psychotherapists at a community mental health clinic work with low-income adult patients who are seen indefinitely. 

Narrative themes that emerged from the focus group discussion include the nature of these patients' diagnoses and life problems; the sociocultural contexts in which they live; the kinds of treatment goals and interventions; the internal and external barriers to termination; and how therapists recognize the need to work indefinitely with some patients to keep them alive or functioning in the community. 

Although a diagnosis of major mental illness was the foremost reason for not planning a termination, participants also mentioned working indefinitely with some higher functioning patients whose lives are perpetually in crisis. Participants emphasized the importance of having a compassionate clinical team and supportive administration for seeing patients indefinitely, even when third party payments end. 

Results are discussed in terms of their implications for service delivery as well as their implications for future investigations of psychotherapy that has no foreseeable endpoint.

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By:  Friedlander ML1, Austin CL1, Cabrera P1.

• 1Department of Educational and Counseling Psychology. 

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Psychotherapy Experiences of Perpetrators of Child Sexual Abuse

Cynicism about treatment of sex offenders pervades both professional and lay literature. A Cochrane review of randomized controlled trials concluded there is no evidence to support any psychological intervention for sex offenders, but RCT design has limitations for evaluating sex offender treatment. Rarely has a qualitative approach been used to explore perceptions of offenders themselves about their psychotherapy experiences. 

The purpose of this study was to discover the meaning of therapy experiences to 11 community-dwelling perpetrators of child sexual abuse. They had received therapy during incarceration or after release, or both. Secondary analysis was conducted of phenomenological interviews about participants' early life, during which they spontaneously revealed insights gleaned during therapy in adulthood. Rigor of the analysis was enhanced by reading transcripts aloud and thematizing them in an interdisciplinary interpretive group. Five interrelated themes constituted a gestalt comprising the essence of the therapy experience: 

• "This treatment, it's just totally changed my whole world." 
• Themes included: 
• "It just stripped away all the pretense, all the lies, all the manipulation;" 
• "I didn't understand myself; I found out all about myself through this;" 
• "Nobody knew any of my secrets; that (therapy) was the first time that I got to tell my story;" 
• "The group has become a family for me;" and 
• "I'm very ashamed of what I've done; this treatment has really helped me, gave me a second chance." 

These findings stand in contrast to cynicism about sex offender therapy and lend support to the increased optimism expressed by several contemporary scholars

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By: Thomas SP1, Phillips KD2, Blaine SK3.

• 1University of Tennessee, Knoxville, TN
• 2East Tennessee State University, Johnson City, TN.
• 3University of Tennessee, Knoxville, TN.

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