CALIFORNIA STATE UNIVERSITY, NORTHRIDGE
LESBIANISM
MAJOR TREATMENT ISSUES
A graduate project submitted in partial satisfaction
of
the requirements for the degree of Master of Arts in
Community/Clinical Psychology
by
Sydney Eaker
January, 1988
The project of Sydney Eaker is approved:
• Donald Butler
Dr. Helen Giedt
Dr. Karla Butler, Chairperson
California State University, Northridge
ii
This project is lovingly dedicated:
to Bunny, for always being there and making me
want to be there as well
to Joan, for all of her love and butterflies
to Caroline, for all of her support and do-dahs
and
to all lesbians who are courageously struggling to
recognize and accept themselves for who they are.
iii
TABLE OF CONTENTS
Dedication.
Abstract •••
I.
II.
III.
IV.
INTRODUCTION
Preexisting treatment •••••
Emerging Treatment Models.
Lesbianism ..•.•..•..•.••••
J:.1AJOR TREATt-1ENT ISSUES
General Issues ••
Lesbian Issues.
Affirmation Therapy ••
CASE STUDIES
Lucy ..•....
Discussion.
Karen •••••••
Discussion.
Helen . . . . . . .
Discussion.
••• iii
v
1
2
4
8
10
16
20
25
28
34
37
45
Sm-1HARY
Case Discussions ••
Conclusion ••••
Bibliography ••••••••
48
50
53
ABSTRACT
LESBIANISM:
MAJOR TREATMENT ISSUES
BY
Sydney Eaker
Master of Arts in Community/Clinical Psychology
The purpose of this paper is to illustrate and
discuss relevant treatment issues and interventions in
psychotherapy with lesbian clients.
Through the use of
case study presentations and by drawing on personal
experience, these issues and techniques are discussed in
relation to existing treatment concerns in the lesbian
therapeutic community.
v
INTRODUCTION
PREEXISTING TREATMENT
Mental health practice with gay and lesbian populations has undergone enormous change in the past twenty
years.
Until recently, the prevailing and almost
exclusive view was that homosexuality was a psychiatric
illness.
The efforts of mental health practitioners were
geared towards diagnosing and curing homosexuality.
However, research in the 1960's and continuing into the
1970's profoundly altered these beliefs.
Homosexuality
began to be understood as more complex, and harder to
define and measure than previously imagined (Gonsiorek,
1982).
Social psychological models began to provide
increasingly more powerful and useful explanations of
some aspects of homosexual behavior than had the illness
model (Gonsiorek, 1982).
Serious questions began to be
asked about treatment outcomes in attempts to cure homosexuality.
Generally, long term results were very
disappointing (Coleman, 1977).
Finally, the ethics of
attempts to change sexual orientation have been highly
controversial (Symposium on Homosexuality and the Ethics
of Behavioral Intervention, 1977).
A recurring theme in a study of lesbianism in which
the experience and perception of the women themselves are
taken into account is the wide divergence between
1
2
concepts about lesbianism in the literature commonly held
by heterosexual "authorities" and the subjective experience and self-definition of the women who are the subject
of this research.
This discrepancy, in the past, has contributed to the
"illness" model of homosexuality.
Now that research is
being done with an eye to the individual and their
adaptive level of functioning, this view has changed
(Wolf, 1979).
EMERGING TREATMENT MODELS
The old illness model has all but disintegrated under
the weight of empirical research, yet new gay and lesbian
affirmative models have been slow to emerge.
imperative that they do emerge.
It is
Any worthwhile gay and
lesbian affirmative model must, from the start, meet a
number of requirements.
It must be relevant to the life
experience of gay and lesbian clients and assist them in
meeting the challenge of the primary task confronting
them, the creation of an equal, healthy, ethical and
useful place in society.
The models must be clinically
useful and creatively assimilate those ideas from the
mainstream of traditional mental health practice which
are relevant to the gay
p~rson
(Fifield, 1979).
Clinicians who want to work affirmatively with gay
and lesbian clients more often know what not to do than
3
what to do in therapy.
This creates a vacuum in which
psychotherapists, like most people, dislike working.
If
new affirmative models do not fill the vacuum, the old
beliefs will gradually re-establish themselves, because
practitioners must have something to guide them in their
work (Coleman, 1977).
Such new models are emerging.
At least one compre-
hensive volume on affirmative counseling techniques with
gay and lesbian clients has been published (Lenna and
Woodman, 1980).
The Journal of Homosexuality has also
been publishing relevant affirmative articles on gay and
lesbian mental health issues.
By continuing to deal with
issues from within the community, the affirmative models
are strengthened and deal more effectively with life
issues for gay men and lesbians.
LESBIANISM
Until the 1970's, research on lesbians was scarce,
and the few studies that did exist focused on causative
factors associated with lesbianism as a mental illness.
In an analysis of five lesbian patients, Ernest Jones in
1927, identified extreme oral eroticism and strong sadism
as primary factors in the etiology of lesbianism.
Freud
traced lesbianism to a strong mother fixation, coupled
with penis envy.
Caprio in 1954 found narcissism to be
the driving force behind lesbianism.
These and other
pathological causation theories are covered in a review
of the literature by Rosen (1974).
Kinsey, Pomeroy, Martin and Gebhard (1953) were the
first to study a non-clinical sample of lesbians.
This
study "provided the first glimpse into homosexuality as
natural sexual behavior rather than a psychiatric
illness" (Rosen, 1974).
Like their predecessors, Kinsey
et al. examined the determinants of lesbianism, focusing
mainly on social conditioning factors.
These reports
were the exceptions in the literature, few in comparison
to the numerous studies investigating male homosexuality.
In fact, Barbara Sang (1978) reports that between
1939 and 1960 there were only twenty-two articles that
mentioned lesbianism.
Of these, the largest sample
studied was fourteen "delinquent" girls.
4
5
It was not until the 1970's that a feminist and gay
impact on the literature began to be seen (Sang, 1978).
Lesbians were finally recognized as a separate area of
concern.
Rather than on etiology, studies now focused on
the lesbianism-as-an-illness or lesbianism-as-a-way-of
-life dichotomy, and usually compared samples of lesbians
and heterosexual women on measures of psychological
adjustment.
In a thorough review of research on lesbians
through 1975, Mannion (1976) referred to eleven such
studies.
Common instruments, such as the Personal
Orientation Inventory (POI), the Eysenck Personality
Inventory and the Sheier and Cattrell Neuroticism Scale
Questionnaire (NSQ) were used.
In general, findings
indicated that:
"While there are personality differences that
distinguish lesbians from heterosexuals,
these differences are not patholbgical in
character. Rather, there emerges a picture
of the lesbian as a woman who is more dominant, autonomous, assertive, self-actualizing
and inner-directed than her heterosexual
counterpart. In some ways, she has been
described as being more healthy than the
heterosexual controls, both in terms of
freedom from neurosis and productivity in the
professional world" (p.37).
Mannion pointed out that these studies represent the
bulk of the empirical data available to us, but many
suffer from methodological flaws.
Conclusions have to be
viewed with a critical eye towards sampling procedures.
6
Just as generalizing from gay male samples is inappropriate unless population differences are clearly defined and
considered, so too can lesbian samples be used inappropriately.
Clinical groups are not equivalent to non-clinical
groups.
A control group of married, heterosexual home-
makers is not comparable to single, working lesbians.
No
sample of lesbians can be considered truly representative
of the total lesbian population as long as negative
societal reactions to homosexuality keep a portion of
that population hidden.
Sang (1978) reported that many of the shortcomings in
lesbian research have been due to researcher bias or a
lack of understanding of the social context surrounding
the lesbian.
She called upon lesbians to foster a new
wave of scientific inquiry that is neither sexist nor
heterosexist.
She commended the "on-going dialogue" that
lesbians have begun to have with one another to try to
"clarify and sort out what is relevant to our own experiences as women and lesbians'' (p.84).
She feels that the
key to quality research is for lesbians and feminists to
work together cooperatively with an aim to "maximize the
growth potential of the individuals being studied"
(p.86).
A very creative pioneer effort is found in redefining
old words.
From a journal of a lesbian pioneer in the
7
Baltimore Collective, which publishes Women:
A Journal
of Liberation, comes:
"I used to worry about some psychologist's assertion that lesbianism was
adolescent. But I finally decided that
there's some truth to that - not how they
mean it, but in the best sense: that we
are once again in groups of women, and we
giggle and do lots of things that are fun.
We have to reclaim that kind of experience,
no matter what they call it. And then look
for it with all that wonderful energy
that's been pushed down."
(1978).
(l
'
GENERAL TREATMENT ISSUES
In looking at specific treatment issues, it behooves
us to explore the needs that gay people bring into the
therapy setting.
Don Clark, in his book, Loving Someone
Gay (1979), identified several psychodynamic generalizations that offer a framework for looking at the gay
person's inner world.
1•
Gay persons have learned to feel different and in
a society that values conformity, that difference is
devalued by the individuals themselves.
2.
Gay people have learned to distrust their own
feelings, beginning with the awareness of their
attraction to someone of the same sex, in an environment
that tells them that their feelings are perverted.
3.
Gay persons are likely to have a decreased
awareness of their own feelings.
The anger generated in
a punitive environment and the anger at self for being
different can't be tolerated and seems unjust.
be pushed out of awareness.
It must
Other feelings become
affected when so much energy is spent on repression.
4.
Gay persons, being invisible to others, are
assaulted daily with attacks on character and ability.
The anti-gay jokes and statements, the myths proclaimed
as fact, all hurt.
Awareness of this hurt must be
silenced to prevent anger and feelings again are
repressed.
8
9
5.
Gay persons fear rejection and limit reaching out
or revealing true thoughts, feelings or identity.
6.
Gay persons are likely to be depressed as hidden
anger and repression of feelings takes its toll.
7.
Gay persons are very likely to turn to alcohol or
drugs to lessen the discomfort and isolation.
The use of
alcohol is reinforced, since bars are one of the safe
meeting places.
More specific problems which are a mixed result of
societal oppression and individual reaction include:
1.
Isolation- often at relationship breakup and
limited social options.
2.
Difficulty in being open and spontaneous.
3.
Unresolved guilt feelings about sex.
4.
Difficulty in forming personal and intimate rela-
tionships. Limited early/current opportunities for social
and emotional experiences and social skills learning.
5.
Unsatisfying relationships.
6.
Fear of homosexual feelings.
7.
Low self-esteem and self-concept.
8.
Confusion about sexual orientation.
9.
Social and familial pressures.
10.
Sex role confusion and exaggerated rebellion.
In consideration of the gay client, we must bear in
mind that we do not generalize these issues to all gay
clients.
These are issues that some clients struggle
with, but not all.
LESBIAN ISSUES
In reviewing the experience of therapy with lesbian
clients, one fact is clear.
"There is no particular
psychotherapy for lesbians, but rather, psychotherapy
with women who happen to be lesbian" (Anthony, 1985).
The prevalent theme for all clients remains one of how to
live self-actualizing lives and what that entails, such
as issues of self-esteem, establishing and maintaining
meaningful relationships and pursuing satisfying work.
In the specific case of lesbians, the lesbian faces
problems and.stresses not encountered by any other group
of individuals in our society.
She is atypical in the
nonperjorative sense of the word; her sexual preference
sets her apart from the vast majority of those around
her.
However comfortable the lesbian may be with her
sexuality, the awareness of her "otherness" cannot help
but permeate her life.
The lesbian's unique position
means that she brings problems and conflicts to the
therapy situation which require a particular sensitivity,
awareness and knowledgeability on the part of the therapist (Women's Resources, 1979).
A basic conflict confronting the lesbian is guilt
(Women's Resources, 1979).
When one is ignoring most of
the expectations with which one has been raised, it is
difficult not to feel guilty.
And when one is female and
brought up to consume guilt, it is especially difficult.
10
11
There are two types of guilt.
One is societal guilt,
which might be described as a depersonalized form.
This
type of guilt arises because the lesbian is disobeying
society in general.
She is going against her religion,
breaking the law and not fulfilling her role as a woman.
The other type of guilt is far more. powerful and far more
crippling.
Many lesbians are not troubled by the demands
of the church or sex-role stereotyping.
Hurting ones'
parents, on the other hand, is an entirely different
matter.
The guilt of causing pain to those we love can
be devastating (Women's Resources, 1979).
The lesbian is clearly in a no-win situation.
While
she may feel that her parents are being narrow-minded,
irrational, etc., there is no denying that she has hurt
them.
Outwardly, she can say, "Well, if they're going to
be that way, it's their problem".
Inwardly, she sees
loved ones in pain and must live with knowing she has
caused the pain.
At some level then, the lesbian lives
with the guilt, guilt which must sometimes contribute to
her questioning of her decision.
At some point in her
life, every lesbian asks herself, "Is it all worth it?
If being a lesbian means being rejected, feared, hated
and discriminated against, wouldn't I be better off as a
heterosexual?''
Maintaining that uncertainty about her
decision is an internal conflict for the lesbian and it
is presupposed that there is a decision involved at all.
12
It may be argued that lesbians no more have a choice in
their sexuality than do heterosexuals.
Nonetheless,
because lesbians do have the option to adopt another
life-style (at whatever price), a decision is involved
(Women's Resources, 1979).
Society has confused the intellectual decision a
lesbian may make about her future with the realization of
lesbianism experienced by a formerly heterosexual or
non-sexual woman.
The result is the idea that lesbians
are "the way they are" because they have chosen to be
that way.
The perceived element of choice in lesbianism
is yet another source of internal conflict.
Although she
knows that she is attracted to women, she also knows that
she could modify her behavior so as to function as a
heterosexual.
The lesbian can easily fall into the trap
of feeling that because she has failed to exercise this
option, she deserves whatever she gets.
Whereas other
minority groups can attack the prejudices and discriminations of an unjust society, many lesbians feel that
they have drawn society's wrath upon themselves.
The
lesbian who feels that she is not a "legitimate" minority
is internalizing society's view on this matter.
This is
a good example of how an external stress can become an
internal conflict.
The interaction of external stresses
and internal conflicts can be especially difficult to
cope with (Women's Resources, 1979).
13
External stresses tend to play into any internal
uncertainty which might be present.
External pressures
may force the lesbian to be secretive about her life, but
the constant need for subterfuge and the fear that she
might slip up cause great anxiety.
The continuous pro-
cess of coming out and the never-ending necessity of
deciding whether and when to announce her sexuality to
new acquaintances, is an externally-induced situation
which also takes its psychological toll.
Where her
employment is concerned, the lesbian indeed may need to
maintain the "illusion of normalcy", for her very livelihood may be threatened by her co-workers.
Therefore, the
lesbian, and especially the lesbian who is just coming
out, is in a double bind.
At the same time that she is
facing severe stress, she is placing herself in the
position of having few or no support systems.
Most
people can discuss their problems with family and
co-workers; for lesbians, these people often are the
problem (Women's Resources, 1979).
In the area of socialization, there are several
difficulties for lesbians.
Women are not experienced in
how to date women, and courtship is almost nonexistent in
the lesbian community (Sang, 1977).
This leaves a rather
large gap to be filled in women's experience.
This
contributes to feelings of loneliness, due to a lack of
knowledge about opportunities to meet other lesbians.
14
Women have rarely been the ones to do the inviting, and
hearing "no" from another woman feels threatening
(Anthony, 1985).
being quite needy.
This situation results in the lesbian
These needs include the need for love
and affection, as well as sexual fulfillment.
There are
few alternatives available to meet these needs.
Until recently, one of the few places to meet other
women has been the gay bars.
The "safety" of this
meeting place has fostered a high rate of substance abuse
among the lesbian population (Clark, 1977).
Fortunately,
this situation has changed and there now exist healthier
ways for women to meet within the community, such as
community organizations which sponsor substance-free
activities, as well as singles' groups for lesbians.
When a lesbian seeks therapy, it may be because of
problems directly related to the stresses previously
mentioned.
She may be having conflicts with her family
over her life-style, or she may be finding that the
pressures of hiding her lesbianism are becoming
intolerable.
More often, the presenting problem will
seemingly have nothing to do with the woman's sexual
orientation.
Lesbians are vulnerable to the same
insecurities, problems and neuroses as are heterosexuals.
The question to be asked is whether these
problems are indeed unaffected by the stress that the
lesbian is under because of her sexuality.
In theory,
15
when a woman seeks counseling because she is having
trouble with her lover, the lover's gender should be
irrelevant.
In reality, however, a number of stresses
complicate lesbian relationships, and these cannot be
ignored in therapy.
Underlying the overt problems may
be a variety of more subtle problems, such as the
absence of opportunities to legalize or legitimize the
relationship and the need to keep it secret.
Therefore,
it is artificial to isolate those problems which relate
to a woman's lesbianism and those which don't.
An
aspect of personality as major as sexuality cannot help
but affect other areas (Women's Resources, 1979).
The following model of Affirmation therapy provides
a framework with which to more effectively work with
lesbians and gay men.
AFFIRMATION THERAPY
The basic premise of Affirmation therapy (Fifield,
1979), is that gay is OK.
The approach to sexuality is
open and supportive of any expression that is loving and
caring.
It is no more pro-gay than pro-heterosexual.
Both are positive, valued expressions as a life-style on
any place on the sexual continuum.
The Affirmation
model incorporates an understanding of androgyny.
This
reflects an integration and balance of feminine and
masculine traits, which results in a self-actualized
person whose options are broadened and enriched.
It
values the person whose behavior exhibits the best of
what is female-associated and the best of what is
male-associated, with the goal of therapy being integration and balance.
Fifield offers the following
specific treatment techniques:
1.
Careful consideration before entering into a
therapy contract to eliminate homosexual feelings.
If
there is something pathological about the gay person's
behavior, work on the pathological facet, not the
homosexuality.
2.
Dealing with our own homophobia as therapists, in
that we be aware of our own feelings about homosexuality,
and the problems that these feelings could cause with
issues of countertransference.
16
17
3.
All gay people experience oppression, though they
may laugh it off.
Behind the laughter is rage that must
be released.
4.
Helping the client to identify incorporated
stereotypes and begin deprogramming and undoing of
negative conditioning.
Sex role behavior is learned as a
part of our socialization.
Emotional stress for gay
clients is not usually due to internal psychic conflicts
but to external societal pressures to conform to
heterosexual conditioning.
Encourage clients to question
all norms and values so they can establish their own
truth.
5.
Theories of behavior based on anatomical
differences and biological determinism must be rejected.
The best emotional balance for the client is achieved by
a blend and balance of characteristics of the individual
client, rather than stereotypical traits.
6.
Use the weight of your authority to approve
homosexual thoughts, feelings and behaviors.
7.
Whenever possible, work in groups.
Clients need
to be with each other for support and exploration.
8.
Encourage clients to establish a gay support
system to break down the feelings of isolation.
9.
Look for signs
~f
drug and alcohol abuse.
Alcoholism results from spending a lot of time in gay
bars.
Work to break that pattern of socialization.
18
10.
Be knowledgeable about gay and lesbian
subculture.
Work to understand societal homophobia and
the resulting oppression and pressure experienced by
clients.
11.
Use sex-role analysis as a treatment technique
by being aware that because gay clients are sex-role
outlaws, the primary source of pathology is societal, not
personal; external, not internal.
These issues are an important part of working affirmatively with gay and lesbian clients and can provide for
a positive therapeutic experience.
With the previously mentioned aims in mind, the
following case studies are presented.
They represent the
course of treatment of three lesbian clients, over the
space of two years of treatment.
The therapist's
theoretical orientation is primarily Existential.
This
approach focuses on the relationship between the client
and the therapist and also employs techniques from other
therapeutic orientations.
These techniques include
Rogerian reflection and validation, as well as
affirmation.
Reality therapy's technique 9f
confrontation is also used in treatment. This work was
done within a community mental health center in Los
Angeles, as a fieldwork placement.
The cases contain a
mixture of specific lesbian treatment issues, as well as
everyday human concerns.
Each case study is
presented~
19
followed by a discussion of the relevant treatment issues
previously discussed by Clark (1979), Fifield (1979) and
\'Vomen' s Resources ( 1 979).
The term "herstory" is used in
the test to describe the client's "history".
This term
has been used increasingly in the feminist literature to
affirm lesbianism.
LUCY
Lucy is a thirty-eight year old lesbian feminist,
politically active in the gay community&
Her recent
addiction to cocaine was the reason for corning to
treatment.
Lucy reported a "healthy" childhood.
She was the
oldest of three siblings, with two brothers, the youngest
of which has muscular dystrophy.
This sibling is also
gay and they share a horne, along with Lucy's mother, who
lives downstairs.
When Lucy was ten years old, her
mother was discovered to have multiple sclerosis and Lucy
became her caretaker.
"loving and nurturing."
Lucy's father was a psychologist,
Although her mother's illness
"shortened" her childhood, she reported "I didn't mind
doing it, someone had to."
Since the death of her father
five years ago, Lucy has lost her parental nurturence and
repressed her feelings about that loss.
Lucy dated briefly in her teens and knew rather early
about her sexual identity.
She explored her feelings for
women at an early age and discovered her true sexuality.
She moved to New York from Los Angeles and became politically active in the lesbian community, being one of the
founding members of a prominent lesbian political organization.
She has had numerous long-term relationships,
alternately described as "wonderful and horrible."
20
21
Her recent drug addiction caused the breakup of a
seven year relationship with Sarah.
Lucy expressed much
anguish over this loss and blames herself for the
breakup.
Sarah had been a lifelong friend and their
grandmothers had also had a relationship as friends.
Lucy lost many good friends "after the divorce" and
experienced feelings of isolation.
She then became
involved in an "absolutely wonderful" relationship with
Jill.
Treatment issues were basically involved with
feelings of isolation from her old friends and ex-lover.
Lucy's presentation in treatment was that of a tough,
capable woman.
She rarely allowed emotion into her
sessions, remaining mostly on an intellectual level of
interaction.
When emotions were discussed, there usually
existed an incongruence between Lucy's content and her
affect.
V~hen
this was pointed out, she would state, "I
just don't feel it now."
Emotions appeared to signify vulnerability for Lucy
and so she developed -v1hat she called "the bitch."
Lucy
felt that "the bitch" helped her get vlhat she needed, by
demanding it, but was unhappy with the way she went about
it.
This was also causing problems in her new relation-
ship, as Jill's reaction to "the bitch" was to become
childlike.
At this point, their communication completely
broke down and neither got what they needed.
{l
'
22
Throughout the course of treatment, which spanned
seven months, Lucy remained relatively unable to express
any emotional affect.
On only one occasion, when her
relationship with Jill was threatening to end, did she
cry and become angry and frightened.
She appeared visi-
bly uncomfortable with these feelings and felt as though
she would "explode."
Connections were made between
Lucy's intellectualizations and her fear of dealing with
her emotions.
Issues of dependency were raised and Lucy
expressed her fear of being vulnerable and needy and not
getting those needs met.
These included her need for
love and affection, as well as her need to be able to
develop a strong, connected relationship with another
woman.
This issue was directly related to her feelings
about her mother and when these were explored, Lucy was
able to get in touch with her own neediness.
This was
very difficult for her to handle and she began to cancel
and reschedule her sessions, appearing afraid to come in
and deal with her needy feelings.
She had never appeared
too attached in her treatment as well, another way to
avoid being vulnerable.
When Lucy did manage to come for
her session, she appeared well- defended and kept content
on an intellectual level.
When asked about this, Lucy
denied having any feelings at that time.
Lucy's problem with cocaine was a clear indicator of
her inability to deal with her feelings and her fear of
23
"exploding", lest she felt them.
She was also unable to
come close to them in treatment and did abuse alcohol
during her more difficult times in therapy.
Since the
bars are one of the major sources for socialization and
support in the lesbian community, Lucy was able to
utilize one of the few supports that she had.
Unfor-
tunately, her alcohol abuse only further dulled her
emotions.
When Lucy's alcohol use became a problem, her
lover, Jill, threatened to leave her.
It was at that
time that Lucy and Jill entered couples treatment, with
another therapist, and Lucy's individual work was
terminated.
Basic treatment techniques included the use of validation and reflection whenever possible.
This appeared
to have no impact on Lucy, as she erroneously assumed
that it was OK to be needy.
The validation of her
neediness, ie. her need for love and connection with
someone, appeared to make her more uncomfortable,
although she would verbally acknowledge it.
When gentle
confrontation was used, Lucy usually denied what was
being said and became somewhat defensive.
Lucy appeared
comfortable with most issues, after an affirmative model
and atmosphere was provided in treatment.
It was clear, in terms of Lucy's herstory, that she
became a caretaker rather early in her life and had to
deny her own feelings.
Interestingly enough, when it
·I
24
carne to her sexuality, Lucy was able to acknowledge her
preference and actively seek out relationships and
support for herself.
Lucy's difficulty manifested itself
in her fear of dealing with her neediness in reference to
parental figures and her anger at having been abandoned
by her mother at an early age.
Lucy also interpreted her
father's death, in part, as another abandonment and fled
into drugs and alcohol, rather than deal with these
feelings.
This neediness clearly interfered with Lucy's
ability to maintain a close relationship, due to her fear
of her neediness.
This applied in therapy as well, as a
working connection between client and therapist never
appeared to form.
Lucy did leave treatment before any
significant progress was made in this area.
DISCUSSION
Lucy's herstory clearly illustrates several treatment
issues previously mentioned.
Her difficulty in dealing
with her feelings of neediness and her anger over her
parents' abandonment are clearly connected to her lesbian
identity.
ment.
These issues figured prominently in her treat-
The following issues, mentioned by Fifield, were
found to be of importance in Lucy's treatment.
Using the affirmative model, the initial therapeutic
environment was one of acceptance and validation.
When
Lucy began discussing her needs, it was clear that she
did not trust her feelings, nor did she want to acknowledge them.
alliance.
This was a major obstacle to the therapeutic
Since Lucy was unable to trust her own needs,
she could not admit that she needed anything from the
therapist either.
Methods to assist Lucy in trusting her
feelings included sharing of personal experience, which
she rejected, and also continuous validation of what
little feelings she did present.
These initial attempts
to aid Lucy in learning to trust her feelings did not
appear to have much impact, as she continued to complain
of the same types of difficulties in her relationship.
This general distrust of her feelings, along with the
repression of much anger·, made treatment more difficult
for Lucy.
She had already overcome an addiction to
25
26
cocaine, but began using alcohol to dull her feelings,
claiming she was a "social drinker."
Throughout her
treatment, Lucy was well defended and when her alcohol
abuse was mentioned, she quickly denied any difficulties.
As Fifield recommends, an attempt should be made
to break the pattern of socialization which leads to
alcohol abuse.
This was virtually impossible in Lucy's
case, as she could not see any problem in that area.
Issues mentioned by Clark also had an impact on
treatment.
Lucy's fear of rejection prevented her from
really connecting in the therapeutic relationship.
Although she appeared well established in her identity as
a lesbian, her life style and relationships seemed to
further encourage her to repress her feelings.
Any
attempt at reflection, interpretation or confrontation
was usually met by denial.
Lucy's staunch position as a
tough, capable lesbian woman seemed to prevent any
contact with the therapist on a personal level.
A con-
tinuous effort to be understanding and supportive of
Lucy's difficulties appeared to have no effect on her
ability to trust herself or her therapist.
Her early
abandonment by her mother very likely affected her
ability to form close relationships.
Her fear of
abandonment, which is related to her inability to trust,
contributed greatly to her issues as a lesbian in
treatment.
As pointed out by Clark and Fifield, the
0
27
inability to trust ones' own feelings, because they are
so different from everyone else's, causes people to fear
intimacy and repress the feelings that accompanied that
fear.
Lucy's case clearly indicates this point.
Overall, it appeared that even though an affirmative
model for therapy was provided, Lucy had much difficulty
in overcoming her distrust of her own feelings.
She
terminated her treatment before any significant progress
was made.
•
,,
KAREN
Karen is a thirty-nine year old lesbian who came to
treatment due to feelings of isolation and loss involved
with a recent hysterectomy and several personal losses.
She introduced herself as a "schizoid personality"
and reported a basically "unhappy" childhood, the older
of two siblings, with an "ambulatory schizophrenic" for a
mother.
Moving frequently added to Karen's feelings of
isolation, as she had no chance to make lasting friendships.
The early friendships that she did have were
mostly "crushes."
She was in touch with her sexuality at
an early age and openly sought lesbian relationships.
Since her mother was basically "emotionally unavailable," Karen vias primarily raised by her grandmother,
with whom she had a close, loving relationship.
This
relationship was an intermittent one though, for Karen
was sent away to boarding school, without previous warning.
Karen never knew her father, but her grandfather
was described as "cold and aloof," and seemed to have no
influence on Karen's early life.
In school and social settings, Karen described herself as "isolated and alone."
She felt different from
her peers and uncomfortable about sharing her home life
with anyone.
She therefore had few friends and would
never bring anyone home.
Karen described her experience
at boarding school as "incredibly traumatic."
28
Not having
'
29
been told by her mother that she was going away to
school, Karen was understandably upset upon her arrival
at the convent school she attended from ages five to
nine.
She reports that she was "constantly being puni-
shed" by the nuns, but was given no explanation as to the
reasons.
Karen appeared to internalize, at an early age,
that she was "bad and defective."
The fact that Karen
never received any explanations about her actions and
their consequences, only served to confuse her and caused
her to withdraw further.
When Karen returned home from the school, again
without advance warning, she once again became the object
of her mother's inattention.
Her grandmother played an
important part in Karen's development of a partially
healthy attitude towards herself and was the only loving
memory that Karen had.
At this time, Karen found herself
"in love" with a girlfriend and discovered that she could
feel pleasure in some way.
This relationship was discov-
ered by her friend's mother and Karen was forbidden to
see her.
By this time in her adolescence, Karen began
rebelling, stating, "I had nothing to lose."
She con-
tinued to see this young woman and at that time, found
that she was "different in a good way."
Karen completed high school while still at home and
was an excellent student.
She remained isolated, how-
ever, having had several unsatisfying relationships.
She
30
began therapy at age nineteen and that experience influenced her to seek a marriage, family and child counseling
license.
She reported
11
I really didn't like being a
therapist, because I didn't like myself.
11
She changed
careers and spent two years in China as an interpreter.
While there, she was involved in a
11
good 11 relationship
which had to end when she needed to return to the states
for a hysterectomy.
Upon her return, Karen felt especially isolated and
alone.
away.
During her absence, her grandmother had passed
After her surgery, due to financial reasons, she
had to live with her mother while recuperating.
This
caused additional anxiety and feelings of impotence, and
brought up old resentments towards her mother.
Having
already been involved with the lesbian community, Karen
managed to gain support through some friends made in the
community.
When she was well enough to return to work,
Karen moved to a place of her own and at that point, came
in for treatment.
Treatment issues involved Karen's ability to be clear
about her neediness and her ability to get those needs
met in a healthy way.
These needs included love and
affection, as well as an ability to feel worthy of someone else's love.
She was also dealing with several
losses, her grandmother, her lover in China and the loss
of her uterus, although she did not plan to have
31
children.
She has had difficulty getting in touch with
these feelings and when they are expressed, she would
feel "overwhelmed."
Karen's lack of self-esteem led to
her feelings of "invisibility" for most of her life.
She
therefore felt, in treatment, that she needed to make
herself "special" to the therapist.
She attempted this
by being very bright, witty and superficially insightful.
When this attitude was questioned, Karen requested
that the therapist-client relationship be changed to a
friendship.
This request was denied, because it was felt
that the therapy relationship was the more important of
the two.
The change in the relationship would have been
considered unethical as well.
Karen was able to deal
with this boundary and express her feelings about not
having her need for friendship met.
She
was encouraged
to meet that need outside of therapy, which she did.
Karen appeared more childlike in her sessions after
the therapist established a good working relationship by
setting the boundaries.
She became depressed, due to
the loss of her job and more frustrated by her inability
to maintain a "whole, healthy relationship."
Karen
became increasingly withdrawn, speaking only on a superficial level in her therapy.
she became even more
express herself.
When confronted about this,
chi~dlike,
withdrawn and unable to
32
This withdrawal appeared to culminate in a complete
withdrawal from therapy and a subsequent suicide
attempt.
Karen mailed letters and objects of signif-
icance to friends, as well as to her therapist, and was
discovered at horne, drugged, but still alive.
She was
hospitalized and, upon her discharge, resumed treatment,
at the rate of twice weekly.
From that point on, Karen
appeared more emotionally available than she had previously been.
She appeared "desperate" to resolve her
emotional pain, since her attempt at death had been
unsuccessful.
At this point, her work revolved around Karen's
ability to care for herself.
Constant reinforcement of
her "ok-ness" and the ability to identify her "needy
child" became the focus of treatment.
Karen began to be
able to identify "little Karen" and tend to her needs in
a more loving way.
The child's need for love, affection
and constancy were of primary importance at this time.
By having Karen keep a journal where she could write to
the "little one", this part of her became more identifiable, thus easier to work with.
She has been able to
construct many more resources with which to take care
ofherself than she had previously.
Her ability to
"parent" herself has increased dramatically since her
attempt, as well as her understanding of her own mother's
33
unavailability.
Both modeling and self-disclosure on the
therapist's part, have assisted greatly in Karen's
ability to care for herself.
As Karen began to recover from her attempt, she
allowed herself to become more involved in the comununity.
Karen met Kate through an organization for lesbian
women.
For the first time, Karen allowed herself to par-
ticipate in a relationship more fully than she had
before.
She allowed herself to be needy and express
those needs, which were met by Kate.
Karen now had a
place to practice what she was learning and this relationship gave her an opportunity to take care of herself,
while being with someone else.
Karen's long standing fear of rejection and her feelings of being "different" figure prominently in her
issues as a lesbian in
treatment~
From an early age,
Karen experienced this sense of "difference," but had
nowhere to validate her feelings.
Through her early
recognition of her feelings for women and her work in
therapy, she was able to see her difference as acceptable, although not her neediness.
Through the use of
validation and affirmation, Karen has integrated these
feelings and needs into a "whole" part of herself and is
able to care for herself·differently than in the past.
(1
DISCUSSION
Karen initially presented herself for treatment due
to several losses in her life.
She dealt with these on
an intellectual level at the beginning of her therapy,
due to the fact that she did not appear to trust the
feelings she was experiencing.
Karen, appeared, at first
glance, to be bright, articulate and well-adjusted.
As
therapy progressed, she became depressed and emotionally
withdrawn.
Karen's main difficulty was the inability to
trust her own feelings.
This is an important point
mentioned by Clark. She would become easily overwhelmed
by emotions and required a lot of reassurance from the
therapist.
Through slow, gentle exploration and the
experience and validation of these feelings in a safe
environment, Karen has learned to not be afraid of the
way she feels.
Karen had previously experienced several unsatisfying
relationships, due to the aforementioned fears.
This is
a common issue for lesbian, as mentioned by Clark.
She
manifested this fear in treatment by being leery of the
therapist and not trusting the therapist to "be there" in
an emergency.
Throughout the latter part of her treat-
ment, Karen had availed herself of the option to call in
between sessions when she was having a difficult time
34
'
35
emotionally.
This has helped to further establish trust
on her part.
Since Karen's basic belief about herself was that she
was "bad and defective", she was sorely lacking in
self-esteem.
Much time was spent affirming the positive
aspects of herself and her life, such as her creative
ability and her intellect, as well as her identity as a
lesbian.
Karen began to become more involved in the
community and also began a relationship at this time.
As treatment progressed, Karen became more depressed
and withdrawn and appeared to shut out any input from the
therapist.
When confrontation was used, Karen would
remain silent, looking much like a pouting child.
This
withdrawal was followed by an unsuccessful suicide
attempt, for which Karen was hospitalized.
After this
incident, Karen's progress in treatment was rapid.
She
experienced much guilt over her actions, especially with
the therapist and this appeared to open up a new area of
emotion for her.
Karen had experienced guilt most of her
life over not having met her mother's expectations.
is an important point raised by Women's Resources.
This
Even
though they were rather unrealistic, Karen still felt
guilty.
As far as the therapist was concerned, Karen
learned that she could
d~sappoint
the consequences of that action.
someone and experience
She also learned that
the therapist still cared about her and validated her
36
feelings, while expressing what it was like to be
disappointed.
Much time was spent at this point in
·therapy, giving positive energy and feedback to Karen's
identity as a lesbian, as recommended by Fifield.
Another therapeutic issue which had to be dealt with
was Karen's fear of rejection and abandonment.
She had
already been rejected and abandoned by her mother so this
was a big issue in her treatment.
The therapist's
familiarity and affirmation of Karen and her identity as
a lesbian helped to lessen her fear of rejection.
This
issue was discussed by both Clark and Fifield, and by
providing a safe environment where her feelings were
constantly being affirmed, she was able to take more
emotional risks and was less afraid of rejection.
Having made much progress in her treatment since her
suicide attempt, Karen was able to trust herself and her
feelings.
herself.
This change allowed her to take better care of
Through experiencing constant affirmation
during therapy, an important point mentioned by Fifield,
Karen's emotional health and comfort level with her
identity as a lesbian and as a woman increased greatly.
HELEN
Helen is a fifty-five year old divorced mother of
three, coming in for treatment due to difficulties with
issues of intimacy, trust and anger.
Helen lived a heterosexual life-style until age
thirty-five, when she discovered her lesbian sexuality.
She divorced her husband, although the divorce was not a
direct result of her lesbianism.
During this time, her
children stayed with their father, as she was seen as an
"unfit mother."
Helen had been involved in the gay
community for the last ten years, since she moved to Los
Angeles from Alabama.
She had had several lesbian
relationships, the last of which "devastated" her, four
years before.
She admitted to having worked on these
issues of intimacy, trust and anger in previous therapy,
but they still remain largely unresolved.
Her childhood was reported as "unhappy."
The oldest
of five siblings, all female, she received the brunt of
parental discipline and anger.
"I remember locking
myself in the bathroom so my father couldn't beat me and
my mother screaming behind him."
Helen spent as much
time as she could outside the home and never really knew
most of her siblings well.
recently died of cancer.
One with whom she was close
According to Helen, "we all had
different childhoods."
37
38
At the age of thirteen, Helen's parents confronted her
upon her return from a night out, with the accusation that
she was no longer a virgin.
They insisted upon taking her
to the doctor for an examination and she refused.
After
that time, Helen spent virtually no time at home, living
with friends.
As soon as she was able to afford it, she
moved from her parents' home and lived on her own.
She
was married, shortly thereafter, at the age of nineteen,
to a man that was "the exact duplicate of my father."
Helen had two children, a boy and a girl.
being "miserable most of the time."
She reported
At the age of
thirty-five, she became involved in a lesbian relationship and opted out of her marriage, due mostly to her
husband's treatment of her, which was constantly abusive.
During this time, Helen reported "I had no time for anyone
but me, I was crazy and terrified, but I knew I had to get
out."
Leaving her children with her husband, she moved
into her own home in the same city, facing disapproval
from family and friends due to her divorce.
Helen chose,
at that time, not to disclose her sexual identity to
anyone in her family, other than her husband•
Upon deciding that she needed to make a change, Helen
moved to Los Angeles in 1977.
She was then more aware of
her sexuality and became.involved in primarily lesbian
relationships.
She became active in the gay community and
attended support groups, as well as individual therapy.
39
Her major treatment issues included repressed anger
towards her father, feelings of guilt about abandoning
her children, feelings of insecurity about her ability to
care for herself and sexual identity issues.
She came to treatment four years after a "devastating" relationship had ended.
Helen had trusted her
feelings for Sue and had committed herself financially,
as well as emotionally.
After living with Sue for six
months, Helen found herself being physically abused, much
in the same way her father and husband had abused her.
She expressed much anger and regret about Sue and the
fact that she allowed herself to continue in the relationship when it was "obviously sick."
She was also
unable to forgive herself for making "such a big
mistake."
The establishment of trust and rapport was the first
difficult task for Helen in her treatment.
She expressed
doubts about the therapist's age and experience, but
since she had asked specifically for a lesbian therapist,
was "willing to give it a try."
A good connection was
established, as Helen was seen promptly and this was one
issue of importance for her.
Her major concern seemed to
focus on whether or not her therapist would "be there in
a crisis" and how effective an intervention that would
be.
The therapist was tested on several occasions, when
Helen would call in between sessions, in crisis,
40
invariably experiencing difficulties with the answering
service.
This appeared to be one way that she could
effectively sabotage any contact, by claiming the service
had not reported her message.
This issue was worked
through with much reassurance and confrontation as to why
she needed to sabotage that contact, and Helen began to
develop the basic trust necessary for treatment to
advance.
Helen's fear of her repressed anger seemed to cause
her a great deal of difficulty in treatment.
She was
unable to express any overt anger towards the therapist,
for fear she \.vould "lose control."
She was also afraid
of showing her anger, in fear that this anger would
"scare" her therapist away.
When incidents arose in
treatment which would have provoked anger, Helen avoided
discussing them.
When questioned about these feelings,
she would respond, "I'm fine, there's no problem, why do
you think that's so important?"
Following these denials
of her feelings, she would report an episode of binge
eating in her next session.
When this was discussed,
Helen appeared able to make the connection of "stuffing"
her feelings intellectually, but not emotionally as
yet.Helen had the opportunity to participate in a women's
group, concurrent with
he~
individual treatment.
The
other members of the group were made aware of the fact
v '
41
that one of the leaders (this writer) was a lesbian and
that there would be lesbian women in the group as well.
Helen quickly identified herself in the group and aligned
herself with her therapist.
Another member of the group,
Marge, happened to have been a friend of Helen's from a
previous job.
Their relationship had ended with much
unexpressed anger on Helen's part and she spoke of this
in individual treatment.
She was encouraged to express
these feelings in the group, but refused, stating "not in
front of all those people."
As the group progressed and became more cohesive,
Helen became more active in dealing with her day to day
issues and feelings, stating "I feel wonderful and
powerful in group."
Since her therapist was the more
active of the two leaders, it was felt that Helen was
using the model provided.
She, at times, became more of
the focus of the groups' projections than did the leaders
and she handled this by withdrawing emotionally.
When
she was confronted by the group about this, she withdrew
further and began talking about leaving the group.
On one particular day, Helen had been listening to
Marge talk about some difficulties and Helen became
noticeably agitated.
She began moving around in her
chair and making faces at the ceiling.
When asked what
was going on with her, she became angry and yelled at
Marge, stating, "You're always doing the same things
42
wrong and then complaining about them."
Marge became
angry as well and began shouting at Helen.
They both
began to use profanities and were stopped from going any
further.
This interchange had occurred at the end of the
group and some time was taken to deal with the group's
feelings, but the incident had major repercussions.
Helen, upon corning in for her session, felt ashamed
and humiliated and refused to return to group.
Through
the use of much validation of her anger and support for
allowing herself to get angry, she did agree to return.
The group was aware of Helen's difficulty with anger and
was supportive of her expression of it, although had some
constructive criticism about her choice of words.
Marge
and Helen were able to discuss their feelings for one
another and Helen was able to see the part of herself
that Marge represented, the part that didn't make needed
changes and then complained about her situation.
The group experience seemed to provide Helen with a
more direct experience of her emotions and shortly after
this incident, she left the group.
In her sessions, she
expressed that she "had gotten all I'm going to get from
the group.''
She still expressed much fear over express-
ing the depth of her anger within the group setting, even
though she had received -some reassurance.
43
Having recently experienced feelings of greater insecurity, due to the loss of her job, Helen expressed a
"wish to be taken care of."
She appeared unable to
recognize and own the fact that she had taken care of
herself most of her life.
When this was pointed out to
her, she would diminish its validity, stating, "I did
what I had to do."
The combination of Helen's age (55)
and her fear of involvement in a relationship was having
a more pronounced effect on her self-esteem at this point
in treatment.
Her wish to be taken care o£ was manifest-
ing itself in some sexual identity confusion, as Helen
believed that "only a man can take care of me.
bisexual."
Maybe I'm
Through the therapist's use of validation and
clarification of her feelings, Helen was able to realize
that being taken care of, for her, meant being abused.
She was aware that she did not want this in any relationship, with a male or female.
Helen also began to under-
stand that it was all right for her to have needs and
acknowledge them.
With a little encouragement, she was
able to ask her friends for some support and caring, as
well as doing some little things for herself.
At this point, Helen made a more concerted effort to
care for herself and was relatively successful.
She was
able to ask more easily jor what she needed and this
appeared to boost her self-esteem.
She acquired a new
44
job which she enjoyed and which made her feel more useful
in general.
Helen's issue with regard to her lesbianism played a
role in her treatment.
She was open about her sexuality
with most friends and family, although her parents did
not know of her sexual preference.
She also chose not to
come out at work, as she feared repercussions from her
co-workers.
Helen's belief that "only a man" could take
care of her was another issue faced in treatment.
Since
women usually play the role of caretaker, it is difficult
to learn how to care for oneself.
The positive modeling
and affirmative attitude taken towards the acceptance of
Helen as a whole and her sexual orientation in particular, was largely responsible for Helen's acceptance of
herself.
She was able to integrate more easily, that
whatever she felt was all right and need not be judged.
This attitude later enabled her to come out to a friend
at work and lessen some of the pressure she felt about
hiding an important part of who she was.
Near the end of treatment, which lasted one and one
half years, Helen appeared to have fewer difficulties
with her initial issues, anger, intimacy and trust.
It
appeared that the group experience had been invaluable
for her, both individually and with regard to the clienttherapist relationship.
-Helen appeared less afraid of
her feelings and was able to make much progress in
therapy.
DISCUSSION
Helen's treatment issues basically revolved around
her sexual identity confusion.
As pointed out by Women's
Resources, Helen experienced much guilt over the fact
that she had left her children.
She was just discovering
her lesbian sexuality and breaking away from the expectations of her family.
This caused a lot of guilt on her
part, as she was directly violating "heterosexual"
rules.
Helen never did come out to her family and also
carries guilt about her secretiveness.
This guilt
prevented Helen form being able to make a clear decision
about her sexual preference.
She remained confused and
this state disabled her emotionally.
Inherent in this confusion was Helen's inability to
trust her ovm feelings as "OK".
As mentioned by Clark,
as well as illustrated in the previous case discussions,
Helen too suffered from a lack of trust in her emotions
and a feeling of being overwhelmed by them, lest she feel
them.
This issue is of central importance to lesbians in
treatment, or for that matter, anyone attempting to live
outside of society's stereotyped roles.
trust ones' own feelings directly
The inability to
~nterferes
with that
individual's ability to ascertain what they want in order
to fulfill their life.
Helen struggled with this issue
through most of her treatment.
45
46
Helen's sexual identity confusion also accounted for
a lack of self-esteem and unsatisfactory interpersonal
relationships.
this isolation.
She experienced much loneliness due to
These issues, such as isolation and fear
of rejection, brought up by Clark, only served to
increase her feelings of worthlessness.
When Helen
allowed herself to actually experience these feelings,
she either became "immobilized" or went on an eating
binge, designed to "stuff down" her feelings.
Through
the therapist's use of gentle exploration of these
feelings and continuous affirmation of her right to feel
them, Helen slowly began to trust her emotions.
The amount of repressed anger on Helen's part, as
mentioned by Clark, also served as an obstacle to her
treatment.
She feared this anger, because she felt she
would lose control.
Her ability to get angry with the
therapist was also hampered, as she believed she would
"destroy" her.
\'Vhen Helen was encouraged to express
small pieces of that anger, she saw that it was
manageable.
Her expression of anger was validated and
her right to feel angry affirmed.
Helen's suspicion that she was bisexual was a clear
indicator of the amount of confusion she was
experiencing.
She felt that she had to identify herself
as either a lesbian or a heterosexual in order to be OK.
Much time was spent on finding out what felt good for her
47
and affirming it.
Helen's own confusion and inability to
care for herself led to her desire to date men.
She
believed that "only a man could take care of me."
This was an erroneous assumption on ·her part and work
was done with sex-role analysis.
This entailed seeing
her role as a lesbian as a "sex-role outlaw", and
understanding that the problem was created externally,
not internally.
Helen needed to be clear for herself
about what it meant to be taken care of and that someone
of either gender could provide that.
She also learned
that she could care for herself and that helped her to
dispel some of the guilt she had felt.
Helen began to
feel OK about caring for herself and less guilty about
not caring for others.
An atmosphere which affirmed her
ability to care for herself aided Helen in clearing some
of her confusion.
Helen had managed to work through most of the initial
issues in her treatment.
She exhibited less confusion
upon the termination of treatment, but continues in
individual work with another therapist.
SUMMARY OF CASE DISCUSSIONS
In reviewing the case studies, one common factor
appears.
In each case, the client had difficulty
trusting her own feelings.
This led to the the problems
each had in allowing herself to experience those feelings
as well.
Many other issues seemed to arise from this
primary problem, as mentioned by Clark.
They include
poor interpersonal relationships, low self-esteem and
difficulty being open and spontaneous.
exhibited in all three cases.
These issues were
In Lucy's case, this issue
led to her continuing abuse of drugs and alcohol.
The issue of being either physically or emotionally
abandoned by their parents also appears to have had an
impact on their lives as lesbians.
In each case, the
client's amount of neediness, ie. need for love and
affection, and ability to trust another appeared affected
by this early abandonment.
Being a lesbian, a "sex-role
outlaw", as Fifield points out, is difficult enough, but
navigating through a life-style with no guidance is even
more difficult.
In Helen's case, she functioned for many years as a
heterosexual woman and, as a result, had great difficulty
in acknowledging and living a lesbian life-style.
In
both Karen and Lucy's cases, they both knew rather early
about their sexuality and had fewer problems adapting to
48
49
the life-style.
Helen appeared to have the most diffi-
culty of the three clients with regard to the issue of
guilt, due to the change in her life-style.
As Women's
Resources pointed out, the guilt arises from not fulfilling the expectations of significant others, and in
Helen's case, was most prominent.
For the most part, the issues previously mentioned by
Clark, Fifield and Women's Resources have played a role
in each client's treatment, in much the same way.
Each
had difficulty being able to trust herself or others and
this affected the treatment approach, in that much time
needed to be spent on developing the trust level in the
relationship.
CONCLUSION
The role of therapists is to help those who request
assistance in growing and developing as humans to their
fullest potential.
In order to succeed, therapists need
to know as much as they can about the new situation in
which the lesbian finds herself.
This new situation is
based on women loving women and on women loving themselves and defining their own identities as humans.
The
lesbian finds no century-old system of rules to guide her
behavior.
Thus, we are charting new territories in
relationships and life-styles.
Viewing lesbians as pioneers-in-process is a positive
approach to dealing with the problems encountered in
developing and growing.
The term pioneer refers to a
person or group that originates or helps to open up a new
line of thought or activity.
Lesbians fit this defini-
tion because they have psychologically stepped outside of
and beyond the boundaries of the heterosexual system.
A
redefinition is needed to dispel the old imagery of
lesbians as alienated or sick.
We create our world by
the terms we use to define it.
Many of the problems
lesbians experience may have more to do with connotations
we give to the words "alienation" or "separateness," than
with the situation in which the woman finds herself.
redefining the situation as one of power, vibrant with
50
By
51
growth potential, a pioneer effort outside the heterosexual system, that we may begin to reduce the problems
that lesbians experience.
It needs to be understood that many women who seek
counseling are in process, the process of coming out,
which is on-going.
They may be conscious of the magni-
tude of the steps they have taken or are contemplating
taking, but for many the impact of their actions is
subconscious, rather than conscious.
not see themselves as pioneers.
Many lesbians would
It is clearly put by
Mary Daly:
The beginning of a breakthrough means a
realization that there is an existential conflict between the self and the structures that
have given such crippling security. This requires confronting the shock of non-being (in
the old world) with the courage to be. It means
facing the nameless anxieties of life, which
become concretized in loss of jobs, friends,
social approval, health and even life itself.
Also involved is an anxiety of guilt over refusing to do what society demands, a guilt which
can hold one in its grip long after it has been
recognized as false. Finally, there is the anxiety of meaninglessness, which can be overwhelming at times when the old simple meanings, role
definitions and life expectations have been
rooted out and rejected openly and one emerges
into a world without models (Daly, 1973).
The point made clearly by the case studies is that
there are definite issues to be concerned with while
engaged in therapy with lesbians.
These issues can be
incorporated into any existing therapeutic approach, and
should contain an emphasis on affirming the client as a
52
positive human being. The role of the therapist, then, is
to attempt to understand this complex process of pioneering and provide the support necessary for the continued
development of the person.
The overall message of the
therapy should focus on the creative capabilities of the
lesbian client and support the courage it takes to
continue.
53
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