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The assumption of heterosexuality in supervision

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Abstract

It is the author's experience that clinical supervision tends to assume heterosexuality unless specifically identified otherwise. Discussed is that art therapy supervisors and supervisees should be alert to the implications of heterosexism for themselves and their clients. Further that it is necessary to hold in mind our identity as pertaining not only to our sexual orientation but to all that makes up our identity.

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... Of course, phantasies cannot be consciously controlled. But surely the absence even of the 'idea' of phantasy leads to a more rigid, or even fearful, exploration of sexuality, as if fluidity is something not allowed or acceptable (Dudley, 2013). As Payne (2010) asks: can we allow our traineesand I add our clientsto move in concert with the impact of phantasies, including the whole range of sexual phantasies? ...
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ABSTRACT Psychoanalytic theories of sexuality have regarded homosexuality as a symptom of arrested sexual development. Such theorizing fails to acknowledge the prejudicial values that underpin it. The work of the philosopher, Michel Foucault, can offer psychotherapists new possibilities of considering sexual orientation that do not presuppose a split between the psychic and the socio-political. The complexity and diversity of lesbian roles, identities, experiences and cultures are particularly highlighted by Audre Lorde (a Black lesbian feminist theorist). The two cases illustrate how a Foucauldian analysis, combined with a psychoanalytic approach, can enable us to respond more sensitively to questions of identity in our work with patients.
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Do transgender people transcend gender or merely cross from one side of a physical binary divide to the other? Can such transcendence offer opportunities for arguments in support of unconscious life which the majority of psychotherapists would fight for, but often without success. Can the transgendered person offer us a way of thinking about what is termed and fixed as a category as mental illness. Copyright © 2010 John Wiley & Sons, Ltd.
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Supervision in art psychotherapy. A theorectical and practical handbook
  • C Case
  • J Schaverien
Case, C., & Schaverien, J. (Eds.). (2007). Supervision in art psychotherapy. A theorectical and practical handbook. East Sussex UK/New York USA: Routledge.
Approaching multiple diversity: Addressing the intersections of class, gender, sexual orientation and different abilities
  • L S Diamond
  • J R Gillis
Diamond, L. S., & Gillis, J. R. (2010). Approaching multiple diversity: Addressing the intersections of class, gender, sexual orientation and different abilities. In C. Lago (Ed.), Race, culture and counselling: The ongoing challenge (pp. 217–228).
Singing with pleasure and shouting with anger: Working with gay and lesbian clients in art therapy
  • J Fraser
  • J Waldman
Fraser, J., & Waldman, J. (2003). Singing with pleasure and shouting with anger: Working with gay and lesbian clients in art therapy. In S. Hogan (Ed.), Gender issues in art therapy (pp. 69–91). London and Philadelphia: Jessica Kingsley Press.
Issues surrounding sexual identity in therapy in final report for the diploma in art therapy. Goldsmiths College, London University Ethnic minority lesbians and gay men:mental health and treat-ment issues Ethnic and cultural diversity among lesbians and gay men
  • J Fulton
Fulton, J. (1992). Issues surrounding sexual identity in therapy in final report for the diploma in art therapy. Goldsmiths College, London University. Unpublished. Greene, B. (1997). Ethnic minority lesbians and gay men:mental health and treat-ment issues. In B. Greene (Ed.), Ethnic and cultural diversity among lesbians and gay men. Thousand Oaks, CA: Sage.
The introduction: Contesting identities
  • S Hogan
Hogan, S. (2003). The introduction: Contesting identities. In S. Hogan (Ed.), Gen-der issues in art therapy (pp. 11–22)
The dictionary of feminist thought
  • M Humm
Humm, M. (1995). The dictionary of feminist thought (2nd ed.). Hemel Hempstead: Prentice Hall/Harvester Wheatsheaf.
From the Peninsula: The geography of gender issues London and Philadelphia The Nafsiyat Intercultural Ther-apy Centre: Ideas and experience in intercultural therapy
  • M Jones
Jones, M. (2003). From the Peninsula: The geography of gender issues. In S. Hogan (Ed.), Gender issues in art therapy (pp. 92–107). London and Philadelphia: Jessica Kingsley Press. Kareem, J. (1992). In J. Kareem, & R. Littlewood (Eds.), The Nafsiyat Intercultural Ther-apy Centre: Ideas and experience in intercultural therapy (pp. 14–37). Oxford: Blackwell Scientific Publications.
Race. In Culture and counselling: The ongoing challenge. Berkshire, England: Open University Press. Loureiro De Olivereira A mediterranean perspective on the art therapists sexual orientation
  • C Lago
Lago, C. (2010). Race. In Culture and counselling: The ongoing challenge. Berkshire, England: Open University Press. Loureiro De Olivereira, J. B. (2003). A mediterranean perspective on the art therapists sexual orientation. In S. Hogan (Ed.), Gender issues in art therapy (pp. 126–147). London and Philadelphia: Jessica Kingsley Press.
Issues in therapy with lesbian, gay, bisexual and trans-gender clients. Pink therapy 3
  • C Neal
  • D Davies
Neal, C., & Davies, D. (2000). Issues in therapy with lesbian, gay, bisexual and trans-gender clients. Pink therapy 3. Berkshire and England: Open University Press.
Wild desires and mistaken identities, lesbianism and psychoanalysis
  • O Connor
  • N Ryan
O'Connor, N., & Ryan, J. (1993). Wild desires and mistaken identities, lesbianism and psychoanalysis. London: Virago.
Where now? Recent thinking on psychoanalysis and homosexuality. In Paper for Women's Therapy Centre And Freud Museum conference. Women Today
  • J Ryan
Ryan, J. (2002). Where now? Recent thinking on psychoanalysis and homosexuality. In Paper for Women's Therapy Centre And Freud Museum conference. Women Today. http://www.the-site.org.uk. June 2013
Supervising the erotic transference Gen-der, countertransference and the erotic transference Epistemology of the closet
  • J Schaverien
Schaverien, J. (2006). Supervising the erotic transference. In J. Schaverien (Ed.), Gen-der, countertransference and the erotic transference. In perspectives from analytical psychology and psychoanalysis (pp. 56–70). Hove: Routledge. Sedgewick, E. K. (1990). Epistemology of the closet. Berkeley: University of California Press.
Working in black & white: An art therapy supervision group Supervision of art psychotherapy. A theoretical and practical handbook East Sussex: Routledge Dynamics of race and culture in the supervisory encounter
  • S Skaife
  • P Tummala-Narra
Skaife, S. (2007). Working in black & white: An art therapy supervision group. In C. Case, & J. Schaverien (Eds.), Supervision of art psychotherapy. A theoretical and practical handbook (pp. 152–1309). East Sussex: Routledge. Tummala-Narra, P. (2004). Dynamics of race and culture in the supervisory encounter. Psychoanalytic Psychology, 21, 300–311.