The assumption of heterosexuality in supervision

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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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Dance movement psychotherapy (DMP) has contributed relatively little to literature and research on the topic of sexuality. Starting with a critical and thematic literature review from 1976 to the present day, attention is drawn to absences in theory, biases in practice, and an overall neglect of approaches to sexuality that employ fluid perspectives. This theoretical paper integrates perspectives from psychodynamic, person-centred, feminist and queer theories to engage with the history of DMP as a clinical discipline. Seven specific reasons are offered as to why the fullness of sexuality has tended to be avoided or ignored in DMP, and suggestions are made concerning how the profession can move forward.
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This article is aimed at psychotherapists and health practitioners who have not reflected on the role of race, culture and ethnicity in the provision of psychological treatments. We highlight the key issues of importance in engagement, assessment and ongoing therapy, supporting practitioners to reach a stage of pre-competency. Competency will be achieved with additional training, supervision and innovation. Psychological treatments are an essential part of a comprehensive mental health service, and there have been a number of influential reviews of their effectiveness. Roth & Fonagy (2005), for example, concluded that psychodynamic interventions are helpful in borderline states and that family therapy is useful for eating disorders and in the treatment of children and adolescents. Cognitive-behavioural therapy (CBT) is an effective treatment for anxiety, obsessive-compulsive disorder (OCD) and depression, and in the management of hallucinations and delusions in chronic mental illness (Turkington et al, 2006). Expressed emotion work is effective in preventing relapse in schizophrenia (although it is rarely well resourced). The ability to conduct psychotherapy effectively with racially and ethnically diverse populations is becoming increasingly relevant and is recognised to be important in addressing inequalities, which may also be patterned by differences in age, gender, class and sexual orientation. In this article we focus on race, culture and ethnicity. We will address issues surrounding gender and sexual diversity in a future article. Regarding the evidence base, few evaluations of the effectiveness of psychotherapy have included adequate numbers of ethnic groups (Alvidrez et al, 1996), and few studies report on adaptations of proven interventions for use by culturally and linguistically unique populations. In many National Health Service (NHS) psycho- therapy departments in the UK large numbers of people are treated, often by a few highly trained senior therapists and by psychiatric, psychology, social work and psychotherapy trainees under supervision. As few training experiences include attention to racial and cultural implications for effective psychotherapy, experienced and trainee therapists alike share the need to develop and adapt their interventions for a society that is increasingly racially and culturally diverse. Critiques of this subject area tend to emerge from experts in culture, health and illness, and include sociological and anthropological disciplines that use specific methodologies for generation of knowledge. These analyses are often theory rich and not easily accommodated into everyday practice, although they can highlight its limitations. Alternatively, psychotherapists practising in multi-ethnic areas immediately recognise the need for better knowledge and models of work with multi-ethnic populations, but it is difficult to ensure that adaptations of existing psychological interventions are effective. In the absence of both well-established guidelines and an adequate evidence base, we consider here some of the complex issues facing psychotherapists working in multicultural and multiracial populations. The article is aimed at practising psychotherapists rather than researchers in cultural psychiatry or medical anthropology.
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abstract The ideas of psychoanalytically-oriented psychotherapists about human sexuality have changed radically in recent years. During the past three decades we have worked toward revising traditional psychoanalytic ideas about sexual orientation in particular. This revision has contributed to changes in clinical theory and practice, and we review both our own work, and these changes, in this article. We have approached the many complex scientific and clinical problems in this field from a developmental, biopsychosocial perspective. We have also emphasized the importance of integrating psychoanalytic theories of sexuality with advances in neuroscience, descriptive psychiatry and sexology generally. In this article we draw on our experience as researchers and clinicians to discuss such common clinical problems in psychotherapeutic work with non-heterosexual patients as assessment of the patient, homophobia, internalized homophobia, gender differences among patients and therapists, the ageing patient, sexual orientation of the therapist, and transference and countertransference.
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we know very little about mental health practitioners' views on treatments to change sexual orientation. Our aim was to survey a representative sample of professional members of the main United Kingdom psychotherapy and psychiatric organisations about their views and practices concerning such treatments. We sent postal questions to mental health professionals who were members of British Psychological Society, the British Association for Counselling and Psychotherapy, the United Kingdom Council for Psychotherapy and the Royal College of Psychiatrists. Participants were asked to give their views about treatments to change homosexual desires and describe up to five patients each, whom they has treated in this way. Of 1848 practitioners contacted, 1406 questionnaires were returned and 1328 could be analysed. Although only 55 (4%) of therapists reported that they would attempt to change a client's sexual orientation if one consulted asking for such therapy, 222 (17%) reported having assisted at least one client/patient to reduce or change his or her homosexual or lesbian feelings. 413 patients were described by these 222 therapists: 213 (52%) were seen in private practice and 117 (28%) were not followed up beyond the period of treatment. Counselling was the commonest (66%) treatment offered and there was no sign of a decline in treatments in recent years. 159 (72%) of the 222 therapists who had provided such treatment considered that a service should be available for people who want to change their sexual orientation. Client/patient distress and client/patient autonomy were seen as reasons for intervention; therapists paid attention to religious, cultural and moral values causing internal conflict. A significant minority of mental health professionals are attempting to help lesbian, gay and bisexual clients to become heterosexual. Given lack of evidence for the efficacy of such treatments, this is likely to be unwise or even harmful.
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Early psychodynamic writing on same-gender sexual preference contributed to its pathologisation and an interest in treatment directed at changing sexual orientation. To establish the therapeutic approaches taken by contemporary psychotherapists and psychoanalysts to gay and lesbian clients/patients. A random sample of individuals listed as working with adults in the British Confederation of Psychotherapists' register were sent postal questionnaires. Data are available from 274 (69%) of 395 questionnaires. Only one of 218 respondents said that he/she was homosexual. One-third said that gay and lesbian patients did have a right to a gay or lesbian therapist. A total of 179 (82% of 218) respondents described work with gay and lesbian clients/patients, and in the majority of cases sexual orientation was an important aspect of the work. Gays and lesbians seeking psychoanalysis or psychotherapy in the National Health Service or outside it for personal and/or training purposes will be unlikely to find a gay or lesbian therapist if they want one. The British Confederation of Psychotherapists' practitioners take on gay and lesbian clients/patients, although many do not see these social identities as relevant to the therapeutic process. Evidence from this study indicates that such clients/patients may encounter overt or covert bias, including the pathologisation of homosexuality per se.
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A questionnaire comprising two scales, the short form of the Attitudes Towards Lesbians and Gay Men Scale (ATLG-S; Herek, 1984) and the newly devised Support for Lesbian and Gay Human Rights Scale (SLGHR) were administered to 226 students taking undergraduate psychology courses at universities in the United Kingdom, to assess their attitudes towards lesbians and gay men, and their level of support for lesbian and gay human rights. The results indicated that whilst only a small percentage of respondents expressed negative attitudes towards lesbians and gay men on the ATLG-S, the sample as a whole did not overwhelmingly support lesbian and gay human rights. The lack of support for lesbian and gay human rights is discussed in relation to its implications for psychology students as future practitioners and policymakers.
Theory and criticism arising from contemporary feminist art discourse can be a significant influence in the development of a feminist art therapy. The dominant cultural paradigm of modernity, with its emphasis on originality and timelessness, and its erasure of gender, has influenced contemporary art therapy practice. This paradigm has influenced our perceptions of ourselves as artists as well as our clients' self-perceptions. Our beliefs about art are as influential as our beliefs about psychotherapy, and will affect our approach to the practice of feminist art psychotherapy.
The explicit integration of political asylum advocacy into the frame of psychodynamic psychotherapy is described. Patients are eighteen gay, bisexual, or transgendered men from twelve countries at various stages in the asylum process. Some are HIV+ or living with AIDS. All were persecuted or tortured in their countries of origin because of their sexual orientation. All are at risk of deportation if they do not win their cases. When they were children, several of the men were sexually abused. As latency-age boys and as older youths, most were physically abused because they were gender atypical. Technical recommendations regarding the process of asylum advoċacy are provided. Advocacy and psychotherapy are not separate activities, but complex psychotherapeutic experiences. The therapeutic relationship is likely to become the crucible for intense feelings associated with childhood physical and sexual abuse, as well as subsequent persecution and torture. Both the therapist and the patient are vulnerable to acting in the transference-countertransference. It is possible that the necessary, asylum-related activity of the analyst in the early phases of the treatment will be negatively experienced by the patient at a later stage. Obstacles to resolving negative therapeutic reactions are discussed.
Using Pierre Bourdieu's ‘theory of symbolic violence’ and ‘misrecognition’ this paper focuses specifically on the way sexuality and gender are negotiated in therapeutic training. Drawing from UK-based research over the past decade with 70 qualified and registered, predominantly cis-gendered, heterosexual and non-heterosexual therapists, I reflect upon, and offer reasons for, the way therapeutic studies continually struggle to offer legitimacy and recognition to mainstreaming anything other than heteronormative versions of social, sexual and emotional life and how an alternative reading using queer theory, can complicate the terrain of sex, sexualities and genders and offer a way out of the present impasse. My own interest in ‘misrecognition’ focuses on the epistemic violence perpetrated when there exists a complicit subordination to the dominant group, and how this is a far more violent practice towards those who are already marginalized, disempowered and socially excluded in relation to sexed, sexualized and gendered bodies because it legitimates oppression, resists radical shifts in power and has wider implications for citizenship (particularly emotional) and sociality. I focus on the strategies employed by therapists to perpetuate this type of ‘gentle violence’ and how it impacts on the construction of the social and emotional self. Although sex, sexuality and gender form the basis of this research, I am only too aware of how these may be used to provide discrete categories within ‘interlocking systems of oppression’ that also include race, ethnicity, class and ableism. For the sake of this article, intersectionality is considered a useful tool, from which to re-negotiate and re-cognize the violent context of therapy and its underlying practices. Copyright © 2011 John Wiley & Sons, Ltd.
The authors describe how regular discussions about their supervisory work with art therapy students highlighted an interest in the role of the image in art therapy supervision. This is explored through their experience of using image making in supervision groups. The nature of the supervision process and the role of image making in supervision is discussed with reference to the literature. The aims and composition of the supervision groups are described in the context of the training. The effects of incorporating aesthetic experience into the groups, and its effect on thinking are explored. The authors conclude by discussing the uniqueness of image making and its evolving position within the profession.
This article explores psychoanalytic attitudes to homosexuality and uses the concept of social unconscious as an aid. Group-analytic silences around the subject are explored and clinical material presented to show a more affirmative stance.
This article addresses the pervasive influence of assumed norms of sexuality in the relationships between co-therapists and groups. It is suggested that there is an automatic tendency for groups to place co-therapists into a normal, heterosexual, married relationship to one another and in relation to the group as family, and the literature assumes that this is, in itself, therapeutic. However, this normality avoids and prevents exploration of alternative sexualities, stigmatising them as inferior to and mere deviations from heterosexuality. This, the author suggests, is blinkered and unhelpful to both client and therapist, and art psychotherapists need to raise their awareness of their own and their clients sexualities.
This article has its origins in a paper ‘Queer Languages/Cultural Bodies’ (which I presented at the conference Queer Analysis, organised by Pink Therapy in October 2004), an extended version of which was published in Psychodynamic Practice, Vol. 11, No. 4 (November 2005). In those earlier papers I drew considerably on the imagery produced by women in a workshop which I facilitated entitled, ‘Am I a Lesbian?’ which I discuss here. I have very much welcomed the opportunity to develop the theme of language and sexualities specifically in relation to art therapy. I aim to open out possibilities of interpretations of sexualities which are not universalising and which arise from an attention to the uniqueness and specificity of the patient's language. I highlight how a phenomenological perspective in particular, Merleau-Ponty's, in which subjectivity is theorised as embodied, contextual and located in language (whether visual, verbal, or gestural), can contribute to a sensitivity to the diversity of sexualities. I am also inspired by Fanon's (1952) and Foucault (1978)'s theorising of the historical and cultural specificity of identities and the richness of Audre Lorde's (1982) poetic explorations of these themes in her novel, Zami. I argue that the imagery of art therapy and the multifarious possibilities of the art media are particularly valuable for the exploration of lived experiences of sexualities, conscious and unconscious.
Supervision has tended to focus on intrapsychic and interpersonal aspects of psychotherapy practice and not include an exploration of the cultural diversity that may be present between supervisor, supervisee and client. This paper looks at how this aspect can be incorporated into supervision practice and in particular explores how this can be understood within the the seven modes of supervision proposed by Hawkins & Shohet (2000) Supervision in the helping professions, Open University Press and within the power dynamics of the supervision triad.
The rapid increase in racial/ethnic minority populations in the United States implicates the necessity of implementing new approaches to the training of psychologists. The author proposes that the integration of racial and cultural diversity related issues in clinical supervision is an essential component of clinical and teaching competence, which has important implications for the provision of services to ethnic minorities and, more broadly, to better addressing the full realm of clients' intrapsychic and interpersonal worlds. Psychodynamic aspects of the supervisory encounter, such as the narcissistic struggles of the supervisor and supervisee and racial and cultural elements in transference, contribute to supervisory interactions around race and culture. Clinical illustrations are discussed to elaborate these dynamic processes. Recommendations for supervisors on how to explore race and culture in a safe supervisory space are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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.
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.
The aim of this study was to determine whether lower body negative pressure (LBNP), combined with noninvasive methods of assessing changes in systemic and cerebral vascular resistance, is suitable as a method for assessing cerebral autoregulation. In 13 subjects we continuously assessed heart rate, blood pressure, cerebral blood flow velocity (CBFV) and cardiac output during graded levels of LBNP from 0 to -50 mm Hg. With increasing levels of LBNP, cardiac output declined significantly (to 55.8+/-4.5% of baseline value) but there was no overall change in mean arterial pressure. CBFV also fell at higher levels of LBNP (to 81.4+/-3.2% of baseline) but the percentage CBFV change was significantly less than that in cardiac output (P<0.01). The maximum increase in cerebrovascular resistance (pulsatility ratio) was significantly less than that in total peripheral resistance (17+/-6% vs. 105+/-16%, P<0.01). Spectral analysis showed that the power of low-frequency oscillations in mean arterial pressure, but not CBFV, increased significantly at the -50 mm Hg level of LBNP. These results show that, even during high levels of orthostatic stress, cerebral autoregulation is preserved and continues to protect the cerebral circulation from changes in the systemic circulation. Furthermore, assessment of cardiovascular and cerebrovascular parameters during LBNP may provide a useful clinical test of cerebral autoregulation.
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