Clinical Social Work Journal Vol. 27, No.

4, Winter 1999

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@ 1999 Human Sciences Pre se, Inc,

'GAY AFFIRMATIVE PSYCHOTHERAPY:1 'A PHENOMENOLOGICAL STUDY

Jonathan Lebolt, Ph.D.

ABSTRACT: There is a need for gay and lesbian affirmative psychotherapy in a society in which gay men and lesbians endure prejudice and discrimination. Using a phenomenological model informed by feminist methodology, this study investigated the gay male client's experience of gay affirmative therapy, The participants shared their experiences in in-depth interviews. Phenomenological analysis revealed certain therapist qualities which were experienced as affirmative. Findings showed that with sensitivity, imagination, and experience, the heterosexual therapist can be gay affirmative; the gay therapist may more readily serve as a role model. Results are compared with other research, and recommendations are offered for future inquiry.

KEY WORDS; gay men; psychotherapy; qualitative; feminist.

INTRODUCTION

We live in a society in which gay men and lesbians continue to suffer stigmatization and discrimination on both familial and institutional levels. The practice of homosexuality among consensual adults in private is still illegal in over half the American states (Hitchcock, 1997). In addition to discrimination in housing, education, and employment, gay men and lesbians endure violent hate crimes, which have increased since the advent of AIDS (Isay, 1989; Paradis, 1991). Gay people are barred from the social and legal benefits of marriage regardless of how

'This article is based on a dissertation submitted in partial fulfillment of requirements for the degree of Doctor of Philosophy in Clinical Social Work at The Union Institute in CincinnatLThe author wishes to acknowledge the editorial assistance of Dr. Martha Gabriel and Vinny Collazo in the preparation of this article.

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long they have remained in a committed relationship. Gay youth continue to mature in a school environment where the epithet, "gay," and its more pejorative variants, such as "faggot," are still used as all-inclusive terms of opprobrium.

Clearly, gay and lesbian affirmative psychotherapy is needed in such an environment to heal the wounds of familial and social homophobia, and to facilitate the development of a healthy gay/leshian identity. Unfortunately, the attitudes of mental health professionals have historically mirrored those of the lay public, and there is still a split between contemporary clinicians who advocate "repairing" or changing the gay client's sexual orientation vis-a-vis affirming it.

Freud contradicted himself on the subject of homosexuality. While positing his theory of universal, innate bisexuality (1905/1962), he spoke of homosexuality as "inversion" like the sexologists of his day (Miller, 1995). He linked homosexuality with narcissism in discussing one of his most admired figures, Leonardo (Freud, 1910). Freud (1921IMay 1977) supported the admission of qualified homosexual applicants to psychoanalytic training institutes and later averred that homosexuality "cannot be classified as an illness" (1935/1951).

In 1940, Rado repudiated Freud's notion of innate bisexuality and proposed that homosexuality was an adaptation to "parental intimidation of sexual behavior" (Friedman, 1988, p. 86). After Rado, psychoanalysts began viewing homosexuality as "perverted" rather than merely "inverted." Contemporary "reparative" analysts such as Socarides (1978) characterize homosexuality as a "reparative" reaction to parental damage and seek to alter the client's sexual orientation.

Following such groundbreaking studies as Kinsey, Pomeroy and Martin (1948) and Hooker (1957), the American Psychiatric Association finally removed homosexuality from its diagnostic manual in 1973. Ego dystonic homosexuality was not removed until 1987 when it was recognized as a response to growing up in a homophobic society.

While the professions of psychology and social work were quick to adopt these changes, it was not until 1992 that the American Psychoanalytic Association developed an affirmative platform statement on homosexuality (Isay, 1996). Unfortunately, despite organizational platform statements, anti-homosexual bias is still common within the mental health professions (Garnets, Hancock, Cochran, Goodchilds and Peplau, 1991; DeCrescenzo, 1984).

Nevertheless, literature on gay and lesbian affirmative psychotherapy has been emerging. Malyon (198211995) proposed a stage model for gay affirmative psychotherapy. Isay (1985/1995, 1989, 1991/1995, 1996), Shannon and Woods (1991), Kooden (1994) and Cornett (1995a, b) utilized case studies to illustrate their theoretical approaches to gay affirmative treatment. Domenici and Lesser (1995) presented theoretical

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critiques of conventional models of psychoanalysis, which incorporated postmodern concepts such as social constructivism and queer theory. Gabriel and Jones (1999) investigated gays,' lesbians,' and bisexuals' experiences in psychotherapy in a nationwide study. Based on a computer search, the current study is the first exploration of the gay male client's experience of gay affirmative psychotherapy.

METHODOLOGICAL FRAMEWORK

Systems of qualitative research are becoming more clearly defined and more rigorous in human science research (Patton, 1990; Moustakas, 1994). The in-depth nature of qualitative inquiry necessitates a small sample limiting the generalizability of findings. However, a qualitative study may be particularly suited to an exploration of the patient's experience of psychotherapy, a complex, intersubjective phenomenon which is not easily quantified.

While primarily phenomenological in focus, this study is also informed by feminist research methodology. Such a combination of qualitative methods, or triangulation, strengthens the study design (Patton, 1990). A feminist perspective was included because of a dearth of specifically gay affirmative research models and the analogy between homophobia and misogyny in our society (Isay, 1989), in which gay men may be hated or feared because they are perceived as being or behaving like women.

Phenomenological Research

Phenomenology is a branch of philosophy formulated by the German philosopher, Husserl, in the early 1900's. Husser! believed "we can only know what we experience by attending to perceptions and meanings that awaken our conscious awareness." Thus, a phenomenological study addresses the question, "'What is the structure and essence of experience of this phenomenon for these people?'" (Patton, 1990, p. 69, deemphasized).

Moustakas (1994) described three processes in phenomenological methodology. In epoche, the researcher sets aside judgments to experience phenomena in an open manner. In phenomenological reduction, "each experience is considered in its singularity, in and for itself. The phenomenon is perceived and described in its totaity,ina fresh and open way" (p. 34). During reduction, the researcher "brackets out the world and presuppositions to identify the data in pure form." The data are then horizonalized; i.e., "all aspects of the data are treated with equal value" (Patton, 1990, p. 408)~ Finally, in imaginative variation,

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the researcher reapproaches the phenomenon from varlousvantages to intuit the essence of the phenomenon.

Feminist Research

Feminist research offers flexible and creative investigative models which reject the hegemony of straight white males in the social and epistemological arenas, and question the possibility or the desirability of objectivity in the human science researcher. Klein's (1983) recommendation of a "conscious subjectivity" on the part of the researcher complements Moustakas's (1994) concept of the participant as "eo-researcher" of the phenomenon, as opposed to a research "subject." Du Bois (1983) urged that theory be grounded in the experiences of the group being studied. Reinharz (1992) utilized self-definition in choosing her sample. Harding (1987) stressed the plurality of women's experiences. Such a view, which emphasizes the importance of individual differences, reaffirms the validity of a qualitative methodology which examines each participant's experience in depth.

The method for this study was an integration of the above phenomenological model and feminist perspectives. The sample was limited to gay men in accordance with Reinharz's (1992) recommendation that the researcher be a member of the group being studied, and to enhance the soundness of the study. in light of the small sample size.

METHOD

A flier was posted at the Lesbian and Gay Community Services Center and various graduate schools and psychotherapy training institutes in New York City. The flier invited prospective participants to share their experience of gay affirmative psychotherapy in a confidential, in-depth interview. Nine adult male respondents participated in tape-recorded interviews lasting 1 114 to 2 hours; an interview guide was utilized.

A copy of the interview transcript was sent to each participant for his review. The data in each amended transcript were phenomenologically reduced via bracketing, horizonalization, and organization into themes. Imaginative variation was utilized to express the essence of

each participant's experience. .

A summary of the interview, including background material, the therapy experience, and the depiction of its essence was sent to each participant with a request for feedback. Such participant validation (Moustakas, 1994) ensures that the researcher accurately captures the participant's experience. After incorporating the participants' feedback,

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qualities were extracted from the essences of each participant's experience to create a description of the group's experience as a whole. This description was also submitted to the participants for validation.

The study was conducted in accordance with the National Association of Social Workers' guidelines for human research (1993, Section I[E]). Participants' names and other identifying information were changed, except in specific instances where the participant requested that identifying information be preserved.

FINDINGS

Essential qualities of the group's experience have been divided into categories for the purpose of clarity. First, qualities which might be applicable to any affirmative therapy experience are presented: general qualities of the therapy and the therapeutic relationship, and "personal" and "professional" qualities of the therapist. Qualities pertaining to specific therapeutic variables follow: therapist qualities specifically related to the client's gayness; qualities of the homosexual and the heterosexual gay affirmative therapist; other therapist variables-namely, gender, age, race and religion; therapy with the client in recovery; and group therapy. The section concludes with a summary of the results of treatment.

Qualities of the Therapy and the Therapeutic Relationship

Participants experienced a sense of connection with their therapist which was often immediate, and usually included feelings of warmth and liking. Feeling "comfortable," "safe," "intimate," and free to talk about anything enhanced the client's sense of trust. Participants felt "completely accepted," "special," or "valued."

While the experience of therapy was generally enjoyable, it could be overwhelming, even "terriflying]." When Roland told the gay male therapist whom he idealized that he "wanted to feel held by him," for example, it felt "scary" hut "wonderful." For some clients, therapy was essential for survival. John described it as "salvation ... a life preserver in a sea of confusion" about his sexual identity. For most, therapy was an "amazing" or "enlightening" learning experience.

Personal Qualities of the Therapist

Clients universally experienced their therapists as "kind," "sensitive," "concerned," or "caring;" and usually as "warm" or "friendly."

Some therapists possessed a quietude that belied their strength:

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Laurence's, for example, had "this wonderful, quiet presence. But you realize he's so powerful."

A sense of authenticity and self-comfort in the therapist was important to most of the participants. For some participants, a sense of style or humor was also crucial, and in the case of Sam, the ability to match his level of intensity and intelligence.

I remember her saying, "Oh, I'm so relievedl" . : . This was the first time that I saw a human side to her. . .. I ... felt very . . . close to her .... It felt ... affirming of me .... If you're accepting me, then you're accepting being gay.

Professional Qualities of the Therapist

The therapist was universally experienced as "nonjudgmental," "open," "embracing," or "accepting." Some therapists indicated "neutral[ity]" through body language. The therapist was "curious" and ac. tively interested and conveyed this interest through words or body language. The therapist was "attentive," fully present, focused, an active listener. Slhe gave the patient space to think, reflect, talk. and feel.

The therapist provided emotional support and reassurance, either verbally or nonverbally. Roland, however, noted that his therapist "wasn't reassuring at all ... that's what made the internalization [of his strength] possible .... " For many clients, the therapist validated experiences, gave direct answers to questions, and offered advice in a respectful manner.

Participants varied in their responses to therapist self-disclosure.

Neil was relieved about its lack: ''The less I know about her, the fewer expectations she will put on me." More frequently, disclosure was experienced as "heJpful."Ed perceived his therapist's early, implied disclosure of her heterosexuality as equalizing: "she'd often say things like, ... 'It's the same thing in the straight world ... it was very clear to me that ... she was saying ... her straight world shares many similarities [with] my gay world." Later in treatment, Ed experienced direct disclosure as "human affirmative" after he tested negative for HIV:

The therapist was perceived as having a good sense of boundaries.

This allowed clients to feel safe even when being held by the therapist (in Laurence's case), or when having social contact outside of therapy (in the case of Sam). Some therapists appeared to go beyond the call of duty (and what some clinicians might consider appropriate): Sam's therapist, for example, "sat up with me one night and helped me type out this paper .... It ... probably saved my job."

The therapist was understanding; empathic, both intellectually and

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emotionally; and intuitive. Slhe had a good memory and sense of judgment. Slhe helped the client identify and express his feelings. Donald described how his therapist facilitated "bringing in ... these whole parts of myself that I wasn't comfortable with ... [or] allowing to see the light of day." The therapist made good interpretations; helped the client make connections among thoughts, feelings, and behaviors; and fostered the development of insight. When the therapist confronted the client, s/he did so "gentl[y]" and respectfully.

The therapist was reliable and consistent. The therapist was comfortable with the clients feelings about the therapist. Roland's therapist, for example, made him feel safe by "tolerating [his] idealization, and holding it, and showing me that it was okay to let whatever feelings come up in that relationship." The therapist instilled hope. Neil said of this therapist, she "gives me faith that there would be someone ... who might love me in a [gay] relationship."

Therapist Qualities Specifically Related to the Client's Gayness

The client felt his gayness was "accept[edl"by his therapist, often from the "beginning" of treatment. He was accepted as a complete human being, which included his gayness. The therapist explored the gay client's difficulties with relationships and the childhood conflicts which influenced them as a "human" rather than a "gay issue," in Laurence's words.

The therapist affirmed the client's need for gay relationships. Robert's therapist "understands that ... my need for a close partner in my life who is a man is ... a healthy thing, and that ... following that need is ... going to make me grow." The therapist encouraged the establishment and development of both social and romantic gay relationships.

The therapist appeared comfortable with sexuality in general, and homosexuality in particular. Slbe validated or normalized the client's sexual and homosexual desires, and feelings about his body. Donald's therapist encouraged him to talk "about what I wanted sexually," gave him "permission [to have these] feelings," and "let me know they were normal," Donald "continued that part of therapy in[to] my life and started feeling more comfortable ... with my sexual self."

The therapist facilitated the client's coming-out process on both internal and external levels, including the development of intimacy with other gay people. When Donald began treatment, he was unsure of his sexual orientation. His sense that his therapist "didn't have a stake in" this, and her exploration of Donald's anger toward his ex-girlfriend, assisted his internal coming-out process. Still in therapy, Donald is now "out at work [and at school] .... I've been in a relationship for three years now and I'm out to my family .... "

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Qualities of the Homosexual, Gay Affirmative Therapist

The therapist increased the client's awareness of homophobia, both internal and external, and heterosexism. This included helping the client perceive the diversity of gay people. For example, John felt alienated by the "effeminacy" of gay men, but learned from his therapist that a gay man can be masculine, and an "individual."

For John and Tom, the therapist was a role model. Self-disclosure could facilitate this process. When Tom's therapist shared her difficulty in coming out to her children, Tom "kn[e]w that you can get through this and ... it's okay." John's therapist's revelation of how the latter asserted his "individuality ... in his own relationships ... gave [John] the confidence to say, "Okay, I can do it, too."

While Roland did not perceive his therapist as a role model, he did view him as someone whom he could "idealize" and with whom he could "identify," "Knowing that he was gay and that he was as magnificent as he was ... was important to me .... He ... came across as somebody who was successful and masculine and powerful and comfortable with himself."

When I talked to her about losses in my life [from AIDS) ... her eyes would well up .... [S]he saw my loss the way she would see a straight person['s] losing somebody of the opposite gender . . . to cancer .... When I saw her moved by my losses, it normalized and legitimized ... the loss of any gay man.

Qualities of the Heterosexual, Gay Affirmative Therapist

The therapist normalized homosexuality and equalized gay and straight relationships. Ed's therapist illustrated this in her legitimization of the pain of loss in gay relationships:

The therapist was capable of understanding the gay experience through intuition or imaginative empathy. Robert, for example, described his therapist as being "able ... not only to accept, but ... take in ... [and] be in touch with thee] experience of being gay ... [and] maybe ... share some of those feelings ... lof] what it's like to be attracted to another man."

In some instances, the therapist disclosed experiences of working with the gay community. Tq the client, this seemed to have increased the therapist's knowledge and understanding of gay issues, thus boosting the client's confidence in the therapist. Laurence described this process with his therapist:

[S]he was very involved in working with people with AIDS .... I ... remember her talking about how families wouldn't be supportive

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of their gay sons, and how angry that . . . would make her, and it helped her understand the difficulty of ... my parents]' attitude toward] being gay .... I felt very acknowledged, comforted by that.

While the therapist encouraged the exploration of gay issues, s/he maintained a neutral position. When Ed felt constrained by limiting himself to monogamous relationships, his therapist's neutrality "gave me the space to explore" this conflict; he then had his first casual sex experience, which was "liberating," Conversely, Laurence felt that his therapist's "objectivity" and "perspective" as "someone who [wa]s not gay" helped him realize that promiscuity could be emotionally and physically dangerous without "ever making me feel that there was something

bad about being gay." .

I'm always very touched when a straight man is that comfortable around a gay man . . . 'cause that wasn't my experience growing up .... It got really important for me to be connected with men ...

whether they were straight or not [My therapist] was so open as

a man .... That also helped me to open up. Open my heart-space

to gay men.

Other Therapist Variables: Gender, Age. Race. and Religion

Laurence described the experience of therapist gender most vividly.

His female therapist's holding him felt "very mothering," and made him feel "so whole that [his] gayness was [integrated]." His experience with his straight male therapist was also transformative:

For Donald and John, their therapists' older age meant a greater depth of experience, which enhanced the therapists' perspective. John, who is of mixed race, and who was used to socializing primarily with gay people of color, felt that the racial difference of his white therapist also enhanced the latter's perspective. As John put it, "he was seeing the forest where I could only see a tree." On the other hand, John's sharing the common religious background of Catholicism with his therapist helped John feel comfortable enough to explore his religious concerns as a gay man.

Therapy with the Gay Client in Recovery

Participants who worked on issues of recovery from substance use or sexual compulsivity experienced their therapists' knowledge of recovery as helpful, particularly when firsthand, Disclosure of the therapist's being in recovery, confrontation of self- destructive behavior in the client, and exploration of the client's relationship to "Higher Power" were also perceived as beneficial. A counselor who attended Tom's rehabilitation

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group suggested that God need not be conceived as "punishing," and the group's visit to a gay church was transformative: "1 saw guys with their arms around each other ... in church; 1['d] never Been that before .... It opened my eyes as far as this lwals an option .... Since I've come home, I've joined a church."

Since I didn't have to fit into a specific groove {in the gay

community,] [I] developled] the conclusion that 1 didn't have to

have my parents' "okay" [about his gayness] ... , I feel a lot calmer, a lot clearer. Less preoccupied with the big problemlsl of "Am I?" or "Should I?" or ''Would I?" It comes down to . . . I am, and therefore I can.

Group Therapy

Tom's group experience in a gay affirmative rehabilitation program offered a powerful sense of belonging. While initially overwhelming, it helped him consolidate his gay identity; "[W]e were just inundated with gay, gay, gay ... [but] it's what 1 needed. , . to own my gayness."

While Laurence was the only gay member of his group, the group's interest in understanding his gay issues helped him perceive them as human issues. Thus, he was able to experience the "power" and "support" of the group.

Effects of Treatment

Participants described feeling more "comfortable" with their "bod[ies]" and their "sexual sel[ves]," They reported an improvement in the quality of gay relationships: sexual, romantic and social. Some participants began their first relationships with men during treatment. The participants became more comfortable with intimacy.

The participants defined and expressed their gay identities and selves in broader ways. They developed a stronger sense of self. John, for example, revealed:

This conclusion freed John to become more "creative" in his career.

Participants who were unsure of their sexual orientation when treatment began developed a gay identity over the course of therapy. They came out to themselves, family members, co-workers, classmates, and teachers. They began to integrate their gay identities with other social roles. Neil described this process:

I've come from a place that's like total emptiness to building some kind of core foundation .... It's like moving from ... where I

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only saw my identity in other people's eyes ... to a sense [of selt] that I can hold onto. . . . I feel more comfortable with my relationships

with gay people I moved from th[e] point of basically living an

asexual life to where I feel like I'm doing a fairly successful job of

integrating my [gay] identity with my [other] roles.

COMPARISON WITH OTHER RESEARCH

All of the participants were deeply affected by their experience of gay affirmative psychotherapy. In Laurence's case, the effect was so profound that he changed careers and became a therapist himself.

I

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The findings confirmed Isay's (1985/1995, 1989, 199111995, 1996) view that an actively affirmative stance in psychotherapy helps counteract the effects of homophobic upbringing, as well as the effectiveness of maintaining positive regard toward the patient as a whole, which includes his gayness. One of the participants referred to this as a "human affirmative" stance. Participants in the early stages of coming out, however, needed to experience the therapist as divested from the client's identifying with a particular sexual orientation.

Isay's (199111995,1996) recommendation that the clinician be familiar with gay-specific issues such as homophobia and the coming-out process was also consistent with the findings. While participants with an openly gay therapist did experience the latter more clearly as a role model, as Rochlin (1981-82) and Isay (199111995, 1996) described, participants with heterosexual therapists did not experience the difference in sexual orientation as an obstacle to treatment, and in some cases felt the difference lent the clinician increased objectivity or the advantage of a different perspective from the client's. Most of the participants experienced the therapist's self-disclosure of sexual orientation as beneficial, even, in distinction from Isay's (199111995) caution, when it occurred before or without exploration of the client's transferentialfantasies.

The participants' experience confirmed Malyon's (198211995) advice that the clinician unconditionally accept the patient's homosexuality and facilitate its expression, as well as his assertion that the treatment relationship may offer a corrective experience to counteract homophobic socialization. Disclosure of the gay therapist's sexual orientation early in treatment appeared to help the participant feel accepted and understood, as Malyon (198211995) suggested. However, this disclosure did not stimulate the projection of homophobic stereotypes in the transference, which could then be analyzed and worked through, as Malyon (198211995) proposed, Instead, the shift from ego-dystonic homosexuality occurred through identification with the therapist as a role model,

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which process Malyon (198211995) also described, or as an idealized figure. The treatment relationship did facilitate identity consolidation, including the development of the capacity for intimacy with other gay men, as Malyon (1982/1995) posited.

One participant did report projection of homophobic stereotypes; however, his therapist was heterosexual. The participants suggested that by normalizing, equalizing, universalizing, or humanizing the gay experience, the heterosexual therapist may help the gay client feel accepted and understood and facilitate identity consolidation and the capacity for intimacy. Slbe may also help the patient create a sense of meaning and purpose in a heterosexistsociety, which Malyon (19821 1995) described as the ultimate goal of gay affirmative therapy. The heterosexual therapist may need to exercise imaginative empathy in this process. Gay affirmative therapy, regardless of the therapist's sexual orientation, can help the client integrate his gay identity with his other social roles, which may facilitate Malyon's (198211995) ultimate goal.

The participants' experience reflected Kooden's (1994) description of the adverse effect of the lack of adolescent socialization rituals on gay male identity development. It also confirmed Kooden's (1994) assertion that individual and group therapy may provide the adult client with another opportunity for such socialization; group treatment seemed particularly effective in this regard. The participants concurred with Kooden (1994) that the gay male therapist may facilitate this process through self-disclosure, role modeling, and community activism. However. they also experienced this with the heterosexual .and the-lesbian clinician, although the gay male therapist appeared to function more clearly as a role model.

Group therapy was effective in both a gay and a mixed setting. In the gay setting, immersion in a gay experience increased the client's awareness of the diversity of gay people and helped him consolidate a gay identity. In the mixed setting, where the client was the only gay member of the group, treatment facilitated the client's experiencing his issues as human, rather than exclusively gay.

Cornett (1995a, b) advocated a self psychological approach to redress the effects of inadequate parenting and societal horoophobia,and to facilitate the client's development of a more cohesive sense of self. In Cornett's (1995a, b) approach, the therapist must empathically reflect and affirm the gay male client, who may initially recoil because of his history of rejection. One participant had a self psychological therapist, who was also gay. While the therapist was empathic, he did not actively affirm the client's gayness. The client averred that such restraint allowed him to experience a sense of therapeutic space. He did, however,

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feel a more cohesive sense of self as a result of treatment. Other participants experienced the process Cornett (1995a, b) described, although their therapists did not identify as self psychological.

The participants' experience confirmed Shannon and Woods (1991) recommendations that the therapist working with gay men cultivate a non-homophobic stance; a knowledge of addictive disorders; an awareness of the issues of gay male couples; group therapy skills; sensitivity to therapist-client boundaries; and a knowledge of HNIAIDS issues, including, as Isay (1989), suggested, a commitment to safer-sex education. Although safer-sex education per se was not reported as significant by the participants, exploration of the client's sexual behavior and its meanings and ramifications was crucial. Therapist sensitivity to boundaries was important, but participants varied as to how much contact they desired or tolerated.

Colcher (1982), Ziebold and Mongeon (1982), Pincu (1989), and Shannon and Woods (1991) described addictive and compulsive behaviors as warding off feelings of shame or anxiety in the gay male client, a description which matched the experiences of those participants who developed these behaviors. Colcher (1982) illustrated the challenge for the counselor to develop trust while confronting denial in the alcoholic patient, and Lewis and Jordan (1989) urged that the counselor be aware of the coming-out process, as internalized homophobia may help engender the patient's alcoholism. These observations applied to participants who engaged in other forms of addictive behavior. Pincu (1989) recommended groups for gay men experiencing sexual compulsivity; participants who identified as sexually compulsive found individual treatment helpful, as well. The findings also suggested that the gay affirmative clinician may help the spiritually or religiously oriented client in recovery to conceive of Higher Power as healing rather than punitive and to develop a positive relationship with the church.

Shannon and Woods (1991) urged therapists working with gay clients of color to be aware of the dominant culture's, as well as the clinician's, attitudes about race and sexual orientation. Moses and Hawkins (1982) advised the white therapist to expect to be tested for prejudice relating to these variables by the black gay client. Participants of color in the study, however, did not experience the therapist's color difference as an obstacle to treatment. One client felt the difference gave the therapist a fresh perspective on the presenting problem, which helped the client perceive the diversity of gay people.

Dunkle's (1994) review of treatment efficacy research suggested that group therapy may facilitate gay identity development; help gay male clients cope with AIDS and AIDS-related relationship difficulties; and improve sexual dysfunction, including the reduction ofcompulsivity.

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The participants found individual as well as group treatment beneficial in these areas.

In a society where gay men continue to experience prejudice and discrimination, gay affirmative psychotherapy provides a way of healing familial and social wounds, and of developing a stronger sense of self in the gay male client. This study suggests that therapists may cultivate qualities and use interventions which will facilitate this process in both individual and group treatment. While the gay therapist may more easily serve as a role model, the heterosexual therapist with sensitivity. imagination, and experience can also be an effective healer for gay men.

Many of the values of the social work profession are concordant with qualities that the participants in this study found affirmative . . These include "regard for individual worth and dignity, ... mutual participation, ... confidentiality, honesty, and ... respect for and acceptance of the unique characteristics of diverse populations (Hepworth, Rooney, & Larsen, 1997, pp. 8-10).

, Further research should include quantitative studies with larger samples to explore gay men's experiences of affirmative psychotherapy. Both qualitative and quantitative studies are needed in the following areas: the experiences of suburban and rural gay male clients; therapy proceeding from an anti-gay bias; and lesbian and bisexual affirmative psychotherapy.

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