Couple Therapy with Gay Men

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This book illuminates the unique needs of gay male couples in therapy and provides a practical framework for clinical intervention. The authors review the basic principles of structural family therapy and guide therapists in adapting treatment goals and interventions to better serve gay clients. Addressed are the universal issues faced by all couples in therapy, gay and straight, as well as the particular challenges gay men face in building nurturing, intimate relationships in a homophobic society. Extensive case examples and session transcripts are used to illustrate effective strategies for helping clients affirm the strength of their union, even in the absence of familial and social support; learn to resolve differences constructively; and overcome culturally conditioned barriers to connection and trust.

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Editorial Reviews

From the Publisher

"Among the numerous books on couples therapy it can safely be said that none match Couple Therapy with Gay Men in scope or depth....We are provided a step-by-step narrative of an exciting behavioral process, rooted in Minuchin's structural theory of family therapy, which aims at corrective experiences and personal growth through an interactive, here-and-now process. This program, richly illustrated by case examples, offers some valuable pointers, some directed specifically at gay therapists working with gay couples....This book merits the interest of all clinicians doing couples therapy."--Leo Goldberger, PhD, Behavioral Science Books Advisory Board Member

"This masterful book--grounded in vivid case examples--gives readers a clear theoretical framework and a 'how-to' guide for intervening actively with gay male couples in therapy. Whereas almost all previous works deal only with the intrapsychic dynamics of the individual partners, this one goes much further, shining a bright light on couple-level processes. The integration of family systems, gender socialization, and gay identity development theories is brilliant!"--Robert-Jay Green, PhD, Alternative Family Institute, California School of Professional Psychology, Alliant International University; coeditor of Lesbians and Gays in Couples and Families

"A breakthrough book. Greenan and Tunnell eloquently describe a clear and compassionate model of therapy that is applicable to gay and straight couples alike, while demonstrating enormous sensitivity to the particular issues confronting gay couples in a homophobic culture. Telling the powerful and poignant stories of gay men courageously building their lives together, Couple Therapy with Gay Men is a superb teaching book about the art of couples treatment. I highly recommend it."--David Treadway, PhD

"In this timely and informative book, we are introduced to the outer world and inner lives of gay men in intimate relationships. In understanding the uniqueness of this bonding, we learn much about the development of sexual identity and the effects of gender acculturation on gay couples' interpersonal dynamics and complementary roles. We also learn much about the nature of love and the elements that go into all intimate relationships. The model of couple therapy presented here is based on transcending cultural stereotypes and creating an identity as a couple based on expanded role definitions, and the in-depth case studies are both informative and inspiring. This book should be required reading for students of psychotherapy as well as experienced therapists."--Peggy Papp, MSW, Ackerman Institute for the Family, NYC

"What is the road map for intimacy among males? Can members of a gay couple allow themselves to be vulnerable with their partners? What is the therapeutic process that expands the experience of a gay couple beyond the accepted norms of the dominant culture for intimacy? In order to elucidate these questions, [this] book presents case excerpts that are written in a form that invites you into the office, where you can observe the respectful way in which therapy moves from support to challenge and to the expansion and incorporation of complexity....Greenan and Tunnell deliver what they have promised: a guide for therapy with gay couples that is clear, practical, and useful."--from the Foreword by Salvador Minuchin, MD

"This book is a much-needed addition to the literature on treating lesbian, gay, bisexual and transgender people. If you think gay couples are just like any other couples, Greenan and Tunnell will change your thinking. As they reveal, gay couples face unique challenges and bring unique strengths to their intimate relationships. Couple Therapy with Gay Men is the perfect place to start your education about how to make therapy relevant and helpful for these clients."--Laura Markowitz, Editor, In The Family: The Magazine for Queer People and their Loved Ones

Journal of Couple & Relationship Therapy

"A much-needed book addressing not only the needs of gay men in couples therapy, but also the therapist's and client's homophobia and perceptions of the potential staying power of gay couples....The enriching aspect of this book is how the authors take you through a child or adolescent's development, from his initial discovery that he is gay through the ensuing trauma that is usually endured alone, and how he is deprived of a relational context in which his authentic emotional self can emerge and grow....useful to all levels of couple/relationship therapists. Beginning therapists may still benefit from the review of structural couples therapy in general, and especially as it pertains to working with gay men in the context of couples therapy....Many case examples of both heterosexual and gay couples help illustrate the similarities and differences of using structural therapy with gay couples....a roadmap in writing a new script for how we deal with gay couples."--Journal of Couple & Relationship Therapy
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Product Details

  • ISBN-13: 9781572308084
  • Publisher: Guilford Publications, Inc.
  • Publication date: 10/16/2002
  • Series: Guilford Family Therapy Series
  • Edition description: New Edition
  • Pages: 214
  • Product dimensions: 6.20 (w) x 9.00 (h) x 0.80 (d)

Meet the Author

David E. Greenan, EdD, is Executive Director of The Minuchin Center for the Family, where he teaches family therapy and consults to agencies that serve inner-city poor families. He is also a psychologist and family therapist in private practice in New York City.

Gil Tunnell, PhD, is a clinical psychologist in full-time private practice in New York City. He supervises and trains psychiatric residents and psychology interns in family therapy at Beth Israel Medical Center.

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Read an Excerpt

Couple Therapy with Gay Men

By David E. Greenan Gil Tunnell

The Guilford Press

Copyright © 2003 The Guilford Press
All right reserved.

ISBN: 1-57230-808-7

Chapter One

Joining with Male Couples

In the preceding chapter we outlined the generic model of structural couple therapy. We demonstrated the model using a heterosexual couple to illustrate the three stages of treatment. In this chapter we will elaborate in greater detail our way of working with male couples so that the reader will have a clearer sense of what is different in working with this group, as compared to straight couples. Whatever the couple's sexual orientation and presenting problems, what remains constant is the three-stage structural model. In this and the succeeding two chapters, we will introduce male couples that we've worked with, whom we will use to illustrate the model as we track their progress through treatment.


Joining is a critical initial stage of the therapeutic encounter. Unless a couple trusts a therapist and has some degree of confidence that they can benefit from intervention, they will either drop out of treatment prematurely or resist any challenge by the therapist to change their behavior. A couple's pull toward homeostasis is powerful, and their resistance can defeat the most experienced therapist. Structural family therapy is a short-term treatment, and the therapy moves along quickly. Thetherapist must take charge of each session, which during the joining phase helps to inspire trust from the couple.

The axiom of having to earn the clients' trust and respect, which is essential during the first phase of treatment, is even truer when working with stigmatized populations such as male couples. Just as with the straight couple, a gay couple entering treatment is in crisis and seeking relief. But for a gay couple entering treatment there are two major differences. One is that they often come in defensively, fearing the therapist will judge them, uncertain whether their relationship is valued and worth saving. Second, few gay men we see in our practices have had the experience of working through differences with significant male others. Many gay men have the impulse to flee at the first sign of conflict, and there are few social or legal structures in place to support men working to repair their relationship.

As we noted in Chapter 2, gay men prior to entering treatment have internalized a message from early developmental experiences that they are less than or inferior to the heterosexual majority. Shame-inducing experiences become internalized as low self-esteem, and many gay men have developed a "false self" in childhood that is integrated into their personality by adulthood. These traumatic experiences can be expressed in adulthood in one of two preferred styles of relating:

1. The gay adult may avoid intimate relationships with other men for fear of repeating earlier negative experiences. The attitude of "I refuse to be mocked again" creates obstacles in building an intimate relationship with another man.

2. The gay man may experience and express his need for affection and intimacy with another man as being so precious that he has a desire to merge with his beloved. In this scenario, the partners risk losing their individuality.

Either dynamic, disengagement or enmeshment, is problematic in long-term relationships.

Gay bars, parks, and clubs where it is safe to approach another gay man have frequently been the key gathering places in a gay man's initial socialization and sexual experiences. Same-sex relationships are often kept secret from family, straight friends, and work colleagues. Little societal support exists for a male couple, and relationships are easily dissolved in this milieu. The socialization process for men, regardless of sexual orientation, traditionally rewards independent, stoic behavior. "Boys don't cry" is axiomatic in U.S. culture. Additionally, men in general are socialized to either dominate the other or avoid conflict, often being acculturated to believe that compromising is the same as "losing"-and losers are sissies. Given the secretiveness of many gay relationships and a society that privileges male stoicism and independence, many gay couples choose to go their separate ways when confronted with seemingly irreconcilable differences.

It's interesting to note that many of these "irreconcilable differences" are not dissimilar to the boundary-making and accommodation issues of heterosexual couples. However, gay couples, bereft of role models, often lack the experience to contextualize their struggles for creating relationships. This atmosphere of instability and dearth of positive socialization experiences are two significant respects in which a male couple's experience differs from that of their straight counterpart.

Although heterosexual couples can come to therapy for help in separating, the majority of such couples are committed to resolving their differences. Separation and divorce are the last, not first, options. In the face of conflict, gay couples often feel that separation is the first option of choice. Creating a therapy that honors and values gay relationships is an essential first step in helping the male couple solidify their relationship.


How is the foregoing knowledge helpful to the therapist, either gay or straight, who is working with same-sex couples? When a gay couple presents themselves for treatment, their antennae will be tuned for any suggestion of homophobia. Nancy Boyd-Franklin (1989) refers to this guardedness on the part of Black clients as "a healthy paranoia," the clients' adaptation to an unsafe world. It is essential for the therapist to be prepared for this dynamic and communicate to the couple that they are in a safe environment.

Creating a nonhomophobic environment begins with the initial telephone call. In contrast to the initial contact with a heterosexual couple, the gay man calling to make an appointment will commonly ask if the therapist is gay. We advise that the therapist answer this question directly. In family therapy the therapist is not interested in encouraging the client's transference, so she becomes a neutral object on which a client can project his psychological process. Structural family therapists are more interested in creating interactions between the couple so that the therapist can explore the ways that each partner has contributed to creating the dynamics of their relationship. If a therapist is gay, there is usually no further discussion once that information is disclosed. If she isn't, she can say just that. During a couple's initial session, she will have the opportunity to demonstrate her respect for gay couples, and the couple can then make the decision whether they want to work with a straight therapist. In our experience, many gay couples initially are more accepting of straight female therapists and more guarded with straight or gay male therapists. Exploration of the meaning of the therapist's sexual orientation or other questions can usually be deferred to the initial session.

Often a couple will also ask about the therapist's fee, participation in managed-care programs, and theoretical orientation. The first two questions can be easily answered, with discussion of the appropriateness of a sliding-scale fee normally deferred to the first session. The last question, regarding the therapist's theoretical orientation, usually reflects the couple's anxiety about the therapeutic encounter. The therapist should answer the question as succinctly as possible: "I'm a social worker (psychologist, psychiatrist) and I have advanced training in family therapy." We usually recommend that a therapist inform a couple that she would like to meet with them for a one- or two-session consultation, so she can ascertain if she can help them, and so a couple can decide if they feel comfortable working with the therapist. The time length of each consultation should also be stated. Again, we recommend that each session be a minimum of 1 hour and, if possible for the initial consultation, 1 1/2 hours. The extra half-hour gives the therapist time to take an initial history and to begin to experience how the couple interact with each other.

Therapists often overlook the importance of having a welcoming waiting room and office that communicates openness to working with gay couples. The therapist can have gay-affirmative literature in the waiting room such as In the Family, a magazine that focuses on alternative families. For instance, one straight therapist who is an amateur photographer has pictures of the local Gay Pride Day parade on his office wall. Literature in the waiting room that is supportive of gay relationships or that promotes gay-affirmative community activities and organizations makes a positive statement to gay clients. If the therapist uses an intake form, the marital status portion of the form should have language that reflects gay inclusiveness (see Figure 4.1).

Initially a therapist can help put a couple at ease by asking a few simple questions as they make the transition into the office. "Was it difficult getting here? Did you encounter a lot of traffic? The elevators are archaic in this building. Did you think you'd have to walk up?" Humor can often help to create a bridge. These questions may sound like idle chatter, but they help ease a couple from one world into the therapeutic environ of a couple's session.

If a couple has filled out an intake form, a therapist will need a few minutes to look at their responses. Alternatively, many clinicians gather this information as part of the joining process. We find it most helpful to have the couple write down certain basic information on the form (i.e., telephone numbers, addresses, relevant medical history) so that we do not need to be writing during the session. We find that a lot of writing during the session can be distracting, and during the early sessions it may act to distance the therapist from the clients. The therapist will also want to orient the couple to her office. If she will be recording the sessions and has not discussed that with them, this is a good time to explain why the therapist records sessions and to obtain the couple's signed permission (see Figure 3.1). "I like to record my sessions because it gives me an opportunity to further explore our sessions and understand how I might be more helpful to you." Or if a therapist is in supervision, " I record my sessions because I consult with a senior colleague when I feel stuck in a session or when I need a neutral informed opinion. And unless we agree otherwise, I erase the tapes as soon as I have had an opportunity to look at them." A therapist can also say that the videotapes can be used for playback in a session with the couple so that they can help the therapist understand what dynamic is being created between them. Usually a new family therapist is more anxious about asking for permission to tape than the couple is about being taped. If the therapist is clear and matter-of-fact about the reasons for taping, most couples will readily give permission. Those who don't give permission initially may be persuaded of the utility of taping during later sessions.


Once the therapist has oriented the couple to the office, the next task is to ask each partner to state why he is seeking treatment. A therapist needs to be in charge in this stage of treatment and create safety in the initial encounter by structuring and leading the session. She might ask a couple, "What brings you in as a couple?" or "How can I be helpful to you as a couple?" The language is simple but the message is complex. The therapist is communicating both that she recognizes the partners as a couple and that she wants initially to get to know them as a couple. In asking the question, she has not addressed a specific person but rather she has asked them as a system why they have come into treatment. Questions about each man's individual history of gay identity development are also important, as those experiences will impact on the men's relationship. We advise though that questions focusing on an individual's development be deferred initially until the therapist has a better appreciation of the couple's presenting problem.

This initial encounter is important for all couples but especially so for gay couples, as the therapist's office may be one of the few places in the gay couple's lives where they are seen and acknowledged as a family. This acknowledgment alone can be therapeutic for a couple. A therapist is also beginning to educate a couple to the unique culture of systemic therapy by focusing on their collective history. The therapist wants to communicate to the couple that she wants to hear each partner's voice and not let one person speak for the system.

When a couple comes into treatment, they are in crisis, and each partner should have the space to express his frustration and anger. Similar to the heterosexual couple, Trudy and Jed, presented in the preceding chapter, gay couples usually present with overly simplistic explanations of their problem that identify one partner as "the patient," such as: "My partner is always working and when he is home he watches television. He's not interested in me anymore." Or, "I'd like to have an open relationship. Tom doesn't want one. He's so inhibited." "Jim stopped going to NA [Narcotics Anonymous] meetings and I'm anxious that he's using drugs again. He's so secretive." Such straightforward statements-what we call linear explanations-communicate to the therapist, "Fix him and our problems as a couple will be solved."

The therapist's task is to begin to formulate hypotheses as he joins with the couple. As the therapist listens to the men discuss their problems and their origins, he is beginning to identify what mutual behaviors maintain them. The therapist remains in control of these early sessions by directing questions to each partner. For a couple to open up raw emotions too quickly can be countertherapeutic and create an unsafe atmosphere. The task during this early stage of treatment is for the couple to know that each partner will have an opportunity to express his concerns. By remaining close to the couple and central during this phase, the therapist can structure the session to help ensure that each person is adequately heard.

Spontaneous interactions between the partners will often occur during this stage of treatment, and experienced therapists can use these enactments to create frames (i.e., images or insights) of how the couple have constructed their relationship that maintains this homeostasis.


Excerpted from Couple Therapy with Gay Men by David E. Greenan Gil Tunnell Copyright © 2003 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Chapter 1 The Marginalization of Gay Male Couples
Chapter 2 Implications for Man-to-Man Closeness from Growing Up Gay Chapter 3 An Overview of Structural Family Therapy
Chapter 4 Joining with Male Couples
Chapter 5 Enactments: Identifying Complementary Roles
Chapter 6 Unbalancing: Discovering New Steps
Chapter 7 A Case Study: Male Couples and Connectedness
Chapter 8 Toward the Future
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