"Gay men, internalised homophobia and therapy": Working with internalised homophobia in gay men using a gay-affirmative model: A systematic literature review
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This dissertation is a modified systematic literature review exploring internalised homophobia in gay men and how the therapist works with this issue within the therapeutic relationship. Information was gathered from several sources including electronic databases, books and journals. This dissertation found that gay men who enter into therapy present with unmet needs for mirroring and idealising, including an alienation from their authentic feelings and desires. The result is often the construction of an unintegrated false self in order to achieve acceptance and approval in the dominant heterosexual culture. The concepts of homophobia and internalised homophobia within gay men are explored and reviewed with their symptoms, causes, and how they affect identity development. Gay identity development differs from heterosexual identity development and this paper explores those differences and describes how gay identity development can arrest. The dissertation then examines how the personal values, views and concepts of the therapist impact upon the therapeutic work and the importance of the therapist understanding the origin of these values. The function of the therapist and therapy is to create an empathic and affirming environment in which the client is able to reflect on his identity freely. The therapist’s understanding of, and responses to, these needs is crucial to the psychotherapeutic relationship and its success. The paper confirms that there is a need for additional training for therapists relating to sexuality and sexual orientation as inadequate training can result in gay clients receiving poor or even harmful treatment. The therapist’s ease with gay affirmative attitudes, regardless of his/her gender or sexual orientation was perceived to be the most helpful, useful and holding by the gay client. If the therapist can hold the gay client in an affirming, positive and respectful way then gender and sexuality are unimportant. However, a gay therapist can work with a gay client potentially more effectively than a heterosexual therapist because of their personal experience, knowledge and understanding of being gay in a heterosexist society. This dissertation presents a gay affirmative therapy model, discussing the therapeutic process and relationship when using this model to work with gay men. Clinical vignettes from gay male clients are included to highlight the need to identify and work with internalised homophobia and the need for the therapist to hold sexual difference in order for the therapy to be effective.