Treatment Of Depression With Lgb Women And

Standard CT for depression (Beck, Rush, Shaw, & Emery, 1979; J. S. Beck, 1995) includes behavioral components to activate patients, to conduct experiments, and to increase approach behaviors, as well as cognitive restructuring techniques to evaluate patient beliefs. Sessions are structured and include setting an agenda collaboratively with the patient, reviewing between-session homework, summarizing frequently throughout the session, determining homework for next session, and gathering feedback from the patient. The collaborative nature of CT makes it a useful technique with LGB patients, especially for those who fear being told to change or who have had bad therapy experiences previously.

Very little is needed to adapt CT for LGB patients. Padesky (1989) demonstrated the compatibility of CT with feminist therapy, which stresses an egalitarian patient-therapist relationship. Padesky posited that the collaborative nature of CT, use of the Socratic method to nudge patients to use their own knowledge to evaluate beliefs, exemplifies egalitarian therapy. Kuehlwein (1992) presented CT as a structured alternative to the haphazard process that gay men typically undergo when coming to terms with their sexual orientation.

Combining the research on LGB persons with the cognitive-behavioral therapy literature, Martell, Safren, and Prince (2004) developed an LGB-

affirmative approach to CT with several clinical populations within the LGB community. LGB-affirmative CT does not radically differ from CT in general. To practice affirmative CT, it is most important that the therapist not pathologize a person because of his/her sexual orientation. LGB-affir-mative means precisely that: Homosexuality or bisexuality are considered normal variants of human sexual adaptation and are not considered to be problematic. LGB individuals also need to be recognized as an oppressed group. Patients who identify with the larger LGB community may find that legislative action to prevent same-sex marriages or civil unions; depictions in the media of LGB people as narcissistically focused on their looks or their sexual behavior (e.g., the character Jack on the popular TV show Will and Grace); or open hostility and harassment from family, neighbors, or cowork-ers, may have a negative impact on their psychological adjustment. Patients who do not identify with the LGB community may not experience oppression as overtly, but they may be distressed about discordance between their sexual-affective desires and their cultural or family values. The LGB-affir-mative cognitive therapist pays careful attention to the social milieu of his/ her patient and is an active part of the patient's support system. If a therapist cannot do so because of personal beliefs or biases, he/she should not work with LGB patients.

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