Terms of Art: Psychotherapy with Gay, Lesbian, Bisexual, Transgendered and Heterosexual Clients


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T E R M S   O F   A R T :

 

Psychotherapy with Gay, Lesbian, Bisexual, Transgendered – and Heterosexual –  Clients

 

 

by William A. Henkin, Ph.D.

 

Copyright C 2005, 2007 by William A. Henkin

 

[In 1997 San Francisco’s Haight-Ashbury Free Clinics celebrated their 30th anniversary with a conference called Caring for the Community. At that conference I presented the first version of this essay. I presented the final version as part of a panel discussion, “Out of the Closet and Onto the Couch: Clinical Practice with Sexual Minorities,” at Unstudied, Understudied, and Underserved Sexual Communities, the Western Regional Meeting of the Society for the Scientific Study of Sexuality 8 May 2005, San Francisco, CA. This paper was originally published in the Electronic Journal of Human Sexuality, Volume 8, May 24, 2005,

www.ejhs.org]

 

 

To speak honestly of sex and to depict sex frankly is revolutionary because the world likes to not speak of it – even though it is central to everyone’s lifestyle. Even the most prudish postal inspector has his sex-style and sex-attitude at the center of his existence. The same can be said of anyone who qualifies to be thought human....

 

-- Joseph Bean, from an interview in Leather Times, the Leather Archives & Museum newsletter, Fall, 2004

 

 

 

Ahem....a Prefatory

 

Thirteen years ago, on the first of May, 1992, in Palo Alto, CA, I participated in a panel discussion at Sexual Diversity, the Western Regional Meeting of the Society for the Scientific Study of Sex (not yet Sexuality). Our panel was called “Voices from the Edge: Sexual Minorities Speak Out.” My co-panelists were Kat Sunlove, then publisher of Spectator and now Legislative Affairs Director of the Free Speech Coalition; James Green, transgender activist, spokesman, and author, who was then also president of FTM International; and Carol Queen, sex activist, author, and now Co-Founder and Director of the Center for Sex and Culture in San Francisco. In my prepared notes, which I later published under the title “Am I a Sexual Minority?” I asserted that I was “straight” as a way to reclaim for general usage a word as sadly lost as “queer” once was. I argued that

if I defined myself as straight, then whatever I did was straight de facto, no matter what configuration of accoutrements or other persons were involved.

 

Building on some aspects of that long-ago evening, but without restating them, I will use this paper to discuss, in terms of two implications, my work as a psychotherapist whose clientele derives largely from the alternate sexuality, or sex and gender minority, communities.

 

 

The First Implication

 

Because “Politically correct sexuality is a paradoxical concept,” as Joan Salon noted in her essay, “The Femme Question,” 1 it is quite possible for virtually anyone to feel that she is a sexual minority, and it is quite possible to agree that she is: the famous minority of one. As a psychotherapist and sex therapist I have found human sexuality to be positively rife with rampant individuality, even among conventionally paired heterosexual adults. While many people I have spoken with have claimed that their sex lives were nothing out of the ordinary, I have learned, when I’ve subjected these conversations to deeper exploration, that little is more extraordinary than what people call ordinary – and vice-versa.

 

Beyond the mainstream, people may be more direct. Especially within major urban centers, but often outside them as well, lesbian, gay, bisexual, and transgendered people frequently identify themselves as members of one or more sexual minorities. The same holds true as well, of course, for many people who are involved with polyamory, consensual sadomasochism (BDSM), cross-dressing, infantilism, or other special inclinations, as well as for those engaged in professional sex work.

 

The first implication inherent in the work I do, then, is that I cannot assume a client is who or what she seems at first to be, even in the most basic ways. In the past couple of months I met a classically married female-bodied person who had come to discuss a lifelong history of male identity; a devoutly gay man disquieted by unexpected heterosexual feelings; and a moderately famous individual with an extremely ordinary public life and a closet full of hidden gender identities, erotic interests, and sexual proclivities.

 

To address this first implication some distinctions are in order. In the final third of the 20th century, feminism in its many forms, gay liberation, and the more recently empowered transgendered communities – as well as various other sex- and gender-based subcultures in our midst – rejected and gave the lie to some ideas about identity that our dominant culture had long taken for granted. Thereafter, the definitions of certain terms most people never even think about had to be re-examined and re-defined. “Queer” is an obvious example of a word that has already been re-processed: once applied pejoratively by the straight community to the gay community, it was first reclaimed as a term of empowerment within much of the gay community, and then usurped as an attitude by whole lifestyles full of people – heterosexual and bisexual as well as homosexual – who did not identify their sexual selves as “straight.” Then, just as “queer” ceased to mean only homosexual in some quarters, so did queer’s antithesis, “straight,” cease to mean merely heterosexual.

 

In the transgendered communities it was Virginia Prince who provided the first useful redefinitions of sex and gender, which, while neither researched for statistical variability nor strictly accurate in terms of genotypes and other biological specifics, have proved fairly durable because they are so often functional: sex, she said, is what’s between the legs, gender what’s between the ears. 2 Even in the face of science, practical sexuality as attitude, behavior, and concept is often best defined this way: on the ground.

 

People with transgendered experience have also caused us to refine and redefine other words and phrases Prince’s life and writings – and those of the people who came after her – called into question, though she neither intended nor knew she would have exactly this effect when, in the early 1960s, she formed the first really out male-to-female (MTF) cross-dresser’s club in Los Angeles. Soon thereafter, gay liberation freed both the gay and the het worlds from the fancy that all gay men were femme and all lesbian women butch. And so, in addition to differentiating between a person’s sex and his gender we can now also distinguish between his gender identity [his self-perception as male, female, both, or something else] and his sexual orientation [his preference for men, women, both, neither, or others as sexual partners].

 

The transgender communities also redefined our definitions for cross-dresser and transvestite, its Latinate original coined by Magnus Hirshfeld 3 in 1910, so that for awhile the former came to mean someone who wears clothes of the complementary gender for purposes of non-sexual relaxation or self-expression, and the latter came to mean someone who cross-dressed for erotic reasons; then, somehow, the meanings reversed.

 

Transsexual, once a term reserved for people who had had sex reassignment surgery [now post-op] – later also known as gender confirmation surgery – is now applied as well to people who have not yet had such surgery [pre-op] and even to people who do not plan to have it [non-op], depending in large measure on their self-definitions, although there are people both within and peripheral to the transgender communities who still think of a non-op as a transgenderist: a person living full-time in a sex-role other than the one she was assigned at birth.

 

It is also possible to have a sexual identity or a gender orientation that is different from one’s gender identity or sexual orientation by identifying as a man or a woman rather than male or female [sexual identity], and by feeling attracted to males or females or other rather than to men or women [gender orientation]. By now, in our post-post-Modernist world, sex roles and gender roles, as the word “role” implies, are seen as social constructs: how one presents oneself or is seen by others. The drag queen Virginia Prince once assumed all gay cross-dressers to be turns out, for now at least, to be a female impersonator – male or female – of a particularly emphatic sort, who, by the early 1990s, had acquired a cross-gendered counterpart in the female-to-male (FTM) cross-dressing world, the drag king.

 

All these definitions are written in rubber: they are fully as much in flux as the communities to which they rightly belong. In her 1994 book Gender Outlaw 5 Kate Bornstein called for the same sort of recognition in our society that some pre-Industrial societies have maintained for people who do not fit neatly into either of the more common gender categories [e.g; French appellation for transgendered/gay men in Native American society, berdache; Navajo nadle]. Under the guidance of Cheryl Chase and her newsletter Hermaphrodites with Attitude, 6 the Intersex Society of North America has become a surprisingly influential political voice among professional sex researchers and clinicians over the past decade. And in 1997 an admittedly short-lived “Third Gender/ Androgyny Support Group” was formally organized in San Francisco, intended, according to its own literature,

 

for transfags, androgynes, genderfuckers, fagdykes, persons with male and female physical characteristics, gender adventurers, anyone who wants to explore multiple sides to gender or gender fluidity and who questions the traditional bipolar gender model. The group is also open to significant others, friends, family, admirers, and supporters. The group’s sexual/political trend so far is queer-friendly, anti-assimilationist, perv-positive (especially leather) and with a mix of ages and genders. 7

 

Despite the nominally clear-cut gender division into male and female at various of the older online interest groups, more recent entries into the definitions derby include the Yahoo newsgroup Transfags, for people with any female or feminine history or characteristics who self-identify as male, and the decidedly all-inclusive United Genders of the Universe (http://www.unitedgenders.org), which is aggressively open to virtually any definition of gender that is not limited by the number two. As our current understanding runs, no one identity or orientation implies any other: I can see I am a morphological man, feel myself to be a woman, be sexually attracted to either, both, neither, or other, present myself before you as anything I want, and never contradict myself. In short, the system is no longer only binary.

 

I’ve focused here on a few of the more prominent definitions current in the worlds of gender variability because our notions of gender go so directly to the heart of our notions of identity, which is very much what my work most deeply concerns. But other sub-cultural communities, such as butch-femme women, leather, and adult babies, have their own languages too, whose explorations confirm my first implication: I cannot assume a client is who or what she seems at first to be, even in the most basic ways; and in the sexual universe I prefer to make my judgments and draw my conclusions with minimal reference to the Diagnostic and Statistical Manual of Mental Disorders 8 because, as Leonore Tiefer notes in her essay, “Towards a Feminist Sex Therapy,” 9 “By ignoring the social context of sexuality, the DSM nomenclature perpetuates a dangerously naive and false vision of how sex really works,” separating what Gayle Rubin once called “the charmed circle [of] good, normal, natural, blessed sexuality” from “the outer limits [of] bad, abnormal, unnatural, damned sexuality.” 10

 

 

The Second Implication

 

     If sex were all, then every trembling hand

     Could make us squeak, like dolls, the wished‑for words.

     But note the unconscionable treachery of fate,

     That makes us weep, laugh, grunt and groan, and shout

     Doleful heroics, pinching gestures forth

     From madness to delight, without regard

     To that first, foremost law. 

 

– Wallace Stevens, “Le Monocle de Mon Oncle”

 

 

Except when there is reason to enter into the etheric realms of spirituality and transpersonal psychology, my professional life is concerned with egos: my ego, certainly, as well as the egos of miscellaneous therapists, physicians, and other colleagues, but chiefly the egos of my clients, and very often especially their sexual egos.

 

In this realm of ego psychology, therefore, a second implication for me, and one that is built on the back of the first, is that, regardless of his or her particular sexual and gender identity and orientation, every leatherman or leatherwoman, every infantilist, fetishist, and polyamorist, every person wrestling with questions of coming out, every gay, lesbian, bisexual, transgendered, queer, heterosexual, or straight person: everyone brings concerns to the therapeutic process that are unique because Everyone brings concerns to the therapeutic dialogue that are simply human: the minority of one again.

 

When I was a student at a very good shrink school exactly one course in human sexuality was required for licensure, and most of that course was devoted to physiology and the heterosexual reproductive process, with a nod to homosexuality, a parenthetical warning about STDs, a cross-cultural lecture, and a sweeping footnote to cover alternative sexual realities. Because I thought sex was a more important constituent of every human’s psyche than could be examined in one course, I pursued further studies – and activities – in sexuality.

 

And from the beginning of my professional life in therapy, from the androgynously dressed, effeminate gay man dying of HIV/AIDS who was my very first private-practice client, many people have come to me because they believed I would feel more comfortable hearing about their sexuality than other therapists they knew about, and therefore they believed they would also feel more comfortable with me. More often than I like, they have introduced their presence in my office with tales of previous therapists who were so embarrassed, offended, frightened, or simply ignorant about sex that they quickly shut my clients down by asserting that it was their sexuality rather than the presenting depression, anxiety, or poor communication skills that was their problem; or my clients simply did not feel safe disclosing their predilections, even in passing. Thereby important avenues of therapeutic exploration were swiftly and entirely closed off.

 

Despite Freud’s concern with sexuality and his profound influence on American psychology, so little training in human sexuality is offered for therapists in general that therapeutic attention to the sexual ego is often sparse and may sometimes be functionally non-existent. It may be worse than non-existent if a therapist has been unable or unwilling to resolve his own sexual issues before encountering related concerns among his clients. Much is made of transference in a few academic psych courses, but except in private consultations I have almost never heard a therapist explore his counter-transference in any depth. The best piece I ever read on the subject written by a peer remains unpublished after 10 years because the therapist – a fine writer and a well-published author – was unwilling to subject herself to the scrutiny she felt would follow such a step.

 

If it is not the constant obbligato Freud believed it to be, the music of sex nonetheless underlies so much of human activity I find it unlikely that I will really understand someone without understanding his sexuality. For that reason I want at least a cursory sexual history even for clients who do not arrive with sex or gender concerns, as well as for clients who are not involved with sex communities.

 

Nonetheless, sex is not all. Many other concerns make us weep, laugh, grunt and groan, and shout our doleful heroics forth. Sex is not all, but we cannot disregard its first, foremost law and, with it, my second implication, that Everyone brings concerns to the therapeutic dialogue that are simply human.

 

 

Termination

 

We serve our clients, ourselves, and our society ill when we identify alternative sexualities as pathologies, for the minority of one is also the majority of one – not just in the religious meaning where we are indeed all one, but in the very pragmatic, human meaning that we all share common attributes. Embracing both my implications – that I cannot assume a client is who or what she seems at first to be, and that Everyone brings concerns to the therapeutic dialogue that are simply human – has encouraged me to grow endlessly as a therapist, and allowed me to better serve my clients of every sort, because when I make myself sensitive to the concerns of any “minority,” starting with the minority of one, I am able to make myself sensitive to the concerns of every human being. As I recognize that everyone is a sexual minority I recognize myself increasingly to be a sexual minority; and then, through the compassion and empathy that follow almost inevitably, I become, to some extent, the very sexual minority of the person with me in the consultation room. When I am he and she is me and we are all together, we become – not oceanic in Freud’s meaning of infant-like and boundary-less – but transcendent: clearly bounded and also one.

 

 

* * * * *

 

Notes

 

1 Salon, J., “The Femme Question,” in Joan Nestle, ed., The Persistent Desire, Boston:  Alyson, 1992

 

2 Bruce, V. [aka Prince, V.] (1967). “The Expression of Femininity in the Male.” Journal of Sex Research, 3: 129-139. Virginia Prince is the grande dame of the male-to-female (MTF) cross-dressing universe. A scholar with a Ph.D. in chemistry, author of some dozen books and many professional articles, and publisher of Transvestia, the first serious modern attempt to create a magazine for people interested in cross-gendered behavior of any kind, she formed the Hose and Heels Club in Los Angeles in the early 1960s for the express purpose of creating a space for male cross-dressers to be. After a few permutations her organization turned into Tri-Ess, the Society for the Second Self, and became the basis for a nation-wide and then a world-wide transgendered community. For further information see the International Journal of Transgenderism, 8:4, “Virginia Prince: Pioneer of Transgendering.”

 

3 Hirshfeld, M., Transvestites (1910), translated by Michael Lombardi-Nash. Buffalo:  Prometheus Books, 1991

 

4 There are racial implications for this position. In The Apartheid of Sex (New York:  Crown, 1995), Martine Rothblatt reflected on Gordon Allport’s1954 observation in The Nature of Prejudice that if we lined up all the people on earth from darkest to lightest skin, no one could tell where one race left off and another one began. She proposed the same is true with the continuum of gender: that if we lined up all the people on earth from most feminine to most masculine, no one could tell where one gender left off and another began.

 

5 Intersex Society of North America, P.O. Box 301, Petaluma, CA 94953-0301; www.isna.org

 

6 Bornstein, K, Gender Outlaw: On Men, Women and the Rest of Us. New York: Routledge, 1994

 

7 Press Release 5/27/97 from Edward G

 

8  Washington, D.C.,  American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, 1994

 

9  Tiefer, L., “Towards a Feminist Sex Therapy,” in Marny Hall, Ph.D. (ed), Sexualities, Binghampton, NY: Harrington Park Press, 1997

 

10 Rubin, G., “Thinking Sex: Notes for a Radical Theory of the Politics of Sexuality,” in C.S. Vance (ed), Pleasure and Danger:  Exploring Female Sexuality. Boston: Routledge & Kegan Paul, 1984

 

 


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