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Category Archives: Multicultural Competence

Shame among Sexual Minorities

I co-authored an article on shame among sexual minorities that was just published in Counseling & Values. The lead author, Veronica Johnson, wrote her dissertation on the topic, and this article is a reflection of her literature review with a focus on implications for counseling. It was nice to see it published in a mainstream counseling journal. Here is the abstract:

Theorists, clinicians, and researchers have suggested that shame is a central concern in the lives of sexual minority individuals. Cognitive theorists believe that shame occurs when a person fails to achieve his or her standards, which are often based on social, cultural, and spiritual values. Although it is asserted that stigma causes shame among members of a sexual minority, the empirical evidence suggests that negative internal cognitions are partly responsible. By targeting negative beliefs, counselors can help sexual minorities reduce their sense of shame, particularly around issues related to sexual identity. The authors offer counseling strategies for reducing shame in sexual minority clients.

shame1What is shame? Shame refers to “an intensely painful affect resulting from an exposure of the self as flawed or inferior, and a concurrent deep belief that this deficiency will result in rejection, abandonment, or loss of esteem.” If your mom ever said, “You should be ashamed” or “Shame on you!” she was likely hoping you would feel something more like remorse. Shame is the emotion that comes “from self-condemnation along with a fear of condemnation from others.”

Shame is not guilt. People feel guilty for things they have done wrong–or when they have failed to do the good/right. Shame is feeling bad (self-condemnation, self-rejection) for who you are; it reflects the idea that you are fundamentally flawed, and that if others knew who you really are, they would reject you too.

Johnson offers a formula for shame that is based on a cognitive theory by Lewis. Here is the formula:

Step 1: A person is raised in a culture in which various standards, rules, and goals are conveyed;

Step 2: That person does not live up to these standards/rules/goals (perceived failure);

Step 3: The person then believes that not living up to these standards is the result of personal deficiencies or shortcomings (negative global attribution);

Step 4: The result is shame.

How does this connect to sexual minorities? For many years now it has been understood that sexual minorities experience shame. In response to this, I have heard conservative Christians respond, “Well, they should!” –perhaps wanting to see guilt or remorse (or a sense of personal conviction) but without much genuine empathy or appreciation for how debilitating shame really is.

What I want to explore is how shame affects sexual minorities and how the church could respond to reduce shame. Let’s do a thought exercise: Think about a teenager in the church who experiences same-sex attraction. She grows up in a faith community with specific standards, rules, and goals specific to sexuality and sexual identity. If the church is not clear about how to understand these standards, she can quickly surmise that she is wrong for even experiencing same-sex attractions, even if she did not make this choice (in other words, she found herself experiencing same-sex attraction as she went through puberty). She is then unable to live up to the standards of her faith community, if those standards are that no one is to even experience same-sex attractions or that the experience of such attractions is sin. If another expectation is that she experience a dramatic change in her feelings through prayer or involvement in ministry, that becomes another source of shame. If she prays and ask God to remove her attractions or otherwise enter into ministry to change her feelings and does not have as much success as she had hoped for, she may confirm in her mind (and to others) that she cannot live up to the standards, rules and goals of the Christian community. The result? Shame.

shame2So this is not a simple matter of helping people become more sensitized to things they are doing wrong so that they can make necessary changes. Shame is a different kind of emotional experience, and one that is frequently associated with depression, anger, blame, and withdrawal from others. If you know a sexual minority who has struggled with shame, you know that it is a very painful emotional state that is not easily overcome.

In the article we offer several suggestions for reducing shame, so let me go over these briefly. First, we point out that a counselor can help a sexual minority identify and name their experience of shame by helping them become aware of related feelings (e.g., inferiority, inadequacy), thoughts (e.g., “God hates me”), and behaviors (e.g., Withdrawing from others).

A second recommendation is to learn to manage or regulate emotions. A person learns more helpful ways of releasing negative feelings, like shame. Here’s how we put it in the article: “regulating shame includes (a) withholding natural maladaptive reactions, (b) using self-soothing techniques to mollify the feelings of shame, (c) willfully refocusing attention outward, then (d) deciding how to act.”

The next recommendation is to address unhelpful thoughts. For the person who contends with shame, the thoughts they hold are self-condemning: “Shame is aroused when an individual holds self-condemning beliefs and fears of condemnation from others, particularly when the individual believes that he or she is failing to attain” standards, rules, and goals held by the community. At this point I am not thinking of what the local church teaches about sexual behavior, but what I am thinking about (as I mentioned above) are standards, rules and goals that may be associated with even having same-sex feelings (which the person did not choose to experience) and not experiencing as much change in their feelings as they may be expected (by their community) to experience. I’ve frequently said we need to find realistic biblical hope, which resides somewhere in between cynical pessimism that says, “No one has or ever will experience any experience of change whatsoever!” and arrogant optimism that says, “Anyone who tries hard enough or has enough faith can expect a 180-degree change from gay to straight!” I will have to return sometime to realistic biblical hope, but I will say that in most churches I visit, arrogant optimism is more often the norm and frequently to the detriment of sexual minorities who are unable to meet its standards.

The final recommendation we offered has to do with healthy and healing relationships, and in the context of mental health services, this usually begins with the relationship a person has with his or her counselor. (BTW: there are other recommendations not mentioned in this article that are better suited for a Christian setting, and I may do a future post on those.) It is frequently through that relationship that a person who struggles with shame can explore that emotional state and associated, unhelpful thoughts, as well as learn that a relationship can be sustained over time–they are not going to be rejected as they are known by another.

What is obviously more complicated in a conservative Christian context is how to address shame when the community (including the sexual minority) adheres to a traditional sexual ethic. How do you help a person feel better about themselves when they have feelings that draw them to engage in behavior about which they themselves feel ambivalent? They want to–they experience strong impulses, and they also don’t want to–they hold values that proscribe such behaviors.

You can understand why the mainstream gay community would ask, “Why are you working so hard? Why not change what you believe? Others have!” In other words, one response is to change what is taught in the church about sexual ethics. If a person feels cognitive dissonance between what they believe and how they live, one way to resolve that dissonance is to change what the person believes. Significantly, many sexual minorities do not believe it is there prerogative to make these kinds of doctrinal changes; their beliefs and convictions are that the Church (globally and historically) has been correct around general principles that inform sexual ethics. So they are looking at another way to respond to the dissonance they may feel. (As an aside, psychology cannot adjudicate the theological questions that surround sexual ethics. Psychology can inform our understanding of emotional experiences like shame, as well as help us recognize some of the complexities in attempting to reduce shame. The theological issues have to be resolved within the church and by the church.)

It is in this context (of retaining conservative or traditional religious beliefs and values) that pastoral care and counseling around shame is especially difficult. All the more reason for those in church leadership to understand ways in which they may inadvertently contribute to shame by how they talk about the topics of homosexuality, sexual identity, and gay and lesbian issues. I will try to come back to this in another post, as I know that many pastors have asked for guidance here. But I wanted to at least let you know about this article and to make the recommendations available for those who find them helpful.

 

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Christian Counseling Ethics, 2nd Ed.

The book, Christian Counseling Ethics, has just been published in its second edition. This is a book edited by Randolph Sanders, former executive director of the Christian Association for Psychological Studies (CAPS). The opening chapters (by folks like Alan Tjeltveit, Richard Butman, and Horace Lukens) orient the reader to a Christian worldview and engagement with counseling and mental health. This is a greater challenge than it sounds like, as the book is for a broad audience and so takes up psychology, counseling, marriage and family therapy, pastoral care, and lay counseling.

ChristiancounselingethicsThe book then turns to specific populations and issues, such as couples therapy, children, those with chronic conditions, navigating multiple relationships, and working with sexual minorities. I worked with Stan Jones and Jill Kays on the chapter on sexual minorities. Other contributors here included Jennifer Ripley, Ev Worthington, Steve Sandage, Jeff Berryhill, Angela Sabates, James Jennison, and Randy Sanders.

Other chapters address some unique considerations for Christians, lay counselors, and ministry settings. These include chapters on the abuse of power (John Shackelford & Randy Sanders), business ethics (Randy Sanders), pastors and lay counseling (Bill Blackburn, Siang-Yang Tan), the military (Brad Johnson), and member care (Kelly O’Donnell).

Most of the chapters are revised, expanded versions from topics addressed in the first edition. Some are new chapters. However, given the changes in the field, even those chapters that are revised or expanded are often substantive updates. I know that material on working with sexual minorities has grown significantly since the first edition came out in 1997.

Sanders also did a nice job asking everyone to be practical. The most obvious signs of this are the appendices. Various ethical codes are reproduced in the appendix, as are sample forms for release of information, demographics, and so on. But even in the various chapters, authors made a concerted effort to make the resource more practical. In our chapter on working with sexual minorities, we added a lot of suggested language that could be used when obtaining informed consent, for instance.

This book is meaningful to me personally. The chapter I coauthored for the first edition was my first publication. When I contributed to that edition, I was a grad student working for Stan Jones at Wheaton College. It was nice to be able to return to that chapter and to update it for Christians in training today.

Having taught a course in Ethical, Legal and Professional Issues in Psychology for more than a decade, I can say that I have not found another comparable book that delves into the professional ethical issues that arise for Christians and that is written from a Christian worldview. Given that 16 years had passed since the publication of the first edition, it was definitely time for a second edition, and I think the reader will not be disappointed.

 

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What is Integration?

A reader of the blog asked me the following question:

I don’t understand why we need an integration of psychology and Christianity. Can’t a Christian psychologist help non-Christians? Can’t a non-Christian psychologist help Christians? Are you talking about the necessity of a psychologist to be Christian to understand Christians? Then are you advocating that psychologist should only work with patients that match his/her religious background? What about other background characteristics, like wealth, race, gender, etc?

Here was my reply:

I agree with you that a Christian psychologist can help a nonChristian. I hope I’ve done that several times over the years. And, yes, nonChristian psychologists can help Christians. In fact, I recommend competence (in providing mental health services) over religious identification every time. But I do think that Christians in the field of psychology (beyond clinical psychology, but also including clinical/applied) ask different questions than do nonChristians. In other words, they have concerns that come out of being a part of the Christian community that might not be the same concerns that nonChristians have. So a benefit to having Christians in the field of psychology is that they might conduct research on topics that are important to that community. A good example might be research on forgiveness. Forgiveness is one of those key Christian concepts. It is central to Christianity, although nonChristians can certainly appreciate it, research it, and benefit from it in their own lives. But even if no one else was interested in forgiveness (or grace or humility or patience), the Christian psychologist might be interested in it anyway, by virtue of how central it is to Christianity, and how potentially helpful it could be in clinical practice.

Let me elaborate on the question about integration. Part of my reply was to clarify why we benefit from having Christians in psychology. I reached this conclusion over many years but was personally deeply influenced by the Christian philosopher Alvin Plantiga, who had written about Christian philosophy in the following manner:

Christian philosophers … are the philosophers of the Christian community; and it is part of their task as Christian philosophers to serve the Christian community. But the Christian community has its own questions, its own concerns, its own topics for investigation, its own agenda and its own research programs. (p. 6)

What I did in my page on integration is substitute “psychologist” for “philosopher” and we have the following:

Christian [psychologists] … are the [psychologists] of the Christian community; and it is part of their task as Christian [psychologists] to serve the Christian community. But the Christian community has its own questions, its own concerns, its own topics for investigation, its own agenda and its own research programs. (p. 6)

By substituting psychologist for philosopher, I want to make the point that Christians in the field of psychology often have our own research interests that may not be shared by the broader field, just as other groups may have their own research agendas. You can think about this by nearly any other demographic characteristic: age, gender, race, sexual orientation, disability, and so on.

Those who are disabled, for instance, will think about research questions (and design, methods, interpretation of data, etc.) in ways that are not identical to the way those who are not disabled will think about these things. We benefit from having psychologists with disabilities insofar as they help the field think about ability/disability in ways we would not if we did not glean from their experience. I think the same is true for race, age, gender, sexual orientation, and so on.

So… I am a Christian. What I read in the quote from Plantinga is that Christians will have their own questions to ask. Of course, most Christians in the field of psychology are interested in a lot of the same issues nonChristians are interested in. They research cognitive science, motivation, affect, parenting, and so on. But there will be other areas that might be of particular interest to the Christian but not that interesting to nonChristians. I gave the example of the construct of forgiveness. That might be of interest to both Christians and nonChristians, sure, but it is especially relevant to the Christian community as it is a central construct within the Christian religion. Other key constructs included grace, love, joy, peace, faithfulness, humility, and so on.

Of course, a psychologist can have more than one relevant demographic variable as a central part of their identity. An African-American Christian psychologist, for example, or a gay Jewish psychologist. A biblical feminist psychologist; an older adult psychologist with a disability. The multiple aspects of diversity are sometimes referred to as intersectionality, a concept that might be interesting to blog about at some point in the future.

For now, let me write more about being a Christian in psychology. Not only are their key constructs, such as forgiveness or grace to consider. But there are also key topics. For example, my primary research area has been sexual identity. I tend to study how sexual identity develops and synthesizes over time, particularly in the lives of Christians who experience same-sex attractions. In a cultural setting in which the primary script for making meaning out of same-sex sexuality is to form an identity around attractions (e.g., “I am gay”), I am interested in studying the process by which some people form a gay identity while others do not.

I don’t think many of my peers in the mainstream LGBT community of psychologists are particularly interested in studying those who do not form a gay identity. I could be wrong about that, but that is my impression so far. Most are interested in protecting and advancing the interests of the LGBT community.

I can understand that. I feel similarly when I think about the Christian community. But in the overlap between the LGBT community and the religious community, we see the potential for misunderstanding and miscommunication, particularly if you study something of interest to the religious community, such as whether a person can ever experience change in his or her sexual orientation, that might be experienced as threatening to the LGBT community. This, too, is a good topic for a future blog post. Remind me to get back to it.

In the meantime, I hope this elaboration on the question about integration provides some insight into what integration means and has meant to me as a Christian (in general), and as a Christian who conducts research on sexual identity (in particular).

 

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Clinical Practice with Middle Easterners & Arab-Americans

Our colloquium today featured Dr. Naji Abi-Hashem, a clinical psychologist with expertise on the Middle East. His talk was titled “Understanding and Counseling with Middle Easterners and Arab-Americans.” He regularly presents an extended version of this talk at the American Psychological Association. He is featured in the APA video on providing clinical services to Middle Easterners and Arab-Americans.

Interestingly, Dr. Abi-Hashem reported that there are significant discrepancies in estimates around religious identities of Arab Americans. It has been estimated 75% of Arab Americans are of a Christian background (Catholic, Orthodox, Protestant) while 25% are of Muslim background (some sources put that at 50-50). The majority are from Lebanese descent and relatively young (average age of 35). They tend to be highly educated and self-employed, with many involved in a range of professions.

Dr. Abi-Hashem reviewed several common misconceptions, such as All Arabs are Muslims, All Middle-Easterners are Muslims, All Muslims are Radicals, and All Radicals are Terrorists, in an attempt to help the audience move away from an They versus Us mentality.

To provide a context for understanding Middle Easterners and Arab Americans, he discussed concepts found in the following quote:

The Arabs are a proud and sensitive people whose culture is mainly derived from three key factors: family, language, and religion. No adequate understanding of Arab culture is possible without first examining these three major elements and the pervading impact they have had on their culture. Cultural understanding by Americans of the Arabs is especially important at present because it can provide a basis for our own interactive behavior with them as well as a basis frinterpreting their actions.                     – Edward Badolato

Dr. Abi-Hashem unpacked what this means in terms of understanding some of the nuances of family, language, and religion. He then briefly discussed virtuous characteristics including hospitality, truthfulness, respect, esteeming elders, insight, faithfulness, dignity, honor (saving face, avoiding public shame), hard work, generosity, and patience.

On providing clinical services, Dr. Abi-Hashem discussed assessing acculturation and community, flexibility in where you meet and the possible use of a translator. He discussed various gestures to avoid, as well as signs of respect to keep in mind, particularly if a person or family is more traditional. He encouraged us to note intergenerational dynamics (e.g., familial-communal heritage, moral-ethical values) and to be prepared to address grief and trauma when relevant. In this context, he compared and contrasted unhealthy coping styles (e.g., aggression, moving/leaving, blaming, complaining, etc.) and healthy coping styles (e.g., family/friendship bonds, expressing/talking, creating group atmosphere, public prayers/religious services, etc.).

We often discuss multicultural competence with different groups, but it was helpful to take one group and go deeper with it. Dr. Abi-Hashem is in a unique position to reflect upon the Middle East and to train psychologists in working competently with Middle Easterners and Arab Americans.

 
 

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