the spicy, the pungent, the salty, the aromatic,

these were her lovers and her legacy to me.

We would come home month after month to the same

spaghetti casserole—she kept baking it 

for thirty years, each ingredient the same, 

salami sliced to an exact thickness,

heated to the same precise Fahrenheit temperature and left,

uncovered, for exactly the same number of minutes

every time it was prepared

So that if you were to slip into that lengthy, deep, 

yet fitful sleep of childhood, passing,

you’d swear it was the only one she ever cooked,

sleeping and waiting, waiting and eating,

the casserole slowly disappearing, taken in bites 

between dreams.

Food was my mother’s path to Nirvana.

like a mantra she kept repeating

for thirty years, the same long sound.

The citrus and the spicy, the sour and the salty

each to satisfy her in their own way and time.

When I grew up and fled the nest, 

my mother found her solace in restaurants. 

Dining in the Schezuan half light

finding comfort in the Kung Pao chicken

peace in the shrimp lo mein.

Noodles damp with anticipation

My mother’s stomach fat with the memory of 

hundreds of identical meals long since eaten, 

long since forgotten. 

I inherited her taste for citrus, salt and heat.

The tongue responsive, bathed in the clear, light fluid 

of remorseless, sexless salivation.

I sometimes drink a glass of pure, iridescent lime juice,

The burn of it going down

puckering the esophagus like a fine blend of whiskey,

satisfying warmth filling the gullet.

Like her, I crave the salty play of anchovies

swimming through mozzarella ponds on deep pan pizza, or

leaping and diving among the romaine, the endive, 

the radishes, cohabiting with capers, 

arching across hearts of palm

and later, that unquenchable thirst

The abdominal umbilicus that ties me to my mother—

her appetites, her ways of appeasing them. 

Beth A. Firestein

used to say, “Most problems are caused by caterpillars.”

I couldn’t believe he said this to me on moving day.

We were vacating the home we had loved together for twelve years.

Our outstretched arms carrying

the contents of our married lives,

Splitting and separating

Breaking the long-time cohabitation of kitchen knives,

egg-beaters, plush cotton towels and boxer shorts.

The oven-baked dishware crying out for the kitchen cabinets

from their temporary variegated cardboard homes. 

And hundreds of tiny green caterpillars 

falling like rain onto our hands, the boxes, 

everything we once held dear.

The weight of the dishes burning the muscles of my arms,

my small hands straining to bear the weight, the guilt, 

the sorrow of tearing them from the only home

they have ever really known.

And, personally, I think the caterpillars are innocent.

The magnificent tree that once shaded our whole lives

weeping their tiny bodies, like soft green tears raining down

on the contents of a dream torn in two 

by forces beyond our understanding.

And I look at the receding form of this man I have loved

for all these years, watching as he slips downstream

into the waiting embrace of another,

and somehow I know, in my heart of hearts

that the caterpillars had nothing to do with this.

Beth A. Firestein

Download the full presentation here.

Salt Lake City, March 8-12, 2000

LEARNING FROM MY TRANSGENDERED CLIENTS

Beth A. Firestein, Ph.D.

Introduction

Like the majority of my feminist psychotherapist colleagues, I came to my work with transgendered clients through the side door.  My formal preparation as a psychologist never included any reference to the transgendered and transsexual population, much less any guidance as to how to work ethically, knowledgeably, or compassionately with such an individual should they happen to stumble across my doorstep and become a client.  As mentioned earlier, those of us who incorporate feminist perspectives into our psychotherapy work or who practice as feminist therapists are being increasingly sought out by sexually diverse and differently gendered clients.  I think this happens in part because we routinely address gender as an important lens to apply in understanding psychological issues and because we treat sexuality issues as important and valuable areas of exploration and understanding.  

For those of us who are actively involved in working with and serving gay, lesbian, and bisexual populations, the developing political affinity between BLG and transgender folk can rather naturally bring us into contact with those questioning concepts of gender and exploring issues of gender identity.  Other clients exploring gender issues may stumble upon us in a purely accidental fashion. But once it becomes known that a therapist works in a compassionate and effective way with transgendered clients, word of mouth usually ensures further referrals.  Many transgendered clients have had one or more unfortunate experiences with biased or unknowledgeable therapists. Many fail to seek help at all due to their fear of being misunderstood and mistreated.

My own journey of involvement began when I was formulating my vision for the book I edited, entitled Bisexuality: The psychology and politics of an invisible minority, which was published by Sage in 1996.  In this book, I talk about the need for a paradigm shift within our field—the need to move away from dichotomous models of understanding sexual and gender identities toward multi-dimensional, fluid models of understanding sex and gender.  I provisionally named the new paradigm the LesBiGay/Transgender affirmative paradigm, and my inclusion of Transgender in the name of the paradigm was both conscious and deliberate.  I recognized that both bisexuality and transgender identity defy dichotomous conceptualizations of identity and sexuality.  I invited two highly intelligent and visible leaders of the male-to-female and female-to-male national organizations serving the transgendered, cross-dressing, and transsexual populations to team up and co-author a chapter to explore the intersection of gender identity and bisexuality.  

The publication of that chapter and of my book initiated a series of events that has led me to become increasingly involved in providing support and clinical assistance to the transgendered population.  These wonderful people have been my clients and my teachers.  I have learned, and continue to learn, a tremendous amount from my contact with these brave and incredible individuals. These people are living lives that defy easy description or explanation, lives that are not easily lived.  Currently, I work with a diverse range of clients presenting with gender concerns.  Working with these clients has been a source of fresh learning and considerable challenge.  In this presentation, I would like to share with you some of the many things I have learned from my transgendered clients and some of the ways I have been challenged to grow, both as a person and as a professional.

Phases of Development as a Therapist to Transgendered Clients

First, I would like to share a little about what I see as the stages of my growth as a therapist dealing with transgendered issues in my clients.  One thing I discovered was that reading about gender identity was one thing and sitting across from a biological male cross-dressed as a woman is another experience.  Until I began working with individuals and leading the transgendered support group, my only exposure to transgendered and transsexual individuals had been through the caricatures of media portrayals and the few transgendered folk I had come across at national and international conferences on bisexuality or in gay pride marches.  

Initially, I felt uncomfortable sitting across from a man wearing make-up, skirts or dresses, and sometimes wigs.  The stretch involved when clients were not cross-dressed was sometimes even more challenging.  Depending on their own stage of self-exploration and self-acceptance, clients often prefer to be addressed by their femme name in therapy, even when they are dressed in attire appropriate to their biological sex.  It was initially a challenge for me to address a client in male attire by her femme name, but I recognized it as critically important to that client’s emotional well being that I do so. After all, outside of the safety of the therapy room, transgendered and transsexual clients feel the pressure of constant and unrelenting invalidation of their core sense of self—that is, that their internally felt gender exists in sometimes dramatic opposition to their external, daily gender expression.

My process of developing comfort as a therapist working with TG clients also involved seeking out reading material and educational information about transgenderism, transsexualism, and cross-dressing.  I have had many very intelligent, energetic, and resourceful clients who have turned me on to resources that were available to help me deepen my understanding of the transgendered experience.  Denver is also fortunate to have an incredible resource called the Gender Identity Center that makes high quality information, outreach, and programming available to the population of Colorado.  They sponsor a nationally recognized conference, the Gold Rush, that brings in a variety of medical experts, psychological experts and activists to educate, support and empower the transgendered population and those who are trying to serve this population.  Attending events where I could converse and spend time around a number of cross-dressed and full-time living gender folk has gradually and continuously increased my comfort with this population.  Seeing some of the same individuals over time and getting to know them as individuals increases that comfort level even more and normalizes diverse ways that people have of expressing gender.

Finally, my experiences in working with transgendered individuals, leading the monthly Gender Support Group for the past 2 ½ years, and listening to a cross-section of voices of cross-dressing, transgendered, and transsexual clients, authors and activists has led me to a place of relative comfort in my work with transgendered clients.  The most difficult challenges I have faced to date have revolved around embracing my role as “gate-keeper” with clients who are ready to move toward full-time living and SRS (Sex Reassignment Surgery).  I consider the responsibility of writing a letter of support for an individual who intends to undergo radical body modification and genital reconstruction to be an enormously weighty responsibility and the prospect of doing so still causes me considerable anxiety.  So far, I have only had a couple of clients who have progressed that far under the auspices of our therapy relationship.

Listening to Transgendered Voices

One of the most valuable outcomes of my work with transgendered clients is coming to deeply understand their experience of the world.  At times, it has been a real stretch for me to grasp their phenomenological realities.  I would like to share with you, anonymously, some of the voices of my transgendered clients, as they struggle to articulate various aspects of their experience to me and to one another. 

Regarding the issue of fear, one male cross-dresser remarked, “Now that you’ve taken the first step and admitted that you have a problem, the only thing you can’t do is nothing.”  

Commenting on what joy he found in his feminine role, a cross-dressing, bisexual man stated, “I am who I am and I feel good.  I’m thankful that I am able to enjoy the presentation of femininity.  I am grateful to have these friendships.  I enjoy being with a man as a woman.” 

When I asked members of the transgender support group what they like about being transgendered, these were some of the remarks:

“No more civil war.”

“I get to mess with people’s heads.”

“I like the wide range of roles and expressions.”

“Overcoming half a century of fear, guilt, and shame, I had to stare fear in the eye or fear would never go away.”

“I’m not going to run and hide like a criminal. I’m a proud human being. I like freedom.”

One individual with a strong impulse toward activism commented, “What I really enjoy is making a difference. I get upset when things are wrong and I try to change them.”

Not everyone felt as positive about the experience.  Others comments:

“I would like to be born in the right (female) body to begin with.  I don’t like being transgendered.”

“I’m doing what I can to just fit it.”

“It’s better to be looked up to than to be looked down on; I have no desire to be like this.”

Those having high levels of self-acceptance sometimes move beyond even having the need to successfully “pass” as a member of the other sex.  These individuals view a transgendered or transsexual identity as completely valid and different from being a “woman” or being a “man.”  They take pride in being who they are and expressing gender in non-conforming ways, even if they can be “read” (i.e. identified as attempting to present as a different gender than their biological sex). One such person said,

“If you’re passing, you aren’t helping.”   

Many individuals cannot successfully pass. Those who cannot pass and are still take pride in who they are seek a level of cultural acceptance that goes beyond passing.  Those who are able to find that acceptance within the broader culture “help” by broadening the range of acceptable forms of gender expression thereby making more room for the rest of us to express ourselves in diverse ways.

Challenges of Working with Gender Clients

I have encountered a number of significant challenges in working with my differently gendered clients. First and foremost has been the “stretch” involved in understanding my gender clients.  Just as exclusively heterosexual people have trouble understanding and really grasping the experience of being gay, and both gay and lesbian identified men and women have difficulty grasping the experience of being bisexual, those of us whose gender identity corresponds to our assigned gender and birth sex often have difficulty understanding the experience of those whose sense of gender differs from their assigned gender.  As a woman-identified genetic female who has never questioned my gender identity and has always loved being a woman, the concept of not feeling that one’s gender identity is congruent with one’s birth sex was a very foreign idea, and initially quite troubling.  It has been easier for me to relate to the transgender experience out of my experience of my own bisexuality.  Transgender expression moves us beyond the two-gender system; bisexuality moves us beyond the two-gender system of loving. 

Some of my greatest challenges in working with gender clients have come around the actual challenges of the therapy work.  These have taken several forms.  I have felt the challenge of supporting clients and validating their self-perceptions in the face of frequently overwhelming social invalidation. Few of my clients’ family members or friends usually support them in their preferred gender identity choice.  My clients frequently face incredible levels of misunderstanding, ridicule and hostility in the homes and work places should they reveal themselves to others or attempt to live full time in their preferred gender role.  Often I am place in the position of supporting a client to take risks to be authentic which are likely to yield multiple negative real-life consequences (risk of losing a job, a spouse, or relationships with their own children).  While these risks can also occur with other clients who move toward authenticity and self-empowerment, these risks are much more profound and have far-reaching implications for my gender clients.  The risks of “coming out” transgendered are not unlike the risks of coming out gay, lesbian, or bisexual, but the transgendered identity is even more stigmatized and even less well understood than LesBiGay identities currently are in our culture.

This circumstance frequently leads me as a therapist to support clients as they struggle with complex issues related to privacy, secrecy, and deception.  Most of my clients “pass” as typically gendered in their jobs and in their families.  Many maintain a “secret life” involving cross-dressing, self-adornment, body modification, and sometimes hormonal treatment while still functioning and passing as their biological sex.  These issues continually challenge my personal and professional values around honesty and authenticity, particularly in intimate relationships or marriage.  The issue of coming out to one’s children is also a complex issue confronting many people with gender issues. 

Another challenge revolves around issues of advocacy and dual roles.  Some of my transgendered clients have lost jobs, lost families or been chronically suicidal.  Some have ended up on SSI Disability, either due to medical or psychiatric disabilities, or both.  It has been my experience that many of my gender clients are so “starved” for validation that I feel a strong desire from some of them for me to become more involved in their lives and in their political movement.  I do what I can, but it has been challenging for me to struggle with the limits of my time and energy to invest in this arena when I also have commitments to so many other issues and causes.  I feel appreciated, but I often feel that I am letting them down because I am unable or unwilling to do more.  Of course, the pull is not there at all with some of my clients and strongly there with others depending on their level of dependency needs, degree of isolation, and degree of personal activism.  Some of my most powerful, self-accepting and activist clients are the ones I feel the strongest pulls from and feel the most guilt and conflict about with respect to what I am able to give.  Finally, there is also the issue of how various forms of psychopathology interact with gender identity concerns and how to treat the individual’s pathology without pathologizing the gender identity issue.  There are many other challenges I could name but I will save these for the discussion.

What I have learned from my transgendered clients

In summary, I have found my experience in getting to know and working with differently gendered clients to be immensely rewarding, fascinating, and challenging.  I have been challenged to balance, and to help clients balance subjective and objective realities with an awareness of the socially constructed nature of both of these.  I have come to believe that the transsexual experience originates largely from a body-centered truth that sometimes defies ready or obvious external validation. I have learned to honor my clients’ subjective truth even when it is at variance with the objective data of my senses.

With my differently gendered clients I have learned about other difficult and authentic ways of living that are different from my own, yet I have also found strength for my own coming out journey in the power of theirs.  My transgendered clients are some of the bravest, funniest, smartest, and most persevering people I have ever known.  I have learned a lot about managing a stigmatized identity in a hostile culture and validating one’s right to a place in that culture—making a place for oneself in that culture even in the face of threatened disapproval, alienation, ostracism, discrimination, or violence.  I have learned a great deal from my gender clients about the journey from self-rejection to self-acceptance—from the “dark night of the soul” to “gender celebration.”  I have learned about coming home to one’s self.  

I applaud my clients for their courage and their willingness to journey into the unknown regions of their being, for their trust in allowing me to facilitate their journey, and for their willingness to hear and know the complex and sometimes difficult truth of their own being.  May we all have such courage.

SELECT BIBLIOGRAPHY ON GENDER ISSUES*

Bem, S. L. (1993). The lenses of gender: transforming the debate on sexual inequality. New Haven: Yale University Press.

Bornstein, K. (1995). Gender Outlaw: On men, women and the rest of us.  New York: Vintage Books (Random House).

Bornstein, K. (1998). My gender workbook.  New York: Routledge.

Butler, J. (1990).  Gender trouble: Feminism and the subversion of identity.  New York: Routledge.

Brown, M.L. & Rounsley, C.A. (1996). True selves: Understanding Transsexualism. San Francisco: Josey-Bass.

Califia, P. (1997).  Sex changes: The politics of transgenderism.  San Francisco: Cleis Press.

Chodorow, N.J. (1994).  Femininities, masculinities, sexualities: Freud and beyond. Lexington: University Press of Kentucky.

Franzini, L.R.; Casinelli, D.L. (1986). Health professional’s factual knowledge and changing attitudes toward transsexuals. Social Science and Medicine 22, 535-539.

Gagne, P. & Tewksbury, R. (1998). Conformity pressures and gender resistance among transgendered individuals. Social Problems 45, 81-101.

Kirk, S. & Rothblatt, M. (1995). Medical, legal and workplace issues for transsexuals: A guide for transformation. Blawnox, PA:  Together Lifeworks. (P.O. Box 38114, Blawnox, PA 15238).

Kockett, G. & Fahrner, E.M. (1988). Male-to-female and female-to-male transsexuals: A comparison. Archives of Sexual Behavior, 17, 539-546.

Price, J. (1985). Psychotherapy with transsexuals: Do we need a new approach? Journal of Contemporary psychotherapy, 15, 5-19.

Rudd, P. (1999). Crossdressing with dignity: The case for transcending gender lines. PM Publishers, Inc., P.O. Box 5304, Katy, TX 77491-5304. www.pmpub.com

Wilchins, R. A. (1997).  Read my lips: Sexual subversion and the end of gender. Ithaca, NY: Firebrand. 

*Many thanks to Monique Pauling and Alisa Beaver, from whose excellent March 1999 bibliography I drew many of these citations.

Beth A. Firestein, Ph.D.

Initial Fellow Application, November 2003

When Laura Brown, Chair of the Fellows Committee, wrote me in September 2003 encouraging me to apply for Fellow status in Division 44, I felt surprised, honored, and greatly appreciative. Moving through this intricate and thorough process has given me an unprecedented opportunity to step back and really examine the path of my professional journey. It has been interesting to examine the linking of personal history, professional training, and circumstance that have led to the development of this passionate body of work I call my “career.”  

My interest in psychology began in high school and continued to develop with greater clarity and intensity as I moved through undergraduate and graduate courses of study.  Dr. Mary Alice Gordon, my psychology professor and advisor at Southern Methodist University, played an especially pivotal role in encouraging me to pursue psychology as a career. She supervised my senior year Independent Study on rape myths, provided advice and encouragement to me in applying to graduate programs, and sponsored my first presentation at a regional psychology conference in 1978. I went on to earn my Masters in Educational Psychology and my Ph.D. in Counseling Psychology, both from the University of Texas at Austin, in 1987. I feel especially fortunate that the past 16 years have allowed me to experience such quality mentoring from psychologist peers and fulfillment in so many different roles as a professional psychologist.  

I completed my pre-doctoral internship at the Counseling Center at Colorado State University in 1985-86. Following completion of my internship, I worked for ten years as a staff psychologist in a University Counseling Center with an APA-approved training program (at SIU-Carbondale), where I provided direct service, training, supervision, outreach, and consultation services on a wide variety of topics. I also gained experience in program development and administration as Coordinator of the Office of Women’s Services.  This professional role provided a fertile context and great opportunity to develop and creatively expand my professional identity as a feminist psychologist. For the past seven years, I have focused on clinical work and consultation in the context of my private psychotherapy practice, Inner Source Psychotherapy and Consultation Services. Most recently, I began offering consultation to employers encountering the challenge of having employees who are transitioning their gender (from male to female or female to male) while on the job.  I have established the consulting firm “Gender Solutions” to provide an entry point for employers seeking assistance with these kinds of issues.  Throughout my career, I have remained active with professional organizations and scholarly activities related to my interests in women’s issues, trauma recovery, and my specialty areas in bisexual, gay, lesbian, and more recently, transgender issues in psychology.

When I came out as a bisexual woman in the mid-1970s, there were very few resources to mirror my experiences or my identity.  The immense curiosity I felt about my own emerging identity and others I met whose identities did not fit neatly into prescribed categories of  “straight” or “gay” propelled me to read all the available literature I could find at that time.  Later, my curiosity and passion to learn became the touchstone for my powerful drive to expand the scope of the field of psychology to include broader and more inclusive conceptualizations of sexual orientation, identity, and expression.  I also found myself seeking to understand human development in the context of the various “systems” that color our perceptions: the lenses of family, race, gender, sexual orientation, age, and culture, to name a few. I found feminism to provide a powerful and transformative perspective that has continuously shaped both my personal and professional life. Over time, my bisexuality, my feminism, and my strong interest in humanistic psychological models converged with my professional training to create the increasingly complex and integrated body of work I continue to develop to this day. 

My research interests have continuously reflected my desire to expand the boundaries of psychological inquiry. For example, my dissertation research expanded the focus of the domestic violence literature to include “dating violence” and linked the abuse, social support, and self-esteem literatures in creative ways.  The quality of my research was recognized when I was awarded the First Place Student Research Prize for “outstanding research on women and gender” by the Association for Women in Psychology in 1987.  Over time, AWP has become my long-term professional “home.”  With strong mentoring and encouragement from feminist psychologist peers, I have moved into increasingly substantial roles within the organization, helping to found and eventually Co-Chair the organization’s Caucus on Bisexuality and Sexual Diversity. This Caucus has played an increasingly influential role in shaping the direction, focus, and perspective of feminist psychology with respect to issues of sexual diversity, sexual orientation, gender identity.  

My colleagues at AWP have witnessed my journey of personal and professional development over the past 16 years of my involvement with the organization. I have moved though a wide variety of roles: from student presenting dissertation research and poster session, to fledgling psychologist presenting workshops, to becoming a well-respected and recognized author and clinician invited to share my experience and original thinking on sexuality issues in Plenary Session panels in 2000 and 2002. In these plenary sessions, I have been addressed some of the “difficult dialogues” feminist psychologists must have with one another during this new century. I am willing to speak, write and present about difficult “cutting edge” issues facing feminist psychology, particularly in the areas of sexual orientation and gender identity. I have been asked to speak to increasingly larger and more diverse audiences and to share my thinking and my vision in these contexts. This has been a great honor for me. Over time, I have also begun to move into mentoring roles with other young professional women.  I have found this new development in my professional life to be particularly meaningful and rewarding.

Perhaps the cornerstone of my work has been my deep engagement in clinical service to both traditional and non-traditional populations.  I have served hundreds of psychotherapy clients through individual, couple, family, and group psychotherapy and have gradually established specialty areas within my strong, generalist practice that have attracted regional and national interest.  I consider myself to have special expertise in women’s issues, couple counseling, trauma recovery, EMDR therapy, and facilitating the healing and growth of gay, lesbian, bisexual, and transgender individuals, couples and families.  I am one of the few psychologists in Colorado specifically addressing the needs of bisexual clients and one of the experienced and respected clinicians in this region serving the transgender and transsexual populations of a multi-state area.

I consider these areas of specialty to be the most innovative aspects of my clinical practice.  It is my commitment to create a “safe space” where individuals struggling with delicate and complex issues relating to their sexuality can come and receive truly qualified, sensitive, and professional psychological assistance. Related to this, working with transgendered and transsexual people has become a significant and integral part of my clinical practice, training, and consulting work. As mentioned earlier, I have begun providing consultations to employers who have individuals that are transitioning gender while on the job. I did some very successful work around policy development for a internationally recognized Fortune 100 company.  In addition, I have facilitated the Northern Colorado Gender Support Group for the past six years in my small, rather conservative Colorado community.

This aspect of my practice has been an incredibly enriching aspect of my own personal and professional development, challenging me to confront my own internalized “xenophobia.”  I have had to develop the ability to make increasingly refined clinical discernment between “difference” and “pathology” without doing my clients the potent disservice of pathologizing their difference simply because that “difference” is poorly understood by our profession.  One of my principal goals is to push the boundaries of psychological understanding to account for the complexity of this most delicate flower, our sexual being. At the same time, I remain cognizant of the critical need to contain sexual expression within appropriate boundaries of consensual, adult activity, clearly supporting cultural prohibitions against abusive and non-consensual sexual behavior such as child sexual abuse, rape, or sexual harassment.

Perhaps the most significant professional contribution emerging from the confluence of my theoretical work and clinical experience has been the book I edited, Bisexuality: The psychology and politics of an invisible minority (Sage, 1996), which won a Distinguished Publication Award from APA Division 35 and AWP in 1997. This book begins to fill a significant gap in the professional literature on sexual orientation and sexual identity by shining a clear, strong light on the topic of bisexuality.  Bisexuality brings together a number of the leading researchers, writers, and theorists in the field to discuss what is known and what remains to be known about bisexuality. 

Perhaps the most important thesis of my book concerns the necessity for a next paradigm shift in sexual orientation theory, research, and practice. The first significant theoretical shift was the shift from the illness model of homosexuality to gay and lesbian affirmative models of identity development and psychotherapy. In Bisexuality, I propose that we move beyond dichotomous models of gay and lesbian identity to a LesBiGay/Transgender affirmative model. A LesBiGay/Transgender affirmative model is necessary to provide a paradigm capable of accounting for non-dichotomous, fluid, and evolving sexual and gender identities, such as those experienced by bisexual, queer-identified, and transgender individuals. I think the book also helps bring about this shift in our paradigms by providing both a theoretical basis and a review of the empirical research that substantiates the necessity for the new paradigm. 

Bisexuality has also inspired a number of researchers to pursue “new paradigm” research questions related to sexual orientation and identity. It has been used as a textbook in several GLB studies courses (for example, at the University of Vermont and MIT) and functioned as an important resource in the development of APA’s new Guidelines for Psychotherapy with Gay, Lesbian, and Bisexual Clients (APA, 2000).  I think the book was also valuable to Division 44 as the Division went through the lengthy and lively multi-year dialogue surrounding whether to expand the name and mission of the Division to include bisexual issues in psychology. I am currently in the process of developing a prospectus for a new handbook of psychotherapy with bisexual clients, which will most likely consist of two volumes—one with a multicultural focus and one with a lifespan focus.  I am fortunate to have a publisher who has already expressed interest in this project.  

The purpose of my clinical and scholarly work has been twofold: 1) to promote the scientist-practitioner model in the realms of sexual orientation and gender identity, and  2) to cultivate a climate of permission, safety, and education to enhance the healing and growth work we offer for an increasingly complex, multicultural, and evolving population.  Homophobia, biphobia, and transphobia take a tremendous toll on GLBT individuals and families. As psychologists, we have a strong ethical imperative to help in qualified, informed ways without adding to our clients’ suffering with our own ignorance.  Graduate programs are only now beginning to offer training to psychologists and doctoral students around GLBT issues in psychology and such training is still minimal and uneven across most clinical graduate training programs, with perhaps a few exceptions.  I intend to continue developing resources for the profession and providing education, training, and strong, affirmative clinical assistance to racially, ethnically, and sexually diverse populations on both national and international levels. 

I have been fortunate to have the opportunity on several occasions to present on a variety of psychological topics to international audiences.  I was part of an AWP-sponsored symposium, “Feminist Perspectives on Trauma,” presented at the NGO Forum held in conjunction with the United Nation’s Fourth World Conference on Women in Beijing, China in 1995.  I also did a presentation on “American Perspectives on Psychology” at the American Center in Moscow, Russia in 2001. Most recently, I was an invited participant on the Bisexual Mental Health panel held during the Bisexual Health Summit Pre-conference Institute offered as part of the North American Bisexual Conference in San Diego in August 2003.  Currently, I am working on a proposal dealing with issues of sexual orientation that I intend to submit for consideration and possible presentation at the International Psychology Congress to be held in Beijing, China in August 2004.  We live in a global community. Cross-cultural dialogue and the exchange of theoretical perspectives and ideas about clinical practice are essential to an ethical, comprehensive, and culturally sensitive approach to psychology in the 21st century. 

I think the body of my work, taken as a whole, has as its purpose to articulate the needs and complex issues around sexuality, sexual orientation, and gender identity that are the inevitable product of our increasingly complex and global society. Additional forces come into play as we move from one generation to another. This is further complicated by the fact that multiple generations co-exist simultaneously in our culture. I am interested in organizing intergenerational dialogues to facilitate learning and building alliances across generations with culturally distinct perspectives. Another major thrust of my work is to increase the awareness, quality of research, and clinical competence of psychologists and educators seeking to serve sexual and multicultural minority populations.  I also like to get people thinking about cutting edge ideas around human sexuality and human relationships in gentle, yet provocative ways.

There is no doubt in my mind that the personal is political and that the way we live our individual lives shapes the culture.  Coming out about diverse and stigmatized identities is a risky and courageous act in this culture.  Every time I have taken the risk to be more authentically myself, I have been rewarded with an unanticipated degree of support, an enhanced sense of community, and the gratitude of others who have felt silenced around these same issues.  Ignorance, misunderstanding, and prejudice exist within our diverse sexual orientation communities as well as between our communities and the larger heteronormative society. Sexism, racism, homophobia, biphobia, transphobia and other afflictions of the human spirit manifest in both internalized and externalized forms. 

I enjoy participating in multiple communities and building bridges of understanding and acceptance between those communities.  I have written, published, and presented about bisexual, lesbian, gay and transgender issues in psychology for a variety of professional, student, and lay audiences. I believe my work has had a cumulative impact in raising consciousness and enhancing practice in academic, corporate, and community settings. Some of the most challenging, rewarding, and innovative work I have done has been within the LGBT community.  I have facilitated a number of “Lesbian/Bisexual Women’s Dialogues,” that have been powerful in building alliances and healing long-standing wounds between lesbian and bisexual women.

There is certainly other work to be done.  My hope is that I can embody the best of the scientist/practitioner model, developing theory that influences clinical practice and allowing my clinical experience to inform the development of my ideas, my writing, and my teaching.  The contributions I have been able to offer so far have emerged out of the organic interaction of multiple elements or threads of my own life and identity.  When I began this journey years ago, I never imagined that my unique, individual process of self-discovery would link me in such profound ways with whole communities of kindred spirits. Working to create a space for myself in the culture has had a synergistic and beneficial interaction with the efforts of others in creating a larger cultural recognition for bisexual and other sexual minority individuals. 

It is work that I would have had to do anyway, just to find my own place to belong in this world. Little did I guess that I would find so much company and so much community along the path. It is a tremendous gift to feel like part of something larger than I am and even more meaningful to feel that I have a role to play in shaping the larger culture in some small way.  I have developed a deep love for my profession and I have felt richly rewarded for doing something that I would have needed to do for myself anyway.  I intend to be a long-term contributor and hope to continue to create a positive and broadening impact on the field in areas of theory and practice related to sexual orientation, identity, and expression.  I am grateful for this opportunity to give and for the opportunity this application process has provided me to reflect on the content and meaning of my journey.

The Working Group on A New View of Women’s Sexual Problems offers clinicians a compelling alternative to physiologically based, performance driven models of women’s sexuality derived largely from ahistorical, decontextualized views of women’s sexuality.  The Working Group points out that the existing system of categorization of women’s sexual difficulties, canonized in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, erases the relational context of sexuality and fails to acknowledge important differences among women that affect women’s sexual functioning.  In contrast, the model proposed by this working group of feminist theorists is multi-dimensional, complex, and clearly contextual. This model functions as a springboard for clinicians and educators seeking a new conceptual platform for expanding their interventions to women seeking to understand their own sexual functioning better.  I wish to focus on the implications of this model for opening more comprehensive discussions addressing sexually transmitted diseases and the impact these diseases have on women’s sexual attitudes, behavior, functioning and relational choices.  

Sexually transmitted diseases (STDs) and their impact on women’s sexual functioning have generated minimal empirical interest or investigation beyond the large number of studies examining AIDS-related risk and prevention behaviors. AIDS is a critical health issue affecting women’s sexuality; however, it is only one of numerous sexually transmitted diseases that cause physical, emotional, and psychological problems for girls and women.  Millions of women are affected in acute and chronic ways by the vast array of curable and medically manageable, but incurable, STDs prevalent in the United States and other countries.  Although most of these diseases are not life-threatening, many women are directly affected by these STDs in physically and emotionally devastating ways.

The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IV) acknowledges that sexual disorders may be due to a general medical condition, substance abuse, or psychological factors, or to a combination of these, but gives virtually no recognition to the role STDs may play in disorders of desire, vaginismus, or sexual aversion disorders.  The DSM-IV does not address the issue of STDs directly, but an acknowledgement of the existence of sexually transmitted diseases affecting women’s functioning can be inferred from the text describing the “sexual pain disorders,” such as dyspareunia (pain with intercourse), in which physiological causes for sexual pain are to be “ruled out” before assigning a diagnosis. The classification  “Sexual dysfunction due to a general medical condition” refers to vaginal infections as one category of general medical conditions that can cause disorders of arousal, orgasm, or pain syndromes, but does not acknowledge the psychological impact that STDs or the fear of contracting STDs might have on an individual.

In contrast, the Working Group’s paper acknowledges sexually transmitted diseases as both direct and indirect causes of women’s sexual suffering.  Under the category, “Sexual problems due to socio-cultural, political, or economic factors,” STDs are named as one of several reasons for some women’s anxiety about sex.  These authors posit that inadequate access to information and services for STD prevention and treatment, as well as the absence or inadequacy of information and services about contraception, abortion and other matters pertaining to sexuality, can have a direct negative impact on women’s sexual functioning.  The second category “Sexual problems relating to partner and relationship” mentions “inhibitions in arousal or spontaneity due to partner’s health status or sexual problems,” which could include a partner’s sexual health problems, such as having frequently recurring herpes outbreaks, a positive HIV status, hepatitis, or other STD-related health difficulties.  The third category of women’s sexual problems, “Sexual problems due to psychological factors” clearly mentions the potential for “sexual inhibition due to fear of sexual acts or of their possible consequences,” including pain during intercourse and the risk of contracting a sexually transmitted disease. Finally, the fourth category, “Sexual problems due to medical factors,” refers to the presence of pain or lack of physical response during sexual activity that can occur despite the presence of a supportive and safe interpersonal situation when medical conditions, including STDs or the side effects of medical treatments, interfere with sexual pleasure and functioning.

This explicit acknowledgment of the multiple roles that sexually transmitted diseases play in the development and continuation of women’s sexual difficulties is extremely important and has implications for educators and clinicians committed to increasing women’s sexual pleasure and self-empowerment.  This working document develops a conceptual framework that permits us to expand our understanding of the role STDs play in inhibiting women’s sexual self-esteem and self-expression. This “new view” of women’s sexual problems can become a springboard for the work of educators and practitioners working with female clients on their sexual difficulties.

Effects of STDs on Women’s Sexual Functioning: Beyond Prevention

Prevention has been the primary focus of most sex education regarding sexually transmitted diseases.  A second aim of STD-related education, particularly that directed at high school age girls, appears to be to use the fear of STDs to discourage girls and young women from engaging in sexual behavior and to encourage the practice of sexual abstinence.   Some educational material, particularly information presented in the brochures on specific STDs available in health clinics and physician offices, focuses on how medically to prevent transmission of recurring and chronic STDs, such as HIV, venereal warts, herpes, or hepatitis, to one’s sexual partner and encourages communication with partners about STD status before engaging in sexual activity.  

What, then, do we offer to women who are already actively dealing with the emotional and physical challenges of having one or more STDs and to women who are dealing with partners who have STDs.  Education about prevention is very important, but is not adequate to address these women’s needs.  The issues involved are numerous and include the following: 

1. We need to assist women to develop comfort with asking a new or potential male or female partner specific questions about his or her prior exposure to STDs and teach women strategies for assessing their relative level of risk from exposure to chronic, viral STDs or STDs that may be asymptomatic in a partner.  A primary concern for women who may be carriers of a viral STD is the fear of acquiring another, different STD through exposure to a partner.
2. We need to provide education and effective intervention to women whose levels of sexual self-esteem and relational trust have been damaged due to having contracted a curable or chronic sexually transmitted disease to assist them in integrating this new element into their sexual identity in a way that does not lead to either denial (and associated risk behavior with a new partner) or to self-rejection and resignation to a life without sexual involvement and pleasure.
3. Women who have partners that suffer from recurring outbreaks of a viral STD, such as venereal warts and herpes, or neurological pain disorders, such as vulvodynia, that cause pain with sexual activity or penetration, need to be helped to separate fear from fact and to determine a personal range of safe and pleasurable sexual behaviors; behaviors that allow for sexual satisfaction of both partners while decreasing the risk of exposure to their partner’s disease.  Such women could also benefit from coaching in ways to deal with a partner’s STD that protects the woman without eroding their partner’s sexual self-esteem or healthy sense of sexual self-expression.
4. Many women suffering from STDs lack access to adequate information about allopathic and complementary treatments that might assist them in reducing the physical or psychological burden on or interference level with their sexual lives.  Although we certainly hope that most women have access to well-trained, sensitive medical providers who are up-to-date in their medical knowledge about STD treatment, in actuality, many women need to be encouraged to be proactive, participatory consumers of health care services.  We can encourage women to be assertive with their providers about their questions, needs, and concerns related to having an STD, and train them in the skills they need to communicate their concerns effectively to their health care provider.  Women also need to be taught that it is acceptable to seek a second opinion, even a third opinion, if their condition fails to improve or if their practitioner seems disrespectful, disinterested, or unknowledgeable.
5. Educators and counselors need to have a keen awareness of the role that fear of contracting another STD might have on a woman’s sense of sexual well-being and be alert to relationship and intimacy avoidance patterns that might have their root in the feelings of discomfort and dis-ease that many women experience once they have acquired an STD, particularly if the circumstances of acquiring the STD involved a dishonest or unscrupulous partner.
6. Finally, these issues also affect the thinking and decision-making of women who may be considering, or be asked by a partner to consider having more than one lover simultaneously.  The choice to be polyamorous, either as a single person or through involvement in a negotiated, ethical, responsible, non-monogamous relationship has significant implications for managing the risks associated with STDs.

Extending our Vision

As indicated earlier, prevention has been the primary focus of most sex education regarding sexually transmitted diseases. The document, “The New View of Women’s Sexual Problems” extends our thinking about the ways in which either the threat or the actuality of having an STD can affect women’s sexual functioning, satisfaction, and decision-making.  Educators and clinicians can effectively utilize the ideas contained in the “New View” document to become more conscious and effective in helping women retain and nurture positive sexual self-esteem and a sense of sexual safety in the face of the challenges sexually transmitted diseases pose to our sexual health and happiness.

(Revised Draft: 2/22/2000)

Abstract 

BEYOND STD PREVENTION:

IMPLICATIONS OF THE NEW VIEW OF WOMEN’S SEXUAL PROBLEMS

Beth A. Firestein

The new view of women’s sexual problems proposed by this working group provides educators and clinicians with a multi-dimensional, context-sensitive framework for understanding sexually transmitted diseases and STD prevention. Sexually transmitted diseases function as both direct and indirect causes of women’s sexual suffering.  This article discusses both common and less frequently recognized issues concerning STDs and their impact on women’s sexual functioning and psychological well-being.  The summary focuses on implications for educators and clinicians committed to increasing women’s sexual pleasure and self-empowerment.

Key words:

STD prevention, women, sexuality, sexual problems, sexually transmitted disease, HIV/AIDS

I am sitting in my office across from a conscientious, professionally accomplished, divorced 48 year old woman, single parent of two teenage children. She is attending the session with her 16 year old daughter.  Historically close to one another, mother and daughter have been having more frequent conflicts of late as their needs have become more and more disparate.  Daughter is working on differentiation, autonomy and unbeknownst but strongly suspected by Mom—sexual self-discovery.  Mom is feeling the need to protect and guide, perhaps even control her daughter through the sexual and emotional rapids of middle adolescence and they are coming into increasing conflict.  Mom doesn’t like daughter’s boyfriend.  Daughter sees his shortcomings, but is having the time of her life and really loves the boy, who is just a year or two older than she.  Mom suspects they are having sex, and having been trapped into marriage by an unwanted pregnancy at a young age, Mom is terrified of her daughter’s budding sexuality—that it will be out of control, or that sex will somehow ruin her daughter’s life.

Having talked with each privately I know that daughter is, in fact, having sex with her boyfriend.  I see clearly how mother’s well-intentioned, protectively motivated attempts at sexual control are driving a wedge between she and her daughter and the tension between them mounts daily.  The daughter feels unable to be honest with her mother, knowing that honesty about her burgeoning sexual needs and desires would only produce an intensification of the conflicts they have already been having.  I sit here as a feminist therapist watching the drama unfold and wondering what role I can usefully play to help heal the understanding between mother and daughter while respecting their differing age-related motivations and needs.

Feminist psychology provides me with little guidance in this arena.  If I were sitting across from a young woman experiencing incest or sexual assault, I would know what to do.  I check with the daughter and find out that she is being responsible about her sexual activity.  She is having sex only with this boy and they are in a relationship that she perceives as emotionally trustworthy.  She feels emotionally connected to him. And secretly, on her own, she has sought and obtained birth control.  She is aware of at least the broadest parameters of safe sex and is engaging in pregnancy prevention.  I offer her more specific information about the risk of various types of sexual activities, but she is generally well informed.  I do not tell Mom she is having sex, but I do not deny or minimize Mom’s suspicions either.  I wonder if I am doing the right thing.

As feminist psychologists, we have focused a great deal of our energy on unearthing the hidden horrors of sexual victimization.  In so doing, we have performed a profound service to sexually victimized women, girls, men, and boys and profoundly and irrevocably removed society’s mask of denial around experiences of sexual victimization.  It is probably one of feminist psychology’s greatest contributions to the culture.  We have focused on issues of sexual abuse, sexual harassment and teen pregnancy.  We have talked about the value of helping girls celebrate the passage into young womanhood marked by the onset of menses, and we have openly addressed the problematic ways that girls frequently find themselves silenced as they enter adolescence.  We have spoken of girl’s needs to find their voices, but we have remained silent about their urgently felt need to find their clits, their passion, their sexual agency, or their sexual pleasure.  Teenage sexuality terrifies us, and because it terrifies us, we are often unable to be helpful to our daughters in their times of greatest need.

I am here today to suggest that it is time for feminist psychology to move beyond an almost exclusive focus on women’s sexual victimization and into an affirmative, empowering, proactive perspective on girls and women’s sexuality.  Our girls desperately need for us to do this and we need to do this for one another.

With a profound respect for both mother and daughter, I gently encourage Mom to loosen her controls and allow daughter her privacy and her sexual freedom.  I was able to assure her that if her daughter was, in fact, being sexually active, I was confident that she was doing so with foresight and in a responsible manner.  I helped mother explore the sources of her own fears about daughter’s blossoming sexuality and work through some of the trauma of her own early romantic disappointments, her personal history of sexual entrapment.  Three months later, at follow-up, the daughter was still doing well in school, still working part time, and feeling closer and more comfortable in her relationship with her mother.  Recognizing her boyfriend’s limitations, she was questioning whether she wanted to remain in her current romantic relationship, but was still enjoying the intimacy they shared.   Mom reported less fighting between them and less anxiety about her daughter’s well being. While she would still have preferred that her daughter be more disclosing and not be sexually active, she was enjoying a more open communication with her daughter than they had known in years, and Mom was beginning to open up more about her early life experiences, sharing her wisdom and her source of her fears with her daughter so that her daughter could learn from Mom’s own life lessons.  At six month follow-up, the mother daughter relationship remained stable and healthy and Mom was ready to deal with other issues related to career and other matters affecting her adult level of life satisfaction.

We are here today to initiate Difficult Dialogues within our own tribe, to open ourselves to the silenced and unacknowledged voices of women who occupy marginalized positions within the subculture of feminist psychology, to open our ears in a spirit of respectful listening and compassionate understanding to these minority voices, the voices of women who frequently perceive their lived experience as being at variance with feminist theory or who live out versions of feminism that we can not relate to or find intolerable.  My task today is to highlight some of the challenges feminist psychology faces around issues of sexual diversity as we move into the new millenium.  Teen sexuality is only one of the difficult and disturbing issues engaging the minds and hearts of feminist psychologists, and teens only one of a number of diverse sexual populations earnestly calling for a response of acknowledgement and acceptance by feminist psychologists.

We must not let our politics blind us to the voices of girls and women whose experiences may or may not reflect our own life experiences or the feminist analysis into which we came of age.  As feminist psychologists of diverse ages, we are historically and culturally located at a multiplicity of intersections and our personal histories inevitably and profoundly affect our personal and political visions.

Today, I’ve been asked to speak about some of the issues around sexual diversity requiring that we engage in “difficult dialogues” with one another.  I have been asked to begin by naming the diverse communities that I belong to or otherwise represent.  I speak to you today as a woman and as a feminist psychologist whose personal biography contains no incest or child sexual abuse, but does contain a representative range of experiences of sexual victimization, including inappropriate sexual advances, sexual harassment in the workplace, and a date rape experience in college.     

A sexually curious and active teen, I initiated a variety of sexually exploratory experiences that included the discovery of my bisexuality and sensuous/sexual experiences with more than one partner simultaneously.  I fell in love with a woman for the first time at age18, and have sometimes maintained more than one loving or sexual relationship in my life at one time—today we call this polyamory.  At 21, I became involved with a creative and imaginative lover with whom I got to explore a range of sexual fantasies, including discreet public sex and the emotional and sexual intensity of consensual power exchange, more commonly known as S/M.  As I deepened into my study of feminist psychology, my S/M interests went underground and lay dormant for many years as I struggled to reconcile this aspect of my sexual desire with the prevailing feminist analysis of S/M as a form of violence against women.  Although my personal experiences with S/M had never felt victimizing or violating, I wasn’t sure how to make sense of my new sexual experience in a way that could encompass both my identity as a feminist and the full range of my passionate expression. 

I speak to you today as a feminist psychologist with a twenty year history of dedicated service to women who have been victims of violence.  I have served as a rape crisis counselor, a volunteer at a domestic violence shelter, the administrative director of the Office of Women’s Services at a major four year university, and as a researcher of dating violence and its impact on women.  I have counseled numerous women and men who have been victims of emotional, physical, and sexual violence.  I also speak to you today as a sexually adventurous, bisexual, polyamorous woman and a member of the safe, sane and consensual leather community.  The fact that I do not experience these diverse elements of my identity as contradictory or invalidating to one another reflects my sense of personal wholeness and integration.  But claiming these aspects of my identity publicly feels like an enormous risk.  Given traditional feminist concepts of female sexuality, I risk anger, censure, and the loss of the credibility of my feminist voice.  I also risk being stigmatized, judged, and misunderstood by my feminist peers.  But sexual silence is not the answer.

I am reminded of the words of Audre Lorde, who, facing a diagnosis of  breast cancer once wrote, “In becoming forcibly and essentially aware of my mortality…what I most regretted were my silences. Of what had I ever been afraid?  . . . I was going to die, if not sooner then later, whether or not I had ever spoken myself. My silences had not protected me. Your silence will not protect you.”

When our sense of self-identity as feminist psychologists rests exclusively on a feminist political analysis grounded primarily in women’s experiences of sexual victimization, we cannot make sense of the diverse sexual experiences of women whose forms of sexual expression may differ from our own.  A teenage girl’s desire for sexual experimentation may be viewed as a reflection of low self-esteem and dependency on male approval, a woman’s desire for multiple partners becomes routinely pathologized as “promiscuity,” and girls or women who desire multiple sexual partners or actively initiate a range of sexual experiences see themselves as “sluts.”  Women who enjoy consensual, adult sexual experiences involving consensual power exchange or other non-traditional forms of sexual expression are labeled victims of patriarchy rather than being recognized as self-aware, self-empowered sexual agents and potentially healthy role models for other sexually diverse women.

Sexual self-empowerment forms just as powerful and valid a foundation for feminist analysis as the recognition of women’s history of sexual subjugation and sexual victimization.  We cannot judge the basis of a woman’s sexual motivation from the externals of her sexual behavior.  We have to understand what that behavior means to her and honor her phenomenological reality.  Just as there are women whose bisexuality represents a transitional experience en route to a fully formed lesbian identity, there are other women for whom bisexuality becomes an accurate, ongoing representation of their ability to love both men and women.  Even as a majority of sex workers may be driven into sexual service by gender-oppressive economic conditions and patriarchal demand, we need to recognize and honor those women for whom sex work is an empowered choice reflective of their love of sex.  A woman’s choice to have multiple sexual partners may reflect a fear of emotional commitment or an empowered personal and political choice to reject models of relationship involving possessiveness and “sexual ownership” between lovers.  We cannot judge the feminist relevance of a particular form of sexual self-expression from the outwardly manifest behavior.  We have to understand the experience of the woman who is living that reality.  Every form of sexual expression is potentially feminist in its origin and in its impact.

I see this as the primary challenge facing feminist psychology with respect to the issue of sexual diversity: the challenge of stepping back from our own individual histories and traditional feminist political analysis long enough to listen anew to the voices of a new generation of girls and women, women and girls who have had the benefit of coming of age in an era of feminist-inspired sexual self-empowerment, women whose voices challenge us to make room for their different sexual realities, women who ultimately give us more room to discover and express ourselves.

I would like to conclude with another quote by Audre Lorde, who writes, “In the cause of silence, each of us draws the face of her own fear—fear of contempt, of censure, or some judgment, or recognition, of challenge, of annihilation.  But most of all, I think, we fear the visibility without which we cannot truly live.  [But]  for every real word spoken, for every attempt I had ever made to speak those truths for which I am still seeking, I had made contact with other women while we examined the words to fit a world in which we all believed, bridging our differences.”

Bi Health Summit

National Conference on Bisexuality

San Diego, California

August 21, 2003

Maya Angelou wrote a poem for Bill Clinton’s presidential inauguration entitled “On the Pulse of Morning.”  Giving voice to the experience of disenfranchised African Americans and other minorities in this culture, Maya Angelou speaks of “Arriving on a nightmare, praying for a dream,” a feeling that many in our community can certainly relate to.  Those of us attending today’s Bi Health Summit feel that we have our part in turning the nightmare of biphobia, homophobia, and sex-negative cultures that adversely impact bi health into dreams of courage and hope, equality and affirmation.

As Maya Angelou also says in this inaugural poem, “History, despite it’s wrenching pain, cannot be unlived, but if faced with courage, need not be lived again.”  I find these words inspiring.

We are here to talk today about difference and unity, about accommodation and individuation, both inside of ourselves and within our professions.  We are here to talk about the past and the future, about the contours of courage that will give us the hope of a better tomorrow for bisexuals everywhere.  Most of us know in our bones that the original impetus of gay liberation was unity, not polarization. In 1977, Don Clark wrote,

“We who are gay can still love someone of another gender, and fully love someone of the same gender.” Gay liberation was about expansion and inclusion. Bisexuality was a seamless element n the fabric of gay life then—unnamed, unquestioned, part and parcel of the movement for sexual and emotional freedom.

The transition into identity politics has been a lengthy and complex 25-year journey, well documented by a variety of bisexual, gay, and lesbian authors.  The affirming and disadvantaging aspects of identity-based theory and activism have affected by health and shaped the medical and mental health treatment of bi people in a number of brad and specific ways. Identity politics has led to the articulation of bisexual perspectives and to backlash from both gay and straight quarters.

Our further, uneven movement toward queer theory and queer “identities” (if there be such creatures), poses us with the potential obliteration of “bisexual” as a category of identity before it even has a chance to be validated as a “legitimate” identity category. This raises thorny issues about where bisexuals may wish to position ourselves in relation to these “queering” influences.

The pitfalls of articulating and reinforcing the concept of “bisexual identity,” while multiple, nonetheless creates a platform of equivalency that is probably necessary to the legitimization and systematic exploration of the distinct elements of bisexual experience.  These have profound and enduring implications for bi mental health.  Fortunately, there is no “either/or” here around the imperative of “queering bisexuality.”  Bisexual healers, lovers, and activists can and should support one another in taking multiple positions in relation to identity-based research and queer politics.  It is important to explore and demarcate fully all of these territories of knowledge and practice applicable to our needs and those of our clients.  A lot of incredible work has already been done.  

Ron Fox’s large scale study of bisexual identity development in men and women, Emily Page’s ground-breaking research on bi women’s experiences with mental health providers, Paula Rust’s 2001 Social Sciences reader on bisexuality, the emergence of the Journal of Bisexuality, and the bi leadership and bi inclusion in the development of Division 44’s Guidelines for Psychotherapy for Lesbian, Gay, and Bisexual clients are just a few of the amazing steps we have taken in “turning the nightmare into a dream.”

I think we are at an exciting juncture in the movement for bi health and there are several reasons for my excitement.  First, we continue to have the opportunity to facilitate the paradigm shift from illness models of homosexuality to gay and lesbian affirmative models, and the further transition form gay and lesbian affirmative models to a LesBiGay/Transgender affirmative paradigm (Firestein, 1996), more inclusive in scope and more accurate in descriptive and predictive power than any prior paradigm. 

Second, we are still in the early stages of the bi health movement—a period of time during when each of us has considerable definitional freedom and power.  We get to name the terms of the discussion and frame the dialogue as a conversation rather than a debate.  Key in this process, and reflected in the structure and content of this Bisexual Health Summit, is the continuous press to address bisexuality in it’s full complexity, integrating the perspectives of multiple, overlapping, culturally, ethnically, and otherwise diverse populations who embody behavioral, emotional, or identity-based bisexuality.

Of particular relevance to my recent experience in clinical practice is my own therapy and consulting work with cross-dressing, transgendered, and transsexual individuals, their relationship partners, and family members.  I am finding a high incidence of bisexual exploration, redefinition of sexual identity in light of ongoing construction of trans-gender narratives, and frequent movement to openly embrace a bisexual identity among many of my transgender, particularly transsexual clients—both M-to-F and F-to-M.

A related phenomenon in my clinical practice involves the way in which my clients’ movement toward bisexuality impacts partners and spouses in their own sexual identities and self-definitions.  In contrast to the situation of gender-conforming clients discovering their bisexuality, the ability or inability, success or failure of the partner or spouse in negotiating their own process of sexual identity redefinition is often what determines whether a primary, committed relationship will continue or end.

As clinicians, we cannot afford to remain ignorant or prejudicial in our work around issues of transgender, polyamory, kink, and other sexually diverse choices made by those we want to assist.  It is our ethical responsibility to educate ourselves and to teach and train students and others in the mental health field to understand these issues and to develop the skills to intervene meaningfully, with individuals, couples, triads, and expanded family communities who are pioneering in the shadow of these challenges.

In my recent practice, I have worked with several transsexual clients coming out as bisexual, both within and outside of traditional, heterosexual marriage.  I have worked with a bisexually identified heterosexually married per-operative transsexual client actively seeking to form a triadic relationship (expanded family) by expanding her (formerly) heterosexual marriage to include an outside male partner with whom to share their lives.  I also recently worked with a kink-oriented bi woman dealing with family of origin issues while transitioning her involvement levels in multiple, overlapping intimate relationships simultaneously.

A powerful and defining aspect of my work is to continuously challenge myself to effectively discriminate between “deviance” and “difference,” between pathologically-motivated behavior and unconventional choices that function as creative solutions to the dilemmas of living complex, multi-layered identities in a conservative, binary culture.  This often puts me in the uncomfortable position of evaluating and defining the healthy and problematic aspects of others’ behavior because to uncritically support all clients in every choice can be just as damaging to these individuals as forcing every unconventional client into the Procrustean bed of Puritan monosexuality.  Our clients trust us to provide meaningful criteria by which to evaluate the health of their own functioning and the health or dysfunction of relationship and partner behavior, yet we must do this without crossing over the line of respect for client autonomy by “telling them what to do”.

This adds urgency to our present dialogue in this Bi Health Summit. We need to forge new conceptualizations and interventions grounded in appropriately critiqued personality theory, an understanding of behavior change, and approaches consistent with our values, ethics, spiritual beliefs, and political commitments.  Such practices will also be positioned in specific, yet dynamic relationship to sexual orientation theory and evolving concepts of sexual and gender identity.

It is a fun and exciting time to be a queer/bi mental health practitioner.  Other issues of current interest to me in my clinical work with bisexual people include:

1. Helping clients manage heterogeneous social circles and identities;
2. The broad issue of accommodation versus individuation, as these play out in the lives of my bisexual and gender diverse clients;
3. Visibility and invisibility, including the implications of “passing”—choices, options, and strategies;
4. As mentioned earlier, implications of “queering” bisexuality. This affects us as therapists helping bi clients come to self-understanding;
5. The constant challenge of sensitively and effectively attending to the racial, sociocultural, educational, religious, and cultural complexity and diversity within bisexual identities and experiences;
6. The issue of multidirectional partiality, a theoretical term from family systems approaches that speaks to the therapist’s need to balance loyalties to various family members within a client family in a non-prejudicial way when counseling multiple members of a family.   I find this particularly challenging in the arena of working with trans-bi clients in relationships with straight-identified spouses coming in for relationship or marital therapy.

Jay Paul (p. 11) writes that, “Researchers have imparted an artificial consistency to an inchoate sexual universe.”  At the risk of implosion, or the dissolution of focus in what we now understand to be an “ever expanding universe of sexual and relational possibilities in an ever-expanding universe! (smile), let us take care not to do the same.  Let us strive to embrace complexity without falling into the abyss of atheoretical support and poorly guided intervention.   We skate the thin ice of politically driven clinical activism and clinically driven political research, working to align our values, our ethical commitments, and what we know about mental health with our own experiential realities and the needs and desires of our clients.

If we succeed, we map the contours of new frontiers in bisexual health.  We cannot afford to fail.  A new aesthetic of healing and creative clinical engagement beckons our conscious and unconscious participation.  In Maya Angelou’s words, “The horizon leans forward offering you space to place new steps of change. Lift up your eyes to this day breaking for you. Give birth to the dream.”

1 Part of a panel on Bi Mental Health and Community Outreach. Panel participants included Beth Firestein, Ph.D., “Fuji” Collins, Ph.D., Emily Page, Ph.D., and Geri Weitzmann, Ph.D.

References

Angelou, M. On the Pulse of Morning. (poem)

APA Guidelines for Psychotherapy with Gay, Lesbian, and Bisexual clients.

Firestein, B. Paradigm Shift chapter in Bisexuality

Fox, R Study of identity

Page, E.  (in press)  Bi women in Therapy

Paul, J. (        )      p.11?

Rust, P., Ed. (2001). Bisexuality in the United States: A social sciences reader