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A Case Study on Alex

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on 4 March 2015

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Transcript of A Case Study on Alex

Being Different
Alex has always felt and acted a little bit
different to his brothers and classmates.

He always knew he was different since he was about 8 or 9, but he tried to hide his true


In primary school friends and teachers would comment on his 'girliness'

By the age of 13 he knew he was attracted
to boys

Growing Up
Growing up through high school was tough for Alex. The secret he had to keep ate away at him because it was such a
part of himself.

"Living in the closet is exhausting and scary... Some become experts at hiding, but at a great expense to their health and well-being." (Mallon, 2001).

Alex even had a couple of girlfriends whom he was sexually active with in order to cover his true identity.

Dad would use gay-related insults for anything negative. The word 'gay' is so widely used.

The normal person wouldn't notice this, but every time he heard it, it felt like a personal dig at his real self...

LGBT issues in Adolescence: A TRUE Case Study.
His Dad is very much a masculine father figure.

He was a well-known football hooligan and respected by fellow football fans.

Alex's three younger brothers followed in his footsteps by playing rugby, and supporting the same football team.

It is a very
His Mum has always been a
caring and loving person in his life

At times she has been wrapped up in her own personal problems.

She also suffers from Bipolar Disorder
Much like many other LGBT youths,
Alex chose to remain 'invisible' for a
fear of:

Rejection from friends and family
Verbal harassment
Physical violence from others
Being treated differently
Being misunderstood
Being exclusively sexualised
Being perceived as sick, deviant or sinful.
You're not gay son...
You're just going through a phase, you're only a teenager...
Mallon, 2001, .

Identity Formation
in LGBT adolescents is a complex and painful process for the individual.

Cass's (1979) model:
Identity Confusion
Identity Comparison
I needed to find a way to allow him to
his sexual orientation.

He needed to get to the point where his sexuality is an aspect of his life, not the focal point.
Clark (1987), adapted by Davies (1996)

Getting involved – live an affirmative life; become familiar with the issues; strive for social justice and social change.

Create an affirmative setting – provide LGBT friendly reading material, literature and resources.

instead ask about a client’s

Be open about your commitment to providing affirmative therapy with all clients, regardless of sexual orientation or gender identity. With heterosexual clients, act as an advocate by challenging heterosexism.

Familiarise yourself with all the sexual possibilities and language

Alex's Feelings
Internalised homophobia -
Displaced Anger
- highlighted by his acting-out behaviour.
Suicidal Thoughts

Guilt &
Toxic Shame
What approach would be most appropriate
in supporting Alex through the coming-out
process and in helping him eradicate these
negative feelings?
LGB Affirmative Therapy or Gay Affirmative Therapy (GAT)
An approach to therapy that embraces a positive view of LGBT identities and relationships and addresses the negative influences that homophobia, transphobia, and heterosexism have on their lives.
Rock, M., Carlson, T. S., & McGeorge, C. R. (2010)
Specifically aimed at LGBT clients, but also can be transferable to other clients (you can never
who is gay). Non-LGBT clients may also find GAT therapeutic for their own 'differentness'.

Strongly against thinking of homosexuality
as pathological or undesirable, or a choice.

Rather than working to alter or modify the client's sexual feelings (like raparative/conversion therapy), reduce feelings of stigma, learn to recognise reality of heterosexism.

Encourages pride of sexual identity.
Being an Affirmative Therapist involves:
Alex is a 16 year old teenager in
Year 11 at secondary school.

His parents are divorced- he sees his Dad at weekends

He lives with his mother, stepfather
and three younger brothers
aged 15, 13 and 11.

Mom is expecting another
boy in three months.

My Approach for Alex
Any Questions?
Or ideas...
To Summarise
Coming-out is not a one-time event, it is a long-term process and is in control of the client at all times.

Respect the culture, sexuality and experiences of LGB clients to fully be able to provide an accepting and helpful relationship.

Develop a rapport of trust and congruence with the client, as with all other persepctives in order to achieve therapeutic change.

Avoid perceiving the world through a heteronormative lens. Don't make assumptions - You never know who may be LGBT.
Davies outlined the core condition of
. This includes full respect for the personal integrity of the client, respect for lifestyle, and culture of the client.
All clients are unique in their own way, each LGBT individual has different experiences, and perceptions of what it is to be different.
This approach cannot be used as a sort of 'recipe' of what to do with LGBT people... use it as a set of guidelines.
"Imagine a world where a fundamental part of your identity required hiding. What would help you to value yourself in such a world." (Perlman, 2003).
To Conclude
Being affirmative doesn't come without criticism.

Some say the approach is too forceful and restricts a client's power to work through and create their own meaning within the therapeutic relationship.
Guide through coming-out process
When talking through Alex's feelings about his hidden identity, be sure to use the words gay or homosexuality.

Practise coming-out in role-play activities

Help Alex to envisage a life without having to hide, to give him some hope for the future

Point him to helpful literature, such as poems.

Remind Alex he has more to his identity than his sexual orientation. He's not alone

challenge denial
modify parents' concept of homosexuality
facilitate parents through a sense of loss
explore effects of heterocentrism on children
work on helping them to disclose to friends and other family members
LGBT Communities and Support Groups
Work through suicidal thoughts
Overcome Internalised Homophobia
Cass, Vivienne. C. (1979). Homosexuality Identity Formation: A Theoretical Model . [online].
Journal of Homosexuality, 4
(3), 219-235. Article from Taylor & Francis last accessed 11 November 2013 at: http://tandfonline.com/

Davies, Dominic & Neal, Charles (eds). (1996).
Pink Therapy: A Guide for Counsellors and Therapists working with Lesbian, Gay and Bisexual Clients.
. Berkshire: Open University Press.
Fish, J. (2006).
Heterosexism in Health and Social Care
. Hampshire: Palgrave Macmillan.

Fish, J. (2012).
Social Work and Lesbian, Gay, Bisexual and Trans People: Making a Difference
. Bristol: The Policy Press.

Landridge, D. (2007). 'Gay Affirmative Therapy: A Theoretical Framework and Defence'. In: Peel, E., Clarke, V., & Drescher, J. (eds).
British Lesbian, Gay, and Bisexual Psychologies: Theory, Research and Practice
. New York: The Haworth Medical Press. pp.27-45.

Mallon, G. P. (2001).
Lesbian and Gay Youth Issues
. Washington: Child Welfare League of America.

Milton, M. and Coyle, A. (1999). Lesbian and Gay Affirmative Psychotherapy: Issues in theory and Practice,
Sex and Marital Therapy: The Journal of the British Association for Sexual and Relationship Therapy, 14
(1) pp.43-60.

Perlman, Graham. (2003). 'Gay Affirmative Practice', In: Lago, Colin., & Smith, Barbara (eds).
Anti-Discriminatory Counselling Practice
. London: Sage. pp.50-61.

Rock, M., Carlson, T. S., & McGeorge, C. R. (2010). Does affirmative training matter? Assessing CFT students’ beliefs about sexual orientation and their level of affirmative training.
Journal of Marital and Family Therapy
, 36(2), 171-184

Ryan, C. & Futterman, D. (1998).
Lesbian & Gay Youth: Care & Counselling
. Chichester: Columbia University Press.

Warwick, Ian., Oliver, Christine., & Aggleton, Peter. (2000). 'Sexuality and Mental Health Promotion: Lesbian and Gay Young People'. In: Aggleton, Peter, Hurry, Jane., & Warwick, Ian. (eds).
Young People and Mental Health
. Chichester: John Wiley & Sons. pp. 131-147.

Allow Alex to unload any negative emotions, such as the anger he feels at society, family members or anything at all.

Let him know how important his life is to the people around him.
Pinpoint sources of homophobia.

Realisation that internalised homophobia is a result of cultural programming that reflects homosexuality in a negative way.

Come to learn that being gay is perfectly normal, and is in at least part genetic, it's not an illness or a choice.

Develop self-esteem and self-worth and a sense of pride.
(Landridge, 2007)
(Plock, 1997; Cross, 2001; Goldenberg, 2000, in Landridge, 2007).
GAT, although an effective approach, cannot stand on its own. Instead it can be used in line with the therapists existing theoretical model.

I personally, would practise CBT with Alex and take a more gay affirmative approach to increase chance of healthy therapeutic change.

(Davies & Neal, 1996)
Alex started drinking, getting into the wrong crowd and not going to school.

Although he seemed perfectly fine he was secretly planning to commit suicide on his 16th birthday in a few weeks.
He grew up believing being gay was
somehow bad and wrong.
Alex is at high-risk
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