Case Example:

The case of Walter and Bob, by contrast, is an example of a better working out of discrepant desire. The difference in sex drive between Walter and Bob was probably about the same as that for Reggie and Betty. But other aspects of their situation were dissimilar. Neither man believed the other was "wrong:" each accepted the situation for what it was – a difference between them with no personal meaning. The discrepancy, however, had been apparent from the beginning of their relationship. Bob never showed high sexual desire, even at the height of romance. Walter, however, was pragmatic. He had had plenty of lovers in the past who were great in bed and made terrible partners, so he appreciated Bob’s maturity and capacity for non-sexual intimacy. Compared to Reggie, Walter did not romanticize sex at all, nor did he believe Bob capable of extraordinary change. Further, Walter was older and had had extensive sexual experience. He did not experience the lack of earth-shattering sex in his relationship with Bob as a sadness or deprivation. Finally, both men were able to work out some compromises in which Bob "helped" Walter masturbate to orgasm when he himself was not "in the mood."

Case Example:

Aurora and Shelley’s sexual problems are somewhat typical of the queer community. These women began sex therapy because Shelley seemed to have lost nearly all her interest in sex with Aurora. After several months of treatment, Shelley finally admitted that she had consuming fantasies of s/m sex and felt compelled to "try it," although she had not acted upon her desires up until this point. Because s/m sexual activity is so public and, by now, so generally accepted within the lesbian community, Shelley knew she could easily get support for her interests and opportunity to actualize her fantasies. Aurora, on the other hand, was an incest survivor who was horrified at the thought of sex that involved dominance and submission. Ultimately, the women separated, and Shelley became active in what is sometimes called the "leatherdyke" community.

Sex Addiction in the Millenium

Although the concept of sex addiction is fraught with opportunity for moralistic and sex-negative abuse, sometimes one works with individuals for whom no other model seems appropriate.

Case Example:

Billy came for help when he felt he was destroying his relationship with Roger and endangering his own health. Before the HIV epidemic, Billy had had a "golden showers" fetish. His sex life had revolved around public scenes in the backrooms of gay bars in which scores of men urinated upon him. Because this sexual activity actually carried little risk of HIV transmission, Billy had never become infected, but the AIDS epidemic resulted in the closing down of the backroom settings where Billy’s sexuality had played out. Forced to change his sexual script, he began to have sex in public parks and bathrooms, acting as a "bottom" in oral sex, i.e., the person who gives oral sex and might swallow semen.

Billy became involved with Roger in 1989 and for a while he gave up public sex. But when Roger and Billy became more intimate and eventually lived together in a marriage-like arrangement, Billy found he lost interest in sex with Roger. He discovered that his desire was fully dependent upon an element of risk, danger, and anonymity. He was no longer capable of play-acting dangerous sexual scenes with Roger as the two had done early in the relationship. "I can’t have that kind of sex with my ‘wife,’" he complained, sounding eerily like a heterosexual man. "And I’m not interested in sweet, close sex."

Billy eventually joined Sex Addicts Anonymous in desperation. For several years he was completely asexual, as even masturbation aroused almost uncontrollable urges in him to "act out." Fortunately, his partner Roger was able to take "the long view." Roger had himself had a great deal of sex in the pre-AIDS era and was willing to sacrifice partner sex for an otherwise extraordinarily loving and intimate relationship. Even years later, Billy could only occasionally be sexual with Roger.

Case Example:

Byron was addicted to the World Wide Web, but in his case his "addiction" may have been a step forward. When Byron entered treatment he was an anachronism. Well into his fifties, Byron had "come out" in the bad old days of complete shame and secrecy, and his history included flight into the priesthood to escape his sexual urges, disillusionment with the priesthood when he discovered the extent of homosexual activity within the monastery walls, and suicide attempts and hospitalizations.

Byron had never had a steady lover and rarely had sex; he was isolated and self-hating. Then he discovered the Internet. Byron invented a persona for himself of a twenty-something "hunk." He scanned a picture of a young man taken from a pornographic magazine into his computer profile, and corresponded with dozens of admiring cybersuitors. He because cybersexually active and his mood brightened considerably. He had some anxious moments when his suitors pressed to meet him in "3-D," or real life, but always managed to elude this attempts at face-to-face meetings. Despite the obvious fact that his suitors were falling in love with a fictitious Byron, Byron seemed to derive satisfaction and self-esteem from these interactions. It was as though he was experiencing an adolescence he had never had a chance to explore. Byron’s addiction seemed benign, and when he left treatment he had no desire to expand his sexual relationships to the flesh.

CONCLUSION

Although work within the queer community challenges the therapist to learn things not usually taught in graduate school, the clinician benefits from this work perhaps more than the client. For example, after several years of working with members of the S/M, or "leather" community, I noticed that S/M partners often had unusually good communication with each other about their sexual likes and dislikes, and I began to teach my non-S/M clients communication skills I learned from the "leather" population.

Certain attitudes and behaviors are useful in working with sexual minority clients. First, one must erase all preconceptions about "normal" and "abnormal" sex. The therapist must be open to all possibilities of erotic variation, and be willing to suspend judgment. You may want to use the IPG criteria: lack of consensuality and clear destructiveness are the only definite characteristics of "pathological" sex.

The therapist must also remember that work with this population requires suspending preconceived notions of gender and relationships as well as biases about sexual acts. Many clients who live on the sexual fringe desperately need to have their lifestyle validated by an "authority figure." This validation is surely a major aspect of the therapeutic experience for most clients who are socially stigmatized.

Counselors must also stay current with developments in the "queer" community. A subscription to a gay magazine, trips to a local gay bookstore, or periodic searches at websites like, for example, amazon.com , are helpful, as continuing education courses about the sexual fringe are difficult to find.

The therapist who works with the queer community must not be afraid to admit not knowing. It is often useful to ask clients themselves for information; the feel flattered and more empowered in their own treatment.

Although this chapter of necessity emphasizes differences, it is useful to remember that we are all more alike than we are different. Colorful and unusual differences in behavior and style may be prominent in minority clients; nevertheless, most therapeutic interventions will not vary that much from interventions used in a more mainstream population.

REFERENCES

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Bernstein, R. & Silberman, S. (Eds.)(1996). Generation Q. Los Angeles: Alyson Publications.

Browning, F. (1994) The culture of desire. New York: Vintage Books.

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Califia, P. (1994) Public sex: the culture of radical sex. Pittsburgh: Cleis Press.

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Laumann, E., Gagnon, J., Michael,R., & Michaels, S. (1994). The social organization of sexuality: sexual practices in the United States. Chicago: University of Chicago Press.

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Nichols,M. (1994). Therapy with bisexual women: working on the edge of emerging cultural and personal identities. In M. P. Mirkin, (Ed.) Women in context: toward a feminist reconstruction of psychotherapy, (pp.149-169). New York: Guilford Press.

Nichols, M. (1990). Lesbian relationships: implications for the study of sexuality and gender. In D. McWhirter, S. Sanders, J. Reinisch (Eds.), Homosexuality/heterosexuality: concepts of sexual orientation. (pp. 351-363) London: Oxford University Press.

Nichols, M. (1988). Low sexual desire in lesbian couples. In S. Leiblum & R. Rosen(Eds.), Sexual desire disorders (pp. 387-412). New York: Guilford Press.

Ragaza, A. (1999) Back to life, back to reality. In POZ magazine, April 1999. New York: POZ Publications.

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Stein, A.(Ed.) (1993) Sister, sexperts, and queers: beyond the lesbian nation. New York: Penguin Books.

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