Jacqueline N. Cohen

Lesbian, Gay, and Transgender Persons with Severe Mental Illness: Negotiating Wellness in the Context of Multiple Sources of Stigma

The experiences of lesbian, gay, and transgender (LGT) individuals with severe mental illness (SMI) have received minimal attention within the clinical and research literatures despite evidence to suggest that these groups receive inadequate psychiatric services. In the present study, 11 individuals from a midsized Canadian city who self-identified as lesbian, gay, or transgender were interviewed about their experiences of sexual identity, gender, mental illness, and psychiatric services. Their narratives were analyzed using grounded theory methods. The findings highlight the complex interactions of the stigma associated with mental illness and LGT identities, as well as the illness and identity-related challenges these persons face in psychiatric services. The participant narratives also speak to resilience and wellness, suggesting that these are cultivated through connection and community. Finally, strategies that service providers can use to deliver more effective services for this population are discussed.

Beyond Lesbian Bed Death: Enhancing Our Understanding of the Sexuality of Sexual-Minority Women in Relationships

The goal of this study was to characterize the sexuality of sexual-minority (i.e., lesbian, bisexual, queer, unlabeled, questioning) women. Participants were 586 women (87% White) in a same-sex relationship of 1 to 36 years in duration. They completed measures assessing their sexual behavior (frequency of nongenital and genital sexual activities), motivation (sexual desire), and cognitive-affective responses (sexual satisfaction, sexual esteem, sexual anxiety, negative automatic thoughts). On average, the women reported experiencing their sexuality positively across all domains. Regardless of relationship duration, most of the women reported engaging in both genital and nongenital sexual behaviors with their partner once a week or more; few reported that they had not engaged in sexual activity in the previous month. A multiple regression analysis indicated that frequency of genital sexual activity, sexual desire, sexual anxiety, and automatic thoughts contributed uniquely to the prediction of sexual satisfaction over and above the other sexuality variables. The findings are discussed in terms of the idea that lesbians have sex less frequently than other couple types and that sexual frequency declines rapidly in lesbian relationships (i.e., “lesbian bed death”) and descriptions of sexual-minority womens sexuality that suggest that genital sexual activity is not important to sexual satisfaction.

Using feminist, emotion-focused, and developmental approaches to enhance cognitive-behavioral therapies for posttraumatic stress disorder related to childhood sexual abuse.

A body of research indicates the efficacy of cognitive-behavioral interventions for the treatment of posttraumatic stress disorder (PTSD) subsequent to sexual assault in adulthood. The generalizability of these treatments to women who present with trauma symptoms associated with childhood sexual abuse (CSA) has yet to be shown, however. A number of characteristics and dynamics of CSA that make it unique from sexual assault in adulthood are described, specifically its disruption of normal childhood development, its impact on attachment style and interpersonal relationships, its inescapability, and the stigma attached to it. Then, drawing on the developmental, emotion-focused, and feminist literatures, a number of considerations that would enhance the application of cognitive- behavioral trauma therapies to the treatment of women with PTSD related to CSA are delineated. These considerations relate to providing clients with corrective interpersonal experiences, creating new relationship events, enhancing affect regulation skills before initiating exposure therapy, considering the time elapsed since the abuse, addressing themes of power, betrayal, self-blame, stigma, and sex-related cognitions and emotions, and helping clients develop a feminist consciousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Validation of the Interpersonal Exchange Model of Sexual Satisfaction With Women in a Same-Sex Relationship:

We examined the validity of the interpersonal exchange model of sexual satisfaction for sexual-minority women (SMW) with a range of sexual identities (lesbian, bisexual, queer, unlabeled, questioning). Participants, 898 (192 who were dating, 439 who were cohabitating) SMW in a romantic relationship of at least 3 months, completed an online survey that included the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire. The results provide support for the validity of the model for SMW in that all the model components (relationship satisfaction, balance of sexual rewards and costs, balance of relative sexual rewards and costs, equality of rewards, equality of costs) were significantly associated with sexual satisfaction. All of the components, except equality of sexual costs, contributed uniquely to the prediction of sexual satisfaction. Neither relationship stage (dating vs. cohabiting) nor sexual identity (lesbian vs. other sexual-minority identity) moderated these associations. Women daters reported a significantly higher level of sexual rewards, sexual costs, and sexual satisfaction than did women cohabiters. The interpersonal exchange model may be used by clinicians as a framework for exploring experiences of low sexual satisfaction with a couple. The results also add to an emerging positive picture of the sexual relationships of SMW at both stages; this information can be used to counter negative stereotypes. Online supplemental files are available at http://journals.sagepub.com/doi/suppl/10.1177/0361684316679655 .