Rebecca Emberger, LAMFT

Sex & Relationship Therapist
Sex, Gender, & Relationship Diversity Specialist

Role Play - Counseling Gay Male Couple

 

Self-Analysis of Residency Role Play Case Study

 

by

Rebecca A. Emberger

 

 

 

A Paper Presented in Partial Fulfillment

Of the Requirements of COUN5291 – Marriage & Family Therapy

Pre-Practicum Course II

November 2009

 

 


Introduction

Damon and Angelo are a gay male couple who have been in relationship for approximately four years. While Damon has reportedly identified as gay for his entire life, Angelo lived a straight lifestyle until he met Damon shortly after a traumatic break-up with a woman. Damon has assisted Angelo in his coming-out process and they have reportedly been very happy until recently. Several months ago, Angelo began developing a friendship with a woman, and he has recently started having romantic feelings for her. Damon is feeling resentful of this woman’s influence on and priority in Angelo’s life, and he is afraid of losing Angelo. Angelo, on the other hand, is beginning to recognize that maybe he’s neither straight nor gay, but perhaps bisexual. He is torn between wanting to keep his relationship with Damon and wanting to maintain a connection to his female friend.

The therapist in this case does not assume that the clients’ sexual identities have anything specific to do with their presenting complaints, but she does briefly suggest that some personal counseling with Angelo might help him negotiate and redefine his current sexual identity (not shown in accompanying partial transcript).

In the transcript itself (following), each speaker is identified by first name: Angelo and Damon are the clients; Rebecca is the therapist.


 

Transcription

Clinical Competencies

Analysis of Clinical Thinking

Evaluation of Response

Angelo: Um, all right, well, we’re having a disagreement. We’re gay, but I’m having some issues with my sexuality right now. I was straight up until college, I had a really bad break-up with a girl, and um, I met him, and I kind of just fell for him. I had feelings I had never had for a man before, it was kind of freaky, but he helped me through it, and uh, I’m happy, but I have a very close friend, she’s a female, we’ve been nothing but friends. I’ve done nothing with her, we just talk a lot, but I’m starting to notice that I’m having feelings for her, and I’m starting to want more, but I don’t want to hurt Damon about it, but I feel like he’s attacking me and saying I’m having an affair, but I’m not, I’m just talking to the girl, and I’m trying to be honest with him that I’m having feelings for a woman.

 

 

 

Rebecca: Okay, so let me understand…how long have you guys been together?

Reflection of content; showed neutrality

Here, I was simply trying to get a handle on the presenting complaint and relevant relationship history. Through reflecting the content and feelings of Angelo’s statements, I was able to convey that I understood her on both levels.

Through nonjudgmental reflection (Gehart & Tuttle, 2003), I have conveyed to Angelo and to Damon both, that they are safe to reveal themselves in this counseling session. I am not conveying a bias against homosexuality, bisexuality, or perceptions of fidelity, but acknowledging and accepting them and their presenting complaint of feeling disconnected, regardless of their sexual orientation (Kort, 2008)

Angelo: About four years.

Rebecca: Four years? Okay, so up until you got together, you were straight, and you had a bad break-up with a girl, met him, and you guys fell into a relationship

Angelo: Yes

 

Rebecca: And that’s been true for the last four years. Okay and so now you have this female friend in your life, and you’re starting to feel more…

Reflection of feelings; showed neutrality

Angelo: attraction

Rebecca:…attraction toward her. Okay, and you’re feeling like he doesn’t understand?

Angelo: He thinks I’m having an affair.

 

 

Rebecca: He thinks you’re having an affair. Okay.

 

Angelo was definitely the more talkative of the two, and I think that by inviting Damon’s perspective early, I was able to convey equal respect for both and it helped with building rapport with him

Angelo: Uh huh.

 

Rebecca: [turns to Damon] Let me hear what you feel, what you’re thinking, what’s going on for you.

Drawing out quieter client

I wanted to invite and  acknowledge Damon’s perspective before Angelo got much further

Damon: Well, I think I’ve always been very understanding of his whole process. You know, I’ve been gay since the day I was born, never had any feelings towards a girl. I like to think I understand, but I think whenever you’re intimate with somebody, whether physically or emotionally, you’re having an affair on the person you’re with. And I just feel like that’s what he’s done with this girl. Like I trust him, I don’t think they’ve done anything physically, but I just think that the emotional connection itself is an affair.

 

 

 

Rebecca: Okay. So, in your opinion, he needs to be not only sexually faithful, but emotionally.

Reflection and summation of content; possibly also normalizing/reframing

I think I was trying to summarize his complaint in such a way as to seem normal, by providing concise language that captured his rambling explanation

Although Damon seemed to feel heard and acknowledged by my reflection, I wish I’d not said “In your opinion” because that seems, in retrospect, to be kind of limiting, as if suggesting that his opinion is different than most peoples’. I also wish I’d asked Angelo a circular question, to check his perception about what “fidelity” means to him

Damon: Yeah.

 

 

 

Rebecca: So you guys worked out that relationship agreement ahead of time?

Assessment of problem; trying to determine how formalized their relationship development was (Ragg, 2006)

Here I was trying to determine if the couple had established clear rules about fidelity that both understood and agreed on

What came out of this question was a realization for both of them that this is a topic that could be discussed and negotiated.  It’s also serving to highlight the differences in their perception of what “infidelity” means. It might have been better to keep delving more deeply into this area of inquiry with both of them, rather than jumping to my next question.

Angelo: Not really, it was kind of unexpected, I mean, we both have female friends, females as friends, I just started to develop these feelings out of nowhere, I don’t know where it came from, but I was honest about it, and I don’t consider being an affair. I feel like I’m not hiding it, I’m not sleeping with her, I come home every night with him, I just think this something I need help on because I don’t want to do that to him.

 

 

Rebecca: Okay, so what kind of help are you actually looking for?

Clarifying what the client feels is the problem

It occurred to me at this point that I wasn’t sure what this couple was really looking to resolve

This question elicited a more direct problem statement from Angelo. I should have directed this question to Damon, as well, to see if he perceived the same problem and felt that this had priority over any other problems he may be perceiving

Angelo: I guess maybe there’s something missing that I am feeling this way towards my friend. I don’t know.

Rebecca: You think there might be something missing in your relationship with Damon?

Angelo: Yeah.

Rebecca: Okay. But you haven’t really pinpointed what that could be?

Angelo: I mean, she is fun, we do things that are fun, we do go out, you know, just maybe to the mall or something, but I’m always honest to Damon about it, he doesn’t like it, but I do it anyway, which is probably messed up but, I just want to be able to do more; all he wants to do is sit in the house all the time.

In this section, I was observing the interactions between the couple

I decided to be quiet for a moment, to see what more would come out of the two of them talking directly to each other about the problem

More did come out about the problem through their direct exchange, than what they were sharing with me directly. I learned about the friend’s constant calling and texting, while Damon got to voice his irritation with this behavior.

Damon: He spends more time with her than he does with me.

Angelo: That’s because you don’t want to go anywhere.

Damon: I don’t want to go anywhere because I don’t feel like you really want to be with me. You’re just on your phone, texting her, she’s calling you, and…

Rebecca: Okay, so let me interrupt for a moment. How was your relationship before she came into your life?

Redirecting habitual communication pattern; asking form of exception question (when wasn’t this a problem)

I wanted to get a sense of how their relationship was prior to the current issue, and see if we could recognize an exception to the current problem feelings

This solution-focused question did elicit reflection on how much better the relationship was prior to the current problem; this is something that we built on later in the session.

Angelo: It was great.

 

Rebecca: Yeah?

Minimal encouragement

Damon: It was wonderful.

 

Rebecca: What was different?

Asking them to reflect on the exception

Angelo: We did everything together. We’d go to a beautiful park; we’d go traveling, on vacations. It was like he had this boost of energy that just like went down the drain. You know.

 

 

 

Rebecca: [turns toward Damon] Do you perceive that? That your energy went down the drain somewhere?

Circular question

I wanted to check Damon’s agreement with Angelo’s statement of his experience

The question got us into a deeper affective reflection, which I thought was significant. I just wish I’d followed this line a bit more, and perhaps had asked Angelo how she felt about Damon’s statement of fear of abandonment.

Damon: Well, yeah, I’m scared. You know? I’m a gay man, I’m in a gay relationship, and now he’s having feelings towards a female. It’s scary to me.

 

 

Rebecca: What’s scary about it?

 

 

Damon: Not only am I risking losing him to other guys, but I’m risking losing him to other girls, too.

 

 

Rebecca: So the threat of abandonment feels like it’s doubled.

Reflection feeling

 

Damon: Yeah. Anybody could take him from me.

 

Angelo: I don’t want it to be like that. I really am upset that he feels that way, because it hurts me, but I can’t help the way I feel at the same time, and I’m not going to lie to him, because that’s only gonna make it worse. And I want to listen to him, and stop talking to my friend, but it’s like I’ll sit in the house and just look at him look miserable, I just don’t want to be there. I get comfort from her by getting my mind off of things, by going out and having a good time. I wish I could have that from him, but I don’t.

 

 

Thankfully, I didn’t need to ask Angelo her input, as she jumped right in.

Damon: But we had it though. We did have it.

 

 

 

Angelo: Yeah, we did.

 

 

 

Damon: And it wasn’t so long ago.

 

 

Rebecca: How long has she been part of this? How long has she been around?

Further assessment questions

Here I was trying to get a clearer picture of how long the problem has been present

I received basic information as a result of this question. I wish I’d taken some time to explore the boundary management issues (structural family therapy) (Gehart & Tuttle, 2003). If there is an outside person with too much influence on the relationship, the boundary is too permeable and can result in problems (Ragg, 2006).

Angelo: I guess it’s been like maybe about 7 months now.

Rebecca: 7 months?

 

 

Angelo: yeah.

 

 

Rebecca: And when did the romantic feelings start?

 

 

Angelo: Real recent, maybe like three months ago.

 

 

Rebecca: Okay. So you guys can remember as recently as 3 to 7 months ago things were not like it is right now. And you both want it to go back to that?

Reflection of content & feelings; clarification of desired solution

Here I was attempting to engage the couple in a goal-setting conversation via a solutions-focused approach

I didn’t stick with this, to develop the vision of what their desired solution could be, or how to identify what would be different in their preferred life together (Gehart & Tuttle, 2003). I think we could have developed this further.

Angelo: Yeah, I would like for it to go back, I think.

Rebecca: You think?

Angelo: Yeah.

Rebecca: How are you identifying these days? Are you still identifying as gay?

Assessment question

Here I’m trying to determine how much of the current issue stems from sexual identity issues apart from or in addition to the infidelity issues

Although I think this is an important question to explore, I believe that every time I got stumped on what to ask next, I went back to an assessment position and asked something on a different track.

Angelo: I don’t know. I want to, but I don’t think I am, because if I’m attracted to a woman, then I’m not completely gay.

 

 

Angelo’s answer certainly deserves more attention

Rebecca: Okay.

Minimal encouragement

 

 

Angelo: At least that’s what I think. It’s all new for me, too, it’s a lot of pressure for me too. And it kills me, because I know I’m hurting you, but I have to be honest. So…

 

 

 

Rebecca: If this were another guy that you were having feelings for, how would you handle that?

Solution building question from solution-focused therapy (Gehart & Tuttle, 2003); open-ended question

I was curious about whether the gender of the outside interest would make a difference

Obviously the gender of the outside influence does make a difference – this question gave us the opportunity to explore potential alternatives to the problem. This thinking outside the box and questioning assumptions is important to open the conversation and expand the potential solutions.

Angelo: Um, I think it’d be worse, I think he’d probably kill me (laughter all around)

 

 

Damon: [nodding]

 

 

Angelo: If it was another guy, you know what, I think it being a woman is a comfort, I think I’d be a lot more intimidated to be open with it.

 

Rebecca: so you wouldn’t feel as comfortable being open with him if you were feeling something for another guy.

Reflection of feeling

 

 

Angelo: Yeah

 

 

Damon: Well we kinda worked through the whole process, cause you were kinda like getting over a girl when we met, and so I think I’m pretty understanding of it, because we’ve been dealing with the process of you being gay, or whatever you are now, for our whole relationship.

 

 

There’s an opportunity here where I could have explored Damon’s seeming derision about “whatever Angelo is now”, possibly pointing to some biphobia that could be explored.

Angelo: That’s true.

 

 

 

Rebecca: So, what I’m hearing is that you personally are having some issues with your sexual identity, okay, but that the two of you as a couple are having some issues with fidelity. And that it’s not so much the potential bisexuality as the fact that you’re very monogamous. Is that right?

Reflection of content; summarizing problem

Here I was trying to summarize all the discussion and distill the problems into two clear statements, with one taking obvious priority.

Since the clients agreed with my assessment of the problems and their priority, we’re now at a point where we can start working toward some solutions, setting goals and steps to achieve those goals. We now have a working alliance and a sense of purpose on which to build future therapeutic work (Ragg, 2006).

Damon: Nods

 

 

 

 

Reflection, Observation Analysis, and Summary

This role play exercise provided an excellent opportunity to observe myself as a therapist, and to identify my strengths and areas I need to work on developing more fully. I feel that I established a good rapport with these clients fairly early, as they both seemed to respond willingly to my questions and fairly quickly started sharing thoughts and feelings. I was able to maintain good eye contact with each of them and turned my body to face whoever was speaking. I also feel I did a fairly good job of paying attention to both clients equally. Even though Angelo was obviously the more outgoing, and Damon the more reticent, I managed to draw Damon into the conversation repeatedly to get his perspective. I nodded a lot and used a moderate amount of hand gestures to demonstrate points and draw the clients in, and my facial expression and posture conveyed active interest in both clients. I was also comfortable with being silent and observing their interactions at times, allowing them to get a little deeper into their process without having to feel like jumping in after every sentence.

I was disappointed to note that my style is not necessarily consistent with any one theory or therapy model, and that my approach tended to jump around a lot from topic to topic. I identified several areas where I could easily have delved more deeply into an area of concern, but I found myself getting stuck, not sure where to take it or what questions to ask. I recognized many times, too, where I could have utilized more circular questioning to help the two of them reflect on each other’s experience.

I think my style most closely aligned with Solutions-Focused Therapy, but I didn’t specifically ask any of the classic questions associated with that approach (Gehart & Tuttle, 2003). I didn’t really have a strong hypothesis about this couple’s presenting concern and I often felt like I was floundering, trying to figure out what was going on, what they actually wanted help with, and how to accomplish that goal. Perhaps the problem is that in an initial session, the primary purpose is to simply gather information so that you can form a hypothesis, which will provide direction for future sessions. By the end of the transcription, I did feel like we were beginning to get somewhere, so perhaps my expectations are too high for what I thought I should be able to accomplish in this initial, abbreviated session.

Although these clients responded to my jumping right in and asking, “What brings you here today,” I have a feeling that I need to work on developing more of an opening statement and doing more to establish rapport. It would have been interesting to see how I handled the situation if Damon chose to be even more reticent than he was – I’m not real sure how I would have drawn him out if he’d been actively resistant to the whole process.

Overall, I think I have demonstrated a solid foundation, but I could certainly use more practice establishing rapport, and in working from a theory-based approach to help direct my questions and inform my hypotheses.


References

Gehart, D. R., & Tuttle, A. R. (2003). Theory-based treatment Planning for marriage and family therapists. Pacific Grove, CA: Brooks/Cole-Thomson Learning.

Kort, J. (2008). Gay affirmative therapy for the straight clinician. New York: W. W. Norton & Co., Inc.

Ragg, M. D. (2006). Building family practice skills: Methods, strategies, and tools. Belmont, CA: Thomson Brooks/Cole.

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